LESSON PLAN

Preventing Diabetes: Controlling my Portions

Alejandra Quezada

HS6453

October  2012

Title of Health Intervention: Preventing Diabetes: Controlling my Portions

Intended Audience: The target population is adult Hispanic Women in the city of Farmers Branch, Texas. The Hispanic population represents 45% of the population in Farmers Branch (U.S. Census Bureau, 2012). I anticipate that the average participant will be between 40 and 50 years of age but all adult women (18+) are invited to participate. The presentation will be in Spanish but for the purposes of the class it is written in English.

Background

The Hispanic population represents one the largest minority group in the U.S. and the fasting growing ethnic group. As of 2006, the Hispanic population represents almost 15% of the total U.S. population, or 44.3million people , and is projected to make up almost 25% of the U.S. population in 2050 (U.S. Census Bureau, 2010). The Hispanic growth rate is estimated to be about 4 times the growth rate of the total population (24.3 vs 6.1) (U.S. Census Bureau, 2010).  Like many minority groups, Hispanics suffer disproportionately with the burden of poverty and disease.  Diabetes is one disease which is more prevalent among Hispanics in the U.S; 11.8% of Hispanics in the U.S. have diabetes (CDC, 2011). Hispanics are 66% more likely to be diagnosed with diabetes that non-Hispanic whites (National Diabetes Education Program [NDEP], 2011). 

Diabetes is a group of diseases in which there is a problem with insulin production or the body’s ability to use it, causing high levels of blood glucose (CDC, 2011). There are four general types of diabetes; type 2 diabetes represents over 90% of all diagnosed cases (CDC, 2011). Diabetes affects approximately 26 million people (8.3% of the population) in the United States (CDC, 2011).  Diabetes one of the leading causes of death in the U.S. and is responsible for many severe health complications such as cardiovascular disease, kidney failure, loss of vision, amputation and nerve damage (CDC, 2011).

Even more concerning is that about 79 million adults (age 20+) have prediabetes (CDC, 2011).  . Prediabetes is a condition where blood glucose levels are above normal but not high enough to be diagnosed as diabetes (NDEP, 2011).  Research has shown that early diabetes intervention and lifestyle changes can significantly reduce the risk of developing diabetes (NDEP, 2011). 

A large study by the The Diabetes Prevention Program found that people at high risk for diabetes were able to reduce their risk of developing type 2 diabetes by almost 60% through lifestyle

intervention to lose weight and increase physical activity (CDC, 2011). The reduction was even higher among adults aged 60 years or older, up to 71% reduction in risk (CDC, 2011).  Research has shown that lifestyle interventions are more cost-effective than medications (CDC, 2011). To reduce the risk of diabetes it is recommended to lose 5 to 7 percent of body weight, engage in physical activity for 30 minutes a day, 5 days a week and make healthier food choices and limit the amount of calories and fat in the diet (CDC, 2011).

Preventing Diabetes: Controlling My Portions will target portion control as a way of reducing the risk of diabetes. Controlling portions will help with weight loss and can help individuals plan healthier meals, for example, by increasing fruit and vegetable intake. I will discuss proper portion sizes using The Plate Method recommendations. The Plate Method is an effective way to teach individuals about the type and amount of foods they should eat at each meal (Raidl et al, 2007). It can also be tailored to fit different cultural food preferences as no foods are off limits.

Setting:

Mary Immaculate Catholic School in Farmers Branch, Texas. 

Classroom

Tuesday evening from 6:00pm – 7:15pm

Need 4 circular tables with 6 chairs each                   

Estimated Timeline

Total time – 75min
1. Introduction (5 min)

2. Overview of presentation and dissemination of materials (5 min)

3. Pre-intervention questionnaire (10min)

            Nutrition Questionnaire

4. Topic 1 – Preventing Diabetes (5min)

5. Portion sizes (20 min)

            Present Portion Distortion slides - (National Heart, Lung, and Blood Institute, 2012).

            Pass out portion size examples – ping pong balls, tennis ball, etc

            Briefly review portion size handout

            Discussion

6. Break (5 min)

7. Topic 2 – Plate Method (15 min)

            Review Plate Method on powerpoint

            Discussion

8. Post-intervention questionnaires and dissemination of additional resources (10 min)

            Nutrition Questionnaire

            Blank Plate Method Handout

            Portion Sizes quiz

            Blank sheets for presentation evaluation.

9. Summary and closing (5min)

Materials Needed:

50 pencils

Folders for all necessary handouts

30 Portion Sizes Handouts

30 Plate Method handouts (filled in)

30 Plate Method blank handouts

60 Nutrition Self-Efficacy Questionnaires (1/2 pre-intervention, ½ post-intervention)

30 blank sheets for feedback and presentation evaluation

4 round tables

30 chairs (6 extra)

Projection Screen and Projector

Labtop computer

Flash drive with presentation information including PowerPoint slides

Dry Erase or Chalkboard

4 Dry Erase markers – different colors

Portion size models: 2 ping pong balls, 1 tennis ball, 1 deck of cards, 1 checkbook, 1 lightbulb, 1 poker chip and 3 dominoes

Guiding Health Education Theory or Model

Behavior change can be difficult and at times daunting. If an individual feels that change is not possible or a goal unachievable that can deter the individual from taking steps to make that health behavior change. Successful interventions are able to reduce challenging behavior changes to small and manageable steps (McAlister, Perry & Parcel, 2008). Increasing an individual’s confidence in their ability to make behavior changes is an effective approach for health interventions (McAlister, Perry & Parcel, 2008; Rosal et al, 2011).  Self-efficacy is a construct of the Social Cognitive Theory.  Self-efficacy consists of a person’s belief about their capacity or ability to perform behaviors that produce desired outcomes (McAlister, Perry & Parcel, 2008).  The relationship between self-efficacy and outcomes has been widely studied. It has also been studied in the Hispanic community and addressing self-efficacy is an effective way to improve habits impacting diabetes risk such as physical activity level and dietary habits (Rosal et al, 2011).  Controlling My Portions will address attitudes about food. It will highlight that culture specific foods can still be part of a healthy diet.  Previous studies have demonstrated that Hispanics may believe that some foods are “forbidden” or that healthy food does not taste good (Caban, Walker, Sanchez & Mera, 2008) so it is important to demonstrate that all foods have a place in a healthy diet.

Literacy sensitive materials and strategies can help influence positive behavior changes (Rosal et al, 2011). It will help with acquiring new knowledge and skills and increasing confidence in one’s ability to make healthy dietary changes. Controlling My Portions will utilize culturally appropriate material in the participants’ native language (Spanish) and utilizes visuals and models to facilitate learning.

Goal

The goal of the presentation is to provide participants with information and resources so that they are confident in their ability to identify proper portion sizes and plan healthy meals.                                

 Process Objectives

1. Process Objective: Four weeks before presentation distribute marketing materials. Post flyers on the Mary Immaculate Church and Mary Immaculate School bulletin boards. Publish small advertisement in weekly Mass bulletin. Distribute flyers to Farmers Branch recreational center.

2. Process Objective: Redistribute marketing materials one week before the presentation.

3. Process Objective: To recruit 24 participants from the Farmers Branch community.

Outcome Objectives 

1. Outcome Objective: At the end of this session, 75% participants of the participants will be able to correctly label the different sections of the Plate Method and provide one example of a food in each category (Cognitive domain)

2. Outcome Objective: Compared to a pre-intervention baseline assessment, participants will demonstrate at least a 25% increase in self-efficacy on a post-intervention assessment regarding self-efficacy for appropriate portion control and meal planning (Affective domain).

3. Outcome Objective: At the end of this session, 75% participants of the participants will be able to correctly identify the portion sizes the models represent.

4. Outcome Objective: Participants will identify one or two small goals they can start 
     working on now to improve their eating habits (Cognitive and Affective domain).

Procedures (20 pts)

           

1. Introduction (3-5 min)

Say: Hello! My name is Alex Quezada and I am a health educator. Today I hope to share with you valuable information and resources to help you. Now let’s get to know you. Can I have everyone introduce themselves by stating your name, the reason for participating and what you hope to get out of the program. Can we start with you? (gesture to the person closest to you).

2. Overview of presentation and dissemination of materials (5 min)

Program Overview and Dissemination of Materials

Say: Welcome to Controlling My Portions. This program is designed to help participants learn how to identify proper portion sizes and how controlling portions can help prevent diabetes. The program will show you how portions have changed over the past 20 years, provide easy tips to measure your portions and help you plan your meals.

While you are giving a brief program overview have a program assistant start distributing the pre-intervention questionnaire.

Say: If you need any assistance or have any questions please don’t hesitate to ask. Don’t forget to put your name on the form.

3. Pre-intervention questionnaires (10min)

Circle the room to be available for any questions. Collect all questionnaires.

4. Topic 1 – Preventing Diabetes (5 min)

Say: You might ask, I know that I’m at risk for diabetes, but what to prevent it? The good news is that there is something you can do to reduce your risk. By making small lifestyle changes you start reducing your risk today!  If you already have diabetes, these small changes can help you better control your blood glucose. A national Diabetes Prevention Program study found that people at high risk for diabetes can prevent or delay the onset of the disease by losing 5 to 7 percent of their body weight with healthy eating and 30 minutes of physical activity 5 days per week. If you’re not already active, it’s a good time to start but we’ll talk about that another day. Today we’re going to talk about healthy eating and what you can do to make healthier food choices every day. We’re going to focus on portion control which will help you reduce your calorie intake, help you lose weight and help you plan healthier meals.

5. Topic 2 – Portion sizes (20 min)

Say: Larger portions means that you are consuming more calories. Calories are a measure of the energy a food provides. A person’s daily calorie needs depends on many factors, such as age, height, weight, sex, and physical activity level. When extra calories are eaten they are stored as

body fat and weight gain occurs. Conversely, when you use more calories than are consumed, this leads to weight loss.

Say: Let’s talk a little bit about portions and have they’ve changed over the years.

Present Portion Distortion slides (National Heart, Lung, and Blood Institute, 2012). Focus more on the image comparisons and not the calorie counts. This program is focused on making portion control simple and mostly visual; it is not focused on calorie counting.

Say: Because you don’t always have access to measuring tools every time you eat, it can be helpful and much easier to learn some ways to estimate those amounts.

Pass out portion size examples – ping pong balls, tennis ball, dominoes, check book, deck of cards, 1 poker chip and the light bulb.

Say:  A deck of cards is similar to 3oz of meat. A checkbook estimates 3oz of fish. A tennis ball can help you estimate 1 cup of pasta or rice. Three dominoes is roughly 1.5oz of cheese. The two ping pongs balls are equal to 2 tablespoons of peanut butter. The poker chip is 1 serving of olive oil or salad dressing and the light bulb is about ½ cup of rice or pasta.

Say: You can also use your hand to estimate portions: A closed fist about a cup or a serving of starches,the palm of your hand is a serving of meat, a cupped hand is about ½ cup or a serving of vegetables, and the tip of the thumb is a serving of cheese or teaspoon. Everyone has different hand sizes but this will at least give you an idea of your portions. Try it!

Briefly review portion size handout while assistants hand them out.

Say: What do you think? Is this something that will help you eye-ball your portion sizes. Are you already having these portions or maybe a little more?

Discussion, share a dicho - Para alargar tu vida disminuye tu comida.

6. Break (5 min)

7. Topic 3 – Plate Method (15 min)

Say: We’re going to talk about something that will help you get more fruits and vegetables into your meals. This is also an easy way to control calorie intake. The Plate Method works by dividing a standard size (9-inch) plate into sections and filling the sections with specific food groups. You can use the Plate Method as a guide for what and how much to eat at breakfast, lunch, and dinner.

Try these simple steps to get started:

Review Plate Method on powerpoint

Say: Using your plate, put a line down the middle of the plate.

1.      Then on one side, cut it again so you will have 3 sections on your plate.

2.      Fill the largest section with non-starchy vegetables such as:

a.      spinach, carrots, lettuce, greens, cabbage

b.      green beans, broccoli, cauliflower, tomatoes,

c.       salsa, onion, cucumber, beets, mushrooms, peppers

3.      Now in one of the small sections, put starchy foods such as:

a.      whole grain breads, whole grain cereal

b.      cooked cereal such as oatmeal, hominy, or cream of wheat

c.       rice, pasta, tortillas

d.      cooked beans and peas, such as pinto beans or black beans

e.       potatoes, green peas, corn, lima beans, sweet potatoes, squash

f.        low-fat crackers and popcorn

4.      And then on the other small section, put your meat or meat substitutes such as:

a.      chicken or turkey without the skin

b.      fish such as tuna, salmon, cod, or catfish

c.       seafood such as shrimp, clams, crab

d.      lean cuts of beef, pork, lamb

e.       eggs, low-fat cheese

5.      Add an 8 oz glass of non-fat or low-fat milk. If you don’t drink milk, you can add another small serving of carbohydrate such as a 6 oz. container of light yogurt or milk substitutes like almond, rice or soy milk.

6.      And a piece of fruit or a 1/2 cup fruit salad. Fresh, frozen, canned (in light syrup) are all good choices

Plate Method talking points retrieved from American Diabetes Association (2012).

Say: So how do our plates compare? What are some changes we can make today to start eating healthier?

Discuss The Plate Method with participants, seek feedback. Assess participants’ attitudes about nutrition and habit changes.

8. Post-intervention questionnaires and dissemination of additional resources (10 min)

While you are reviewing what we’ve covered today have a program assistant start distributing the post-intervention questionnaire, the blank Plate Method handout and the Portion Quiz.

Say: If you need any assistance or have any questions please don’t hesitate to ask. Don’t forget to put your name on the form.         

Say: We’re also handing out a blank page for you to provide any feedback. We welcome all comments and appreciate your time today!   

9. Summary and closing (3-5min)

Say: Thank you all for your participation today! I hope you can take something away with you today to help you with your health. You are welcome to leave after you have finished the questionnaires or you can stay to ask me questions.

Evaluation

Process Objectives

Evaluation Process Objective #1: Ensure Mary Immaculate School, Church, Farmers Branch all have marketing material accessible to potential participants.

Evaluation Process Objective #2: Ensure materials are redistributed to all locations.

Evaluation Process Objective #3:  Maintain attendance log.

Outcome Objectives 

Evaluation Outcome Objective #1: Use the blank Plate Method handout to assess participant’s knowledge. Participants will be asked to label the Plate Method sections and name one example of a food in each category.

Evaluation Outcome Objective #2: Using the pre-intervention and post-intervention Nutrition

Questionnaire we will assess changes in self-efficacy among participants.

Evaluation Outcome Objective #3: Members will be asked to correctly identify the portion sizes of the models. The portion size quiz will be used to assess knowledge.

Evaluation Outcome Objective #4: This will be evaluated during our Topic 3 group discussion. We will discuss setting small goals.           

We will also perform a brief evaluation of the presentation by distributing blank sheets for participants to share overall satisfaction with the program.

Anticipated Problem(s) and Solution(s)

If unable to present powerpoint slides due to technical problems have 30 copies of Portion Distortion power point slides and Plate Method powerpoint slides

If there is greater participation than planned, arrange access to printer for additional materials and arrange before hand to have access to more tables and chairs.

If literacy levels are low for some participants have a bilingual assistant at the presentation to help with filling out questionnaires and assessments.

References

American Diabetes Association. (2012). Create your plate. Retrieved from http://www.diabetes.org/food-and-fitness/food/planning-meals/create-your-plate/

Caban, A., Walker, E. A., Sanchez, S. & Mera, M. S. (2008). “It feels like home when you eat rice and beans”: Perspectives of urban Latinos living with diabetes. Diabetes Spectrum, 21(2), pp. 120-127.

Centers for Disease Control and Prevention. (2008). Power to Prevent: A family lifestyle approach to diabetes prevention. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention.

Center for Disease Control. (2011). National diabetes fact sheet, 2011. Retrieved from http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf

McAlister, A. L., Perry, C. L., & Parcel, G. S. (2008). How individuals, environments, and health behaviors interact: Social Cognitive Theory. In K. Glanz, B. Rimer, & K. Viswanath (Eds.), Health behavior and health education: Theory, research, and practice (pp.169-188).  San Francisco: Jossey-Bass.

National Diabetes Education Program. (2011). The facts about diabetes: A leading cause of death in the U.S. Retrieved from http://ndep.nih.gov/diabetes-facts/index.aspx

National Heart, Lung, and Blood Institute. (2012). Portion distortion! Do you know how food portions have changed in 20 years? Retrieved from http://hp2010.nhlbihin.net/portion/index.htm

Raidl, M., Spain, K., Lanting, R., Lockard, M., Johnson, S., Spencer, M…& Hartman-Cunningham, M. (2007). The healthy diabetes plate. Preventing Chronic Disease, 4(1). Retrieved from http://www.cdc.gov/pcd/issues/2007/jan/06_0050.htm.

Rosal, M. C., Ockene, I. S., Restrepo, A., White, M. J., Borg, A., Olendzki, B., Scavron, J., Candib, L., Welch, G., & Reed, G. (2011). Randomized trial of a literacy-sensitive, culturally tailored diabetes self-management intervention for low-income Latinos. Diabetes Care, 34, pp 838–844.

U.S. Census Bureau. (2010). Hispanics in the United States. Retrieved from   http://www.census.gov/population/www/socdemo/hispanic/files/Internet_Hispanic_in_US_2006.pdf

U.S. Census Bureau. (2012). State and county quick facts: Farmers Branch, Texas. Retrieved from http://quickfacts.census.gov/qfd/states/48/4825452.html