Lesson Plan

Title of Health Intervention

Gestational Diabetes: Guide for Expecting Parents

Health Topic and Intended Audience

Intended Audience

Intended audience includes low income pregnant women with gestational diabetes.  Participants’ age range varies between 20 and 45 years old. Readability level is estimated at the 7^th grade.  They participate in the Special Supplemental Nutrition Program (SNAP) for Women Infant and Children (WIC), at the Logan County Health Department, located in Guthrie, a city in Logan County, Oklahoma. 

Logan County is considered as one of the medically underserved areas in Oklahoma (Oklahoma State University [OSU], 2013).  Most of the cities in Logan County are considered as rural communities.  According to the U.S.Census Bureau (C.B., 2012), rural communities are those having less than 25,000 people.  Based on the latest information from the U.S. Census Bureau (n.d.) for the year 2010, the majority of cities located in Logan County have less than 25,000 people.   

Link between Health Issue and Target Audience

Gestational diabetes is a form of diabetes that is first diagnosed during pregnancy (American Diabetes Association [ADA], 2013; Kim et al., 2013).  It is believed that hormonal changes during pregnancy lead to gestational diabetes and that the condition usually disappears after delivery (Oklahoma Gestational Diabetes Collaborative [OGDC], 2013).  Gestational diabetes may lead to serious health consequences for the mother and infant.  Adverse consequences of gestational diabetes include large infant (macrosomia), cesarean delivery, birth trauma, infant hypoglycemia, or breathing problems, high blood pressure and higher risk of developing Type 2 diabetes in the future (U.S. Department of Health and Human Services [DHHS], 2012; Kim, Saraiva, Curtis, Wilson, Troyan, England, & Sharma, 2013; Healthy People 2020, 2013). 

In general, being overweight is one of the most cited factors that lead to gestational diabetes in all ethnic groups (Kim et al., 2013).  Diet and low impact physical activities have been shown to help in managing blood glucose for mothers with gestational diabetes (Agency for Healthcare and Research Quality [AHRQ], 2009).

Target audience was selected on the basis of health disparities found in rural communities and literacy levels.  According to the National Library of medicine, rural communities experience more health disparities than urban communities (National Library of Medicine [NLM], 2013).  This can be attributed to  limited availability and access to healthy foods and beverages, fewer physical activities opportunities, limited access to health care services, low population density that prohibits safe walking, “food deserts” that require residents to travel long distances to purchase affordable healthy foods, and lack of recreational centers (Tovar, et al., 2012).  

Determinants of health include social and economic environment, physical environment, and a person’s characteristics, such as level of education (World Health Organization [WHO], 2013; Centers for Disease Control and Prevention [CDC], 2012).  The National Patient Safety Information (NPSI, n.d.) considers literacy as one of the strongest predictors of a person’s health.  Due to their inability to comprehend health information, many patients have poor health outcomes because they have limited abilities to use helpful and basic health information.  Despite the fact that one out of five people in the U.S. have a 5^th grade reading level and that the average American reading level is estimated at the 8^th or 9^th level, most health information materials are written in a 10^th grade reading level (NPSI, n.d., para. 2).  By targeting this population with easy to read materials, health care professionals will contribute in the effort of increasing access to primary health information that benefits patients living in the rural communities of Logan County, Oklahoma.  With that in mind, I have prepared this lesson plan in order to provide useful and easy to understand information for pregnant women with gestational diabetes. 

Setting and Estimated Time

Setting

            The lesson will be administered to pregnant women who have recently been diagnosed with gestational diabetes and have been referred to the Logan County Health Department Clinic for gestational diabetes education.  Because most mothers need transportation to the center, there will two different sessions per week.  The number of participants per session will vary between 6 to 8 participants, aged between 20 to 50 years of age. Each session will take place in the conference room.  We will use a half-circle seating arrangement (see Appendix B).  There will 8 seats available during each session.  In case a participant brings her partner or a guest, he/she will seat on the participants’ designated row, and the partner/guest will seat right behind the participant.    

Estimated Time: 1 to 1 ½ hour (s)/session

We will have a two sessions of one hour, each on Thursday from 03:00 p.m. to 04:30 p.m.; there will be a free childcare will be provided for two and half hours (from 2:30 p.m. to 05:00 p.m.), to encourage participants to come in early, in case they have to depend on someone else’s transportation, and leave without rushing after the session. 

Activities Sequence

1.      Introduction (2 minutes)

2.      Importance of the topic (3 minutes)

3.      Icebreaker Activities and Pre-Assessment Activity (5-7 minutes)

a.       Give instructions to participants

b.      Demonstrate to participants what you instructed them to do by tossing up the ball to one of them.

4.      Go over participants’ folder content (2 minutes)

5.      Topic 1: Gestational diabetes presentation  (7-10 minutes)

a.       Causes

b.      Consequences

c.       Management strategies

                                                              i.      Healthy Nutrition

                                                            ii.      Physical Activities

                                                          iii.      Medications

d.      Participants ask questions, if any.

6.      Topic 2: You Can Manage Gestational Diabetes (20-30 minutes)

a.       Presentation1: Healthy Nutrition (10-15 minutes)

Ø  My Plate

Ø  Ask participants to pull a blank copy of My Plate from their folders

Ø  Ask participants to create a plate, using the list of foods provided

Ø  Questions, if needed 

b.      Presentation 2: Low Impact Physical Activities (10-15 minutes)

Ø  Presentation:

                                                                                      i.      Explain low impact physical activities and give examples

                                                                                    ii.      The benefit of low impact physical activities during pregnancy (3 minutes)

                                                                                  iii.      Video from You Tube (3 minutes)

                                                                                  iv.      Practice walking and moving legs (8 minutes)

7.      Questionnaires (8 – 10 minutes)

a.       Measures of TRA and TBP Constructs (see Appendix A)

b.      Satisfaction Survey Questions (See Appendix I)

Materials Needed

We will need the following items:

Ø  Writing materials: 3sharpie markers, 8 pencils, 2 pencil sharpeners, 8 erasers,  2 sign-up sheets, 1 white board, 1 black dry erase markers for the white board, 1 white board eraser

Ø  Presentation materials: 1 computer system connected to the internet and 1 projector, 1 laptop (in case the computer does not work), 1 portable projector (in case the classroom projector does not work), 1 flash drive with presentation materials, 1 pointer, 8 two-pocket folders containing

o    You Can Manage Gestational Diabetes Brochure (see Appendix C).

o   Tear-off USDA My Plate Placemat Handout (see Appendix E)

o   Tips for Eating Healthy Fast Food handout (See Appendix F)

o   Blank My Plate (See Appendix G)

o   Healthy and Homemade Meals: Nutrition & Fitness Calendar (See Appendix H)

Ø  Introduction/icebreaker materials: 20 name tags, 1 inflated Nasco’s Diabetes Toss-Up ball (see Appendix D)   

Ø  Conference materials: 8 participants’ chairs arranged in half-circle, 8 guests’/partners’ chairs positioned behind participants’ chairs, one chair for the health educator, located in the front of the circle, and two folding table at the back of the room (see Appendix B).

Ø  50 bottled water.

Ø  Additional 8 My Plate flyers for guests

Guiding Health Education Theories or Model

This education session is guided by the Theory of Reasoned Action (TRA) and Theory of Planned Behavior (TPB).  According to Glanz, Rimer, and Viswanath (2008), a person’s attitude, subjective norm (TRA), and perceived control (TPB) may influence his or her intention of performing a specific behavior (p. 70).  Using the TRA, a gestational diabetes patient’s attitude is determined by her beliefs that a healthy diet and physical activities during pregnancy lead to better short (no cesarean section, no birth trauma) and long term outcomes (decreased risk of type 2 diabetes);  this is also referred to as behavioral beliefs.  The patient’s subjective norm is determined by the belief that her partner/significant other, her doctor, or even her consultant at the Hope Pregnancy approves or disapproves of her eating healthy and being physically active (normative beliefs).  With TPB, the intention to be physically active, to select and eat healthy foods will determine the behavior itself (Glanz, Rimer, & Viswanath, 2008, p. 71).  The facilitator will use a power point presentation, handouts, short videos, and interactive activities to educate participants about gestational diabetes, its consequences, the benefits or using diet and physical activities in order to manage the condition.  In order to measure TRA and TPB constructs, participants will be asked to complete a questionnaire at the end of the session (see Appendix A).        

Goals

            The goal of this education session is to promote healthy nutrition and physical activities for patients with gestational diabetes.   

Objectives and Learning Domains

Process Objectives

Objective 1:  Confirm the number of participants by calling the Hope Pregnancy Center a day before the session. 

Objective 2: Assess participants’ knowledge about diabetes at the beginning of the session, using the Nasco’s Diabetes Toss-Up ball (Nasco, 2013).

Objective 3: Evaluate participants’ readiness to implement nutrition and physical activities, using the TRA and TPB questionnaire at the end of the session.

Objective 4: Evaluate participants’ overall satisfaction about the session, using a short survey at the end of the session.   

Impact/Outcome Objectives

Objective 1: Participants will be able to identify at least three foods from each food group from the commonly eaten food list provided to them, according to My Plate guidelines (cognitive).

Objective 2: Using the blank My Plate paper, participants will label each blank space with one food from each food group, based on My Plate guidelines (cognitive).

Objective 3: Participants will show willingness to engage in at least one type of low impact physical activity on most days of the week, based on their fitness level and their doctor’s recommendations (affective).

Objective 4: Participants will voluntarily perform at least one low impact physical activity during the education session, based on their fitness level as determined by their physicians during referral (psychomotor).

Learning Domains

            Cognitive learning domain.

            In order to identify foods from each food group categorize foods into food groups (objective 1), and label each blank space of the blank My Plate handout, participants need to know foods and their food groups and recall the information.

            Affective learning domain.

            After listening and watching a short video about the benefits of low impact physical activities, participants will show willingness to engage in low impact physical activities, based on their doctor’s recommendations.

            Psychomotor learning domain.

            After watching a short video about the benefits of physical activities, the facilitator will ask those who are already physically active and whose doctor indicated on the referral form that they could perform low impact physical activities, to perform at least one activity during the education session.   

Procedures

1.      10 minutes prior to participants’ arrival, check the room to make sure that the set-up is in place, the folders are placed on each participant’s seat, computer and projectors are compatible.

2.      Introduction (2 minutes)

Ø  Tell participants about yourself (name, profession and what you enjoy doing for fun)

Ø  Ask participants to introduce themselves and say what they like doing for fun.

3.      Importance of the topic (3 minutes)

Ø  Let participants know that you are here to talk about gestational diabetes and how to manage it.

4.      Icebreaker Activities and Pre-Assessment Activity (5-7 minutes)

Ø  Give instructions to participants

a.       Let participants know that this activity is to help them share what they know about diabetes and that mistakes are allowed.

b.      Participants will seat, forming a half circle.  The facilitator will say her name (My name is X) and will read and answer the question under his/her left thumb. After answering the question, he/she will then toss up the ball into the group.  The next person who catches the ball will restate the first person’s name, and will say his or her name (X, my name is Y).  After stating his/her name, the second person will read and answer the question under his/her left thumb.  Then the ball will be tossed up to another person, who will repeat the procedure.  The ball will be tossed up until all participants introduce themselves. The last person will toss up the ball back to the facilitator (adapted from The Name Game, by Gilbert, Sawyer, & McNeil, 2011).

c.       Activity objective: determine participants’ knowledge about diabetes and its management.

Ø  Demonstrate to participants what you instructed them to do by tossing up the ball to one of them and asking the person you tossed the ball up to, to toss it up back to you.

Ø  Start the game

5.      Go over participants’ folder content (2 minutes)

Ø  Explain the purpose of each item in the folder.

Ø  Let participants know that they can use the folders as a support to write during the session.

6.      Use the presentation tools (Power point, You Tube video, and Handouts)  to introduce each topic, and its related activities.  

Ø  Topic 1: Gestational diabetes presentation  (7-10 minutes)

                                                              i.      Causes

                                                            ii.      Consequences

                                                          iii.      Management strategies

1.      Healthy Nutrition

2.      Physical Activities

3.      Medications

                                                          iv.      Participants ask questions, if any.

Ø  Topic 2: You Can Manage Gestational Diabetes (20-30 minutes)

Ø  Presentation1: Healthy Nutrition (10-15 minutes)

                                                                                      i.      My Plate

                                                                                    ii.      Ask participants to pull a blank copy of My Plate from their folders

                                                                                  iii.      Ask participants to create a plate, using the list of foods provided

                                                                                  iv.      Questions, if needed 

Ø  Presentation 2: Low Impact Physical Activities (10-15 minutes)

                                                                                      i.      Presentation:

a)      Explain low impact physical activities and give examples

b)      The benefit of low impact physical activities during pregnancy (3 minutes)

c)      Short video from You Tube, available at http://www.youtube.com/watch?v=EaFXznbUnRI.  The video features some of the recommended low impact physical activities and length of time (2 minutes (3 minutes)

d)     Practice walking and moving legs (8 minutes)

ü  Walk without moving forward: ask participants to stand and walk, without moving forward (count thirty steps).

ü  Legs movement: ask participants to move one leg of their choice to the front (as if they were stepping forward), then move it back to the center (initial position), then move it to the back (as if they were stepping back), and finally move it back to the center (initial position).  Do it twice for each leg, and count four sets.
(3 minutes)

e)      Ask participants to sit down and offer them to get bottled water, if they need to.

7.      Questionnaires (8 – 10 minutes)

a.       Ask participants to answer the two questionnaires

Ø  Measures of TRA and TBP Constructs (see Appendix A)

Ø  Satisfaction Survey Questions (See Appendix I)

Evaluation

Process Objective Evaluation          

Count the number of participants to see if it matches expected number.  Observe participants’ reactions after they answer Nasco’s Toss up ball questions to assess the level of comfort during the session.  Observe participants’ reaction when asked to complete the TRA and TPB Constructs questionnaire and Satisfaction Survey at the end of the session to assess satisfaction.  

Impact/Outcome Objectives Evaluation

Check each participant’s completed blank My Plate handout to see if they have understood My Plate concepts.  Review the TRA and TPB Constructs Questionnaire to assess participants’ readiness to engage in low impact physical activities, to use healthy nutrition, and to meet with their primary care physician, if they need to know more about managing gestational diabetes.  Are participants willing to practice walking and moving legs during the session? 

Anticipated Problems and Solutions

Potential Problems	Solutions
The computer and projectors are not working	Distribute presentation handouts to participants
Flash drive is not compatible with computer	Use your laptop or distribute presentation handouts to participants
More participants than expected show up	Arrange to have at least 5 more chairs in the vicinity of the room. Prepare at least 12 more two-pocket folders with handouts, 12 more pencils and erasers
Participants not willing to stand up for physical activity practice	Encourage volunteers to try or do it yourself with enthusiasm.
Particpants are shy during icebreaker activities	Encourage them to participate by pointing out the benefits of icebreaker activities

Appendix A – Measures of TRA and TPB constructs

 

Appendix B – Participants’         , Guests’       , Health Educator’s         Chairs, and Tables      Positioning inside the Education room   

Appendix C:  Brochure “You Can Manage Gestational Diabetes” 

Appendix D

– Nasco’s Diabetes Toss-Up Ball 

Appendix E – Tear-off USDA My Plate Placemat

Appendix F – Tips for Eating healthy Fast Food      

Appendix G – Blank My Plate

Appendix H – Healthy and Homemade Meals: 2014 Nutrition and Fitness Calendar

Appendix I: Satisfaction Survey Questions

Appendix J: Power Point Presentation

 

References

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            reviews-and-reports/?pageaction=displayproduct&productID=162

American Diabetes Association. (2013).  Diabetes basics. Retrieved from

            http://www.diabetes.org/diabetes-basics/gestational/what-is-gestational-diabetes.html

Centers for Disease Control and Prevention. (2012). Social determinants of health: Frequently

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Gilbert, G. G., Sawyer, R. G, & McNeil, E. B. (2011). Health education: Creating strategies for

            school and community health. Sudbury, MA: Jones and Bartlett Publishers.

Glanz, K., Rimer, B. K., & Viswanath, K (Eds.). 2008. Health behavior and health promotion:     Theory research, and practice. San Francisco, CA: Jossey-Bass. 

Healthy People 2020. (2013). Diabetes. Retrieved from 

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Kim, S. Y., Saraiva, C., Curtis, M., Wilson, H. G., Troyan, J., & Sharma, A. J. (2013). Fraction

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            doi:10.2105/AJPH.2013.301469

Nasco. (2013). Nasco’s diabetes toss-up ball. Retrieved from

            http://www.enasco.com/product/WA24122HR

National Diabetes Information Clearinghouse. (2012). Gestational diabetes: What you need to

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National Patient Safety Information. (n.d.). Health literacy scope at glance.  Retrieved from

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Oklahoma Gestational Diabetes Collaborative. (2013).  Memorandum. Retrieved from

http://www.ok.gov/health2/documents/Letter%20for%20Health%20Care%20Authority.pdf

Oklahoma State University. (2013). Medically underserved areas & populations: January 2013.

Retrieved from http://www.healthsciences.okstate.edu/ruralhealth/documents/OkMUAP0113.pdf

Shin Y., K., Saraiva, C., Curtis, M., Wilson, H. G., Troyan, J., England, L., & Sharma, A. J.

(2013). Fraction of Gestational Diabetes Mellitus Attributable to Overweight and Obesity

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