1 2 / 1 5 / 2 0 10 d e a r jan e ,
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Participant Interest and Retention Survey Fond du Lac Reservation. 1 2 / 1 5 / 2 0 10 D e a r Jan e , - PowerPoint PPT PresentationTRANSCRIPT
12/15/2010
Dear Jane,
As your lifestyle coach for the Diabetes Prevention Program, I wanted to check in and see what your current needs and interests are. Please take a moment to complete the questions below and return to me in the postage-paid envelope. Happy Holidays - Jenn
1. I would like to continue in the DPP and participate in (please circle all that apply):a. Required medical appointments and labb. Group activitiesc. Contact with my lifestyle coachd. Repeat group weekly classes (sit-in with upcoming groups starting the program)
OR 2. I would not like to continue in the DPP because:
a. I feel comfortable with the information I learned in the program. I can continue my efforts to prevent diabetes on my own and will follow-up with my medical provider.
b. Other health problemsc. Family problemsd. Scheduling difficultiese. I don’t like the programf. Other:
If you are only interested in required medical appointments and labs, or if you are no longer interested in continuing the program, you do not need to answer the remaining questions.
3. How often would you like to participate in DPP group activities?a. Weeklyb. Twice a monthc. Monthlyd. Every 3 months
4. Please list activities you are interested in:
5. How would you prefer to be contacted by your lifestyle coach?a. Schedule an individual appointment for discussion or physical activityb. E-mail (please list your current e-mail)
c. Phone call (please list the phone number I should contact you during clinic hours)
d. While attending the YOUR Way Adult Weight Management program at MNAW or CAIR.e. I would prefer to contact my lifestyle coach at least every 3 months.
6. How often would you like to participate in lifestyle coaching?a. Weeklyb. Twice a monthc. Monthlyd. Every 3 months
Participant Interest and Retention SurveyFond du Lac Reservation
Remember Your Purpose
These are your answers:
Why I joined the Diabetes Prevention Program: “My doctor, because my sugar was a little high.”
What I hope to achieve by taking part in the DPP: “To not get diabetes.” How healthy eating and being active will help me and/or others: “I will feel better and
live a long healthy life to enjoy my family.”
Jane’s Program Goals
7% weight loss goal = 165# Daily fat gram goal = 42 grams Daily calorie goal = 1,500 calories Activity goal = 150 minutes per week
Lifestyle Coaches
Jennifer Hall: 878-2146; [email protected] Katie Hughes: 878-3794; [email protected] Chris Foss-Tietz: 878-3709; [email protected] Amanda Thompson: 878-3731; [email protected]