4 Train the Trainer Pre-Post Test

Evaluation Instruments: Set 2 O.M.B 0925-0491

Exp. XX/XX

Evaluation Instrument: Community Health Worker

"Train the Trainer" Pre-Test and Post-Test

CHAN Training Using With Every Heartbeat is Life

We used Community Health Worker "Train the Trainer" pre and post tests to accompany the "With Every Heartbeat is Life" training conducted in the 5 communities from 2009 through 2010. We have the pre and post tests from 4 of the 5 communities. The evaluation form has demographic information as well as lifestyle behavior questions. It also included information such as age, education level, gender and training experience. The training was conducted over a 12 month period and recommendation from the manual was over a 12 week period. The workers voted to conduct trainings during the monthly meetings. Among the 4 groups, we were able to review and describe similarities and differences and describe the pre and post test behavioral changes of the 4 groups.

Public reporting burden for this collection of information is estimated to average 6-15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0491). Do not return the completed form to this address.

Community Health Worker Train the Trainer Pre-test and Post-test

FOR INTERNAL USE ONLY

(For Strategy 1)

Participant identification (ID) number:

Name of person teaching the manual: ________________________________________

[ ] Pretest Start Date (MM/DD/YYY):_____/_____/______

[ ] Posttest End Date (MM/DD/YYY):_____/_____/______

[ ] 30-day follow-up Date of contact (MM/DD/YYY):_____/_____/______

Was the participant contacted 30 days after training ended to get information about how she or he is using the "With Every Heartbeat Is Life" Manual? [ ] Yes [ ] No

What activities are the participant doing? ____________________________________

Patient Information

Please tell us some information about yourself by completing this form before the training2. Ask for assistance if you need it.

1. Today's date (MM/DD/YYY): / /

2. Date of birth (MM/DD/YYYY): / /

3. Age (in years):

4. Gender: [ ] Male [ ] Female

5. Do you consider yourself Latino or Hispanic? [ ] Yes [ ] No

6. Which race do you consider yourself to be?

[ ]American Indian or Alaska Native

[ ] Asian

[ ] Black or African American

[ ] Native Hawaiian or other Pacific Islander

[ ] White

Community Health Worker Train the Trainer Pre-test and Post-test (continued)

7. How many years of school have you completed? [ ] Some elementary school [ ] Finished elementary school [ ] Some high school [ ] Graduated from high school or received high school equivalency diploma(GED) [ ] Some technical/vocational school [ ] Some college/university [ ] Graduated from college/university [ ] Some post graduate school [ ] Graduated from post graduate school
8. Have you worked as a community health worker before? [ ] Yes [ ] No	9. If yes, for how long? _______years _______ months
10. What health topics have you taught? (You may select more than one answer). [ ] None [ ] Asthma [ ] Diabetes [ ] Cancer [ ] HIV/AIDS [ ] Cardiovascular [ ] Others (please specify):
11. Have you used manuals to teach community members? [ ] Yes [ ] No If yes, please write the name(s) of the manual(s) that you have used.
12. Is this your first training with the "With Every Heartbeat Is Life" manual? [ ] yes [ ] No

Community Health Worker Train the Trainer Pre-test and Post-test (continued)

Please circle only one answer for each question.

Mrs. Jones, who is 65 years old, is Gloria's mother. Mrs. Jones has diabetes and her blood pressure is 148/98 mmHg (millimeters of mercury). Her blood cholesterol is 250 mg/dL (milligrams per deciliter). Mrs. Jones always has a salt shaker at her table and likes salty food.

1. What are the risk factors that put Mrs. Jones at risk for heart disease?

a. Using small amounts of salt, being physically inactive and being overweight

b. Having high blood pressure, having high blood cholesterol and having low blood sugar

c. Being a female older than age 55, having high blood pressure, having high blood cholesterol, having diabetes and eating foods high in sodium

d. Having high blood cholesterol, having low blood pressure, using lots of salt and being physically inactive

2. A community health worker explains to Mrs. Jones what high blood pressure is:

a. High blood pressure. is the number that you get when you add 100 to your age.

b. High blood pressure is when the body circulates more blood based on your height and weight.

c. High blood pressure is a measurement of 140/90 mmHg or greater.

d. High blood pressure is when the blood suddenly stops going to the brain.

Gloria, the daughter of Mrs. Jones, is 30 years old. She cooks with a lot of fat and she is 15 pounds overweight. She prepares fried chicken and likes nachos with lots of cheese. When Gloria does not have time to cook, she buys a super-sized hamburger, French fries and a regular soda. Instead of walking, Gloria drives her car, even to the corner. Her "best friends" are the remote control for her television and her green chair. Gloria's cholesterol level is 240 mg/dL.

3. Gloria's risk factors and lifestyle habits that put her at risk for developing heart disease are:

a. Having high blood cholesterol, walking and being age 30 and overweight

b. Being overweight, having high blood pressure and having a family history of heart disease

c. Being overweight, physically inactive and cooking and buying foods high in fat

d. Being age 30, having had a heart attack before and having low blood pressure

4. Which of these lifestyle changes can help people prevent heart disease? Mark your answer with an X.

a.	Reading the food label to choose foods with less than 5 percent of the Percent Daily Value for sodium	] ] yes	[ ] No	[ ] Don't know
b.	Preparing foods by baking, broiling or boiling instead of frying.	[ ] yes	[ ] No	[ ] Don't know
c.	Drinking a lot of whole milk.	[ ] yes	[ ] No	[ ] Don't know
d.	Stocking the kitchen with lots of snacks like potato chips	[ ] yes	[ ] No	[ ] Don't know
e.	Cooking with lard	[ ] yes	[ ] No	[ ] Don't know
f.	Eating large portions of food	[ ] yes	[ ] No	[ ] Don't know

5. This question is about food serving sizes. Mark your answer with an X.

a.	Is 1 cup of cooked rice one serving?	] ] yes	[ ] No	[ ] Don't know
b.	Is 1 cup of strawberries one serving?	[ ] yes	[ ] No	[ ] Don't know
c.	Is 1 cup of orange juice one serving?	[ ] yes	[ ] No	[ ] Don't know
d.	Is 1 cup of cooked beans one serving?	[ ] yes	[ ] No	[ ] Don't know
e.	Is 1 slice of bread one serving?	[ ] yes	[ ] No	[ ] Don't know

6. Do you think that the following actions help you take steps toward a healthier lifestyle?

Mark your answer with an X.

a.	Removing the skin from chicken	] ] Agree	[ ] Disagree	[ ] Don't know
b.	Cooking with lard instead of canola, olive or corn oil	] ] Agree	[ ] Disagree	[ ] Don't know
c.	Buying canned vegetables instead of fresh or frozen vegetables	] ] Agree	[ ] Disagree	[ ] Don't know
d.	Choosing regular sandwiches instead of super-sized sandwiches when eating out	] ] Agree	[ ] Disagree	[ ] Don't know
e.	Adding fruits and vegetables to your meals	] ] Agree	[ ] Disagree	[ ] Don't know

7. Mark your answer with an X for the following statements.

a.	Secondhand smoke is not dangerous to your heart health.	] ] Agree	[ ] Disagree	[ ] Don't know
b.	The desirable level for LDL, bad cholesterol, is less than 100 mg/dL.	] ] Agree	[ ] Disagree	[ ] Don't know
c.	Having a waist measurement greater than 35 inches is healthy for a woman.	] ] Agree	[ ] Disagree	[ ] Don't know
d.	Adults need about 60 minutes of moderate to vigorous physical activity on most days to prevent weight gain.	] ] Agree	[ ] Disagree	[ ] Don't know
e.	The hemoglobin AIC (Hb A1C) test shows the average blood glucose level during the last 24 hours.	] ] Agree	[ ] Disagree	[ ] Don't know
f.	People know when they have high blood cholesterol because they begin to gain weight.	] ] Agree	[ ] Disagree	[ ] Don't know

8. A heart healthy diet should be followed by:

(Circle the answer below that you think correctly completes this statement):

a. Only people who have high blood cholesterol

b. Only adults who have heart disease

c. Everyone older than 2 years of age for their lifetimes

d. Everyone between 40 and 65 years old

9. How important is it to you to reduce your risk of heart disease? Mark your answer with an X.

[ ] Not important [ ] Somewhat important [ ] Important [ ] Very important

10. How confident are you about teaching the "With Every Heartbeat Is Life" manual to community members? Mark your answer with an X.

[ ] I am not confident.

[ ] I am somewhat confident.

[ ] I am confident.

[ ] I am very confident.