A Training Manual for Health Workers on Healthy Lifestyle: An … · · 2016-02-28In the...

2009 Revised Edition

A Training Manual for Health Workers on Healthy Lifestyle: An Approach for the Prevention and Control of

Noncommunicable Diseases

Trainer’s Guide

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World Health Organization and Department of Health, Philippines © 2009

This publication is a revised edition of the Training Manual for Health Workers on Promoting Healthy Lifestyles released in 2003. All rights reserved. Adaptation to other countries or regions will require inclusion of the national or international guidelines that are appropriate in the new

context. The document, however, may be freely reviewed, abstracted, quoted, reproduced, or translated in part or in whole, provided that such is not done in, for, or in conjunction with commercial purposes and provided that, if it is intended to translate or reproduce the entire

work, or substantial portions thereof,prior applications is made to the Copyright owners.

ForewordNoncommunicable diseases (NCDs) are now the leading killers worldwide. Sixty percent of all deaths in the world are caused by NCDs. Cardiovascular disease, diabetes, cancer, and chronic respiratory disease are rising as a result of a global epidemic of smoking, unhealthy diet, harmful use of alcohol, and physical inactivity. These diseases cut productivity so insidiously and drain family resources so thoroughly, that they have become a major threat to the economic and social development of developing countries.

In the Philippines, six of the top ten causes of mortality are due to NCDs. Diseases of the heart and vascular system are the top killers, comprising nearly one-third (31%) of all deaths. Other NCDs in the top list include malignant neoplasms, chronic obstructive pulmonary disease (COPD), diabetes mellitus, and kidney diseases.

The NCD problem is likely to persist in the country as indicated by recent statistics that show a large number of Filipino adults who continue to exhibit NCD risks. Consider the following prevalence as follows: 27% are overweight, 25% have hypertension, 5% have high blood sugar, 10 % have high total cholesterol level, and 48% of adult males are smokers. High levels of physical inactivity (more than 70%) is also reported. Alarmingly too, more and more children and adolescents are becoming exposed to overweight and obesity and other NCD risks.

In the last twenty five years or so, much has been learned about the causes of NCDs, and many national and local initiatives have been put in place. Since then, there have been good practices and models established, and some improvements in prevalence of risk factors achieved. The WHO Action Plan for the Global Strategy for the Prevention and Control of Noncommunicable Diseases (2008–2013) and the Western Pacific Regional Action Plan for NCDs have guided Philippines and other Member States in the fight against NCDs in recent years. But the challenges have remained, and there is now a need to accelerate efforts and strengthen initiatives to dramatically reduce prevalence of NCDs and their risk factors in the country.

The revised training manual on the integrated approach for the prevention and control of NCDs is envisioned to be an important capacity building tool for health care providers and health partners in their continuing mission on NCD prevention and control. WHO Philippines is happy to have supported the updating of said training manual. We remain committed to continually serve as technical partner of the country in reducing the magnitude of the NCD problem and contributing to overall health and well-being of all Filipinos.

Thank you and mabuhay!.

Dr Soe Nyunt-UWHO Representative in the Philippines

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ForewordAs we all know, chronic lifestyle-related Noncommunicable Diseases (NCDs) such as cardiovascular diseases, cancer, diabetes, chronic respiratory and renal diseases, remain as global and national epidemics. In the Philippines, these diseases are among the top ten leading causes of mortality and morbidity, including trauma from accidents and injuries, which bring serious consequences to individuals in particular and to country’s development in general.

In response to the growing epidemic on NCDs, two demonstration projects in the municipality of Pateros in Metro Manila and the province of Guimaras in Western Visayas implemented in 2003 an integrated and community-based approach for the prevention and control of NCDs. Relative to this, series of trainings for public health workers in both demo sites and later on in other regions of the country were conducted focusing on key areas of primary prevention of

risk factors and the major NCDs.

Today, the call for promoting healthy lifestyle by reducing risk factors such as physical inactivity, smoking, poor diet and nutrition remains a challenge in both rural and urban settings, despite some improvements on the prevalence of risk factors in some areas. Moreover, there is a need to understand the underlying social determinants caused by globalization, urbanization and aging population to help reduce the prevalence of mortality and morbidity from NCDs.

Along this context, the Department of Health recognizes and adopts the Plan of Action on NCD of the World Health Organization emphasizing the different interventions such as: (1) policy and regulatory interventions at the environmental level, (2) population-based lifestyle interventions at the level of common and intermediate risk factors; and (3) clinical interventions targeting high risk individuals at the level of disease.

Hence, the DOH is happy to release this revised edition of the Training Manual for Health Workers on Promoting Healthy Lifestyle, now entitled, A Training Manual for Health Workers on Healthy Lifestyle: An Approach for the Prevention and Control of Noncommunicable Diseases. This manual is intended primarily for health workers namely: doctors, nurses, midwives and nutritionists in all public health facilities. It aims to guide them in addressing the rising trend of NCDs throughout the country using holistic approach starting with proper risk assessment and screening procedures.

Finally, it is hoped that this material will aid the health workers in efficiently implementing NCD Prevention and Control Program as one priority program of the Department.

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Preface

The prevalence of Noncommunicable Diseases (NCDs) continues to rise and promoting healthy lifestyle is very much needed and relevant as ever. The last series of training on promoting healthy lifestyle have been conducted five years ago (2004-2005). The first edition of the Training Manual for Health Workers on Promoting Healthy Lifestyles was developed in 2003 by the University of the Philippines Manila College of Nursing commissioned by the Department of Health with funding from the World Health Organization Western Pacific Regional Office (WHO-WPRO). The training manuals were used in training doctors, nurses and midwives in the two demonstration projects on NCD prevention and control: in the municipality of Pateros and the province of Guimaras. These manuals were also used in the National Training of Trainers and training of public health workers at the Regional Centers for Health and Development.

Recently, there have been a lot of developments in the prevention and control of NCDs globally and locally. WHO WPRO developed a Regional Action Plan on NCD which utilizes a comprehensive approach to effect change by doing advocacy, research, surveillance and evaluation, leadership, and health systems strengthening. DOH clarified the roles of the public health workers in the prevention and control of NCDs at the national, regional, municipal, and barangay levels. New evidence on what works to prevent and control major NCDs and their risk factors have strengthened programs on diet, physical activity and smoking cessation. With the goal of renewing and updating the series of training for health workers on the prevention and control of NCDs, WHO Philippines and DOH commissioned the University of the Philippines Open University together with the UP Manila College of Nursing to review the training curriculum in promoting healthy lifestyle and revise the training manuals based on current needs assessment and scientific updates.

In the process of revising the Training Manuals, several steps were conducted. A Round Table Discussion was conducted among NCD coordinators at the Regional Centers for Health and Development to solicit their comments on how the existing manuals could be revised based on their practical use in the community. Surveys and focus group discussions were also conducted in three cities in Metro Manila to gather more information on how to improve the content of the manuals, the teaching-learning strategies and the actual conduct of the training. Content writers were then gathered in a workshop to update and reorganize the content in a more useful and practical way. Strategies for changing behaviour and creating supportive environment were incorporated in the modules on promoting specific interventions such as: (1) promoting good nutrition and healthy diet, (2) promoting physical activity, (3) promoting smoke-free individuals and reducing harm from

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alcohol use, and (4) promoting mental health and wellness. Alcohol and mental health are the new topics added to the revised edition because of their significant contribution to the prevalence of major NCDs.

The new set of Training Manual is now composed of six modules, namely: • Module 1. Overview of Major Noncommunicable Diseases• Module 2. Risk Factors Assessment and Screening Procedures• Module 3. Promoting Good Nutrition and Healthy Diet• Module 4. Promoting Physical Activity• Module 5. Promoting Smoke-free Individuals and Reducing Harm from Alcohol Use• Module 6. Promoting Mental Health and Wellness

The Trainer’s Guide is basically the same structure and format as the previous edition. This contains a proto-type training schedule of four days. Suggested teaching and learning strategies are highly interactive using a participatory and experiential approach which is consistent with principles of empowerment. Training outcomes include development of skills in assessment of clients for risk factors, perform and interpret results of basic screening procedures, perform health education sessions on risk factor modification and promoting healthy lifestyle and mobilizing communities.

Prior to final design and layout of the training manuals, two batches of pre-testing were done involving DOH officials and public health workers at the regional and local levels. Slide presentations were likewise developed and adapted to suit the local contexts.

The Trainer’s Guide, Training Modules, Training Program and Slide Presentations comprise the complete set of training materials for the Training of Health Workers on the Integrated Approach to the Prevention and Control of NCDs. It is hoped that by giving this complete set to the regional and local health officials, the training of public health workers on the prevention and control of major NCDs will be more meaningful, standardized and successful.

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EditorsSheila R. Bonito, RN, DrPHUniversity of the Philippines Open University (UPOU)

Luz Barbara P. Dones, RN, MPHUniversity of the Philippines Manila College of Nursing (UPM-CN)

ContributorsAraceli O. Balabagno, RN, PhD- UPM-CN Sheila R. Bonito, RN, DrPH - UPOUFrances Prescilla L. Cuevas, RN, MAN – DOH-Degenerative Diseases Office (DOH-DDO)Luz Barbara P. Dones, RN, MPH – UPM-CNJohn Juliard Go, MD, MPH – World Health Organization PhilippinesLydia T. Manahan, RN, MAN – UPM-CNJenniffer Paguio, RN – UPM-CNJosefina A. Tuazon, RN, DrPH – UPM-CNBethel Buena Villarta, RN, DrPH – UPM-CN

ReviewersJacqueline Acosta – DOH HHRDBMa Elizabeth I. Caluag, MD – DOH-DDOFranklin C. Diza, MD – DOH-DDORachel Rowena R. Garcia - MD, DOH-CHD for Metro ManilaRemedios S. Guerrero – DOH-DDORosemarie P. Holandes, RND – DOH-DDONelson M. Mendoza – DOH-DDODinah P. Nadera, MD, Ms Epi - UPOURemedios V. Niola – DOH-DDODitas Purisima Raymundo – DOH-DDOAnthony R. Roda – DOH National Center for Health Promotion (DOH-NCHP)Ma. Blesilda Viorge - DOH NCHP

Administrative Support:Lucellie Barrion - DOH - DDONenita De Jesus - DOH - DDOJovanni Infante - DOH - DDOVivencia Martinez - DOH - NCDPCLina Yusuf - UP College of Nursing

Layout ArtistKatherine K. Esteves

Logo DesignZando Escultura

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Participants to the First Pretesting of the Training ManualCurrimao, Ilocos Norte

1. Dr. Madeline J. Retuta

2. Carmelita Genevieve P. Soliven

3. Larisa C. Foronda

4. Dr. Elsie A. Pintucan

5. Sandra M. Sangab

6. Erlinda Maglanque

7. Ramonico L. Usman

8. Blesilda M. Yap

9. Ma. Theresa Y. Malubag

10. Maria Sheila B. Berbano

11. John Elvin M. Elemia

12. Heizel Vidallo

13. Dr. Rey J. Millena

14. Marino A. Abogado

15. Melba T. Vera Cruz

16. Madel C. Kho

17. Dr. Rachel Rowena R. Garcia

18. Dr. Ma. Luisa Paran

19. Teresita D. Foman-Eg

20. Dr. Annabelle P. Yumang

CHD I

ILOCOS

PHO-Ilocos Norte

CHD II

CHD II

CHD III

CHD III

PHO-Zambales

CHD IV-A

CHD IV-A

CHD IV-A

PHO-Cavite

CHD V

PHO-Camarines Norte

CHD V

CHD-NCR

CHD-NCR

CHD-CAR

CHD-CAR

CHD-Davao

MS IV

Nurse II

HEPO II

MS III

Nurse V

Nurse V

Nurse I

Administrative Officer V

HEPO III

AA III

Provincial Health Officer

MS II

HEPO II

Nutritionist Dietitian IV

SI

MS III

MS III

Nurse V

MS III

Name OFFICE STATION DESIGNATION

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21. Ma. Corazon S. Mendez

22. Chona G. Dazon

23. Dr. Jean V. Apolinares

24. Dr. Regina M. Bernabe

25. Dr. Ma. Dulce G. Macabudbud

26. Rammel M. Martinez

27. Joyce P. Parco

28. Thelma D. Valdez

29. Karen A. Molina

30. Ma. Visitacion S. Saingan

31. Dorothy Gabona

32. Czerina A. Canda

33. Ignacio B. Paguigan

34. Vivian B. Paguio

CHD- Davao

CHO-Davao City

PHO-Davao Norte

CHO-Manila

CHO-Manila

MHO-Pateros

MHO-Pateros

PHO-La Union

PHO-Kalinga

PHO-Benguet

PHO-Cagayan

PHO-Pampanga

PHO-Isabela

PHO-Sorsogon

Nurse V

Nurse IV

Nutritionist Dietitian III

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Participants to the Second Pretesting of the Training ManualTagbilaran, Bohol

1. Ralph Falculan

2. Analiza F. Malayao

3. Luningning M. Vendiola

4. Dr. Aurora G. Campita

5. Dr. Judita T. Tawatao

6. Emmalyn S. Fernandez

7. Milagros B. Israel

8. Leonidas L. Saniel

9. Elvira A. Lanza

10. Daisy R. Gorgonia

11. Josephine L. Dela Fuerte

12. Dr. Ma. Agnes Z. Mabolo

13. Ma. Victoria Arquiza

14. Dr. Andresa C. Beñas

15. Lady Venus A. Maghanoy

16. Perla B. Dinlayan

17. Agnes P. Pajamutan

18. Jenelyn Ellie P. Ventura

19. Dr. Leonora A. Lozana

20. Dr. Duvia D. Tabugo

21. Dr. Jane Y. Lugo

22. Delma Legazpi

23. Noraida Ibrahim

24. Manuel E. Dulay Jr.

25. Edmiraldo S. Wee

PHTO-Romblon

CHD4B –MIMAROPA

PHTO-Mindoro

CHD4B-MIMAROPA

CHD-Central Visayas

CHD-Central Visayas

PHO-Bohol

PHO-Bohol

CHD-Eastern Visayas

PHO-Eastern Visayas

PHO-Northern Samar

CHD-Zamboanga

CHD-Zamboanga

CHD-Northern Mindanao

PHO-Lanao Norte

PHO-Bukidnon

PHO-Misamis Oriental

CHD-Soccsksargen

CHD-Soccsksargen

CHD-Soccsksargen

CARAGA

CARAGA

ARMM

PHO-Maguindanao

PHO-Sulu

DOH Representative

Administrative Aide VI

DOH Representative

MS III

MS III

Nurse III

Nurse V

Med-Tech

HEPO III

MS IV

Nurse V

MS III

HEPO I

HEPO II

Nurse II

Nurse III

MO IV

RHP/OIC

MS

Nurse

Nurse V

RHP

HEPO


IntroductionTarget Participants

Objectives of the Training ProgramTraining Outcomes

Training Curriculum and Learning MethodsHow to Use the Training Manual

Schedule of Training ActivitiesPrototype of Training Schedule

Key Messages and Notes for the TrainersInstructional Plans

Module 1. Overview of Major Noncommunicable DiseasesModule 2. Risk Factors Assessment and Screening Procedures

Module 3. Promoting Healthy NutritionModule 4. Promoting Physical Activity

Module 5A. Promoting Smoke-free Individuals and EnvironmentModule 5B. Reducing Harm from Alcohol Use

Module 6. Promoting Mental Health and WellnessAppendix:

Pre-test / Post-test for Training ParticipantsDaily Evaluation Sheet

Trainer’s GuideMODULE

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Trainer’s GuideMODULE

0I. Introduction

Noncommunicable diseases (NCDs) are considered a major public health concern worldwide. They account for 60 percent of total deaths globally (with 40 million deaths estimated occurring annually), and contribute to 40 percent of universal disease burden annually. It is projected that if no action is done in the present, these rates would increase to as high as 73 percent to total deaths and 60 percent to disease burden respectively by 2020 (WHO, 2005).

The prevalence of NCD continues to rise in the Philippines and promoting healthy lifestyle is very much needed and relevant as ever. More than half (58%) of total deaths in the country in 2003 were caused by NCDs. Diseases of the heart and vascular system made up almost one-third (30.2%) of all deaths (Philippine Health Statistics, 2003). Other NCDs in the top list include malignant neoplasm, chronic obstructive pulmonary diseases (COPD) and diabetes mellitus. NCDs have replaced the positions of infectious diseases particularly pneumonia and tuberculosis as top-most common causes of deaths.

The burden of illness due to NCD is great and the cost of care is something that the country cannot afford. The cost of diagnosis and treatment is generally beyond the resources of the average Filipino and the government’s health budget is inadequate. There is an urgent need therefore to focus all efforts in promoting healthy lifestyle to avoid the major risk factors that cause these diseases.

The common risk factors for the major NCDs, which include: smoking, lack of physical activity, obesity, hypercholesterolemia and unhealthy dietary practice can be prevented or modified early through behavior change and environmental support. Health workers, particularly those at the primary care level need to be reoriented and trained on integrating primary prevention of NCDs and promotion of healthy lifestyle in their regular activities.

In the past years, the Philippine Department of Health (DOH) has experienced that having a separate program for each major disease is expensive, not effective and inefficient. The costs of diagnosis, treatment and rehabilitation of NCDs are expensive. The prevalence of NCD is increasing despite the presence of program-specific interventions. The use of resources is not efficient because of overlapping of efforts and not focused on primary prevention. While the high-risk approach cannot be discounted, studies have shown that intervening early using a population approach could be more effective. The recommended approach, therefore, is to prevent and modify the underlying causes and risk factors of leading NCDs using a population or community-based approach.

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In response to the World Health Organization’s challenge to promote an integrated community-based approach to the prevention and control of NCDs, DOH launched the National Healthy Lifestyle Program in 2003 to encourage the establishment of healthy lifestyle programs at the provincial and municipal levels all over the country. Since then, DOH has been streamlining and reorganizing its programs and structure towards a more integrated approach in the delivery of health services.

Health workers at the primary care setting and in communities play a critical role in promoting healthy lifestyle. The first national training on promoting healthy lifestyle was done in 2003 with the help of the University of the Philippines Manila - College of Nursing (UPM-CN). The focus of the training then was on the areas of risk factors assessment and screening, nutrition, physical activity and tobacco control. After almost seven years there have been many technical updates in NCD prevention and control and some new strategies in promoting healthy lifestyle. It is therefore important to conduct a nationwide re-training of community health workers.

This new training organized by the University of the Philippines Open University (UPOU) and UPM-CN will focus on five areas: (1) risk factors assessment and screening for major NCDs, (2) diet and nutrition, (3) physical activity, (4) tobacco and alcohol control and (5) mental health and wellness. This training will also include health promotion strategies such as information dissemination, health education, communication, and social mobilization using different forms of media and technology.

The training will also include health promotion strategies such as information dissemination, health education, communication, and social mobilization. In information dissemination, they can be taught how to develop leaflets, brochures, posters, etc. Health education could focus on individual or population as target audience. In communication, use of mass media (print, radio, TV, internet) is going to be emphasized. Social mobilization is about organizing networks for advocacy and policy development.

The promotion of healthy lifestyle focuses on five areas:

1. good nutrition and weight control2. regular physical activity and exercise3. smoking cessation and smoke-free environment4. stress management5. regular health check up

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II. Target Participants

The target participants of this training program are primarily the public health workers based in the community, health centers and other health facilities. These include doctors, nurses, midwives and nutritionists.

It is important that the number of trained health workers reach a critical mass to create an impact in the community. Thus, this training program can be modified to train other health workers such as dentists, sanitary inspectors, barangay health workers and barangay nutrition scholars. It can also be used to train other people in the community such as policy makers and schoolteachers, and involve other sectors such as business and workplace.

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III. Objectives of the Training Program

The over-all objective of the training of health workers is to promote healthy lifestyles for themselves and their clients using the integrated community-based approach for the prevention and control of lifestyle-related noncommunicable diseases.

This training is also intended to develop the skills of NCD coordinators, health promotion officers, training officers at the regional and provincial level as advocates and potential trainers in their own localities and for them to develop their regional and local plans for training community health workers and other persons in different sectors on promoting healthy lifestyle.

General Objectives

By the end of the training, the participants will be able to:

1. Appreciate their roles in the prevention and control of major NCDs;2. Assess individual clients’ risk for major NCDs;3. Promote behavior change in the different aspects of healthy lifestyle using health education and health

promotion strategies;4. Create supportive environment for healthy lifestyle through advocacy and policy5. Work towards sustainability of the healthy lifestyle program

Specific Objectives

1. Recognize the magnitude of the problem in major NCDs;2. Perform risk assessment and screening procedures related to NCDs;3. Develop skills in risk modification and promoting healthy lifestyle in the following areas: nutrition,

physical activity, smoking and alcohol drinking, and mental health;4. Enhance skills in communicating with, educating and motivating clients and other health workers in

promoting healthy lifestyle5. Mobilize communities to promote and support healthy lifestyle program

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a. State basic information needed by clients for healthy lifestyle and risk factor modification

• Nutritional guidelines for Filipinos• Benefits of and guidelines for physical activity• Harmful effects of smoking and alcohol• Strategies to manage stress and enhance effective coping

IV. Training Outcomes

The four-day training program aims to develop the following competencies of the health workers:

2. Perform and interpret results of basic screening procedures

a. Screen for hypertension• Blood pressure measurement

b. Screen for dyslipidemia• Total blood cholesterol• High- density lipoprotein• Low-density lipoprotein

c. Screen for diabetes mellitus• Fasting blood sugar• 2-hour post-prandial blood test

d. Screen for cancer• For breast cancer: clinical breast examination; breast self-

examination• For cervical cancer: VIA with acetic acid wash; Pap smear• For prostate cancer: digital rectal examination

e. Screen for COPD and/or asthma• Measurement of peak flow rate

3. Perform health education to clients on healthy lifestyle and risk factor modification

1. Assess clients for risk factors of noncommunicable diseases and make appropriate referrals

a. Obtain information about risk factors:• Dietary intake of fat and salt• Level of physical activity and exercise status• Smoking and alcohol history• Personal and family history of hypertension, diabetes, cancer

or asthma• Level of stress and coping

b. Obtain/calculate measurements for obesity• Ideal body weight• Body mass index• Waist -hip ratio• Waist circumference

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4. Mobilize communities in noncommunicable disease prevention and control using the integrated approach

b. Provide information for early detection of NCD• Warning signs of cancer• Clinical and breast self-examination• Cervical cancer screening through Pap’s smear, acetic

acid wash and colposcopy• Digital Rectal examination

c. Demonstrate basic skills in:• Health education and counseling• Basic nutritional counseling• Formulating physical activity or exercise plan• Minimal intervention for smoking cessation and alcohol

avoidance• Strategies in effective coping and managing stress

a. Organize support groups/clubs forspecific group of patientsb. Utilize IEC materialsc. Conduct health education/health promotion programsd. Modify health programs according to community needs and resourcese. Disseminate information about health programsf. Solicit participation to health programsg. Network or build linkages with other agencies and groups

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V. Training Curriculum and Learning Methods

This four-day training program is concerned with the development of health promotion skills of health workers in the prevention and control of major NCDs in the country.

This revised TRAINING CURRICULUM is based on a recent training needs assessment of community health workers in selected areas in Metro Manila, DOH evaluation of previous training programs on healthy lifestyle, and review of old training manual by the NCD coordinators from the different Centers for Health Development. Experiences from the different LGUs and inputs from clinical experts and health promotion practitioners were likewise considered in the revision. Current guidelines and consensus statements from the World Health Organization and reputable professional associations were also gathered and integrated into the manual.

The FOCUS OF THE TRAINING is on primary and primordial prevention of NCDs through prevention and control of the most significant and modifiable risk factors. These risk factors include but are not limited to the following: elevated cholesterol, hypertension, smoking, obesity and sedentary lifestyle. In particular, the training program involves the enhancement of health education and community organizing skills in promoting healthy lifestyles in the areas of nutrition, physical activity, smoking and alcohol and mental health.

The program is both content-focused and process-oriented. Content includes an overview of five leading lifestyle-related NCDs and their major risk factors, guidelines and procedures for risk assessment and screening, and promotion of proper nutrition, physical activity and exercise, smoking cessation and a smoke-free environment, no alcohol and mental health wellness. The process refers to how health workers can be more effective in promoting healthy lifestyles. The process is integrated into the learning activities as well as the practice sessions on counseling and conducting health education sessions.

The LEARNING METHODS used are mostly experiential, “learning by doing” method, and participatory to promote self-awareness and behavior change in the participants themselves as well as to develop their skills in training other health workers. Additional sessions are also given to increase the skills of trainers and health workers in adapting the training curriculum to the needs of their own locality.

The training program is designed to be a total experience for the participants, that is, living a healthy lifestyle for the duration of the program while learning how to promote this among their clients and in the community. This is achieved through a live-in training program, careful selection of venue, provision of smoke-free living quarters and meeting rooms, close coordination with hotel/resort staff regarding food to be served, and ensuring there is adequate space for group exercise. Such an experience is intended to enhance awareness and motivation on the part of the participants for a healthy lifestyle. Unfreezing activities are also selected to enhance achievement of the objectives while making the total experience fun and stimulating for the health workers.

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Developing Skills through Exercises, Workshops, Practicum

An important objective of the training is the development of skills of the participants. Although it is recognized that health workers have many experiences and basic skills on prevention and control of NCDs, results of the training needs assessment showed that these skills needed much refining, particularly in taking anthropometric measurements and blood pressure measurements. Assessing for obesity using body mass index and waist circumference is new to some.

Therefore, skills of participants in risk assessment and basic screening procedures for the five major NCDs need to be practiced and checked. To provide practice and an acceptable level of mastery of these skills, tabletop exercises and hands-on practicum are integrated into the training curriculum. Participants will also not only practice how to perform risk assessment and screening procedures, but also how to teach and supervise others to perform procedures like breast self-examination.

For nutritional assessment, each participant will have an opportunity to assess self and a partner using a guide. Accomplishing a 24-hour food diary for three days during the training is also integrated into this activity. Practicum will also be provided for counseling and program planning on nutrition, physical activity, smoking cessation and alcohol control, and mental health wellness.

To improve techniques and skills on health education, communication, and mobilization, participants will be required to develop health education, communication and community mobilization plans and materials. This will be presented to the whole group for feedback and critiquing.

The health workers are also expected to develop a community health plan on promoting healthy lifestyle appropriate for selected target audiences and various settings. It is expected that they will work as teams coming from the same region or local area so that they have common context and can address their issues more effectively.

In order to have greater multiplier effect for this training, a session on how to organize a training program on healthy lifestyle is also included. This part will discuss needed preparations for conducting the training program and how to ensure that the training objectives will be achieved.

Training of Trainers Program

The training program for trainers is intended to develop further the skills of a core group of trainers for each region, province or municipality in organizing their own training programs for other health workers in their own locality. Careful selection of trainers is important for the success of the program. Possible trainers include,

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among others, municipal health officers, public health nurses, selected rural health midwives, nutritionists, health education and promotion officers (HEPO), and DOH representatives.

The program also consists of a five-day, live-in workshop. The curriculum is generally the same as the basic training program except that there is greater emphasis and more time given on the following:

• Framework for the integrated community-based prevention and control of NCD in the country• Action Plan for promoting healthy lifestyle in their community• Action Plan for planning and implementing the training of health workers

The main practicum of the trainers is the implementation of the subsequent training of other health workers in their locale with some supervision and guidance from resource persons. The program includes a workshop for trainers to plan the training of other health workers, including the organization of core teams per locality.

Responsibilities of core trainers per area include the following:• Mobilizing participation and attendance of other health workers;• Conducting each session of the program using lectures and learning activities appropriate to the topic;• Acting as facilitators for workshops and exercises;• Planning and implementing “unfreezing” activities that are appropriate with session objectives; and• Assisting in the running of other aspects of the program like registration, assignment of rooms for

the participants, coordinating with training venue regarding food, physical arrangement and the like during the actual training days, and acting as officers-for-the day.

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VI. How to Use the Training Manual

The TRAINER’S GUIDE provides a description of the training program and the instructional plans for conducting each module session. Trainers will find the session plans useful in implementing this training program. Each session plan contains the following:

• Module Objectives – specifies the learning outcomes for each session;• Content Outline/Key Messages – gives the outline of topics as presented in the training manual and

provides the key messages that trainers should emphasize during the session;• Teaching-Learning Activities – suggests the learning activities or exercises for communicating the

messages and developing skills of participants; points out the materials needed, worksheets, and handouts (including the specific pages from the manual);

• Evaluating Learning – activities to obtain feedback and evaluate if the participants were able to achieve the session objectives;

• Notes for Trainers – provide some useful tips and reminders for trainers and facilitators in conducting the sessions; and

• Worksheets – instructions and guide questions for individual or group activities/workshops.

This TRAINING MANUAL reflects an integrated, community-based or population approach in the prevention and control of NCDs. Integrated program refers to the integration of health promotion services and modification of the common risk factors associated with the five NCDs, instead of the previous disease-based programs. It was drafted to facilitate learning of health workers during the training. It also serves as a ready reference material that health workers can use in the course of their work or as a guide in providing training or lectures for other groups.

The manual consists of six modules, namely: • Overview of Major Noncommunicable Diseases• Risk Factors Assessment and Screening Procedures for NCDs• Promoting Good Nutrition and Healthy Diet• Promoting Physical Activity• Promoting Smoke-free Individuals and Reducing Harm from Alcohol Use• Promoting Mental Health and Wellness

A set of slide presentations for each manual is also included in the Trainer’s Kit. Additional references are also provided.

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VII. Schedule of Training Activities

A prototype of the schedule of training activities is provided as a guide in conducting this training program. The prototype includes the suggested schedule of activities and some points to consider in planning and implementing this program using the training manual as the main learning resource for the participants.

In adopting this prototype schedule, modify the training activities depending on the following characteristics of the participants:

• Typeofparticipants – (doctors, nurses, midwives, allied health professions)• Roles they are expected to perform in the Integrated Community-based NCD Prevention and Control

Program – whether they will be trainers, direct service providers, health educators, or researchers• Participants’levelofresponsibility in their respective agencies – influence in policy or decision-making

Considering the above characteristics of the participants, the following aspects of the training will need to be modified:

• Depthandbreadthoftopics - focus on the key messages that they are supposed to emphasize when attending to clients. You can simplify content and contextualize to local setting.

• Skillstobelearned - In training health workers, one has to be reminded about the roles the participants will eventually perform when they go back to their respective areas.

• Practice sessions – Provide adequate practice for development of skills. Skills included in this training program include cognitive skills (e.g. calculation and interpretation of BMI, assessment of risk, formulating plans), psychomotor skills (e.g. correct performance of breast examination, BP and peak flow measurement, conducting health education sessions) and affective skills (e.g. demonstrating caring attitude during counseling, sensitivity to participants’ needs).

• Teachingandlearningstrategies – Teaching-learning activities are just suggestions. You can create or modify the said activities given longer time and opportunity. For example, field practicum may be conducted to assess the acquired competencies of the participants in conducting health education on topics as smoking and alcohol drinking, nutrition or physical activity to different age or population groups. Participants may also be brought to the health centers and related facilities to develop or hone their clinical skills related to risk factor assessment and screening procedures.

• Effectivecommunications- Participants should be able to communicate effectively the key messages of the NCD program. Emphasis on developing communication skills must be highlighted. Planning individual counseling and group health education activities require appropriate language and teaching and learning strategies

Training Prototype

14

Tim

e

8:0

0 AM

8:4

5 AM

9:0

0 AM

10:0

0 AM

10:3

0 AM

11:3

0 AM

12:3

0 AM

1:3

0 PM

2:3

0 PM

3:0

0 PM

3:3

0 PM

4:0

0 PM

5:0

0 PM

5:1

5 PM

Day

1

Regi

strat

ion

and

Pre-

test

Ope

ning

Cer

emon

ies

“Get

ting

to K

now

You

”Act

ivity

/Se

tting

Exp

ecta

tions

Orie

ntat

ion

to th

e Tra

inin

gC

offee

Bre

akM

odul

e 1.

Ove

rvie

w o

f Maj

or

NC

Ds

Nat

iona

l Fra

mew

ork

for t

he

Inte

grat

ed A

ppro

ach

to N

CD

Pr

even

tion

and

Con

trol

Lunc

hM

odul

e 2.

Risk

Fac

tor A

sses

smen

t an

d Sc

reen

ing

Proc

edur

esSc

reen

ing

Proc

edur

es

Coff

ee B

reak

Risk

Fac

tors

Ass

essm

ent/

Scre

enin

g Pr

oced

ures

Pra

ctic

umD

aily

Sum

mar

yAs

signm

ent:

Dai

ly F

ood

Dia

ry

Dai

ly E

valu

atio

n

Day

2

Gro

up P

hysic

al A

ctiv

ityBr

ief R

ecap

Mod

ule

3. P

rom

otin

g G

ood

Nut

ritio

n an

d H

ealth

y D

iet

Coff

ee B

reak

Nut

ritio

nal A

sses

smen

t and

C

ouns

elin

g an

d Pr

ogra

m P

lann

ing

Lunc

h Br

eak

Mod

ule

4. P

rom

otin

g Ph

ysic

al

Activ

ity

Coff

ee B

reak

Phys

ical

Act

ivity

Pro

gram

Pla

nnin

g (c

ontin

uatio

n)D

aily

Sum

mar

yAs

signm

ent:

Phy

sical

Act

ivity

Gui

de

Dai

ly E

valu

atio

n

Day

3

Gro

up P

hysic

al A

ctiv

ityBr

ief R

ecap

Mod

ule

5. P

rom

otin

g Sm

oke-

Free

In

divi

dual

s and

Env

ironm

ent

Coff

ee B

reak

Mod

ule

5. R

educ

ing

Har

m fr

om

Alco

hol U

seSm

okin

g St

atus

Ass

essm

ent/

Cou

nsel

ing

Lunc

h Br

eak

Prog

ram

Pla

nnin

g fo

r Tob

acco

and

Al

coho

l Con

trol

Mod

ule

6. P

rom

otin

g M

enta

l H

ealth

and

Wel

lnes

sC

offee

Bre

akM

enta

l Hea

lth a

nd W

elln

ess

Prog

ram

Pla

nnin

gD

aily

Sum

mar

yAs

signm

ent:

Men

tal H

ealth

W

elln

ess

Dai

ly E

valu

atio

n

Day

4

Gro

up P

hysic

al A

ctiv

ityBr

ief R

ecap

Prog

ram

Pla

nnin

g fo

r Pro

mot

ing

Hea

lthy

Life

style

Coff

ee B

reak

Prog

ram

Pla

nnin

g fo

r Pro

mot

ing

Hea

lthy

Life

style

(con

tinua

tion)

Mon

itorin

g an

d Ev

alua

tion

Lunc

h Br

eak

Org

anizi

ng T

rain

ing

of H

ealth

W

orke

rs o

n N

CD

Pre

vent

ion

and

Con

trol

Plen

ary

Sess

ion

Coff

ee B

reak

Clo

sing

Cer

emon

ies

Dai

ly S

umm

ary

Eval

uatio

n/ P

ost-t

est

Dai

ly E

valu

atio

n

Key Messages and Notesfor the Trainers

16

DAY

1

Regi

strat

ion

Activ

ities

Ope

ning

Cer

emon

ies

Pre-

test

Act

ivit

yK

ey M

essa

ges

Invi

te k

ey p

eopl

e in

the

loca

lity

who

m y

ou th

ink

will

hav

e in

fluen

ce in

pus

hing

the

prog

ram

dow

n to

the

bara

ngay

leve

l. Th

is is

the

best

time

to d

emon

strat

e so

lidar

ity a

nd a

dvoc

acy

wor

k w

ith lo

cal e

xecu

tives

and

with

oth

er st

akeh

olde

rs o

f the

pr

ogra

m.

Expl

ain

to th

e pa

rtic

ipan

ts th

e ob

ject

ive

of th

e pr

e- te

st. (S

ee

Pre-

test/

Post

test

in A

ppen

dix

A). E

mph

asize

that

the

resu

lts

will

hel

p th

e or

gani

zers

det

erm

ine

area

s tha

t nee

d to

be

give

n fo

cus.

Sam

ple

pret

est/p

ostte

st is

prov

ided

.

Not

es fo

r th

e Tr

aine

rs

“Get

ting

to K

now

You

” Ac

tivity

Orie

ntat

ion

to th

e Tra

inin

g Pr

ogra

mD

iscus

s the

nat

ure

and

the

obje

ctiv

es o

f the

trai

ning

pro

gram

, re

latin

g th

em to

the

part

icip

ants’

exp

ecta

tions

. Ide

ntify

whi

ch

of th

ese

expe

ctat

ions

will

be

addr

esse

d by

the

trai

ning

and

wha

t w

ill b

e do

ne w

ith th

ose

not a

ddre

ssed

by

the

trai

ning

.

Prov

ide

an o

verv

iew

of t

he c

onte

nt a

nd g

ener

al a

ctiv

ities

for

the

dura

tion

of th

e pr

ogra

m. B

e ex

plic

it w

ith th

e ex

pect

ed

outp

uts a

s the

trai

ning

pro

gres

ses;

e.g.

mec

hani

cs o

f the

cou

rse,

m

etho

dolo

gy.

Take

not

e of

the

part

icip

ants’

exp

ecta

tions

that

may

not

be

cong

ruen

t to

the

gene

ral o

bjec

tives

of t

he tr

aini

ng p

rogr

am.

Non

com

mun

icab

le d

iseas

es (N

CD

s) a

re c

onsid

ered

a m

ajor

pu

blic

hea

lth c

once

rn w

orld

wid

e, in

clud

ing

in th

e Ph

ilipp

ines

. Th

is is

both

a h

ealth

and

eco

nom

ic b

urde

n to

the

coun

try.

This

trai

ning

add

ress

es th

e ne

ed fo

r hea

lth w

orke

rs to

be

upda

ted

on th

e in

tegr

ated

app

roac

h to

NC

D p

reve

ntio

n an

d co

ntro

l – b

y fo

cusin

g on

the

four

com

mon

risk

fact

ors-

toba

cco

use,

unh

ealth

y di

et, l

ack

of p

hysic

al a

ctiv

ity a

nd a

lcoh

ol u

se.

17

Disc

uss g

ener

al ru

les o

f con

duct

dur

ing

the

trai

ning

giv

ing

impo

rtan

ce to

atte

ndan

ce a

nd p

unct

ualit

y.O

rgan

izers

of t

he tr

aini

ng c

an a

lread

y sta

rt in

volv

ing

the

part

icip

ants

by g

ivin

g th

em re

spon

sibili

ties f

or th

e du

ratio

n of

the

trai

ning

, e.g

. eac

h gr

oup

shou

ld b

e as

signe

d to

be

the

coor

dina

tor f

or th

e da

y in

-cha

rge

of th

e re

cap

exer

cise

s, ic

e br

eake

rs, e

tc.

Ove

rvie

w o

f Maj

or N

CD

: Et

iolo

gy a

nd R

isk

Fact

ors

• Ep

idem

iolo

gy o

f N

CD

/mag

nitu

de o

f th

e pr

oble

m•

Cau

ses a

nd ri

sk fa

ctor

s of

the

maj

or N

CD

s•

Key

are

as fo

r prim

ary

prev

entio

n of

maj

or

NC

Ds

The

four

maj

or N

CD

s in

the

Phili

ppin

es a

re c

ardi

ovas

cula

r di

seas

es, c

ance

rs, c

hron

ic o

bstr

uctiv

e pu

lmon

ary

dise

ases

and

di

abet

es m

ellit

us. Th

ese

dise

ases

are

link

ed b

y fo

ur m

ost c

omm

on

prev

enta

ble

risk

fact

ors r

elat

ed to

life

style

, nam

ely:

toba

cco

use,

un

heal

thy

diet

, lac

k of

phy

sical

act

ivity

and

alc

ohol

use

.

Refe

r to

Mod

ule

1

Upd

ates

on

the

epid

emio

logy

of m

ajor

NC

Ds a

nd th

eir r

isk

fact

ors a

re im

port

ant f

or th

e he

alth

wor

kers

to h

ave

a de

ep

appr

ecia

tion

of th

e im

port

ance

of p

reve

ntin

g an

d co

ntro

lling

bo

th N

CD

s and

the

maj

or ri

sk fa

ctor

s.

This

sess

ion

is al

so im

port

ant t

o ad

dres

s ade

quat

ely

the

man

y m

iscon

cept

ions

of h

ealth

wor

kers

on

the

caus

es a

nd ri

sk fa

ctor

s of

NC

Ds.

Fram

ewor

ks fo

r N

CD

Pr

even

tion

and

Con

trol

•

WH

O W

este

rn P

acifi

c Re

gion

al A

ctio

n Pl

an fo

r N

CD

• Pr

even

tion

and

Con

trol o

f Chr

onic

-Li

festy

le R

elat

ed N

CD

(I

nteg

rate

d N

CD

Pr

even

tion

and

Con

trol

Prog

ram

Fra

mew

ork)

The W

este

rn P

acifi

c Re

gion

al A

ctio

n Pl

an fo

r NC

D se

eks t

o eff

ect c

hang

e at

the:

(1) e

nviro

nmen

tal l

evel

, thr

ough

pol

icy

and

regu

lato

ry in

terv

entio

ns; (

2) le

vel o

f com

mon

and

inte

rmed

iate

ris

k fa

ctor

s, th

roug

h po

pula

tion-

base

d lif

esty

le in

terv

entio

ns; a

nd

(3) a

t hig

h-ris

k in

divi

dual

s (ris

k fa

ctor

mod

ifica

tion)

and

per

sons

w

ith e

stabl

ished

dise

ase

(clin

ical

man

agem

ent).

The

DO

H P

reve

ntio

n an

d C

ontro

l of C

hron

ic L

ifesty

le-R

elat

ed

NC

D (I

nteg

rate

d N

CD

Pre

vent

ion

and

Con

trol)

is gu

ided

by

a po

licy

and

strat

egic

fram

ewor

k, w

hich

con

tain

s: vi

sion,

miss

ion,

go

al, o

bjec

tives

, gui

ding

prin

cipl

es, p

olic

y di

rect

ions

and

key

str

ateg

ies.

Refe

r to

Mod

ule

1

This

sess

ion

is im

port

ant f

or th

e Tra

inin

g of

Tra

iner

s bec

ause

it

prov

ides

the

ratio

nale

for u

sing

an in

tegr

ated

com

mun

ity-

base

d ap

proa

ch. U

se th

is se

ssio

n to

situ

ate

the

trai

ning

pro

gram

w

ithin

the

over

all e

ffort

to p

reve

nt a

nd c

ontro

l NC

Ds.

For t

rain

ing

of o

ther

hea

lth w

orke

rs, t

his n

eed

not t

ake

up a

w

hole

sess

ion.

This

can

be in

tegr

ated

into

the

ratio

nale

for t

he

trai

ning

pro

gram

usu

ally

giv

en a

s an

intro

duct

ion

at th

e sta

rt o

f th

e pr

ogra

m.

18

• Ro

les a

nd fu

nctio

ns o

f he

alth

wor

kers

in N

CD

pr

even

tion

and

cont

rol

Sele

ct a

men

u fo

r the

ent

ire tr

aini

ng p

erio

d th

at is

con

siste

nt

with

the

mes

sage

s on

heal

thy

nutr

ition

.

Use

of f

ood

calo

rie c

ount

er w

ill a

lso b

e us

eful

for t

each

ing

part

icip

ants

how

to c

ount

thei

r dai

ly c

alor

ic in

take

Fram

ewor

ks fo

r N

CD

Pr

even

tion

and

Con

trol

•

WH

O W

este

rn P

acifi

c Re

gion

al A

ctio

n Pl

an fo

r N

CD

• Pr

even

tion

and

Con

trol o

f Chr

onic

-Li

festy

le R

elat

ed N

CD

(I

nteg

rate

d N

CD

Pr

even

tion

and

Con

trol

Prog

ram

Fra

mew

ork)

• Ro

les a

nd fu

nctio

ns o

f he

alth

wor

kers

in N

CD

pr

even

tion

and

cont

rol

The W

este

rn P

acifi

c Re

gion

al A

ctio

n Pl

an fo

r NC

D se

eks t

o eff

ect c

hang

e at

the:

(1) e

nviro

nmen

tal l

evel

, thr

ough

pol

icy

and

regu

lato

ry in

terv

entio

ns; (

2) le

vel o

f com

mon

and

inte

rmed

iate

ris

k fa

ctor

s, th

roug

h po

pula

tion-

base

d lif

esty

le in

terv

entio

ns; a

nd

(3) a

t hig

h-ris

k in

divi

dual

s (ris

k fa

ctor

mod

ifica

tion)

and

per

sons

w

ith e

stabl

ished

dise

ase

(clin

ical

man

agem

ent).

The

DO

H P

reve

ntio

n an

d C

ontro

l of C

hron

ic L

ifesty

le-R

elat

ed

NC

D (I

nteg

rate

d N

CD

Pre

vent

ion

and

Con

trol)

is gu

ided

by

a po

licy

and

strat

egic

fram

ewor

k, w

hich

con

tain

s: vi

sion,

miss

ion,

go

al, o

bjec

tives

, gui

ding

prin

cipl

es, p

olic

y di

rect

ions

and

key

str

ateg

ies.

Refe

r to

Mod

ule

1

This

sess

ion

is im

port

ant f

or th

e Tra

inin

g of

Tra

iner

s bec

ause

it

prov

ides

the

ratio

nale

for u

sing

an in

tegr

ated

com

mun

ity-

base

d ap

proa

ch. U

se th

is se

ssio

n to

situ

ate

the

trai

ning

pro

gram

w

ithin

the

over

all e

ffort

to p

reve

nt a

nd c

ontro

l NC

Ds.

For t

rain

ing

of o

ther

hea

lth w

orke

rs, t

his n

eed

not t

ake

up a

w

hole

sess

ion.

This

can

be in

tegr

ated

into

the

ratio

nale

for t

he

trai

ning

pro

gram

usu

ally

giv

en a

s an

intro

duct

ion

at th

e sta

rt o

f th

e pr

ogra

m.

Lunc

h (fo

r Day

s 1-4

)

Lunc

h (fo

r Day

s 1-4

)Se

lect

a m

enu

for t

he e

ntire

trai

ning

per

iod

that

is c

onsis

tent

w

ith th

e m

essa

ges o

n he

alth

y nu

triti

on.

Use

of f

ood

calo

rie c

ount

er w

ill a

lso b

e us

eful

for t

each

ing

part

icip

ants

how

to c

ount

thei

r dai

ly c

alor

ic in

take

19Ris

k A

sses

smen

t and

Sc

reen

ing

Proc

edur

es

• Im

port

ance

of r

isk

fact

ors a

sses

smen

t and

sc

reen

ing

• Pr

inci

ples

of r

isk fa

ctor

s as

sess

men

t•

Gui

delin

es fo

r scr

eeni

ng

maj

or N

CD

s•

Dem

onstr

atio

n of

sp

ecifi

c sc

reen

ing

proc

edur

es (B

P ta

king

, BM

I, w

aist

circ

umfe

renc

e, w

aist-

hip

ratio

, bre

ast s

elf-

exam

inat

ion,

pea

k flo

w

mea

sure

men

t)

Risk

fact

ors a

sses

smen

t mus

t be

adm

inist

ered

to a

ll cl

ient

s who

co

me

in fo

r con

sulta

tions

in th

e he

alth

faci

lity,

whe

ther

for

spec

ific

com

plai

nts r

elat

ed to

NC

Ds o

r oth

er p

rese

ntat

ions

.

Risk

fact

ors a

sses

smen

t inc

lude

s ass

essin

g fo

r ant

hrop

omet

ric

mea

sure

s, di

et a

nd n

utrit

ion,

leve

l of p

hysic

al a

ctiv

ity, s

mok

ing

statu

s, an

d al

coho

l int

ake.

Scre

enin

g re

fers

to th

e im

plem

enta

tion

of a

sim

ple

test

that

aid

s in

the

diag

nosis

to d

eter

min

e w

heth

er a

n in

divi

dual

has

the

give

n co

nditi

on o

r not

.

Hea

lth w

orke

rs sh

ould

be

guid

ed b

y th

e gu

idel

ines

for s

cree

ning

an

d di

agno

sis o

f cor

onar

y ar

tery

dise

ase,

hyp

erte

nsio

n, d

iabe

tes,

canc

ers,

CO

PD a

nd a

sthm

a.

Refe

r to

Mod

ule

2

Also

refe

r to

DO

H M

anua

l of O

pera

tions

on

NC

D P

reve

ntio

n an

d C

ontro

l

See

Risk

Fac

tors

Ass

essm

ent F

orm

and

Che

cklis

t for

Scr

eeni

ng

in M

odul

e 2

Plan

for t

he d

emon

strat

ion

and

prac

tice

sess

ions

on

spec

ific

risk

fact

or a

sses

smen

t and

scre

enin

g pr

oced

ures

.

Dai

ly E

valu

atio

n (fo

r Day

s 1-4

)Se

e D

aily

Eva

luat

ion

Form

in A

ppen

dix

B of

Tra

iner

’s G

uide

Dai

ly e

valu

atio

n en

able

s the

org

anize

rs to

det

erm

ine

whe

ther

se

ssio

n ob

ject

ives

wer

e ac

hiev

ed a

nd th

at p

artic

ipan

ts’ n

eeds

w

ere

met

.

Sess

ion

for T

rain

ers:

Pr

oces

sing

of D

ay’s

Activ

ities

Pl

anni

ng fo

r Nex

t Day

’s Ac

tiviti

es (f

or D

ays 1

-4)

This

sess

ion

is m

ainl

y fo

r the

Tra

inin

g of

Tra

iner

s and

is u

sual

ly

incl

uded

at t

he e

nd o

f eac

h tr

aini

ng d

ay. Th

is is

an im

port

ant

sess

ion

for d

evel

opm

ent o

f tra

iner

s’ sk

ills i

n co

nduc

ting

trai

ning

and

in fi

rmin

g up

thei

r tea

mw

ork.

20

Trai

ners

mee

t to

eval

uate

the

day’s

act

iviti

es a

nd to

refin

e th

e ne

xt d

ay’s

plan

of a

ctiv

ities

. Tw

o as

pect

s mus

t be

look

ed in

to:

the

cont

ent a

nd th

e te

chni

cal s

ide

of th

e tr

aini

ng p

rogr

am.

If th

ere

wer

e iss

ues n

ot re

solv

ed in

term

s of c

onte

nt, t

hen

thes

e ha

ve to

be

clar

ified

the

next

day

. Tec

hnic

al p

robl

ems m

ust b

e co

nfro

nted

to im

prov

e flo

w o

f tra

inin

g.

Assig

nmen

t:

24-H

ourF

oodR

ecal

lA

pers

onal

food

dia

ry fo

r the

pr

evio

us d

ay a

nd D

ay 1

of

the

trai

ning

See

24-H

our F

ood

Reca

ll Fo

rm in

Mod

ule

2

This

is pa

rt o

f the

exp

erie

ntia

l app

roac

h. E

ach

part

icip

ant g

ets

to p

ract

ice

usin

g th

e 24

-hou

r foo

d di

ary

form

at t

he sa

me

time

deve

lop

som

e se

lf- a

war

enes

s int

o hi

s/he

r per

sona

l nut

ritio

nal

prac

tices

.

21

DAY

2

Gro

up P

hysic

al A

ctiv

ity

Act

ivit

yK

ey M

essa

ges

Arra

nge

for e

arly

bre

akfa

st be

fore

doi

ng th

e ex

erci

se a

ctiv

ity.

Mak

e su

re th

at th

ere

is a

plac

e w

ide

enou

gh to

con

duct

the

exer

cise

act

ivity

. If t

rain

ing

venu

e do

es n

ot p

rovi

de a

dequ

ate

spac

e, sc

out f

or n

earb

y pl

aces

such

as p

ark,

gym

or b

each

that

w

ill b

e co

nduc

ive

for t

he a

ctiv

ity.

Part

icip

ants

mus

t also

be

instr

ucte

d to

wea

r exe

rcise

out

fits

such

as j

oggi

ng p

ants

or sh

orts

and

rubb

er sh

oes.

The

phys

ical

ac

tivity

can

rang

e fro

m si

mpl

e str

etch

ing,

aer

obic

s or d

ance

.

Proc

ess t

he a

ctiv

ity, e

ither

righ

t afte

r or a

t sta

rt o

f nex

t ses

sion.

Prov

ide

adeq

uate

tim

e fo

r par

ticip

ants

to re

fresh

afte

r the

ac

tivity

.

This

activ

ity c

an b

e a

gam

e or

a c

onte

st. I

nvol

ve p

artic

ipan

ts in

pl

anni

ng fo

r it.

Reca

p sh

ould

not

be

mor

e th

an 1

5 m

inut

es.

Not

es fo

r th

e Tr

aine

rs

Reca

pitu

latio

n of

Day

1

22 Prom

otin

g G

ood

and

Hea

lthy

Die

t

• M

agni

tude

of N

CD

s re

late

d to

die

tary

pr

actic

es•

Nut

ritio

n-re

late

d pr

actic

es le

adin

g to

N

CD

s•

Key

are

as a

nd st

rate

gies

to

pro

mot

e go

od

nutr

ition

and

die

tary

pr

actic

es•

Disc

uss d

ieta

ry

reco

mm

enda

tions

fo

r spe

cific

dise

ase

cond

ition

s•

Nut

ritio

n ed

ucat

ion

and

coun

selin

g fo

r po

pula

tion

grou

ps•

Nut

ritio

n-fri

endl

y en

viro

nmen

t

Ther

e ar

e th

ree

mai

n str

ateg

ies t

o ad

dres

s the

nut

ritio

n pr

oble

ms

and

prac

tices

rela

ted

to N

CD

s.•

Aim

for i

deal

bod

y w

eigh

t.•

Build

hea

lthy

nutr

ition

-rel

ated

pra

ctic

es.

• C

hoos

e fo

ods w

isely.

Follo

win

g th

e nu

triti

on g

uide

lines

of l

ow sa

lt, lo

w fa

t and

in

crea

sed

fiber

in th

e di

et h

elp

decr

ease

the

risks

of d

evel

opin

g N

CD

s.

Hea

lth w

orke

rs h

ave

the

resp

onsib

ilitie

s to

prom

ote

heal

thy

nutr

ition

in th

e co

mm

unity

:•

Educ

ate

peop

le o

n ba

lanc

ed a

nd h

ealth

y di

et•

Asse

ss fo

r wei

ght p

robl

ems a

nd u

nhea

lthy

nutr

ition

-re

late

d pr

actic

es•

Scre

en fo

r oth

er ri

sk fa

ctor

s rel

ated

to n

utrit

ion,

such

as

bloo

d ch

oles

tero

l lev

el, h

yper

tens

ion)

• Fo

r per

sons

foun

d to

be

at ri

sk o

f NC

D, a

dvise

and

co

unse

l for

risk

mod

ifica

tion;

• M

ake

refe

rral

s whe

re a

ppro

pria

te; a

nd•

Advo

cate

for a

supp

ortiv

e en

viro

nmen

t whe

re h

ealth

y fo

od is

ava

ilabl

e an

d aff

orda

ble.

Refe

r to

Mod

ule

3

See

24-h

our F

ood

Reca

ll Fo

rm in

Mod

ule

3.

Plan

for t

he e

xerc

ise o

n pl

anni

ng d

iets

for p

eopl

e w

ith sp

ecifi

c co

nditi

ons a

nd d

iffer

ent p

opul

atio

n gr

oups

23

Proc

ess t

he e

xper

ienc

e by

hav

ing

the

part

icip

ants

shar

e w

hat

they

felt

durin

g an

d af

ter t

he p

hysic

al a

ctiv

ity.

Prep

are

for t

he g

roup

wor

k on

pro

gram

pla

nnin

g on

pro

mot

ing

phys

ical

act

ivity

for a

spec

ific

age

grou

p or

pop

ulat

ion

setti

ng.

• Be

nefit

s of p

hysic

al

activ

ity•

Prin

cipl

es o

f pro

mot

ing

phys

ical

act

ivity

• Re

com

men

ded

guid

elin

es

in p

rom

otin

g ph

ysic

al

activ

ity•

Stra

tegi

es to

pro

mot

e ph

ysic

al a

ctiv

ity in

di

ffere

nt se

tting

s•

Stra

tegi

es to

pro

mot

e ph

ysic

al a

ctiv

ity a

mon

g pe

rson

s with

chr

onic

N

CD

s•

Plan

ning

for p

hysic

al

activ

ity p

rogr

ams

• Ad

voca

cy o

n su

ppor

tive

envi

ronm

ent f

or p

hysic

al

activ

ity

The

min

imum

reco

mm

ende

d am

ount

of p

hysic

al a

ctiv

ity n

eede

d to

ach

ieve

hea

lth b

enefi

t is 3

0 m

inut

es p

er d

ay o

f mod

erat

e in

tens

ity a

ctiv

ity fo

r 5 d

ays o

r mos

t day

s of t

he w

eek.

Whe

n do

ing

vigo

rous

inte

nsity

act

ivity

, 3 o

r mor

e da

ys o

f the

wee

k is

enou

gh fo

r hea

lth b

enefi

t.

Ther

e ar

e ph

ysic

al a

ctiv

ity p

resc

riptio

ns fo

r eve

ry a

ge g

roup

and

di

ffere

nt c

hron

ic c

ondi

tions

to e

nsur

e th

at th

e ac

tivity

is sa

fe a

nd

fits t

he n

eed

and

inte

rest

of th

e in

divi

dual

s.

Prom

otin

g Ph

ysic

al

Act

ivit

y •

Epid

emio

logy

of m

ajor

N

CD

s rel

ated

to la

ck o

f ph

ysic

al a

ctiv

ity

Regu

lar p

hysic

al a

ctiv

ity p

rom

otes

phy

sical

and

psy

chos

ocia

l wel

l be

ing.

It im

prov

es th

e bo

dy’s

func

tion

and

redu

ces t

he se

verit

y of

ot

her f

acto

rs th

at m

ay in

crea

se th

e ris

k fo

r hea

rt d

iseas

e, su

ch a

s ob

esity

, hyp

erte

nsio

n, h

igh

bloo

d le

vels

of su

gar,

chol

este

rol a

nd

uric

aci

d.

Refe

r to

Mod

ule

4

Use

diff

eren

t exa

mpl

es o

f phy

sical

act

iviti

es in

the

mor

ning

be

fore

sess

ion

start

s; or

eve

n as

unf

reez

ing

activ

ities

24 DAY

3

Prom

otin

g Sm

oke-

free

Indi

vidu

als

and

Envi

ronm

ent

• Ep

idem

iolo

gy o

n to

bacc

o us

e /

smok

ing

• M

echa

nism

s how

toba

cco

caus

es

harm

• Be

nefit

s of s

mok

ing

cess

atio

n•

Key

are

as fo

r pro

mot

ing

smok

e-fre

e in

divi

dual

s and

env

ironm

ent

• Sm

okin

g ce

ssat

ion

strat

egie

s/pr

ogra

ms

• Ad

voca

cy o

n sm

oke-

free

envi

ronm

ents

Refe

r to

Mod

ule

5Al

so re

fer t

o D

OH

Man

ual o

n Sm

okin

g C

essa

tion

Prep

are

for t

he g

roup

wor

k on

pro

gram

pla

nnin

g on

pro

mot

ing

smok

e-fre

e in

divi

dual

s and

env

ironm

ent.

Refe

r to

Mod

ule

5

Hav

e an

ope

n fo

rum

and

enc

oura

ge d

iscus

sion

on th

e ch

alle

nges

of i

mpl

emen

ting

cam

paig

n on

redu

cing

har

m fr

om

alco

hol d

rinki

ng.

How

is th

is ca

mpa

ign

rela

ted

to to

tal b

an o

n al

coho

l drin

king

?

Hea

lth w

orke

rs p

lay

a sig

nific

ant r

ole

in p

rom

otin

g a

smok

e-fre

e en

viro

nmen

t and

pro

mot

ing

smok

ing

cess

atio

n.

Min

imal

inte

rven

tion

for h

ealth

wor

kers

to p

rom

ote

smok

e-fre

e in

divi

dual

s and

env

ironm

ent:

• AS

KIN

G a

bout

smok

ing

• AD

VIS

ING

smok

ers t

o qu

it•

ASSI

STIN

G b

y pr

ovid

ing

info

rmat

ion,

refe

rrin

g to

sm

okin

g ce

ssat

ion

prog

ram

s•

ARR

ANG

ING

follo

w-u

p to

pre

vent

rela

pse

Red

ucin

g H

arm

from

Alc

ohol

D

rink

ing

• Ep

idem

iolo

gy o

n al

coho

l-rel

ated

ris

ks•

Mec

hani

sms h

ow a

lcoh

ol

drin

king

cau

ses h

arm

Ther

e ar

e he

alth

risk

s and

soci

al c

onse

quen

ces a

ssoc

iate

d to

alc

ohol

drin

king

bec

ause

of i

ts to

xic,

into

xica

ting

and

depe

nden

ce-p

rodu

cing

pro

pert

ies.

Exce

ssiv

e al

coho

l dr

inki

ng is

also

ass

ocia

ted

with

an

incr

ease

d ris

k of

in

jurie

s, in

clud

ing

from

traffi

c ac

cide

nts a

nd h

as b

een

show

n to

lead

to d

evel

opm

ent o

f chr

onic

dise

ases

.

Act

ivit

yK

ey M

essa

ges

Not

es fo

r th

e Tr

aine

rs

25• Be

nefit

s of a

lcoh

ol

avoi

danc

e•

Key

are

as fo

r red

ucin

g ha

rm fr

om a

lcoh

ol

WH

O R

egio

nal S

trat

egy

to re

duce

alc

ohol

-rel

ated

har

m in

clud

e:

• Re

duci

ng th

e ris

k of

har

mfu

l alc

ohol

use

• M

inim

izing

the

impa

ct o

f har

mfu

l use

of a

lcoh

ol•

Regu

latin

g th

e ac

cess

ibili

ty a

nd a

vaila

bilit

y to

redu

ce th

e ha

rmfu

l use

of a

lcoh

ol a

nd•

Esta

blish

ing

mec

hani

sm to

faci

litat

e an

d su

stain

im

plem

enta

tion

of re

duct

ion

of a

lcoh

ol-r

elat

ed h

arm

Men

tal d

isord

ers s

uch

as d

epre

ssio

n, a

lcoh

ol, s

ubsta

nce

abus

e,

child

/ado

lesc

ent d

evel

opm

ent p

robl

ems a

re a

mon

g th

e ris

k fa

ctor

s for

som

e N

CD

s and

can

also

con

trib

ute

to u

nint

entio

nal

and

inte

ntio

nal i

njur

y.

Men

tal h

ealth

pro

mot

ion

wor

ks a

t thr

ee le

vels:

•

Stre

ngth

enin

g in

divi

dual

s –in

crea

sing

emot

iona

l re

silie

nce

thro

ugh

inte

rven

tions

to p

rom

ote

self-

este

em,

life

and

copi

ng sk

ills

• St

reng

then

ing

com

mun

ities

– in

crea

sing

soci

al

incl

usio

n an

d pa

rtic

ipat

ion,

impr

ovin

g ne

ighb

orho

od

envi

ronm

ents,

dev

elop

ing

heal

th a

nd so

cial

serv

ices

w

hich

supp

ort m

enta

l hea

lth, a

nti-b

ully

ing

strat

egie

s an

d se

lf-he

lp n

etw

orks

.•

Redu

cing

stru

ctur

al b

arrie

rs to

men

tal h

ealth

- th

roug

h in

itiat

ives

to re

duce

disc

rimin

atio

n an

d in

equa

litie

s an

d to

pro

mot

e ac

cess

to e

duca

tion,

mea

ning

ful

empl

oym

ent,

hous

ing,

serv

ices

and

supp

ort f

or th

ose

who

are

vul

nera

ble.

Refe

r to

Mod

ule

6

Prep

are

for t

he g

roup

wor

k on

pro

gram

pla

nnin

g on

pr

omot

ing

men

tal h

ealth

of i

ndiv

idua

ls an

d po

pula

tion

grou

ps.

Prom

otin

g M

enta

l Hea

lth

and

Wel

lnes

s•

Epid

emio

logy

of N

CD

s re

late

d to

men

tal h

ealth

• Be

nefit

s of m

enta

l hea

lth

and

wel

lnes

s•

Fact

ors t

hat c

ontr

ibut

e m

enta

l hea

lth p

robl

ems

• Pr

omot

ing

men

tal h

ealth

ac

ross

the

life

span

• St

rate

gies

for p

rom

otin

g m

enta

l hea

lth in

diff

eren

t se

tting

s•

Men

tal h

ealth

pro

gram

s fo

r chr

onic

con

ditio

ns•

Advo

catin

g fo

r su

ppor

tive

envi

ronm

ent

26

Star

t with

ass

essin

g le

arne

rs’ n

eeds

and

con

text

for N

CD

pre

vent

ion

and

cont

rol i

n th

eir a

rea

(Ref

er to

App

endi

x G

for s

peci

fic g

uide

on

deve

lopi

ng a

n In

struc

tiona

l Pla

n fo

r NC

D p

reve

ntio

n an

d co

ntro

l.)

Con

duct

faci

litat

or m

eetin

g to

disc

uss t

rain

ing

prog

ram

and

task

s

Fam

iliar

ize se

lf w

ith th

e Tra

iner

s Gui

de a

nd T

rain

ing

Man

ual

Prep

are

slide

s, fo

rms,

wor

kshe

ets,

and

othe

r res

ourc

es n

eede

d fo

r the

tr

aini

ng

Ensu

re v

enue

is c

ondu

cive

to le

arni

ng a

nd p

rom

otes

hea

lthy

livin

g

DAY

4

Prog

ram

Pla

nnin

g fo

r the

In

tegr

ated

App

roac

h to

NC

D

Prev

entio

n an

d C

ontro

l

Refe

r to

DO

H M

anua

l of O

pera

tions

Plan

ning

con

sists

of th

e fo

llow

ing

steps

: 1.

As

sess

ing

the

NC

D si

tuat

ion

in th

e po

pula

tion;

2.

Dev

elop

ing

the

miss

ion,

goa

ls, a

nd o

bjec

tives

;3.

Id

entif

ying

key

inte

rven

tions

and

dec

idin

g m

eans

of

impl

emen

ting,

mon

itorin

g, a

nd e

valu

atin

g th

em.

Plan

ning

for T

rain

ing

on

Inte

grat

ed A

ppro

ach

to N

CD

Pr

even

tion

and

Con

trol

Step

s in

deve

lopi

ng a

trai

ning

pro

gram

• Id

entif

ying

Tra

inin

g N

eeds

• Id

entif

ying

Goa

ls an

d O

bjec

tives

• D

evel

opin

g Le

arni

ng A

ctiv

ities

• C

ondu

ctin

g th

e Tra

inin

g•

Eval

uatin

g th

e Tra

inin

gFo

llow

the

prin

cipl

es o

f adu

lt le

arni

ng w

hen

cond

uctin

g tr

aini

ng:

• Ad

ults

have

man

y pr

evio

us e

xper

ienc

es th

at sh

ould

be

brou

ght i

nto

the

lear

ning

pro

cess

.•

Adul

ts ha

ve a

gre

at m

any

preo

ccup

atio

ns o

ther

than

wha

t yo

u ar

e tr

ying

to te

ach

them

. If y

ou w

aste

thei

r tim

e, th

ey

will

rese

nt it

.•

Adul

ts ar

e fa

ced

with

real

dec

ision

s to

mak

e an

d re

al

prob

lem

s to

solv

e. If

trai

ning

doe

s not

hel

p th

em w

ith e

ither

, it

may

be

was

ted.

• Ad

ults

reac

t to

auth

ority

by

habi

t acc

ordi

ng to

thei

r ex

perie

nces

.•

Adul

ts ar

e pr

oud

and

self-

dire

cted

. Lea

rnin

g is

mos

t effi

cien

t w

hen

it is

the

lear

ner’s

idea

, and

mee

ts hi

s spe

cific

nee

ds.

Act

ivit

yK

ey M

essa

ges

Not

es fo

r th

e Tr

aine

rs

Instructional Plan

28

M

odul

e O

bjec

tive

s

C

onte

nt

T

each

ing

Lear

ning

Act

ivit

ies

R

esou

rces

Ev

alua

tion

Mod

ule

1 O

verv

iew

of M

ajor

Non

com

mun

icab

le D

isea

ses (

NC

D)

1.

Des

crib

e th

e ep

idem

iolo

gy

of th

e m

ajor

NC

Ds i

n th

e Ph

ilipp

ines

EPID

EMIO

LOG

Y O

F T

HE

MA

JOR

NC

Ds

• Le

adin

g ca

uses

of d

eath

in th

e Ph

ilipp

ines

are

car

diov

ascu

lar

dise

ases

and

dise

ases

of b

lood

ve

ssel

s, ca

ncer

s, ac

cide

nts,

chro

nic

lung

dise

ases

, and

di

abet

es m

ellit

us.

Usin

g m

etac

ards

, ask

par

ticip

ants

to

list t

he le

adin

g ca

uses

of m

orta

lity

in

the

Phili

ppin

es a

nd a

sk th

em to

pos

t it

in fr

ont.

Show

rece

nt ta

ble

or g

raph

of

mor

talit

y tre

nds i

n th

e Ph

ilipp

ines

or

in th

e lo

cal a

rea

if av

aila

ble

Ope

n di

scus

sion

on th

e po

ssib

le

reas

ons f

or th

e in

crea

sing

trend

of

maj

or N

CD

s in

the

Phili

ppin

es

Slid

e pr

esen

tatio

n

Met

acar

ds, p

ente

l pen

s

Stat

istic

al ta

bles

and

gr

aphs

of c

urre

nt

mor

talit

y an

d m

orbi

dity

tre

nds r

elat

ed to

maj

or

NC

Ds

Part

icip

ants

mus

t be

able

to

:•

Iden

tify

the

maj

or

NC

Ds i

n th

eir o

wn

com

mun

ity.

• Id

entif

y po

ssib

le

fact

ors p

rese

nt in

th

e co

mm

unity

that

co

ntrib

ute

to N

CD

pr

eval

ence

.•

Anal

yze

loca

l, re

gion

al

and

glob

al d

ata

on

maj

or N

CD

s

2.

Expl

ain

the

caus

es a

nd ri

sk

fact

ors o

f the

maj

or N

CD

sC

AUSE

S A

ND

RIS

K

FAC

TO

RS

OF

TH

E M

AJO

R

NC

Ds

• C

ausa

tion

path

way

of m

ajor

N

CD

sPr

ovid

e ex

plan

atio

n to

the

caus

atio

n pa

thw

ay o

f maj

or N

CD

s. Em

phas

ize

Slid

e pr

esen

tatio

nPa

rtic

ipan

ts m

ust b

e ab

le

to:

29

• Ex

plai

n th

e ca

usat

ion

path

way

of m

ajor

N

CD

s•

Des

crib

e th

e ch

arac

teris

tics o

f the

m

ajor

NC

Ds i

n te

rms

of c

ause

s, ris

k fa

ctor

s an

d pr

even

tion

area

s.

3.

Disc

uss t

he k

ey a

reas

for

prim

ary

prev

entio

n of

the

maj

or N

CD

s

• un

derly

ing

dete

rmin

ants

• co

mm

on ri

sk fa

ctor

s•

inte

rmed

iate

risk

• fa

ctor

s•

mai

n ch

roni

c di

seas

e

• D

escr

iptio

n of

the

maj

or

NC

Ds

• C

ardi

ovas

cula

r dise

ases

• H

yper

tens

ion

• C

ereb

rova

scul

ar d

iseas

e or

stro

ke•

Can

cers

• D

iabe

tes m

ellit

us•

Chr

onic

resp

irato

ry

dise

ases

that

the

com

mon

risk

fact

ors o

f the

m

ajor

NC

Ds i

nclu

de u

nhea

lthy

diet

, la

ck o

f phy

sical

act

ivity

, tob

acco

sm

okin

g an

d al

coho

l

KEY

AR

EAS

FOR

TH

E P

RIM

AR

Y P

REV

ENT

ION

OF

TH

E M

AJO

R N

CD

s

Prim

ary

prev

entio

n is

a m

ore

cost-

effec

tive

appr

oach

in th

e pr

even

tion

and

cont

rol o

f maj

or

NC

Ds.

The

follo

win

g ar

e th

e ke

y ar

eas f

or p

rimar

y pr

even

tion:

• Pr

omot

e pr

oper

nut

ritio

n•

Enco

urag

e m

ore

phys

ical

ac

tivity

and

exe

rcise

Disc

uss t

he ra

tiona

le fo

r em

phas

izing

pr

imar

y pr

even

tion

of N

CD

s.

Expl

ain

the

key

area

s for

prim

ary

prev

entio

n. A

llow

for o

pen

disc

ussio

n to

pro

vide

par

ticip

ants

a gl

imps

e of

ho

w p

rimar

y pr

even

tion

activ

ities

can

be

inte

grat

ed in

thei

r reg

ular

clin

ic

activ

ities

.

Slid

e pr

esen

tatio

nPa

rtic

ipan

ts m

ust b

e ab

le

to:

• Ap

prec

iate

the

impo

rtan

ce o

f pr

imar

y pr

even

tion

as a

n ap

proa

ch in

the

prev

entio

n an

d co

ntro

l

Dia

gram

of t

he C

ausa

tion

Path

way

of m

ajor

NC

Ds

30

Disc

uss t

he re

leva

nt fr

amew

orks

in

NC

D p

reve

ntio

n an

d co

ntro

l:•

WH

O-W

PRO

Reg

iona

l Act

ion

Plan

• W

HO

-WPR

O S

trat

egic

Ap

proa

ch to

NC

D P

reve

ntio

n an

d C

ontro

l

• Pr

omot

e a

smok

e-fre

e in

divi

dual

s and

en

viro

nmen

t•

Disc

oura

ge a

lcoh

ol u

se•

Prom

ote

men

tal h

ealth

an

d m

anag

e str

ess

effec

tivel

y•

Regu

lar h

ealth

che

ck-

up fo

r ear

ly d

iagn

osis

and

prom

pt tr

eatm

ent

of m

ajor

NC

Ds.

• Ex

plai

n th

e ke

y ar

eas f

or p

rimar

y pr

even

tion

of m

ajor

N

CD

s.

4.

Des

crib

e th

e re

gion

al a

nd

natio

nal f

ram

ewor

k fo

r the

In

tegr

ated

Com

mun

ity-

base

d Pr

even

tion

and

Con

trol o

f NC

Ds

TH

E W

HO

WES

TER

N

PAC

IFIC

REG

ION

AL

ACT

ION

PLA

N F

OR

NC

D

Focu

ses o

n pr

actic

al, c

ost-

effec

tive

and

evid

ence

-bas

ed

inte

rven

tions

to a

chie

ve

redu

ctio

n in

NC

D ri

sk fa

ctor

pr

eval

ence

; bui

lt ar

ound

eig

ht

(8) k

ey p

rinci

ples

:•

Peop

le-c

ente

red

heal

th

care

• C

ultu

ral r

elev

ance

• Fo

cuse

d on

redu

cing

in

equi

ties

• En

com

pass

ing

the

Slid

e pr

esen

tatio

n

Refe

r to

full

docu

men

t in

the

DO

H M

anua

l of

Ope

ratio

ns o

n Pr

even

tion

and

Con

trol o

f Chr

onic

Li

festy

le-r

elat

ed

Non

com

mun

icab

le

Dise

ases

WH

O-W

PRO

Reg

iona

l Ac

tion

Plan

Part

icip

ants

mus

t be

able

to

:

• D

iscus

s prin

cipl

es,

strat

egic

app

roac

h an

d ob

ject

ives

of

the

Regi

onal

Pla

n of

Ac

tion

31

entir

e ca

re c

ontin

uum

• In

volv

ing

the

who

le

soci

ety

• In

tegr

al to

hea

lth

syste

ms s

treng

then

ing

• C

onsis

tent

with

the

glob

al a

ctio

n pl

an•

Flex

ibili

ty th

roug

h a

phas

ed a

ppro

ach

WH

O-W

PRO

Str

ateg

ic

Appr

oach

to N

CD

Pre

vent

ion

and

Con

trol-

corr

espo

nds t

o th

e ca

usat

ion

path

way

Prev

entio

n an

d C

ontro

l of

Chr

onic

Life

style

-Rel

ated

N

onco

mm

unic

able

Dise

ases

in

the

Phili

ppin

es (I

nteg

rate

d N

CD

Pre

vent

ion

and

Con

trol

Fram

ewor

k)

Nat

iona

l pol

icy

on N

CD

Pr

even

tion

and

Con

trol

prov

ides

the

obje

ctiv

es, g

uidi

ng

prin

cipl

es a

nd k

ey lo

cal

strat

egie

s to

redu

ce th

e bu

rden

of

dise

ase

and

deat

h du

e to

N

CD

s

Expl

ain

the

natio

nal f

ram

ewor

k of

Pre

vent

ion

and

Con

trol o

f C

hron

ic L

ifesty

le-r

elat

ed N

CD

s in

the

Phili

ppin

es (I

nteg

rate

d N

CD

Pr

even

tion

and

Con

trol F

ram

ewor

k).

• D

iscus

s the

gu

idin

g pr

inci

ples

of

the

Prev

entio

n an

d C

ontro

l of

Chr

onic

Life

style

-re

late

d N

CD

s in

the

Phili

ppin

es

(Int

egra

ted

NC

D

Prev

entio

n an

d C

ontro

l Fra

mew

ork)

WH

O –

WPR

O S

trat

egic

Ap

proa

ch to

NC

D

Prev

entio

n an

d C

ontro

l

32

M

odul

e O

bjec

tive

s

C

onte

nt

T

each

ing

Lear

ning

Act

ivit

ies

R

esou

rces

Ev

alua

tion

Mod

ule

2 R

isk

Fact

ors A

ssse

ssm

ent a

nd S

cree

ning

Pro

cedu

res

RIS

K F

ACT

OR

AN

D R

ISK

FA

CT

OR

S A

SSES

SMEN

T

Risk

fact

or is

defi

ned

as a

ny

attr

ibut

e, c

hara

cter

istic

or

expo

sure

of a

n in

divi

dual

w

hich

incr

ease

s lik

elih

ood

of

deve

lopi

ng N

CD

.

Etio

logi

c or

cau

sativ

e fa

ctor

is

diffe

rent

from

risk

fact

or;

etio

logi

c or

cau

sativ

e fa

ctor

pr

ovid

es d

irect

exp

lana

tion

for

the

dise

ase.

• R

isk F

acto

rs A

sses

smen

t ba

sical

ly in

volv

es h

istor

y ta

king

, and

taki

ng o

f sim

ple

mea

sure

men

ts w

hich

bec

ome

the

basis

of

cla

ssify

ing

whe

ther

the

indi

vidu

al is

at r

isk o

r not

.

To in

trodu

ce th

e to

pic,

disc

uss

the

impo

rtan

ce o

f ide

ntify

ing

the

pres

ence

of r

isk fa

ctor

s and

to sc

reen

fo

r pos

sible

NC

Ds t

o pr

even

t dise

ase

prog

ress

ion

and

com

plic

atio

ns.

Disc

uss o

bjec

tives

and

con

tent

of t

he

sess

ion.

Cla

rify

the

follo

win

g:•

Risk

fact

or v

ersu

s cau

sativ

e/

etio

logi

c fa

ctor

• R

isk fa

ctor

ass

essm

ent

Pres

ence

of r

isk fa

ctor

mea

ns d

iseas

e is

mor

e lik

ely

to d

evel

op; c

ause

m

eans

this

is de

finite

ly g

oing

to le

ad

to d

iseas

e.

Slid

e pr

esen

tatio

nPa

rtic

ipan

ts m

ust b

e ab

le

to • D

iffer

entia

te ri

sk

fact

or fr

om a

cau

sativ

e fa

ctor

• D

escr

ibe

how

risk

fa

ctor

s ass

essm

ent i

s ca

rrie

d ou

t•

Appr

ecia

te im

port

ance

of

risk

fact

ors

asse

ssm

ent i

n ea

rly

dete

ctio

n of

NC

Ds

1.

Expl

ain

the

impo

rtan

ce o

f ris

k fa

ctor

ass

essm

ent f

or

maj

or N

CD

s

33

• R

isk F

acto

rs a

sses

smen

t re

quire

s tho

roug

hnes

s, co

mpl

eten

ess a

nd a

ccur

acy

in o

btai

ning

info

rmat

ion

and

mea

sure

men

ts as

wel

l as

obs

erva

tion

of e

thic

al

cons

ider

atio

n an

d cu

ltura

l se

nsiti

vity

• R

isk fa

ctor

s ass

essm

ent

is im

port

ant f

or th

e ea

rly

diag

nosis

, tre

atm

ent a

nd

cont

rol f

or N

CD

s.

2.

Disc

uss r

isk fa

ctor

s co

mm

on to

maj

or N

CD

sC

OM

MO

N R

ISK

FAC

TO

RS

OF

MA

JOR

NC

Ds

The

maj

or N

CD

s inc

lude

:•

Hea

rt d

iseas

e•

Can

cer

• St

roke

• C

hron

ic R

espi

rato

ry d

iseas

es•

Dia

bete

s

Cau

satio

n Pa

thw

ay fo

r NC

Ds

• In

term

edia

te R

isk fa

ctor

s•

Rai

sed

bloo

d su

gar

• R

aise

d bl

ood

pres

sure

Brie

fly d

escr

ibe

the

epid

emio

logi

cal

char

acte

ristic

s of t

he m

ajor

non

-co

mm

unic

able

dise

ases

from

loca

l an

d gl

obal

per

spec

tives

. Util

ize lo

cal

heal

th st

atist

ics i

n or

der t

o hi

ghlig

ht

the

need

to g

ive

atte

ntio

n to

NC

Ds

in th

e lo

calit

y.

Use

the

caus

atio

n pa

thw

ay fo

r NC

Ds

to e

xpla

in th

e in

term

edia

te a

nd

com

mon

risk

fact

ors a

nd to

disc

uss

the

base

s of N

CD

pre

vent

ion

and

cont

rol.

Slid

e pr

esen

tatio

nPa

rtic

ipan

ts m

ust b

e ab

le

to • Id

entif

y th

e m

ajor

N

CD

s com

mon

in

thei

r loc

ality

• D

escr

ibe

the

inte

rmed

iate

and

co

mm

on ri

sk fa

ctor

s fo

r the

maj

or N

CD

s

For e

xam

ple,

smok

ing

is no

t onl

y a

risk

fact

or to

man

y di

seas

es; i

t is a

lso

a ca

usat

ive

fact

or fo

r CO

PD.

34

RIS

K F

ACT

OR

S T

HAT

NEE

D

TO

BE

ASS

ESSE

D F

OR

N

CD

PR

EVEN

TIO

N A

ND

C

ON

TR

OL

Appl

ies t

he g

ener

al p

rinci

ples

of

risk

fact

ors a

sses

smen

t util

izing

:

• Ab

norm

al b

lood

lipi

ds•

Ove

rwei

ght/o

besit

y

• C

omm

on ri

sk fa

ctor

s to

maj

or N

CD

s •

Non

-mod

ifiab

le•

Age

• H

ered

ity•

Mod

ifiab

le•

Unh

ealth

y di

et•

Phys

ical

inac

tivity

• To

bacc

o an

d al

coho

l use

• St

ress

Soci

al a

nd e

cono

mic

im

plic

atio

ns o

f NC

Ds i

n th

e co

mm

unity

Disc

uss b

urde

n of

dise

ase

brou

ght

abou

t by

maj

or N

CD

s in

a co

mm

unity

in th

e lo

calit

y •

Reco

gnize

soci

al

and

econ

omic

im

plic

atio

ns o

f NC

Ds

in in

divi

dual

s, fa

mili

es

and

com

mun

ities

3.

Perfo

rms r

isk fa

ctor

s as

sess

men

t for

clie

nts b

ased

on

gui

delin

es a

nd u

sing

appr

opria

te ri

sk a

sses

smen

t to

ols.

Disc

uss t

he g

ener

al p

rinci

ples

of r

isk

asse

ssm

ent.

Slid

e pr

esen

tatio

nPa

rtic

ipan

ts m

ust b

e ab

le

to:

35

• ST

EPw

ise a

ppro

ach

for

surv

eilla

nce

• Li

fe sp

an a

ppro

ach

• pr

egna

nt &

lact

atin

g w

omen

• pa

rent

s or c

are

prov

ider

s of i

nfan

ts &

ch

ildre

n•

adol

esce

nts

• Ad

ults

• O

lder

per

sons

Risk

Fac

tors

Ass

essm

ent m

ust

be in

tegr

ated

into

the

rout

ine

histo

ry ta

king

of e

very

hea

lth

faci

lity

whe

ther

this

be a

BH

S,

RH

U, h

ospi

tal o

r oth

er se

tting

s (s

choo

l clin

ics,

corp

orat

e clin

ics,

clin

ics o

f priv

ate

prac

titio

ners

, et

c.).

Risk

Fac

tors

Ass

essm

ent m

ust

be a

dmin

ister

ed to

all

clie

nts

who

com

e in

for c

onsu

ltatio

ns

in th

e he

alth

faci

lity,

whe

ther

fo

r spe

cific

com

plai

nts r

elat

ed

to N

CD

s or w

ho a

re w

ell b

ut

com

e in

for f

ollo

w-u

p se

rvic

es

(e.g

. pre

gnan

t wom

en a

nd

Brie

fly d

escr

ibe

the

STEP

wise

ap

proa

ch fo

r sur

veill

ance

. Ref

er to

th

e N

CD

Man

ual o

f Ope

ratio

n (p

age

113)

des

crib

ing

the

first

step

on a

sses

sing

the

risk

fact

ors p

rofil

e of

th

e po

pula

tion.

Con

sider

all

age

grou

ps th

at a

re m

ost

vuln

erab

le to

NC

Ds.

Hav

e pa

rtic

ipan

ts pr

actic

e on

the

use

of ri

sk a

sses

smen

t for

m a

s gui

de in

co

llect

ing

info

rmat

ion

from

clie

nt.

Gro

up p

artic

ipan

ts in

to p

airs

. H

ave

DO

H M

anua

l of

Ope

ratio

ns o

n Pr

even

tion

and

Con

trol o

f Chr

onic

Li

festy

le-r

elat

ed

Non

com

mun

icab

le

Dise

ases

, 200

9

• D

escr

ibe

the

gen

eral

pr

inci

ples

of r

isk

fact

or a

sses

smen

t

36

lact

atin

g w

omen

, chi

ldre

n br

ough

t in

for i

mm

uniza

tion,

et

c.).

Risk

Fac

tors

Ass

essm

ent t

ool

and

proc

ess m

ust b

e ha

rmon

ized

acro

ss le

vels

of th

e he

alth

car

e de

liver

y sy

stem

.

Area

s for

risk

fact

ors a

sses

smen

t sh

ould

incl

ude

the

follo

win

g:

1.

Cig

aret

tesm

okin

gEv

ery

clie

nt sh

ould

be

aske

d ab

out t

obac

co u

se. S

mok

ing

statu

s sho

uld

be re

cord

ed a

nd

upda

ted

at re

gula

r int

erva

ls.

The

follo

win

g in

form

atio

n on

sm

okin

g sta

tus s

houl

d be

co

llect

ed fo

r bot

h cu

rren

t and

fo

rmer

smok

ers:

• Ag

e sta

rted

smok

ing

• Av

erag

e nu

mbe

r of

ciga

rette

s per

day

• Q

uit s

tatu

s

each

par

tner

inte

rvie

w th

e ot

her

usin

g th

e fo

rm.

Expl

ain

the

use

of ri

sk a

sses

smen

t fo

rm to

ass

ess s

mok

ing

statu

s.

Keym

essag

eH

ealth

wor

kers

shou

lda

skea

ch

clien

tabo

utto

bacc

ous

e/sm

okin

g(w

heth

ero

rnot

this

isth

erea

son

for

cons

ultin

g).

Risk

ass

essm

ent f

orm

fo

cusin

g on

smok

ing

Part

icip

ants

mus

t be

able

to

:•

Iden

tify

data

nee

ded

for r

isk a

sses

smen

t on

toba

cco

use

• U

se th

e re

com

men

ded

tool

for r

isk fa

ctor

s as

sess

men

t on

toba

cco

use

• Pe

rform

risk

as

sess

men

t on

smok

ing

37

• If

he h

as q

uit s

mok

ing,

how

lo

ng h

as h

e be

en sm

oke-

free

• Re

ason

s for

smok

ing

2.

Nut

ritio

n/D

ietD

iet i

s a c

ombi

natio

n of

rela

ted

beha

vior

s tha

t are

ofte

n cu

lture

-sp

ecifi

c.

Com

preh

ensiv

e nu

triti

onal

as

sess

men

t inv

olve

s:•

deta

iled

reca

ll m

etho

ds (l

ike

the

24-h

our f

ood

reca

ll•

exte

nsiv

e fo

od fr

eque

ncy

ques

tionn

aire

s•

estim

atio

n of

nut

rient

s ba

sed

on

food

com

posit

ion

tabl

es.

A sim

pler

ass

essm

ent o

f nu

triti

on/ d

iet i

s rec

omm

ende

d fo

r eas

ier a

dmin

istra

tion

espe

cial

ly if

ther

e is

a lo

ng q

ueue

of

clie

nts a

wai

ting

serv

ices

.

Nut

ritio

n/di

et a

sses

smen

t sh

ould

focu

s on

the

follo

win

g:

• Es

tabl

ish th

e am

ount

and

Hav

e pa

rtic

ipan

ts ac

com

plish

a

food

dia

ry fo

r tw

o da

ys to

incr

ease

se

lf-aw

aren

ess a

nd a

ppre

ciat

ion

for

nutr

ition

al a

sses

smen

t.

Hav

e pa

rtic

ipan

ts w

ork

in p

airs

. Ask

ea

ch p

artic

ipan

t to

estim

ate

thei

r pa

rtne

r’s n

utrie

nts o

f foo

d ta

ken

each

day

usin

g th

e fo

od p

yram

id

guid

e. K

eep

food

dia

ries t

o be

use

d fo

r the

pra

ctic

um o

n nu

triti

on

coun

selin

g an

d ed

ucat

ion.

Dev

elop

hyp

othe

tical

situ

atio

ns a

s ex

erci

ses i

n nu

triti

onal

ass

essm

ent

Giv

en o

ne’s

own

data

on

24 -h

our f

ood

reca

ll or

di

ary.

part

icip

ants

are

able

to

:•

Dem

onstr

ate

corr

ect

use

of 2

4-ho

ur fo

od

reca

ll/di

ary

• Pe

rform

nut

ritio

nal

asse

ssm

ent t

o ot

her

peop

le•

Iden

tify

nutr

ition

-re

late

d pr

actic

es o

f cl

ient

s tha

t lea

d to

N

CD

Expl

ain

the

use

of th

e 24

-hou

r fo

od d

iary

. Giv

e ex

ampl

es o

f how

in

form

atio

n ob

tain

ed fr

om th

is ca

n be

use

d fo

r giv

ing

advi

ce a

nd m

akin

g he

alth

teac

hing

mor

e re

leva

nt to

the

clie

nt.

Risk

ass

essm

ent f

orm

fo

cusin

g on

nut

ritio

n/di

etPa

rtic

ipan

ts m

ust b

e ab

le

to:

• Ex

plai

n th

e us

e of

nu

triti

onal

ass

essm

ent

in d

eter

min

ing

risk

of n

onco

mm

unic

able

di

seas

es

38

frequ

ency

of e

atin

g ce

rtai

n fo

ods t

hat c

ontr

ibut

e to

N

CD

dev

elop

men

t.•

Ask

abou

t the

am

ount

and

fre

quen

cy o

f foo

d ea

ten

part

icul

arly

• Fo

r Veg

etab

les :

wha

t ar

e th

e us

ual t

ypes

of

vege

tabl

es e

aten

• Fo

r Fat

: w

hich

par

t of

the

food

is e

aten

, how

of

ten

they

eat

frie

d fo

ods a

nd h

ow o

ften

they

go

out t

o fa

st fo

od

resta

uran

ts•

For S

odiu

m a

nd S

alt:

how

ofte

n pr

eser

ved,

ca

nned

and

insta

nt

food

s are

eat

en p

er

wee

k, h

ow m

uch

salt

is us

ed w

hen

cook

ing

• Fo

r sug

ars/

simpl

e :

how

ofte

n ta

ble

suga

r is

used

, and

freq

uenc

y of

ca

rboh

ydra

tes d

rinki

ng

soft

drin

ks, c

akes

,

39

choc

olat

es, c

andi

es a

nd

othe

r sw

eete

ned

food

pr

oduc

t

• C

ompa

re th

eir a

ctua

l in

take

of t

he a

bove

with

th

e pr

escr

ibed

num

ber o

f se

rvin

gs

3.

Ove

rweig

ht/O

besit

yO

besit

y is

a m

ajor

risk

fact

or

of N

CD

. Dist

ribut

ion

of fa

t, pa

rtic

ular

ly a

roun

d th

e w

aist,

in

crea

ses t

he ri

sk fu

rthe

r.

Indi

cato

rs o

f bei

ng o

verw

eigh

t or

obe

se•

Body

fat i

s bes

t ass

esse

d us

ing

wai

st ci

rcum

fere

nce

(WC

), Bo

dy M

ass I

ndex

(B

MI)

and

wai

st-hi

p ra

tio

(WH

R)

• W

aist

circ

umfe

renc

e is

an

accu

rate

mea

sure

of t

he

amou

nt o

f visc

eral

fat,

thus

a

sens

itive

indi

cato

r of

adip

osity

• BM

I cor

rela

tes c

lose

ly w

ith

tota

l bod

y fa

t in

rela

tion

to

Disc

uss t

he u

se o

f the

follo

win

g in

id

entif

ying

obe

sity

in c

lient

s:•

Gro

wth

tabl

es fo

r chi

ldre

n•

Mea

surin

g w

aist

circ

umfe

renc

e•

Gui

delin

es o

n in

terp

retin

g BM

I•

WH

R in

terp

reta

tion

Body

Mas

s Ind

ex T

able

w

ith A

sian

stand

ards

/ BM

I Sta

ndar

d

FNR

I acc

epte

d gr

owth

ta

bles

& w

eigh

t cha

rts

Nut

ritio

nal G

uide

lines

for

Filip

inos

Food

Exc

hang

e Li

st

Adul

t wei

ghin

g sc

ale

Hei

ght m

easu

rem

ent s

cale

Tape

Mea

sure

Part

icip

ants

mus

t be

able

to

:•

Des

crib

e th

e ap

prop

riate

an

thro

pom

etric

m

easu

rem

ents

to

dete

rmin

e w

heth

er

an in

divi

dual

is

over

wei

ght/o

bese

40

heig

ht a

nd w

eigh

t.•

Wai

st-hi

p ra

tio (W

HR

) is

anot

her u

sefu

l mea

sure

of

cent

ral o

besit

y.

C

orre

ct te

chni

ques

in ta

king

m

easu

rem

ents

Gui

delin

es in

inte

rpre

ting

mea

sure

men

ts

Dem

onstr

ate

corr

ect t

echn

ique

s of

taki

ng m

easu

rem

ents.

Allo

w re

turn

de

mon

strat

ion

Giv

e ex

erci

ses o

n ca

lcul

atin

g ris

k ba

sed

on W

C, B

MI a

nd W

HR

va

lues

. Hav

e on

e fa

cilit

ator

per

5-6

pa

rtic

ipan

ts to

mak

e su

re to

che

ck

each

one

.

Use

the

valu

es sp

ecifi

ed in

Tab

le 2

.5

Gui

de in

Usin

g th

e R

isk A

sses

smen

t Fo

rm in

Mod

ule

2 as

gui

de in

in

terp

retin

g re

sults

of W

C, B

MI

and

WH

R .

Sugg

est t

hat t

he T

able

be

repr

oduc

ed a

nd d

ispla

yed

in th

e cl

inic

s for

eas

y re

fere

nce.

In in

terp

retin

g ris

k, p

oint

out

that

el

evat

ed B

MI e

ven

with

nor

mal

WC

m

eans

incr

ease

d ris

k; a

nor

mal

BM

I bu

t with

incr

ease

d W

C a

lso in

crea

ses

risk.

• Pe

rform

m

easu

rem

ents

to

dete

rmin

e pr

esen

ce o

f ov

erw

eigh

t/obe

sity

in

clie

nts

• In

terp

ret r

esul

ts of

ant

hrop

omet

ric

mea

sure

men

ts

41

Disc

uss t

he in

form

atio

n ne

eded

to

asse

ss h

abitu

al a

lcoh

ol in

take

and

ris

ky b

ehav

ior.

Risk

Fac

tors

Ass

essm

ent

form

focu

sing

on

exce

ssiv

e al

coho

l drin

king

Part

icip

ant m

ust b

e ab

le

to:

• Pe

rform

risk

as

sess

men

t on

Disc

uss t

he d

iffer

ent i

nfor

mat

ion

need

ed to

ass

ess p

hysic

al a

ctiv

ity o

f cl

ient

s.

Diff

eren

tiate

cha

ract

erist

ics o

f ph

ysic

al a

ctiv

ity n

eede

d to

ach

ieve

he

alth

ben

efit f

rom

regu

lar d

aily

ac

tiviti

es.

Risk

Ass

essm

ent f

orm

fo

cusin

g on

phy

sical

in

activ

ity a

nd se

dent

ary

lifes

tyle

Part

icip

ant m

ust b

e ab

le

to:

• Pe

rform

ass

essm

ent

of a

per

son’s

phy

sical

ac

tivity

• In

terp

ret d

ata

on

phys

ical

act

ivity

re

gard

ing

a p

erso

n’s

risk

of N

CD

4.

Phys

icalI

nacti

vity

/Sed

enta

ry

Lifes

tyle

Asse

ssm

ent o

f a p

erso

n’s p

hysic

al

activ

ity in

clud

es in

form

atio

n on

: •

type

of w

ork

whe

ther

se

dent

ary

or n

ot•

Mea

ns o

f tra

nspo

rtat

ion

• Le

isure

-tim

e ac

tiviti

es li

ke

spor

ts an

d ex

erci

se•

Min

imum

am

ount

of

phys

ical

act

ivity

nee

ded

to

achi

eve

heal

th b

enefi

t

Regu

lar p

hysic

al a

ctiv

ity c

onsis

ts of

:•

Min

imum

of 3

0 m

inut

es a

da

y pr

efer

ably

dai

ly•

Mod

erat

e in

tens

ity: 5

or

mor

e da

ys o

f the

wee

k•

Vig

orou

s int

ensit

y: 3

or m

ore

days

of t

he w

eek

5.

Exce

ssive

Alco

holD

rinki

ngIn

ass

essin

g ha

bitu

al a

lcoh

ol

inta

ke a

nd ri

sky

beha

vior

: •

Qua

ntify

the

amou

nt o

f dr

inki

ng•

Det

erm

ine

spec

ific

type

of

beve

rage

to e

stim

ate

etha

nol

42

Slid

e pr

esen

tatio

nPa

rtic

ipan

ts m

ust b

e ab

le

to:

• D

efine

scre

enin

g•

Stat

e th

e go

al o

f sc

reen

ing

• D

iffer

entia

te th

e tw

o ty

pes o

f scr

eeni

ng

prog

ram

s

CO

NC

EPT

S A

ND

P

RIN

CIP

LES

OF

SCR

EEN

ING

The

prim

ary

goal

of s

cree

ning

is

to d

etec

t a d

iseas

e in

its e

arly

sta

ges.

Scre

enin

g is

dise

ase-

spec

ific.

It is

th

e pr

esum

ptiv

e id

entifi

catio

n of

un

reco

gnize

d di

seas

e or

def

ect b

y th

e ap

plic

atio

n of

tests

or o

ther

pr

oced

ures

that

can

be

appl

ied

rapi

dly.

It is

not a

dia

gnos

tic m

easu

re b

ut

a pr

elim

inar

y ste

p to

dia

gnos

is.

Oth

er d

iagn

ostic

tests

and

ph

ysic

ian

eval

uatio

n ar

e sti

ll ne

eded

for d

efini

te d

iagn

osis.

4.

Disc

uss c

once

pts

and

prin

cipl

es o

f scr

eeni

ng

Cla

rify

the

conc

ept o

f scr

eeni

ng b

y di

scus

sing

the

follo

win

g:•

Defi

nitio

n•

Goa

l of s

cree

ning

• Ty

pes o

f scr

eeni

ng p

rogr

ams

Emph

asize

that

scre

enin

g is

diffe

rent

fro

m m

akin

g a

defin

ite d

iagn

osis

of d

iseas

e. H

owev

er, s

cree

ning

is a

pr

elim

inar

y ste

p to

dia

gnos

is.

Emph

asize

that

for N

CD

pre

vent

ion,

m

ass s

cree

ning

may

not

be

the

best

publ

ic h

ealth

app

roac

h. M

oney

is

best

put i

nto

prim

ary

prev

entio

n ra

ther

than

exp

ensiv

e di

agno

stic

tests

.

cont

ent a

nd v

olum

e in

geste

d•

Iden

tify

situa

tions

whe

re

pers

on te

nds t

o dr

ink

exce

ssiv

ely

Show

tabl

e th

at e

stim

ates

eth

anol

co

nten

t of a

lcoh

olic

bev

erag

es.

exce

ssiv

e al

coho

l dr

inki

ng•

Iden

tify

exce

ssiv

e al

coho

l use

in c

lient

s•

Inte

rpre

t risk

of

deve

lopi

ng N

CD

43

Non

-mer

curia

l BP

appa

ratu

s

Teac

hing

stet

hosc

opes

BP P

roce

dure

che

cklis

t

5.

Dem

onstr

ate

corr

ect

tech

niqu

es o

f com

mon

sc

reen

ing

proc

edur

es b

ased

on

cur

rent

gui

delin

es fo

r ea

rly d

etec

t ion

of m

ajor

N

CD

s.

GU

IDEL

INES

FO

R

CO

MM

ON

SC

REE

NIN

G

PR

OC

EDU

RES

FO

R N

CD

s

1.

Scre

enin

gfo

rHyp

erte

nsio

nH

yper

tens

ion

is de

fined

as

pers

isten

t ele

vatio

n of

systo

lic

BP a

t a le

vel o

f 140

mm

hg

or

high

er a

nd a

dia

stolic

pre

ssur

e (D

BP) a

t a le

vel o

f 90

mm

hg

or

high

er.

Scre

enin

g gu

idel

ines

for a

ccur

ate

BP m

easu

rem

ent.

Gui

delin

es in

inte

rpre

ting

resu

lts o

f BP

mea

sure

men

ts an

d fre

quen

cy o

f rep

eatin

g us

ing

7th

Repo

rt o

f the

Join

t Nat

iona

l C

omm

ittee

on

Prev

entio

n,

Det

ectio

n, E

valu

atio

n, a

nd

Trea

tmen

t of H

igh

Bloo

d Pr

essu

re

Allo

w a

dequ

ate

prac

tice

in

perfo

rmin

g sc

reen

ing

proc

edur

es to

he

lp b

uild

up

confi

denc

e an

d se

lf-effi

cacy

of p

artic

ipan

ts.

A sin

gle

perfo

rman

ce m

ay n

ot b

e en

ough

to d

evel

op sk

ill.

D

iscus

s scr

eeni

ng g

uide

lines

for

accu

rate

BP

mea

sure

men

t. U

se th

e pr

oced

ure

chec

klist

in M

odul

e 2.

Disc

uss c

omm

on m

istak

es in

BP

taki

ng a

nd h

ow to

avo

id th

ese.

Al

low

for p

ract

ice

to c

heck

mist

akes

.

Disc

uss T

able

2-1

Cla

ssifi

catio

n an

d Re

com

men

ded

Con

firm

atio

n Sc

hedu

le fo

r Adu

lts A

ged

18+.

Slid

e pr

esen

tatio

n

DO

H M

anua

l of

Ope

ratio

ns fo

r Pre

vent

ion

and

Con

trol o

f Chr

onic

Li

festy

le-R

elat

ed N

on-

com

mun

icab

le D

iseas

es,

2009

Part

icip

ants

mus

t be

able

to

:•

Defi

ne h

yper

tens

ion

• D

emon

strat

e co

rrec

t tec

hniq

ue in

pe

rform

ing

bloo

d pr

essu

re m

easu

rem

ent

• In

terp

ret r

isk o

f N

CD

bas

ed o

n 7t

h JN

C.

Scre

enin

g m

ay b

e do

ne a

t the

in

divi

dual

leve

l or f

or g

roup

s as

in m

ass s

cree

ning

.

44

• Sh

ould

be

cons

ider

ed in

all

pers

ons a

t age

45.

• If

resu

lts a

re n

orm

al, t

est

shou

ld b

e re

peat

ed a

t 3

year

inte

rval

s.

Expl

ain

the

guid

elin

es fo

r tes

ting

diab

etes

.Pa

rtic

ipan

ts m

ust b

e ab

le

to:

• D

escr

ibe

the

peop

le

who

shou

ld b

e te

sted

for d

iabe

tes.

• D

iscus

s rec

omm

ende

d bl

ood

suga

r tes

ts to

Expl

ain

role

of c

hole

stero

l in

mai

ntai

ning

hea

lthy

nerv

e ce

lls

and

prod

ucin

g ce

rtai

n ho

rmon

es.

How

ever

, onl

y a

smal

l am

ount

is

need

ed fo

r the

se.

Disc

uss N

CD

risk

if th

ere

is an

el

evat

ed b

lood

cho

leste

rol.

Disc

uss c

urre

nt re

com

men

ded

valu

es

for c

hole

stero

l and

lipo

prot

eins

.

Part

icip

ant m

ust b

e ab

le

to:

• Ex

plai

n im

port

ance

of

scre

enin

g fo

r ch

oles

tero

l.•

Des

crib

e ho

w

scre

enin

g fo

r ch

oles

tero

l is d

one.

• In

terp

ret v

alue

s an

d es

timat

e ris

k of

de

velo

ping

NC

D.

2.

Scre

enin

gfo

rCho

leste

rol

The

reco

mm

ende

d am

ount

of

diet

ary

chol

este

rol i

s not

mor

e th

an 3

00 m

g/da

y. (F

NR

I)

Elev

ated

cho

leste

rol i

n th

e bl

ood

is de

fined

by

havi

ng

chol

este

rol l

evel

hig

her t

han

norm

al le

vels

of <

200

mg/

100

ml.

Hig

h se

rum

blo

od

chol

este

rol i

ncre

ases

the

risk

of

coro

nary

hea

rt d

iseas

e (C

HD

). If

poss

ible

, tes

t for

LD

L an

d H

DL

Cur

rent

reco

mm

ende

d va

lues

fo

r cho

leste

rol a

nd li

popr

otei

ns.

3.

Scre

enin

gfo

rDia

bete

sM

ellitu

sG

uide

lines

for t

estin

g fo

r di

abet

es

45

• Te

sting

shou

ld b

e co

nsid

ered

at a

you

nger

age

or

per

form

ed m

ore

ofte

n fo

r cl

ient

s with

the

follo

win

g ris

k fa

ctor

s:•

Obe

sity

(> 1

20 %

of

desir

able

bod

y w

eigh

t or

a BM

I abo

ve 2

5kg/

m2

• H

abitu

al p

hysic

al

inac

tivity

• Po

lycy

stic

ovar

y sy

ndro

me

• D

iabe

tes i

n a

first

degr

ee re

lativ

e•

Rac

ial p

redi

spos

ition

(A

frica

n-Am

eric

an,

Hisp

anic

, Nat

ive

Amer

ican

)•

In w

omen

, giv

ing

birt

h to

a b

aby

wei

ghin

g m

ore

than

9lb

or a

hi

story

of g

esta

tiona

l di

abet

es•

Hyp

erte

nsio

n (B

P>14

0/90

mm

Hg)

• A

high

den

sity

lipop

rote

in le

vel <

35

mg/

dl o

r trig

lyce

ride

dete

rmin

e pr

esen

ce

of h

yper

glyc

emia

.•

Inte

rpre

t blo

od su

gar

valu

es a

nd e

stim

ate

risk

of D

M

46

leve

l >25

0 m

g/dl

• O

n pr

evio

us te

sting

, im

paire

d gl

ucos

e to

lera

nce

or im

paire

d fa

sting

glu

cose

Reco

mm

ende

d te

sts to

de

term

ine

pre

senc

e of

hy

perg

lyce

mia

:•

FBS-

fasti

ng m

eans

no

calo

rie in

take

for a

t lea

st 8

hour

s•

Post-

pran

dial

blo

od su

gar–

pe

rform

ed 2

hou

rs a

fter

usin

g 75

g gl

ucos

e di

ssol

ved

in w

ater

or a

fter a

goo

d m

eal

Gui

delin

es fo

r dia

gnos

is of

DM

an

d th

eir i

nter

pret

atio

n

4.

Scre

enin

gfo

rCO

PD/A

sthm

aTh

e fo

llow

ing

pers

ons s

houl

d be

con

sider

ed to

hav

e po

ssib

le

CO

PD a

nd n

eed

to b

e co

nfirm

ed b

y sp

irom

etry

:•

Ove

r 40

year

s old

• Ye

s to

histo

ry o

f sm

okin

g

Disc

uss g

uide

lines

in sc

reen

ing

clie

nts f

or p

ossib

le C

OPD

.Pe

ak fl

ow m

eter

Part

icip

ant m

ust b

e ab

le

to:

• D

eter

min

e in

divi

dual

s who

nee

d to

be

scre

ened

for

poss

ible

CO

PD.

Disc

uss t

he re

com

men

ded

tests

for

diab

etes

. Int

erpr

et th

e re

sults

of

bloo

d su

gar v

alue

s.

Des

crib

e th

e gu

idel

ines

/crit

eria

for

the

diag

nosis

of D

M

47

• Ye

s to

any

of th

e fo

llow

ing

item

• co

ugh

as m

uch

as 4

-6

times

a d

ay, 4

or m

ore

days

out

of t

he w

eek

• co

ugh

on m

ost d

ays f

or

3 co

nsec

utiv

e m

onth

s or

mor

e•

coug

h fo

r mor

e th

an 3

ye

ars

• ph

legm

as m

uch

as 2

tim

es a

day

, 4 o

r mor

e da

ys o

ut o

f the

wee

k•

phle

gm o

n m

ost d

ays

for 3

con

secu

tive

mon

ths o

r mor

e du

ring

the

year

• ph

legm

for m

ore

than

3

year

s•

shor

tnes

s of b

reat

h w

hen

hurr

ying

on

the

leve

l or w

alki

ng u

p a

sligh

t hill

• w

alk

slow

er th

an

peop

le o

f you

r age

on

the

leve

l bec

ause

of

brea

thle

ssne

ss•

stop

for b

reat

h w

hen

wal

king

at o

wn

pace

on

48

the

leve

l•

stop

for b

reat

h af

ter

wal

king

abo

ut 1

00 y

ards

or

afte

r a fe

w m

inut

es o

n th

e le

vel

• br

eath

less

to le

ave

the

hous

e or

bre

athl

ess o

n dr

essin

g or

und

ress

ing

• em

phys

ema

or c

hron

ic

bron

chiti

s or C

OPD

di

agno

sed

by a

doc

tor

Susp

ect a

sthm

a in

per

son

with

th

e fo

llow

ing:

• O

ne o

r a c

ombi

natio

n of

ca

rdin

al sy

mpt

oms (

dysp

nea,

co

ugh,

whe

ezin

g, c

hest

disc

omfo

rt)

• Te

mpo

ral w

axin

g or

w

anin

g an

d / o

r noc

turn

al

occu

rren

ce o

f sym

ptom

s•

A hi

story

of a

ny o

f the

fo

llow

ing:

• sy

mpt

oms t

rigge

red

by

exog

enou

s fac

tors

,•

a fa

mily

hist

ory

of

Disc

uss g

uide

lines

in sc

reen

ing

clie

nts f

or p

ossib

le a

sthm

a.•

Det

erm

ine

indi

vidu

als

who

nee

d to

be

scre

ened

for a

sthm

a.

49

asth

ma

or a

llerg

y,•

a pe

rson

al h

istor

y of

as

thm

a, a

llerg

ic rh

initi

s or

ato

py;

• an

impr

ovem

ent

of sy

mpt

oms w

ith

bron

chod

ilato

r use

Spiro

met

ry is

don

e to

det

erm

ine

the

degr

ee o

f obs

truc

tion.

• Sp

irom

etric

val

ues v

ary

with

ag

e, h

eigh

t, se

x an

d ra

ce.

• Ai

rway

obs

truc

tion

is ev

iden

t if

the

FEV

1 is

redu

ced

to <

80

% o

f pre

dict

ed v

alue

s.•

Clie

nt c

an b

e ca

tego

rized

as

havi

ng re

stric

tive,

obs

truc

tive

or m

ixed

pat

tern

of

vent

ilato

ry d

efec

t.

Step

s in

usin

g pe

ak-fl

ow m

eter

.

5.

Scre

enin

gfo

rCan

cer

War

ning

sign

s of c

ance

r

Spec

ific

guid

elin

es fo

r ear

lyde

tect

ion

of c

omm

on c

ance

rs:

Ask

part

icip

ants

to sh

are

expe

rienc

es

rega

rdin

g fri

ends

or r

elat

ives

di

agno

sed

with

can

cer t

akin

g no

te

of th

e co

mm

on si

gns/

sym

ptom

s m

anife

sted

by e

ach

and

the

poss

ible

ris

k fa

ctor

s tha

t the

y sh

ared

.

Part

icip

ants

mus

t be

able

to

:•

Reco

gnize

war

ning

sig

ns o

f can

cer

Part

icip

ants

mus

t be

able

Brea

st m

odel

Disc

uss s

piro

met

ry v

alue

s in

dete

rmin

ing

degr

ee o

f obs

truc

tion.

Dem

onstr

ate

the

use

of p

eak-

flow

m

eter

.

Dem

onstr

ate

how

to in

struc

t an

othe

r per

son

to u

se th

e pe

ak fl

ow

met

er. Th

en, a

sk p

airs

of p

artic

ipan

ts to

do

retu

rn-d

emon

strat

ion.

• In

terp

ret r

esul

ts of

sp

irom

etric

val

ues.

• Pe

rform

spiro

met

ry

with

the

use

of

peak

flow

met

er to

de

term

ine

degr

ee o

f ai

rway

obs

truc

tion

• In

struc

t ano

ther

pe

rson

to u

se th

e pe

ak fl

ow m

eter

.

50

Brea

st C

ance

r Scr

eeni

ng

Gui

delin

es(T

arge

t 15-

60 y

rs o

ld a

nd a

bove

), Ph

ilipp

ine

Han

dboo

k of

Clin

ical

O

ncol

ogy

2nd

editi

on, 2

001

• M

onth

ly B

reas

t Sel

f Ex

amin

atio

n: c

heap

est a

nd

mos

t affo

rdab

le sc

reen

ing

proc

edur

e fo

r bre

ast c

ance

r•

war

ning

sign

s of b

reas

t ca

ncer

(ski

n ch

ange

s, ni

pple

ab

norm

aliti

es, a

bnor

mal

co

ntou

rs)

• be

st tim

e to

do

BSE

• sp

ecifi

c te

chni

ques

• Br

east

Exam

inat

ion

by

Hea

lth W

orke

r (an

nual

ly)

for a

ll ch

ild- b

earin

g w

oman

: de

tect

mas

ses m

issed

by

the

clie

nt o

r to

confi

rm p

rese

nce

of m

ass d

etec

ted

by th

e cl

ient

. •

It as

sess

es th

e fo

llow

ing:

• Lo

catio

n•

Num

ber o

f lum

ps

or n

odes

(sol

itary

or

Synt

hesiz

e di

scus

sion

and

high

light

th

e w

arni

ng si

gns o

f can

cer

Disc

uss t

he b

reas

t can

cer s

cree

ning

gu

idel

ines

.

Emph

asize

the

impo

rtan

ce o

f BSE

Disc

uss w

hat c

hang

es in

the

brea

st ca

n be

det

ecte

d by

BSE

.

Dem

onstr

ate

how

BSE

is d

one.

D

emon

strat

e ho

w to

instr

uct

a w

oman

to d

o BS

E. A

llow

for

prac

tice.

Expl

ain

the

ratio

nale

why

a h

ealth

w

orke

r stil

l nee

ds to

do

brea

st ex

amin

atio

n to

a w

oman

who

re

gula

rly d

oes B

SE.

Des

crib

e w

hat t

he h

ealth

wor

ker

need

s to

asse

ss d

urin

g br

east

exam

inat

ion.

Expl

ain

othe

r pro

cedu

res t

hat a

he

alth

wor

ker c

an re

com

men

d fo

r

to:

• D

iscus

s im

port

ance

of

BSE

• D

etec

t cha

nges

in th

e br

east

• Pr

ovid

e ad

vice

to th

e w

oman

on

the

best

time

to d

o th

e BS

E•

Perfo

rm th

e sp

ecifi

c te

chni

ques

in B

SE•

Instr

uct a

noth

er

pers

on to

do

BSE

• D

iscus

s im

port

ance

of

bre

ast e

xam

inat

ion

by h

ealth

wor

ker

• Pe

rform

bre

ast

exam

inat

ion

in a

br

east

mod

el.

51

mul

tiple

)•

Con

siste

ncy

(sof

t or

hard

)•

Size

• Fi

xed

or m

ovab

le•

Tend

erne

ss a

long

the

area

• An

nual

mam

mog

raph

y fo

r w

omen

50

year

s old

and

ab

ove

• Fo

r cer

tain

hig

h ris

k w

omen

, ba

selin

e m

amm

ogra

phy

at a

ge 3

5 w

ith re

peat

up

on re

com

men

datio

n of

at

tend

ing

phys

icia

n•

Gen

etic

scre

enin

g an

d co

unse

ling

for h

igh

risk

patie

nts o

r if a

ppro

pria

te

Cer

vica

l Can

cer S

cree

ning

G

uide

lines

(Tar

get w

omen

: 30-

55 y

ears

old

an

d ab

ove)

• W

arni

ng si

gns o

f cer

vica

l ca

ncer

• O

ften

asym

ptom

atic

• Ab

norm

al v

agin

al

blee

ding

Expl

ain

that

abn

orm

al v

agin

al

blee

ding

ofte

n al

erts

a w

oman

ab

out a

pro

blem

in th

e re

prod

uctiv

e sy

stem

but

mor

e of

ten,

cer

vica

l ca

ncer

is a

sym

ptom

atic

; hen

ce th

e ne

ed to

com

ply

with

the

scre

enin

g gu

idel

ines

.

Vid

eo (i

f ava

ilabl

e) o

n Pa

p’s sm

ear a

nd a

cetic

ac

id w

ash

Part

icip

ants

mus

t be

able

to

:•

Rat

iona

lize

the

impo

rtan

ce o

f cer

vica

l ca

ncer

scre

enin

g.•

Det

erm

ine

the

wom

en

who

nee

d to

be

furt

her m

anag

emen

t of s

uspi

ciou

s m

ass o

r any

abn

orm

aliti

es fo

und

durin

g th

e br

east

exam

inat

ion

52

Des

crib

e pe

rson

s who

will

nee

d pr

osta

te c

ance

r scr

eeni

ng.

Expl

ain

the

proc

edur

e of

dig

ital

Vid

eo (i

f ava

ilabl

e) o

n di

gita

l rec

tal e

xam

inat

ion

Part

icip

ants

mus

t be

able

to

:•

Prop

erly

adv

ise m

ale

clie

nts w

ho n

eed

to

Des

crib

e th

e w

omen

who

nee

d to

be

scre

ened

for c

ervi

cal c

ance

r.

Expl

ain

the

two

com

mon

scre

enin

g pr

oced

ures

for d

etec

ting

cerv

ical

ca

ncer

.

Des

crib

e ho

w to

instr

uct t

he w

oman

fo

r nee

ded

prep

arat

ion

prio

r to

the

proc

edur

e.

scre

ened

for c

ervi

cal

canc

er•

Expl

ain

to th

e w

omen

wha

t the

pr

oced

ure

will

ent

ail

and

the

prep

arat

ion

need

ed b

efor

e th

e ex

amin

atio

n.

• Pa

pani

cola

u or

Pap

’s sm

ear:;

do

ne a

mon

g•

Sexu

ally

act

ive

wom

en•

Virg

in w

omen

afte

r 35

year

s of a

ge•

Low

risk

wom

en w

ith

2 or

mor

e su

cces

sive

nega

tive

pap

smea

rs,

may

hav

e su

bseq

uent

sm

ears

eve

ry 2

-3 y

ears

• V

isual

insp

ectio

n w

ith

acet

ic a

cid

(VIA

)Pr

epar

atio

n ne

eded

bef

ore

the

the

proc

edur

es:

• sh

ould

not

dou

che

• no

intr

avag

inal

m

edic

atio

ns•

no se

xual

inte

rcou

rse

24

hour

s prio

r to

test

Pros

tate

Can

cer S

cree

ning

G

uide

lines

(Tar

get a

ge: s

tart

ing

at 5

0 ye

ars

old)

War

ning

sign

s of p

rosta

te c

ance

r in

clud

e sy

mpt

oms o

f ure

thra

l

53

flow

obs

truc

tion:

• U

rinar

y fre

quen

cy•

Noc

turia

• D

ecre

ase

in st

ream

• Po

st-vo

id d

ribbl

ing

• Ac

cord

ing

to A

mer

ican

C

ance

r Soc

iety

(201

0),

the

age

to b

egin

scre

enin

g us

ing

the

digi

tal r

ecta

l ex

amin

atio

n is

linke

d to

ris

k.•

Aver

age

risk

men

: age

50

• Fo

r hig

her r

isk m

en

e.g.

, firs

t deg

ree

rela

tive

with

pro

state

can

cer

befo

re a

ge 6

5 ye

ars:

age

45•

Mul

tiple

fam

ily

mem

bers

dia

gnos

ed

with

pro

state

can

cer

befo

re a

ge 6

5 ye

ars:

age

40•

Pros

tate

-spe

cific

ant

igen

(P

SA) d

eter

min

atio

n to

co

nfirm

dia

gnos

is in

DR

E

rect

al e

xam

inat

ion

Expl

ain

that

the

PSA

confi

rms

diag

nosis

from

DR

E.

unde

rgo

pros

tate

sc

reen

ing

thro

ugh

digi

tal r

ecta

l ex

amin

atio

n.

• D

escr

ibe

to th

e cl

ient

how

the

DR

E is

done

.

• R

atio

naliz

e w

hy P

SA

need

s to

be d

one.

54

Vid

eo (i

f ava

ilabl

e) o

n di

gita

l rec

tal e

xam

inat

ion

or si

gmoi

dosc

opy

Col

on/R

ecta

l Can

cer S

cree

ning

G

uide

lines

(for

mor

e th

an 5

0 ye

ars o

ld)

• W

arni

ng si

gns o

f col

orec

tal

canc

er: c

hang

e in

stoo

l, re

ctal

ble

edin

g, p

ress

ure

on

the

rect

um a

nd a

bdom

inal

pa

in•

Annu

al d

igita

l rec

tal e

xam

• An

nual

stoo

l blo

od te

st (fe

cal o

ccul

t blo

od te

st•

Insp

ectio

n of

col

on o

r fle

xibl

e sig

moi

dosc

opy

ever

y fiv

e ye

ars

Lung

Can

cer S

cree

ning

G

uide

lines

• Th

e fo

llow

ing

pers

ons

shou

ld u

nder

go lu

ng c

ance

r sc

reen

ing:

• Pe

rson

s with

long

hi

story

of s

mok

ing

and/

or sm

okin

g tw

o or

pa

cks o

f cig

aret

tes p

er

day

Des

crib

e th

e pe

ople

who

nee

d to

un

derg

o co

lore

ctal

can

cer s

cree

ning

.

Expl

ain

how

the

exam

inat

ions

are

do

ne a

nd th

e ne

cess

ary

prep

arat

ion

of c

lient

prio

r to

the

test.

Des

crib

e th

e pe

rson

s who

nee

ded

to u

nder

go lu

ng c

ance

r scr

eeni

ng.

Part

icip

ants

mus

t be

able

to

:

• Pr

oper

ly a

dvise

peo

ple

who

nee

d to

und

ergo

co

lore

ctal

scre

enin

g.•

Prov

ide

adeq

uate

ex

plan

atio

n re

gard

ing

the

proc

edur

es a

nd

prep

arat

ions

to th

e cl

ient

prio

r to

the

actu

al te

sts.

• Re

cogn

ize p

eopl

e w

ho

need

to u

nder

go lu

ng

canc

er sc

reen

ing.

• Pr

ovid

e ac

cura

te

expl

anat

ion

to

clie

nts r

egar

ding

the

55

proc

edur

es.

• Pr

ovid

e in

form

atio

n ne

cess

ary

to p

repa

re

patie

nt fo

r the

sc

reen

ing

proc

edur

e.

• C

hron

ic o

r nag

ging

co

ugh

• D

ull,

inte

rmitt

ent,

loca

lized

pai

n•

Hist

ory

of w

eigh

t los

s•

Che

st x-

ray

ever

y six

m

onth

s for

pat

ient

s who

ha

ve h

istor

y of

smok

ing

two

pack

s or m

ore

per d

ay•

Sput

um c

ytol

ogy:

serie

s of

thre

e ea

rly m

orni

ng

spec

imen

Des

crib

e th

e sc

reen

ing

proc

edur

es

and

the

nece

ssar

y pr

epar

atio

n of

pa

tient

s prio

r to

the

tests

.

56

M

odul

e O

bjec

tive

s

C

onte

nt

T

each

ing

Lear

ning

Act

ivit

ies

R

esou

rces

Ev

alua

tion

Mod

ule

3 Pr

omot

ing

Hea

lthy

Nut

riti

on

INT

RO

DU

CT

ION

MAG

NIT

UD

E O

F N

CD

s R

ELAT

ED T

O P

OO

R

DIE

TAR

Y P

RAC

TIC

ES

The

Phili

ppin

es is

one

of t

he 2

3 se

lect

ed c

ount

ries c

ontr

ibut

ing

to a

roun

d 80

% o

f the

tota

l m

orta

lity

burd

en a

ttrib

utab

le to

ch

roni

c di

seas

es in

dev

elop

ing

coun

trie

s, an

d 50

% o

f the

to

tal d

iseas

e bu

rden

cau

sed

by

nonc

omm

unic

able

dise

ases

w

orld

wid

e (W

HO

, 200

8).

7th

NN

HeS

(200

8) p

rovi

des

data

of i

ncre

asin

g pr

eval

ence

of

risk

fact

ors r

elat

ed to

die

t and

nu

triti

on a

mon

g Fi

lipin

os.

To in

trodu

ce th

e to

pic,

ask

the

part

icip

ants

to a

nsw

er th

e fo

llow

ing

ques

tion

usin

g m

etac

ards

:•

Wha

t do

you

perc

eive

to b

e th

e m

ost c

omm

on d

iseas

e/he

alth

co

nditi

ons i

n th

e co

mm

unity

th

at re

late

to p

oor d

ieta

ry a

nd

nutr

ition

pra

ctic

es?

• Is

ther

e a

diffe

renc

e or

cha

nge

in

dise

ase

patte

rns 5

-10

year

s ago

?•

Wha

t are

the

diet

and

nut

ritio

n-re

late

d pr

actic

es r

espo

nsib

le fo

r th

ese

dise

ase

cond

ition

s?

Sum

mar

ize a

nd sy

nthe

size

thei

r an

swer

s.

Show

and

com

pare

sele

cted

glo

bal,

regi

onal

and

loca

l epi

dem

iolo

gic

da

ta:

1.

Lead

ing

NC

Ds

2.

Fact

ors c

ontr

ibut

ing

to

incr

easin

g N

CD

Met

acra

dsSl

ide

pres

enta

tion

Part

icip

ants

mus

t be

able

to

:•

Stat

e th

e im

port

ance

of

NC

Ds a

s a p

ublic

he

alth

pro

blem

in th

e co

untr

y.•

Spec

ify th

e im

port

ant

risk

fact

ors t

hat

cont

ribut

e to

in

crea

sing

trend

of

NC

Ds i

n th

e co

untr

y•

Det

erm

ine

nutr

ition

an

d di

et-r

elat

ed ri

sk

fact

ors t

hat c

ontr

ibut

e to

the

incr

easin

g pr

eval

ence

of m

ajor

N

CD

s.

1.

Reco

gnize

the

mag

nitu

de

of N

CD

s rel

ated

to p

oor

diet

ary

prac

tices

.

572.

Disc

uss n

utrit

ion-

rela

ted

prac

tices

/ con

ditio

ns

lead

ing

to N

CD

.

a. I

ncre

ased

wei

ght

(obe

sity)

b.

Inc

reas

ed fa

t/

cho

leste

rol i

ntak

e

c. I

ncre

ased

salt

inta

ke

d. I

ncre

ased

inta

ke

of

pro

cess

ed/

pr

eser

ved/

insta

nt

food

s

e. In

adeq

uate

inta

ke o

f

d

ieta

ry fi

ber

NU

TR

ITIO

N -R

ELAT

ED

PR

OB

LEM

S LE

AD

ING

TO

N

CD

s

Fact

ors t

hat i

nflue

nce

the

incr

easin

g tre

nd o

f NC

D

wor

ldw

ide

incl

ude:

(FAO

,200

6)•

Incr

easin

g lif

e ex

pect

ancy

• In

crea

sing

urba

niza

tion

• In

crea

sing

indu

stria

lizat

ion

with

glo

baliz

atio

nTh

ese

cond

ition

s hav

e al

so

influ

ence

d th

e di

etar

y pr

actic

es

of th

e pe

ople

.

Food

Con

sum

ptio

n Su

rvey

co

nduc

ted

by th

e FN

RI (

FAO

, 20

06) r

evea

led:

• In

crea

sing

trend

of

over

nutr

ition

(ove

rwei

ght

or o

bese

) am

ong

child

ren,

ad

oles

cent

s and

adu

lts

cons

umpt

ion

from

1998

-20

03.

To in

trodu

ce th

e to

pic,

ask

pa

rtic

ipan

ts to

shar

e th

eir

obse

rvat

ions

rega

rdin

g nu

triti

on-

rela

ted

NC

Ds i

n th

e co

mm

unity

. As

k th

e fo

llow

ing

ques

tions

:1.

W

hat a

re th

e co

mm

on e

atin

g pr

actic

es o

r die

tary

hab

its in

th

e co

mm

unity

that

con

trib

ute

to N

CD

s?2.

W

hat

fact

ors i

nflue

nce

thes

e ea

ting

prac

tices

or d

ieta

ry h

abits

of

the

peop

le?

You

can

ask

part

icip

ants

to w

rite

thei

r ans

wer

s usin

g m

etac

ards

. Su

mm

arize

ans

wer

s. Sy

nthe

size

disc

ussio

n by

ana

lyzin

g th

e re

latio

nshi

p be

twee

n nu

triti

on-

rela

ted

prac

tices

and

soci

oeco

nom

ic

dete

rmin

ants

of h

ealth

.

Use

dat

a ci

ted

by P

edro

, Be

navi

des a

nd B

arba

in th

eir F

ood

Con

sum

ptio

n Su

rvey

(FAO

,200

6)

Met

acar

dsSl

ide

pres

enta

tion

Part

icip

ants

mus

t be

able

to

:•

Disc

uss e

xter

nal

influ

ence

s tha

t co

ntrib

ute

to

chan

ging

die

tary

pa

tters

of F

ilipi

nos.

• Ex

plai

n th

e re

latio

nshi

p of

di

etar

y pr

actic

es w

ith

incr

easin

g tre

nd o

f N

CD

.•

Cha

ract

erize

the

typi

cal F

ilipi

no d

iet

and

link

to in

cide

nce

of m

ajor

NC

Ds.

Cite

7th

NN

HeS

dat

a to

show

in

crea

sing

prev

alen

ce o

f risk

fact

ors

rela

ted

to d

iet a

nd n

utrit

ion

amon

g Fi

lipin

os.

58

• In

crea

sed

cons

umpt

ion

of

cere

al a

nd c

erea

l pro

duct

s in

clud

ing

brea

ds, b

aker

y pr

oduc

ts, n

oodl

es a

nd sn

ack

food

s fro

m fl

our

• In

crea

sed

inta

ke o

f sug

ar

and

syru

ps in

clud

ing

soft

drin

ks

• In

crea

sed

cons

umpt

ion

of fa

ts an

d oi

ls; m

eat a

nd

mea

t pr

oduc

ts in

whi

ch

near

ly 3

0% o

f mea

t int

ake

is pr

oces

sed

mea

t pro

duct

; po

ultr

y; m

ilk a

nd m

ilk

prod

ucts

as w

ell a

s alc

ohol

ic

beve

rage

s•

Dec

linin

g co

nsum

ptio

n of

ve

geta

bles

and

frui

ts

Obe

sity

asso

ciat

ed w

ith h

eart

at

tack

, stro

ke, d

iabe

tes a

nd

canc

er.

Hyp

erch

oles

tero

lem

ia is

link

ed

with

ath

eros

cler

osis,

pre

mat

ure

hear

t dise

ase

and

diab

etes

.

to sh

ow th

e ch

angi

ng p

atte

rns i

n fo

od c

onsu

mpt

ion

of F

ilipi

nos.

59

KEY

AR

EAS

AN

D G

ENER

AL

STR

ATEG

IES

FOR

P

RO

MO

TIN

G G

OO

D

NU

TR

ITIO

N A

ND

DIE

TAR

Y P

RAC

TIC

ES

Key

are

as o

f act

ions

for

prom

otin

g go

od n

utrit

ion

and

diet

ary

prac

tices

: (W

HO

, 200

8)•

Prom

ote

excl

usiv

e br

eastf

eedi

ng a

nd o

ptim

al

feed

ing

for i

nfan

ts an

d yo

ung

child

ren;

• D

evel

op a

nat

iona

l pol

icy

and

actio

n pl

an o

n fo

od a

nd

nutr

ition

that

also

cov

ers

cont

rol o

f die

t-rel

ated

non

-co

mm

unic

able

dise

ases

;•

Esta

blish

and

impl

emen

t fo

od-b

ased

die

tary

gu

idel

ines

and

supp

ort t

he

heal

thie

r com

posit

ion

of

Expl

ain

the

Key

Are

as o

f Act

ions

for

Prom

otin

g H

ealth

y D

iet a

s bas

is or

fra

mew

ork

for d

evel

opin

g str

ateg

ies

to p

rom

ote

good

nut

ritio

n an

d di

etar

y pr

actic

es.

Expl

ain

to th

e pa

rtic

ipan

ts th

at th

is ar

ea o

f act

ion

is ac

tual

ly e

labo

rate

d in

cur

rent

DO

H p

rogr

am o

n Br

eastf

eedi

ng In

fant

and

You

ng

Chi

ld F

eedi

ng.

Cite

effo

rts o

f DO

H a

nd a

llied

ag

enci

es li

ke th

e N

atio

nal N

utrit

ion

Cou

ncil

and

FNR

I-D

OST

tow

ards

th

is.

Disc

uss t

he fo

od g

uide

pyr

amid

s fo

r diff

eren

t age

gro

ups a

nd fo

r pr

egna

nt a

nd la

ctat

ing

wom

en th

at

have

bee

n de

velo

ped

by th

e FN

RI.

Slid

e pr

esen

tatio

n

Dai

ly F

ood

Gui

de

Pyra

mid

s of d

iffer

ent a

ge

grou

ps, p

regn

ant a

nd

lact

atin

g w

omen

Part

icip

ants

mus

t be

able

to

:•

Rela

te th

e ke

y ar

eas o

f ac

tion

in th

e co

ntex

t of

spec

ific

strat

egie

s fo

r pro

mot

ing

good

nu

triti

on a

nd d

ieta

ry

prac

tices

.•

Stat

e th

e th

ree

strat

egie

s to

prom

ote

heal

thy

nutr

ition

-re

late

d pr

actic

es.

Incr

ease

d sa

lt in

take

is re

late

d to

hyp

erte

nsio

n, c

ance

r, at

hero

scle

rosis

and

dia

bete

sIn

adeq

uate

die

tary

fibe

r is

rela

ted

to m

icro

-nut

rient

de

ficie

ncie

s and

col

on c

ance

r risk

3.

Des

crib

e ke

y ar

eas a

nd

gene

ral s

trat

egie

s to

prom

ote

good

nut

ritio

n an

d di

etar

y pr

actic

es

60

Expl

ain

the

impo

rtan

ce o

f edu

catin

g th

e co

nsum

ers o

n re

adin

g fo

od

labe

ls.

Giv

e ex

ampl

es o

f cur

rent

har

mfu

l ad

vert

ising

pra

ctic

es th

at in

fluen

ce

pare

nts a

nd c

hild

ren

to c

onsu

me

unhe

alth

y fo

ods.

Prov

ide

exam

ples

of

food

s tha

t are

hig

h in

satu

rate

d fa

ts, tr

ans-

fatty

aci

ds, f

ree

suga

rs

or sa

lt th

at a

re p

opul

ar a

mon

g co

nsum

ers e

spec

ially

chi

ldre

n.

food

by:

• re

duci

ng sa

lt le

vels

• el

imin

atin

g in

dustr

ially

pr

oduc

ed t

rans

-fatty

ac

ids

• de

crea

sing

satu

rate

d fa

ts•

limiti

ng fr

ee su

gars

• in

clud

ing

mor

e of

di

etar

y fib

er•

Prov

ide

accu

rate

and

ba

lanc

ed in

form

atio

n fo

r co

nsum

ers i

n or

der t

o en

able

them

to m

ake

wel

l-in

form

ed, h

ealth

y fo

od

choi

ces;

• Pr

omot

e th

e re

spon

sible

m

arke

ting

of fo

ods a

nd

beve

rage

s to

child

ren,

in

orde

r to

redu

ce th

e im

pact

of

food

s hig

h in

satu

rate

d fa

ts, tr

ans-

fatty

aci

ds, f

ree

suga

rs, o

r sal

t.

The

follo

win

g ar

e th

e th

ree

mai

n str

ateg

ies t

o ad

dres

s nu

triti

on-r

elat

ed p

robl

ems a

nd

prac

tices

:

61a. A

im fo

r ide

al b

ody

wei

ght

Man

agin

g w

eigh

tO

besit

y oc

curs

whe

n a

pers

on’s

wei

ght i

s 20%

or m

ore

of th

e id

eal b

ody

wei

ght.

• Re

cogn

ize e

atin

g pa

ttern

by

kee

ping

a fo

od d

iary

. Fo

od d

iary

is a

reco

rd o

f fo

od e

aten

dai

ly, h

ow m

any

serv

ings

, and

how

the

pers

on

feel

s at t

his t

ime

• Be

aw

are

of th

e to

tal e

nerg

y al

low

ance

or c

alor

ic/e

nerg

y nu

trie

nt re

quire

men

t bas

ed

on a

ge, h

eigh

t, ty

pe o

f ac

tivity

, phy

siolo

gic

and

dise

ase

cond

ition

of t

he

body

Expl

ain

how

to c

ompu

te fo

r one

’s id

eal o

r des

ired

body

wei

ght.

DB

W =

Des

irab

le B

MI

x H

(m)²

Prov

ide

the

part

icip

ants

the

form

ula

and

ask

each

to c

ompu

te fo

r the

ir id

eal o

r des

ired

body

wei

ght.

Allo

w e

ach

to d

eter

min

e ex

cess

or

defic

ienc

y fro

m th

eir i

deal

or d

esire

d bo

dy w

eigh

t.

Disc

uss t

he u

se o

f a fo

od d

iary

in

anal

yzin

g on

e’s e

atin

g pa

ttern

. The

food

dia

ry is

a to

ol to

mon

itor f

ood

inta

ke/c

onsu

mpt

ion.

Stat

e th

at th

e di

ary

prov

ides

a

poss

ible

exp

lana

tion

of h

ow a

pe

rson

look

s at f

ood.

Is it

a so

urce

of

nou

rishm

ent o

r som

ethi

ng to

fu

lfill

a pa

rtic

ular

em

otio

nal o

r ps

ycho

logi

cal n

eed?

Use

App

endi

x 3.

1a o

f the

M

odul

e fo

r exa

mpl

e on

es

timat

ing

DBW

. Ref

er

to H

andb

ook

on F

ood

Exch

ange

List

s for

Mea

l Pl

anni

ng.

(FN

RI-

DO

ST

1994

)

• C

ompu

te fo

r ide

al

body

wei

ght

Use

the

Food

Dia

ry

Form

in A

ppen

dix

3.6

of M

odul

e 3

as g

uide

to

mon

itor f

ood

inta

ke

• An

alyz

e ea

ting

patte

rn

thro

ugh

the

use

of

food

dia

ry

• D

o no

t try

to lo

se w

eigh

t fa

stD

iscus

s how

to c

ompu

te fo

r ca

loric

requ

irem

ent o

r tot

al e

nerg

y al

low

ance

bas

ed o

n D

BW a

nd

activ

ity:

Use

App

endi

x 3.

1b o

f M

odul

e 3

as g

uide

to

com

pute

for t

otal

cal

oric

• C

ompu

te fo

r tot

al

ener

gy a

llow

ance

ba

sed

on D

BW a

nd

62

• As

k ea

ch p

artic

ipan

t to

com

pute

fo

r the

ir to

tal e

nerg

y al

low

ance

/ ca

loric

requ

irem

ent b

ased

on

thei

r com

pute

d D

BW a

nd

activ

ity.

• In

struc

t the

m to

mon

itor t

heir

food

con

sum

ptio

n by

filli

ng u

p fo

od d

iarie

s fro

m D

ay 1

. •

Use

the

data

to a

naly

ze fo

od

cons

umpt

ion

base

d on

thei

r to

tal e

nerg

y al

low

ance

or f

ood

pyra

mid

gui

de.

Emph

asize

to th

e pa

rtic

ipan

ts th

at

in m

anag

ing

wei

ght,

one

shou

ld

calc

ulat

e hi

s die

t bas

ed o

n hi

s ide

al

or d

esire

d bo

dy w

eigh

t and

type

of

activ

ity h

e da

ily e

ngag

es in

.

Expl

ain

the

poss

ible

har

m o

f fad

di

etin

g. E

mph

asize

the

need

to

coup

le e

xerc

ise w

ith se

nsib

le e

atin

g.

b. B

uild

hea

lthy

nutr

ition

pra

ctic

esBu

ild h

ealth

y nu

triti

on-r

elat

ed

prac

tices

Cha

ngin

g fo

od c

onsu

mpt

ion

patte

rns i

s a re

sult

of

Brie

fly d

iscus

s the

influ

ence

s on

peop

le’s d

ieta

ry p

atte

rns.

Ask

• U

ses t

he d

aily

food

gu

ide

to p

lan

mea

ls

requ

irem

ent o

r ene

rgy

allo

wan

ce b

ased

on

DBW

and

act

ivity

. Re

fer t

o H

andb

ook

on

Food

Exc

hang

e Li

sts fo

r M

eal P

lann

ing.

(FN

RI-

DO

ST 1

994)

Food

dia

ry fo

rm

activ

ity•

Anal

yze

exce

ss o

r de

ficie

ncy

in c

alor

ic

inta

ke b

ased

on

TEA

or

reco

mm

ende

d di

et.

63

Refe

r to

Appe

ndix

3.2

on

mor

e de

taile

d de

scrip

tion

of th

e m

ajor

and

mic

ro

nutr

ient

s and

thei

r fu

nctio

ns.

• #1

Eat

a v

arie

ty o

f foo

d ev

eryd

ay

Poin

t out

that

the

Nut

ritio

nal

Gui

delin

es fo

r Fili

pino

s (FN

RI,

2001

) aim

s to

enco

urag

e co

nsum

ptio

n of

an

adeq

uate

and

w

ell-b

alan

ced

diet

whi

le p

rom

otin

g de

sirab

le fo

od a

nd n

utrit

ion

prac

tices

. Gui

delin

es #

1, 3

, 4, 5

, 6

and

8 re

late

to N

CD

pre

vent

ion

and

cont

rol.

Refe

r to

the

Food

Gui

de P

yram

id

(Fig

ure

3.1

and

Appe

ndix

3.3

fo

r the

Foo

d G

uide

Pyr

amid

s of

diffe

rent

age

gro

ups i

nclu

ding

pr

egna

nt a

nd la

ctat

ing

wom

en) a

s ba

ses o

f foo

d to

be

cons

umed

and

th

e re

quire

d se

rvin

gs

glob

aliza

tion

and

high

-spe

ed

com

mun

icat

ion

and

tech

nolo

gy.

• “E

atin

g rig

ht”

mea

ns

eatin

g fo

od th

at c

onta

in

esse

ntia

l nut

rient

s nec

essa

ry

to p

rovi

de th

e bo

dy w

ith

ener

gy n

eces

sary

to p

erfo

rm

one’s

dai

ly a

ctiv

ities

, bui

ld

and

repa

ir bo

dy ti

ssue

s, an

d re

gula

te b

odily

pro

cess

ess.

• Fo

llow

nut

ritio

nal g

uide

lines

fo

r Fili

pino

s rec

omm

ende

d by

FN

RI e

spec

ially

:

part

icip

ants

to c

ite e

xam

ples

.

Show

Tab

le 3

.2 N

utrie

nts a

nd Th

eir

Func

tions

from

Mod

ule

3.

Base

d on

the

calo

ric/e

nerg

y nu

trie

nt

requ

irem

ent,

ask

each

par

ticip

ant t

o m

ake

own

mea

l pla

n th

at sa

tisfie

s ph

ysio

logi

c de

man

ds, l

ifesty

le a

nd

food

pre

fere

nces

.

vis-

à-vi

s tot

al e

nerg

y al

low

ance

or f

ood

pyra

mid

gui

de.

64

#3 M

aint

ain

child

ren’s

nor

mal

gr

owth

thro

ugh

prop

er d

iet a

nd

mon

itor t

heir

grow

th re

gula

rly

#4 C

onsu

me

fish,

lean

mea

t, po

ultr

y, dr

ied

bean

s #5

Eat

mor

e ve

geta

bles

, fru

its a

nd

root

cro

ps

#6 E

at fo

ods c

ooke

d in

edi

ble/

co

okin

g oi

l dai

ly

Des

crib

e th

e re

com

men

ded

daily

se

rvin

gs o

f veg

etab

les,

fruits

and

ro

ot c

rops

in th

e m

eals.

Diff

eren

tiate

the

type

s of f

ats/

chol

este

rol a

nd th

eir f

unct

ions

.

Disc

uss t

he fo

od p

repa

ratio

n tip

s an

d ho

w to

lim

it in

take

of s

atur

ated

fa

ts. S

tate

the

reco

mm

ende

d ch

oles

tero

l int

ake

of 3

00 m

g da

ily.

Prov

ide

exam

ples

of c

ooki

ng a

nd

eatin

g ha

bits

that

dem

onstr

ate

Refe

r to

Appe

ndix

3.4

of

Mod

ule

3 fo

r exa

mpl

es

on F

ilipi

no fo

ods

clas

sified

acc

ordi

ng to

ch

oles

tero

l con

tent

Food

Pyr

amid

Gui

des f

or

Ages

1-6

and

7-1

2 in

Ap

pend

ix 3

.3

Hig

hlig

ht th

e pr

oble

m o

f ove

r-ea

ting

and

poor

nut

ritio

n ha

bits

amon

g ch

ildre

n as

impo

rtan

t co

ncer

ns re

late

d to

the

NC

Ds.

Emph

asize

the

need

to o

bser

ve

guid

elin

es in

fish

, mea

t, po

ultr

y an

d eg

g co

nsum

ptio

n in

ord

er to

lim

it in

take

of f

ats a

nd c

hole

stero

l pre

sent

in

thes

e fo

ods.

Refe

r to

Appe

ndix

3.

3.

65

Refe

r to

Appe

ndix

3.5

of

Mod

ule

3 fo

r exa

mpl

es o

f fo

ods h

igh

in so

dium

.

exce

ssiv

e us

e of

salt

amon

g Fi

lipin

os.

Dra

w fr

om p

artic

ipan

ts’ o

wn

expe

rienc

es p

ract

ical

alte

rnat

ives

to

use

of s

alt t

o en

hanc

e fla

vor a

nd

taste

of f

ood.

Put

em

phas

is on

lim

iting

salt

inta

ke to

5 g

ram

s/da

y or

2,0

00 m

g so

dium

.

Gui

delin

e #1

0 ca

ptur

es a

ll th

e ar

eas

esse

ntia

l for

pro

mot

ing

heal

thy

lifes

tyle

. Ref

er p

artic

ipan

ts to

the

rest

of th

e m

odul

es in

the

man

ual.

Disc

uss w

ith th

e pa

rtic

ipan

ts th

at

food

is c

onsid

ered

hea

lthy

if th

ey

are:

• Lo

w in

fat a

nd c

hole

stero

l•

Low

in so

dium

• Lo

w in

sim

ple

carb

ohyd

rate

s•

Hig

h in

com

plex

car

bohy

drat

es

and

diet

ary

fiber

c. C

hoos

e fo

ods w

isely

Cho

ose

food

s wise

ly

• Re

cogn

ize fo

ods t

o lim

it/av

oid.

Sel

ect f

oods

low

in

fats

and

chol

este

rol a

nd

sodi

um a

nd h

igh

in c

ompl

ex

Disc

uss i

mpo

rtan

ce o

f rea

ding

food

la

bels.

Exp

lain

the

steps

in re

adin

g fo

od la

bels.

Brin

g fo

od la

bels

of

popu

lar f

ood

prod

ucts

to a

llow

Slid

e/po

wer

poin

t pr

esen

tatio

n

Sam

ple

food

labe

ls

• In

terp

ret f

ood

labe

ls.

#8 U

se io

dize

d sa

lt bu

t avo

id

exce

ssiv

e in

take

of s

alty

food

s

#10

For

a h

ealth

y lif

esty

le a

nd

good

nut

ritio

n, e

xerc

ise re

gula

rly,

do n

ot sm

oke,

and

avo

id

drin

king

alc

ohol

ic b

ever

ages

66

Expl

ain

to th

e pa

rtic

ipan

ts th

e ne

ed to

be

care

ful i

n re

com

men

ding

die

ts to

clie

nts

with

spec

ific

dise

ase

cond

ition

s.

Die

ts sh

ould

be

foun

ded

on

evid

ence

s.

• D

escr

ibe

spec

ial

diet

s for

peo

ple

with

sp

ecifi

c ch

roni

c N

CD

s.

4.

Disc

uss d

ieta

ry

reco

mm

enda

tions

for

spec

ific

dise

ase

cond

ition

s su

ch a

s hyp

erte

nsio

n,

diab

etes

mel

litus

, et

c.

DIE

TAR

Y R

ECO

MM

END

ATIO

NS

FOR

SPE

CIF

IC D

ISEA

SE

CO

ND

ITIO

NS

Ther

e ar

e sp

ecifi

c di

etar

y re

com

men

datio

ns fo

r peo

ple

with

hyp

erte

nsio

n, h

eart

di

seas

es, d

iabe

tes a

nd o

ther

N

CD

s. Th

e tw

o gu

idel

ines

be

low

are

bas

ed o

n ev

iden

ce-

base

d stu

dies

and

are

safe

to

reco

mm

end

to o

ur c

lient

s.

Slid

e pr

esen

tatio

n

carb

ohyd

rate

s and

die

tary

fib

er.

• Re

adin

g fo

od la

bels

is an

im

port

ant p

ract

ice

whe

n se

lect

ing

food

s. F

ood

labe

ls pr

ovid

e in

form

atio

n to

eva

luat

e fo

ods.

• H

ow fo

od is

pre

pare

d/co

oked

is a

lso im

port

ant;

avoi

d fri

ed fo

ods,

grav

y, bu

tter;

use

corn

, soy

bean

, ca

nola

or s

unflo

wer

oil

prac

tice.

Dra

w o

ut fr

om th

e pa

rtic

ipan

ts pr

actic

al w

ays o

f kee

ping

the

food

he

alth

y an

d nu

triti

ous.

67

Des

crib

e the

char

acte

ristic

of

DAS

H th

at h

elps

in

redu

cing

blo

od p

ress

ures

.

Expl

ain

the

basis

for d

evel

opin

g th

e gu

idel

ines

. D

escr

ibe

the

reco

mm

ende

d da

ily a

llow

ance

, foo

d se

lect

ion

and

prep

arat

ion

guid

e.

Disc

uss t

he c

hara

cter

istic

of D

ASH

an

d ho

w it

hel

ps in

redu

cing

blo

od

pres

sure

s.

How

ever

, the

re a

re c

lient

co

nditi

ons w

here

it is

mor

e pr

uden

t to

refe

r the

m to

nu

triti

onist

/die

titia

ns.

Die

tary

App

roac

hes t

o St

op

Hyp

erte

nsio

n (D

ASH

)•

Evid

ence

-bas

ed st

udy

(NIH

, 20

06)

• C

hara

cter

istic

s •

low

in sa

tura

ted

fat,

chol

este

rol,

and

tota

l fat

• em

phas

izes f

ruits

, ve

geta

bles

, and

• fa

t-fre

e or

low

-fat m

ilk

and

milk

pro

duct

s

Nut

riti

onal

Gui

delin

es fo

r th

e Pr

even

tion

of H

eart

Dis

ease

s an

d D

M (F

NR

I-D

OST

).•

Dev

elop

ed in

resp

onse

to th

e gr

owin

g nu

mbe

r of F

ilipi

nos

with

DM

and

hea

rt d

iseas

es.

• H

ighl

ight

s the

follo

win

g:•

Eat f

oods

low

in fa

t and

ch

oles

tero

l•

Incr

ease

inta

ke o

f fibe

r-ric

h fo

ods i

n th

e da

ily

diet

Book

let o

n N

utrit

iona

l G

uide

lines

for t

he

Prev

entio

n of

Hea

rt

Dise

ases

and

Dia

bete

s M

ellit

us (F

NR

I-D

OST

, 20

02)

• D

escr

ibe

the

spec

ific

diet

ary

guid

elin

es

in th

e pr

even

tion

of

hear

t dise

ases

and

D

M.

68

• Pe

rform

nut

ritio

n ed

ucat

ion

and

coun

selin

g to

di

ffere

nt p

opul

atio

n gr

oups

5.

Perfo

rm n

utrit

ion

educ

atio

n an

d co

unse

ling

to sp

ecifi

c po

pula

tion

grou

ps

NU

TR

ITIO

N E

DU

CAT

ION

A

ND

CO

UN

SELI

NG

Resp

onsib

ilitie

s of a

hea

lth

wor

ker i

n pr

omot

ing

heal

thy

nutr

ition

in th

e co

mm

unity

:•

Hea

lth e

duca

tion

to

diffe

rent

pop

ulat

ion

grou

ps•

Asse

ssm

ent o

f risk

fact

ors

for w

eigh

t pro

blem

s and

nu

triti

on-r

elat

ed p

ract

ices

• Sc

reen

ing

for n

utrit

ion-

rela

ted

cond

ition

s suc

h as

hy

pert

ensio

n, d

yslip

idem

ia

and

DM

• C

ouns

elin

g fo

r risk

m

odifi

catio

n•

Advo

catin

g fo

r a su

ppor

tive

envi

ronm

ent w

here

hea

lthy

food

is a

vaila

ble

and

affor

dabl

e.

Disc

uss t

he si

x re

spon

sibili

ties o

f the

he

alth

wor

ker i

n pr

omot

ing

heal

thy

nutr

ition

.

Refe

r par

ticip

ants

to th

e us

e of

ap

prop

riate

food

pyr

amid

gui

des

whe

n pr

ovid

ing

nutr

ition

edu

catio

n to

diff

eren

t pop

ulat

ion

grou

ps.

Refe

r par

ticip

ants

to o

ther

sect

ions

of

the

man

ual f

or ri

sk fa

ctor

as

sess

men

t and

scre

enin

g (M

odul

e 2)

.

Disc

uss t

he p

rinci

ples

in p

lann

ing

nutr

ition

edu

catio

n an

d co

unse

ling.

Ask

part

icip

ants

to sh

are

pers

onal

ex

perie

nces

in c

ondu

ctin

g nu

triti

on

educ

atio

n.

Slid

e pr

esen

tatio

n•

Disc

uss t

he

resp

onsib

ilitie

s of

a he

alth

wor

ker i

n pr

omot

ing

heal

thy

nutr

ition

in th

e co

mm

unity

.

• Li

mit

inta

ke o

f sal

ty

food

s•

Regu

late

alc

ohol

inta

ke

69

Hyp

othe

tical

situ

atio

ns

Food

pyr

amid

gui

de

char

tsC

arto

lina,

col

ored

pap

ers

or c

onstr

uctio

n pa

pers

fo

r add

ition

al v

isual

aid

sM

arki

ng p

ens

Mat

eria

ls fo

r pos

ting

teac

hing

aid

s

6.

Advo

cate

for a

nut

ritio

n-fri

endl

y e

nviro

nmen

t•

Cam

paig

n fo

r nu

triti

on-fr

iend

ly

esta

blish

men

ts in

sc

hool

s, w

ork-

plac

es

and

othe

r set

tings

in

the

com

mun

ity•

Prom

ote

heal

thy

nutr

ition

pol

icie

s•

Prom

ote

avai

labi

lity

of

heal

thy

food

sour

ces i

n th

e co

mm

unity

AD

VO

CAT

ING

FO

R A

N

UT

RIT

ION

-FR

IEN

DLY

EN

VIR

ON

MEN

TTh

e en

viro

nmen

t pla

ys a

maj

or

role

in in

fluen

cing

nut

ritio

n-re

late

d be

havi

or.

Effor

ts to

cr

eate

a n

utrit

ion-

frien

dly

envi

ronm

ent f

ocus

on

the

follo

win

g: •

Hea

lthy

nutr

ition

in th

e sc

hool

s, w

orkp

lace

and

oth

er

setti

ngs

• Ad

voca

ting

for h

ealth

y nu

triti

on p

olic

ies

• Fo

od p

rodu

ctio

n pr

ogra

m

Cal

l to

min

d th

e co

ncep

t of

heal

th p

rom

otio

n as

con

sistin

g of

edu

catio

nal s

trat

egie

s and

cr

eatin

g a

supp

ortiv

e en

viro

nmen

t fo

r pro

mot

ing

heal

thy

lifes

tyle

s. C

reat

ing

chan

ges i

n th

e en

viro

nmen

t is

equa

lly im

port

ant a

s beh

avio

r ch

ange

s.

Div

ide

part

icip

ants

into

thre

e gr

oups

. As

sign

them

into

the

follo

win

g se

tting

s: sc

hool

, wor

kpla

ce

and

com

mun

ity.

Ask

each

gro

up to

an

swer

the

follo

win

g:

Met

acar

ds•

Reco

mm

end

spec

ific

strat

egie

s in

adv

ocat

ing

for a

nu

triti

on-fr

iend

ly

envi

ronm

ent i

n di

ffere

nt se

tting

s.

Prin

cipl

es in

pla

nnin

g nu

triti

on

educ

atio

n an

d co

unse

ling

of

diffe

rent

pop

ulat

ion

grou

ps:

• As

sess

lear

ning

nee

ds a

nd

read

ines

s to

lear

n•

Sele

ct le

arni

ng a

ctiv

ities

• C

reat

e a

posit

ive

clim

ate

for l

earn

ing

• Ev

alua

te le

arni

ng o

utco

mes

Cre

ate

hypo

thet

ical

situ

atio

ns a

nd

ask

sele

cted

par

ticip

ants

to p

erfo

rm

role

pla

ys.

Org

anize

par

ticip

ants

to c

ondu

ct

nutr

ition

edu

catio

n to

spec

ific

popu

latio

n gr

oups

in th

e co

mm

unity

.

70

• G

ive

spec

ific

reco

mm

enda

tions

to

impr

ove

heal

thy

nutr

ition

pr

actic

es in

the

thre

e se

tting

s•

Reco

mm

end

spec

ific

polic

ies

that

a h

ealth

wor

ker c

an

prop

ose

to th

e pr

inci

pal,

man

ager

or l

ocal

gov

ernm

ent

exec

utiv

e to

che

ck u

nhea

lthy

nutr

ition

pra

ctic

es.

• Id

entif

y pr

actic

al a

nd re

alist

ic

appr

oach

es to

incr

easin

g fo

od

avai

labi

lity.

Ask

part

icip

ant t

o w

rite

answ

ers

in m

etac

ards

. Sum

mar

ize a

nd

synt

hesiz

e di

scus

sion.

71Mod

ule

4 Pr

omot

ing

Phys

ical

Act

ivit

y

M

odul

e O

bjec

tive

s

C

onte

nt

T

each

ing

Lear

ning

Act

ivit

ies

R

esou

rces

Ev

alua

tion

1.

Reco

gnize

the

mag

nitu

de o

f N

CD

pro

blem

s rel

ated

to

sede

ntar

y lif

esty

le

EPID

EMIO

LOG

Y O

F M

AJO

R

NC

Ds R

ELAT

ED T

O L

ACK

O

F PH

YSIC

AL

ACT

IVIT

Y

WH

O e

stim

ates

that

aro

und

1.9

mill

ion

peop

le d

ie e

ach

year

as a

re

sult

of p

hysic

al in

activ

ity.

60%

of w

orld

’s po

pula

tion

fail

to

com

plet

e re

com

men

ded

phys

ical

ac

tivity

requ

ired

to in

duce

hea

lth

bene

fits

Phys

ical

inac

tivity

is a

maj

or

risk

fact

or fo

r cor

onar

y ar

tery

di

seas

e an

d in

crea

ses t

he ri

sk o

f ob

esity

, low

HD

L le

vels

or g

ood

chol

este

rol,

high

blo

od p

ress

ure,

str

oke

and

diab

etes

mel

litus

.

Disc

uss t

he p

ublic

hea

lth

signi

fican

ce o

f NC

Ds a

ssoc

iate

d w

ith p

hysic

al in

activ

ity.

Allo

w o

pen

disc

ussio

n on

the

econ

omic

and

soci

al im

plic

atio

ns

of N

CD

s ass

ocia

ted

with

phy

sical

in

activ

ity a

nd se

dent

ary

lifes

tyle

.

Part

icip

ants

mus

t be

able

to

:•

Iden

tify

the

lead

ing

NC

Ds a

ssoc

iate

d to

se

dent

ary

lifes

tyle

.•

Disc

uss t

he e

cono

mic

an

d so

cial

impa

ct o

f N

CD

s ass

ocia

ted

to

sede

ntar

y lif

esty

le.

Slid

e pr

esen

tatio

n

72

BEN

EFIT

S O

F R

EGU

LAR

PH

YSIC

AL

ACT

IVIT

Y

Phys

ical

act

ivity

is a

ssoc

iate

d w

ith

• de

crea

sed

risk

of

card

iova

scul

ar d

iseas

e•

incr

ease

d lif

e ex

pect

ancy

It pr

oduc

es o

vera

ll ph

ysic

al,

psyc

holo

gica

l and

soci

al b

enefi

ts.

Disc

uss b

enefi

ts of

regu

lar p

hysic

al

activ

ity.

Cite

sele

cted

cas

e stu

dies

ta

ken

from

revi

ew o

f lite

ratu

re a

nd

best

prac

tices

.

Part

icip

ants

mus

t be

able

to

:•

Disc

uss b

enefi

ts of

ph

ysic

al a

ctiv

ity.

Slid

e pr

esen

tatio

n

Cas

e stu

dies

2.

Expl

ain

the

bene

fits o

f ph

ysic

al a

ctiv

ity

3.

Disc

uss t

he p

rinci

ples

an

d sa

fety

gui

delin

es fo

r pr

omot

ing

phys

ical

act

ivity

PR

INC

IPLE

S A

ND

SA

FET

Y G

UID

ELIN

ES F

OR

P

RO

MO

TIN

G P

HYS

ICA

L AC

TIV

ITY

Prom

otin

g ph

ysic

al a

ctiv

ity

mea

ns im

prov

ing

perfo

rman

ce o

f da

ily a

ctiv

ities

.

Prin

cipl

es in

pro

mot

ing

phys

ical

ac

tivity

• FI

T p

rinci

ple

for e

xerc

ise

effec

tiven

ess

• M

onito

ring

exer

cise

inte

nsity

Diff

eren

tiate

phy

sical

act

ivity

from

ex

erci

se.

Expl

ain

the

prin

cipl

es in

pro

mot

ing

phys

ical

act

ivity

.

Des

crib

e th

e fa

ctor

s tha

t mak

e up

the

FIT

prin

cipl

e –

frequ

ency

,

Slid

e pr

esen

tatio

nPa

rtic

ipan

ts m

ust b

e ab

le

to:

• D

iffer

entia

te p

hysic

al

activ

ity fr

om e

xerc

ise•

Expl

ain

the

prin

cipl

es

in p

rom

otin

g ph

ysic

al

activ

ity.

73

Safe

ty g

uide

lines

whe

n im

plem

entin

g ph

ysic

al a

ctiv

ity

prog

ram

s:•

War

m-u

p an

d co

ol d

own

• C

omm

on ri

sks

• N

orm

al sy

mpt

oms

• N

eed

for m

edic

al

eval

uatio

n•

Phili

ppin

e N

atio

nal

Gui

delin

es o

n Ph

ysic

al

Activ

ity, 2

010

Disc

uss g

ener

al a

nd sp

ecifi

c gu

idel

ines

in im

plem

entin

g ph

ysic

al

activ

ity to

ach

ieve

hea

lth b

enefi

ts.

• D

iscus

s gui

delin

es

for p

hysic

al a

ctiv

ity

to a

chie

ve h

ealth

be

nefit

s.

inte

nsity

and

tim

e of

exe

rcise

.

Expl

ain

how

to m

onito

r exe

rcise

in

tens

ity b

y co

mpu

ting

targ

et

exer

cise

hea

rt ra

te.

Allo

w

part

icip

ants

to p

ract

ice

on

com

putin

g ta

rget

exe

rcise

hea

rt ra

te

and

dete

rmin

ing

whe

ther

they

are

ab

le to

ach

ieve

this

hear

t rat

e af

ter

an o

rgan

ized

phys

ical

act

ivity

.

Pape

r & p

enci

lSt

opw

atch

• C

ompu

te fo

r tar

get

exer

cise

hea

rt ra

te.

• C

ount

pul

se ra

te

befo

re a

nd a

fter

exer

cise

4.

Des

crib

e th

e re

com

men

ded

guid

elin

es fo

r pro

mot

ing

phys

ical

act

ivity

am

ong

diffe

rent

age

gro

ups.

REC

OM

MEN

DED

G

UID

ELIN

ES F

OR

P

RO

MO

TIN

G P

HYS

ICA

L AC

TIV

ITY

AM

ON

G

DIF

FER

ENT

AG

E G

RO

UP

S

74

5.

Perfo

rm st

rate

gies

to

prom

ote

phys

ical

act

ivity

am

ong

diffe

rent

age

PR

OM

OT

ING

PH

YSIC

AL

ACT

IVIT

Y IN

DIF

FER

ENT

SE

TT

ING

S

Disc

uss w

ith th

e pa

rtic

ipan

ts th

e di

ffere

nt g

uide

lines

that

are

ava

ilabl

e to

the

heal

th w

orke

r who

is p

lann

ing

phys

ical

act

ivity

pro

gram

s for

di

ffere

nt a

ge g

roup

s. O

f par

ticul

ar

help

will

be T

able

4.1

of M

odul

e 4

whi

ch h

ighl

ight

s the

spec

ific

activ

ity

appr

opria

te fo

r eac

h ag

e gr

oup.

Slid

e pr

esen

tatio

nPa

rtic

ipan

ts m

ust b

e ab

le

to:

• D

esig

n ph

ysic

al

activ

ity p

rogr

am fo

r a

spec

ific

age-

grou

p ba

sed

on g

uide

lines

.

Reco

mm

ende

d gu

idel

ines

for

each

age

gro

up:

• C

hild

ren

• Ad

ults

• O

lder

adu

lts

Phys

ical

act

ivity

pre

scrip

tions

•

Chi

ldre

n•

Adol

esce

nts t

o yo

ung

adul

ts•

Adul

ts•

Old

er a

dults

• Se

nior

s

Type

s of p

hysic

al a

ctiv

ity:

• Ac

tive

daily

task

s•

Prog

ram

med

phy

sical

ac

tivity

• H

igh

impa

ct p

lay

• M

uscl

e str

engt

heni

ng a

nd

flexi

bilit

y•

Activ

ities

in th

e w

orkp

lace

• Ba

lanc

e an

d co

ordi

natio

n

75

Prov

ide

exam

ples

of w

orkp

lace

-ba

sed

phys

ical

act

iviti

es•

Stre

tchi

ng e

xerc

ises

Giv

e ex

ampl

es o

f com

mun

ity-

base

d ph

ysic

al a

ctiv

ities

• Ba

llroo

m d

anci

ng fo

r the

old

er

adul

ts•

Aero

bics

for w

omen

• Sp

orts

for m

en a

nd a

dole

scen

ts

Prov

ide

exam

ples

of s

choo

l-bas

ed

phys

ical

act

iviti

es•

Filip

ino

outd

oor g

ames

• Is

omet

ric e

xerc

ises

Slid

e pr

esen

tatio

n

Vid

eo o

f phy

sical

ac

tiviti

es/ e

xerc

ise

regi

men

s app

ropr

iate

for

diffe

rent

setti

ngs a

nd a

ge

grou

ps

Part

icip

ants

are

able

to:

• Fo

rmul

ate

a ph

ysic

al

activ

ity p

lan

for a

sp

ecifi

c po

pula

tion

grou

p or

setti

ng.

grou

ps in

diff

eren

t set

tings

:•

scho

ol-b

ased

pop

ulat

ion

• w

orkp

lace

pop

ulat

ion

• co

mm

unity

-bas

ed

popu

latio

n

Prom

otin

g ph

ysic

al a

ctiv

ity in

sc

hool

s sho

uld

cons

ider

:•

enjo

yabl

e pa

rtic

ipat

ion

• di

vers

e ra

nge

of n

on-

com

petit

ive

and

com

petit

ive

activ

ities

• pr

ovid

ing

skill

s and

co

nfide

nce

need

ed to

be

phys

ical

ly a

ctiv

e•

coor

dina

ted

scho

ol h

ealth

–c

omm

unity

pro

gram

s

Prom

otin

g ph

ysic

al a

ctiv

ity in

th

e w

orkp

lace

con

sider

s:•

occu

patio

nal r

isks o

f lim

ited

phys

ical

act

ivity

• pr

ovid

ing

polic

ies f

acili

ties

and

envi

ronm

ent t

hat

supp

ort r

egul

ar p

hysic

al

activ

ity p

rogr

ams

Prom

otin

g ph

ysic

al a

ctiv

ity in

th

e co

mm

unity

con

sider

s the

di

vers

ity o

f tot

al p

opul

atio

n gr

oup.

76

Slid

e pr

esen

tatio

nPa

rtic

ipan

ts m

ust b

e ab

le

to:

• Ex

plai

n th

e ai

ms

of re

gula

r phy

sical

ac

tivity

pro

gram

for

clie

nts w

ith c

hron

ic

cond

ition

s.•

Reco

gnize

the

impo

rtan

ce o

f med

ical

re

com

men

datio

n be

fore

pre

scrib

ing

or

plan

ning

a p

hysic

al

activ

ity p

rogr

am to

a

clie

nt w

ith sp

ecifi

c co

nditi

on.

• D

evel

op a

pla

n fo

r phy

sical

ac

tivity

for c

lient

s ch

roni

c co

nditi

ons

base

d on

spec

ific

reco

mm

enda

tions

and

pr

ecau

tions

.

SPEC

IFIC

PH

YSIC

AL

ACT

IVIT

Y P

RO

GR

AM

FO

R

DIF

FER

ENT

CH

RO

NIC

C

ON

DIT

ION

S Ai

ms o

f reg

ular

phy

sical

ac

tiviti

es fo

r clie

nts w

ith

diffe

rent

chr

onic

con

ditio

ns:

• In

crea

se p

hysic

al a

ctiv

ity•

Redu

ce te

nsio

n or

anx

iety

• Im

prov

e to

lera

nce

• Pr

omot

e co

mfo

rt a

nd sa

fety

In g

ener

al, m

edic

al c

onsu

ltatio

n is

reco

mm

ende

d be

fore

clie

nts

with

chr

onic

con

ditio

ns e

ngag

e in

stre

nuou

s phy

sical

act

ivity

.

Reco

mm

ende

d ph

ysic

al a

ctiv

ity

prog

ram

s with

the

follo

win

g co

nditi

ons:

• C

ardi

ovas

cula

r dise

ases

• D

iabe

tes m

ellit

us•

Hyp

erte

nsio

n•

Ove

rwei

ght o

r Obe

se•

CO

PD/A

sthm

a•

Mus

culo

skel

etal

pro

blem

s

Disc

uss t

he a

ims o

f a re

gula

r ph

ysic

al a

ctiv

ity p

rogr

am fo

r clie

nts

with

spec

ific

chro

nic

cond

ition

s. Yo

u ca

n us

e hy

poth

etic

al o

r fac

tual

ca

ses.

Emph

asize

the

need

for t

he

heal

th w

orke

r to

be c

autio

us in

pr

escr

ibin

g str

enuo

us a

ctiv

ities

to

clie

nts w

ith c

hron

ic c

ondi

tions

w

ithou

t med

ical

reco

mm

enda

tion.

Disc

uss t

he re

com

men

datio

ns a

nd

spec

ific

prec

autio

ns in

pla

nnin

g ph

ysic

al a

ctiv

ity p

rogr

ams f

or

clie

nts w

ith c

hron

ic c

ondi

tions

.

6.

Perfo

rm st

rate

gies

to

prom

ote

phys

ical

act

ivity

am

ong

indi

vidu

als w

ith

chro

nic

cond

ition

s

77

PLA

NN

ING

PH

YSIC

AL

ACT

IVIT

Y P

RO

GR

AM

S

Prin

cipl

es o

f pla

nnin

g a

phys

ical

ac

tivity

pro

gram

Disc

uss t

he p

rinci

ples

in p

lann

ing

phys

ical

act

ivity

pro

gram

s. D

ivid

e th

e pa

rtic

ipan

ts in

to w

ork

grou

ps.

Assig

n ea

ch g

roup

to d

evel

op a

pr

ogra

m p

lan

of a

phy

sical

act

ivity

fo

r a p

artic

ular

targ

et g

roup

in a

sp

ecifi

c se

tting

.

Slid

e pr

esen

tatio

n

Flip

char

t and

pen

s

Part

icip

ants

mus

t be

able

to

:•

Dev

elop

a p

rogr

am

plan

of p

hysic

al

activ

ity fo

r a sp

ecifi

c gr

oup/

setti

ng.

AD

VO

CAT

ING

A

SU

PP

OR

TIV

E EN

VIR

ON

MEN

T F

OR

PH

YSIC

AL

ACT

IVIT

Y

Prov

ision

of f

acili

ties a

nd

area

s for

phy

sical

act

ivity

in

com

mun

ities

, sch

ools,

w

orkp

lace

s.

Prov

ision

of p

olic

ies t

o en

cour

age

incr

ease

d ph

ysic

al

activ

ity

Revi

ew th

e he

alth

pro

mot

ion

conc

ept a

nd a

ppro

ach

that

em

phas

izes t

he c

ombi

natio

n of

ed

ucat

iona

l and

env

ironm

enta

l str

ateg

ies f

or h

ealth

y lif

esty

le.

Faci

litat

e a

disc

ussio

n ab

out e

xisti

ng

polic

ies a

nd a

vaila

ble

faci

litie

s an

d pr

ogra

ms r

elat

ed to

phy

sical

ac

tivity

in sc

hool

s, w

orkp

lace

s, co

mm

uniti

es.

You

can

also

show

vid

eos o

r pho

tos

that

illu

strat

e eff

orts

to c

reat

e a

supp

ortiv

e en

viro

nmen

t for

phy

sical

ac

tivity

.

Slid

e pr

esen

tatio

n

Flip

char

t and

pen

s

List

of la

ws,

loca

l or

dina

nces

and

pro

gram

s su

ppor

ting

inte

grat

ion

of

heal

thy

lifes

tyle

pro

gram

s in

LG

U d

evel

opm

ent

plan

s.

Refe

r to

“20

Year

s of

NC

D P

reve

ntio

n an

d C

ontro

l”

Phot

os o

r vid

eos (

if av

aila

ble)

Part

icip

ants

mus

t be

able

to

:•

Des

crib

e w

ays

for a

dvoc

atin

g a

supp

ortiv

e en

viro

nmen

t for

ph

ysic

al a

ctiv

ity

7.

Plan

for p

hysic

al a

ctiv

ity

prog

ram

s.

8.

Advo

cate

for a

supp

ortiv

e en

viro

nmen

t for

phy

sical

ac

tivity

.

a)

phys

ical

b)

soci

al

78 Mod

ule

5A

Pr

omot

ing

Smok

e-fr

ee In

divi

dual

s and

Env

iron

men

t

M

odul

e O

bjec

tive

s

C

onte

nt

T

each

ing

Lear

ning

Act

ivit

ies

R

esou

rces

Ev

alua

tion

1.

Reco

gnize

the

mag

nitu

de

of th

e pr

oble

m o

n to

bacc

o

use

EPID

EMIO

LOG

Y O

F T

OB

ACC

O U

SE/S

MO

KIN

G

Smok

ing

prev

alen

ce is

pe

rsist

ently

hig

her a

mon

g m

en

but m

ore

and

mor

e w

omen

and

yo

ung

peop

le sm

oke

toda

y th

an

befo

re.

Toba

cco-

use

acc

ount

s for

at l

east

30%

of a

ll ca

ncer

dea

ths a

nd

87%

of l

ung

canc

er d

eath

s.

One

third

of t

he p

opul

atio

n is

at ri

sk o

f dyi

ng fr

om d

ebili

tatin

g di

seas

es a

nd p

ainf

ul d

eath

s due

to

toba

cco

use.

Burd

en o

f sm

okin

g•

Econ

omic

bur

den

of c

arin

g fo

r pat

ient

s with

smok

ing-

rela

ted

dise

ases

.•

Cos

t to

hous

ehol

d- M

ore

smok

ers l

ive

in lo

w a

nd

Ask

part

icip

ants

to d

iscus

s the

re

ason

s for

con

cern

on

toba

cco

in th

e co

untr

y (o

r the

ir lo

cal a

rea)

Pres

ent d

ata

on a

ge-s

ex sp

ecifi

c sm

okin

g pr

eval

ence

.

Cite

late

st Ph

ilipp

ine

Glo

bal Y

outh

To

bacc

o Su

rvey

(GYT

S)

Refe

r to

late

st or

upd

ated

dat

a fro

m

WH

O o

r DO

H.

Met

acar

ds

Slid

e pr

esen

tatio

n

Part

icip

ants

mus

t be

able

to

:•

Disc

uss t

he m

agni

tude

of

the

prob

lem

on

toba

cco

use.

79

Intro

duce

the

topi

c by

ask

ing

the

com

mon

reas

ons o

r fac

tors

wha

t led

sm

oker

s to

a lif

esty

le o

f sm

okin

g.

Enum

erat

e so

me

of th

e ha

rmfu

l ch

emic

als t

hat e

ach

ciga

rette

stic

k co

ntai

ns

Slid

e pr

esen

tatio

n

Vid

eos o

n sm

okin

g an

d ha

rmfu

l effe

cts o

f sm

okin

g (if

ava

ilabl

e)

Part

icip

ants

mus

t be

able

to

:•

Des

crib

e co

mm

on

reas

ons/

fact

ors w

hy

peop

le sm

oke

• Id

entif

y ha

rmfu

l ch

emic

als p

rese

nt in

ea

ch c

igar

ette

stic

k an

d ho

w th

ey c

ause

da

mag

e to

the

body

• D

iscus

s har

mfu

l eff

ects

of to

bacc

o us

e/

smok

ing.

• D

iffer

entia

te a

ctiv

e ve

rsus

pas

sive

smok

ing.

mid

dle-

inco

me

coun

trie

s th

an h

igh

inco

me

coun

trie

s•

The

aver

age

Filip

ino

hous

ehol

d ea

rnin

g ab

out

Php

5,10

0 m

onth

ly sp

ends

ap

prox

imat

ely

2.6%

of

the

hous

ehol

d in

com

e on

to

bacc

o, w

hich

is m

ore

than

th

ey sp

end

on e

duca

tion

(1.6

%) a

nd h

ealth

(1.3

%)

2.

Des

crib

e th

e ha

rmfu

l effe

cts

of to

bacc

o us

e/ sm

okin

g ac

ross

pop

ulat

ion

grou

ps

HO

W T

OB

ACC

O U

SE

CAU

SES

HA

RM

Reas

ons w

hy p

eopl

e sm

oke

• Ad

vert

ising

influ

ence

s•

Peer

pre

ssur

e•

Misc

once

ptio

ns th

at

prom

ote

smok

ing

beha

vior

• Pa

rent

al in

fluen

ces

Har

mfu

l effe

cts o

f tob

acco

use

/sm

okin

g•

Con

tain

s 400

0 ha

rmfu

l ch

emic

als

Smok

ing

as m

ajor

risk

fact

or to

m

ajor

NC

Ds

80

Revi

ew p

ast d

iscus

sion

on m

ajor

N

CD

s rel

ated

to sm

okin

g or

to

bacc

o us

e.

Expl

ain

that

whe

n sm

oker

s qui

t, th

e ph

ysio

logi

c be

nefit

s inc

reas

e ov

er

time.

3.

Des

crib

e th

e be

nefit

s of

smok

ing

cess

atio

nB

ENEF

ITS

OF

SMO

KIN

G

CES

SAT

ION

If an

indi

vidu

al q

uits:

• Th

ere

is 15

% re

duct

ion

in

the

rela

tive

risk

of a

ll-ca

use

mor

talit

y in

hea

vy sm

oker

s•

Risk

of l

ung

canc

er is

30

-50%

low

er th

an th

e co

ntin

uing

smok

ers a

fter 1

0 ye

ars o

f abs

tinen

ce

Phys

iolo

gic

effec

ts of

qui

tting

sta

rts i

n 20

min

utes

.

Smok

ers h

ave

diffi

culty

qui

tting

be

caus

e of

the

nico

tine

in th

e

Disc

uss t

he o

ver-

all i

mpa

ct o

f sm

okin

g ce

ssat

ion

in te

rms o

f re

duct

ion

in m

orta

lity

and

risk

of

lung

can

cer.

Slid

e pr

esen

tatio

n

Vid

eos (

if av

aila

ble)

Part

icip

ants

mus

t be

able

to

:•

Des

crib

e th

e ep

idem

iolo

gica

l im

pact

of s

mok

ing

cess

atio

n•

Expl

ain

how

a q

uitte

r w

ill b

enefi

t fro

m

givi

ng u

p to

bacc

o ov

er

time.

• D

escr

ibe

how

nic

otin

e pr

oduc

es d

epen

denc

e or

add

ictio

n in

a

smok

er.

Oth

er h

arm

ful e

ffect

s of

smok

ing:

• Sm

okin

g an

d re

prod

uctiv

e he

alth

• Sm

okin

g an

d th

e ag

eing

po

pula

tion

• Sm

okin

g an

d ch

ildre

n

Activ

e ve

rsus

pas

sive

smok

ing

81

Disc

uss t

he m

echa

nism

how

nic

otin

e w

orks

and

pro

duce

dep

ende

nce

or

addi

ctio

n to

the

smok

er.

Des

crib

e th

e w

ithdr

awal

sym

ptom

s qu

itter

s usu

ally

exp

erie

nce

and

how

th

ey c

an b

e su

ppor

ted.

toba

cco.

Am

ount

of n

icot

ine

depe

nds o

n•

Num

ber o

f puff

s tak

en•

Dep

th o

f inh

alat

ion

• D

urat

ion

of sm

okin

g

Nic

otin

e w

ithdr

awal

: one

of t

he

expe

rienc

es th

at p

reve

nt sm

oker

s fro

m q

uitti

ng o

r mak

e th

em

retu

rn to

the

habi

t

• D

escr

ibe

with

draw

al

sym

ptom

s tha

t a

quitt

er m

ay

expe

rienc

e.

4.

Disc

uss k

ey a

reas

for

prom

otin

g sm

oke-

free

indi

vidu

als a

nd

envi

ronm

ents

KEY

AR

EAS

FOR

P

RO

MO

TIN

G S

MO

KE-

FREE

IN

DIV

IDU

ALS

AN

D

ENV

IRO

NM

ENT

• Pr

even

t sm

okin

g ha

bit

initi

atio

n

• As

sess

for n

icot

ine

depe

nden

ce

• As

sess

read

ines

s to

quit

Disc

uss t

he d

iffer

ent k

ey a

reas

for

prom

otin

g sm

oke-

free

indi

vidu

als.

Prov

ide

conc

rete

exa

mpl

es h

ow e

ach

can

be in

tegr

ated

whe

n de

velo

ping

an

act

ion

plan

to p

rom

ote

a sm

oke-

free

com

mun

ity.

Stat

e th

at th

e m

ost w

idel

y us

ed to

ol

to a

sses

s nic

otin

e de

pend

ence

is th

e Fa

gers

trom

test.

Hig

hlig

ht th

e im

plic

atio

n to

hav

e av

aila

ble

clin

ical

inte

rven

tions

onc

e a

smok

er d

ecid

es to

qui

t.

Slid

e pr

esen

tatio

n

Fage

rstro

m T

est f

or

Nic

otin

e D

epen

denc

e To

ol

Part

icip

ants

mus

t be

able

to

:•

Des

crib

e th

e ke

y ar

eas

of p

rom

otin

g sm

oke-

free

indi

vidu

als a

nd

redu

cing

har

m fr

om

alco

hol u

se

• U

tilize

the

Fage

rstro

m

Test

for N

icot

ine

Dep

ende

nce

82

• C

ondu

ct in

terv

entio

ns to

he

lp sm

oker

s qui

t•

For t

obac

co u

sers

w

illin

g to

qui

t: 5A

s M

odel

for T

reat

ing

Toba

cco

Use

and

D

epen

denc

e•

For t

obac

co u

sers

un

will

ing

to q

uit:

Mot

ivat

iona

l in

terv

iew

ing

Stra

tegi

es;

5Rs

• Fo

r the

pat

ient

who

ha

s rec

ently

qui

t•

Addr

essin

g th

e pr

oble

ms o

f a fo

rmer

sm

oker

• D

emon

strat

e ap

plic

atio

n of

the

inte

rven

tions

to h

elp

smok

er q

uit

5.

Advo

cate

for s

mok

e-fre

e en

viro

nmen

ts.SU

PP

OR

TIN

G S

MO

KE-

FREE

EN

VIR

ON

MEN

TS

Ther

e ar

e tw

o ap

proa

ches

in

supp

ortin

g a

smok

e-fre

e en

viro

nmen

t:•

Beha

vior

cha

nge

appr

oach

es•

Polic

ies d

esig

ned

to p

reve

nt

smok

ing

in p

ublic

spac

es o

r w

orkp

lace

s

Emph

asize

that

in a

hea

lth

prom

otio

n ap

proa

ch, t

he h

ealth

w

orke

r giv

es e

qual

impo

rtan

ce

to b

ehav

ior c

hang

es re

sulti

ng

from

edu

catio

nal s

trat

egie

s and

en

viro

nmen

tal c

hang

es re

sulti

ng

from

effo

rts t

o a

advo

cate

for h

ealth

y po

licie

s.

Slid

e pr

esen

tatio

n

Met

acar

ds

DO

H M

anua

l on

Smok

ing

Ces

satio

n,

2007

Part

icip

ants

mus

t be

able

to

:•

Appl

y th

e he

alth

pr

omot

ion

conc

ept

and

appr

oach

to

deve

lop

a pl

an

for a

smok

e-fre

e en

viro

nmen

t.

Expl

ain

how

the

diffe

rent

in

terv

entio

ns w

ill w

ork.

Dev

elop

hyp

othe

tical

situ

atio

ns

and

allo

w p

artic

ipan

ts to

act

out

di

ffere

nt sc

enar

ios i

llustr

atin

g th

e in

terv

entio

ns.

83

Ask

part

icip

ants

to w

rite

dow

n id

eas i

n m

etac

ards

rega

rdin

g sp

ecifi

c ac

tiviti

es to

pro

mot

e sm

oke-

free

envi

ronm

ent i

n th

eir l

ocal

ity. A

llow

fo

r an

open

disc

ussio

n.

6.

Disc

uss t

he d

iffer

ent l

aws/

po

licie

s on

smok

ing

and

toba

cco

use.

Fram

ewor

k C

onve

ntio

n on

To

bacc

o C

ontro

l (FC

TC

)R

A 92

11G

raph

ic H

ealth

Info

rmat

ion

Smok

e-fre

e po

licy

in sc

hool

s and

w

orkp

lace

List

rece

nt p

olic

ies r

elat

ed to

the

prev

entio

n an

d co

ntro

l of s

mok

ing

or to

bacc

o us

e.

Slid

e pr

esen

tatio

n

Met

acar

ds

Part

icip

ants

mus

t be

able

to

:•

List

rele

vant

pol

icie

s

84 Mod

ule

5B

R

educ

ing

Har

m fr

om A

lcoh

ol U

se

M

odul

e O

bjec

tive

s

C

onte

nt

T

each

ing

Lear

ning

Act

ivit

ies

R

esou

rces

Ev

alua

tion

1.

Reco

gnize

the

mag

nitu

de

of th

e pr

oble

m a

lcoh

ol- ‐

re

late

d ris

ks

EPID

EMIO

LOG

Y O

F A

LOC

OH

OL-

REL

ATED

R

ISK

S

Har

mfu

l use

of a

lcoh

ol w

as

resp

onsib

le fo

r 2.5

mill

ion

deat

hs

in th

e w

orld

in 2

004.

An e

stim

ated

69.

4 m

illio

n di

sabi

lity-

adju

sted

life

year

s (D

ALYS

) los

t due

to a

lcoh

ol

drin

king

.

Drin

king

pat

tern

s of m

en

and

wom

en a

re b

egin

ning

to

conv

erge

; but

wom

en a

re o

ften

the

vict

ims o

f har

mfu

l use

of

alco

hol b

y m

en.

Mor

e yo

ung

peop

le in

de

velo

ping

and

dev

elop

ed

coun

trie

s are

incr

easin

gly

drin

king

in th

e sa

me

harm

ful

patte

rns.

Ask

part

icip

ants

to d

iscus

s the

re

ason

s for

con

cern

on

alco

hol u

se

in th

e co

untr

y (o

r the

ir lo

cal a

rea)

Pres

ent g

loba

l, re

gion

al a

nd n

atio

nal

data

to sh

ow m

agni

tude

and

ext

ent

of p

robl

em. U

se lo

cal d

ata

(if

avai

labl

e).

Met

acar

ds

Slid

e pr

esen

tatio

n

Part

icip

ants

mus

t be

able

to

:•

Disc

uss t

he m

agni

tude

of

the

prob

lem

on

toba

cco

use

and

alco

hol- ‐

rela

ted

risks

852.

Des

crib

e th

e ha

rmfu

l eff

ects

of a

lcoh

ol u

se a

cros

s po

pula

tion

grou

ps

HO

W A

LCO

HO

L D

RIN

KIN

G

LEA

D T

O H

AR

M

Har

mfu

l use

of a

lcoh

ol is

as

soci

ated

with

mor

e th

an 6

0 ty

pes o

f dise

ases

and

hea

lth

cond

ition

s suc

h as

:•

Men

tal d

isord

ers a

nd su

icid

e•

Seve

ral t

ypes

of c

ance

r•

Oth

er N

CD

s lik

e ci

rrho

sis•

Inte

ntio

nal a

nd

unin

tent

iona

l inj

urie

s

Alco

hol d

rinki

ng is

also

as

soci

ated

with

hig

h-ris

k be

havi

ors:

• U

nsaf

e se

x•

Use

of o

ther

psy

choa

ctiv

e su

bsta

nces

The

topi

c ca

n be

disc

usse

d by

as

king

par

ticip

ants

to sh

are

real

life

ex

perie

nces

in th

eir c

omm

uniti

es o

n ha

rmfu

l use

of a

lcoh

ol.

Slid

e pr

esen

tatio

n

Trig

ger fi

lms (

if av

aila

ble)

Part

icip

ants

mus

t be

able

to

:•

Disc

uss t

he d

iffer

ent

harm

ful e

ffect

s of

alco

hol u

se.

3.

Des

crib

e be

nefit

s of

alco

hol a

void

ance

BEN

EFIT

S O

F A

LCO

HO

L AV

OID

AN

CE

Ther

e is

a gr

owin

g ap

prec

iatio

n fo

r say

ing

no to

alc

ohol

.

The

asso

ciat

ed h

ealth

risk

s far

ou

twei

gh th

e so

-cal

led

bene

fits.

Allo

w fo

r ope

n di

scus

sion

on th

e co

ntro

vers

ial i

ssue

of h

ealth

ben

efits

of a

lcoh

ol in

take

.

Slid

e pr

esen

tatio

nPa

rtic

ipan

ts m

ust b

e ab

le

to:

• Ex

plai

n th

e be

nefit

s of

alco

hol a

void

ance

.

86

Redu

ced

alco

hol i

ntak

e or

av

oidi

ng a

lcoh

ol d

rinki

ng w

ill

lead

to:

• D

ecre

ased

bur

den

of N

CD

s•

Bette

r men

tal h

ealth

• D

ecre

ased

vio

lenc

e an

d in

jurie

s•

Pote

ntia

l im

prov

emen

t in

ado

lesc

ent,

child

and

re

prod

uctiv

e he

alth

Sum

mar

ize a

nd sy

nthe

size

disc

ussio

n.

Expl

ain

the

pote

ntia

l ben

efits

with

re

duce

d al

coho

l int

ake

or a

void

ing

alco

hol d

rinki

ng.

4.

Disc

uss k

ey a

reas

for

redu

cing

har

m fr

om

alco

hol u

se

KEY

AR

EAS

FOR

R

EDU

CIN

G H

AR

M F

RO

M

ALC

OH

OL

USE

Regi

onal

stra

tegy

to re

duce

al

coho

l-rel

ated

har

m: (

WH

O,

2007

)•

Redu

cing

the

risk

of

harm

ful a

lcoh

ol u

se•

Min

imizi

ng th

e im

pact

of

harm

ful u

se o

f alc

ohol

• Re

gula

ting

the

acce

ssib

ility

an

d av

aila

bilit

y to

redu

ce

harm

ful u

se o

f alc

ohol

• Es

tabl

ishin

g m

echa

nism

to

faci

litat

e an

d su

stain

im

plem

enta

tion

Disc

uss t

he re

gion

al st

rate

gy to

re

duce

alc

ohol

-rel

ated

har

m.

Prov

ide

conc

rete

exa

mpl

es o

n ho

w th

e re

gion

al st

rate

gy c

an b

e op

erat

iona

lized

at t

he lo

cal l

evel

.

Slid

e pr

esen

tatio

nPa

rtic

ipan

ts m

ust a

ble

to:

• Ap

ply

the

regi

onal

str

ateg

y to

dev

elop

a

plan

to re

duce

al

coho

l- ‐ re

late

d ha

rm

in th

e co

mm

unity

.

87Mod

ule

6 P

rom

otin

g M

enta

l Hea

lth

and

Wel

lnes

s

M

odul

e O

bjec

tive

s

C

onte

nt

T

each

ing

Lear

ning

Act

ivit

ies

R

esou

rces

E

valu

atio

n

1.

Reco

gnize

the

rela

tions

hip

amon

g co

mm

on ri

sk

fact

ors,

men

tal h

ealth

and

N

CD

s

EPID

EMIO

LOG

Y O

F N

CD

s R

ELAT

ED T

O M

ENTA

L H

EALT

H

Men

tal h

ealth

pro

blem

s are

dr

amat

ical

ly a

ddin

g to

the

glob

al

burd

en o

f dise

ase

and

disa

bilit

y w

orld

wid

e (W

HO

, 200

7).

50%

of m

enta

l diso

rder

s beg

in

befo

re th

e ag

e 14

with

aro

und

20%

of w

orld

’s ch

ildre

n an

d ad

oles

cent

s hav

e men

tal d

isord

ers

or p

robl

ems (

WH

O, 2

007)

Men

tal d

isord

ers s

uch

as

depr

essio

n, a

lcoh

ol a

nd

subs

tanc

e ab

use

are

amon

g th

e ris

k fa

ctor

s for

som

e N

CD

s.

Seve

ral s

tudi

es p

rovi

de e

vide

nce

linki

ng m

enta

l hea

lth c

ondi

tions

pa

rtic

ular

ly d

epre

ssio

n to

ph

ysic

al c

ondi

tions

and

illn

esse

s in

clud

ing

anxi

ety,

hear

t dise

ase,

str

oke,

dia

bete

s, as

thm

a an

d ca

ncer

.

To in

trodu

ce th

e to

pic,

ask

the

part

icip

ants

wha

t are

the

beha

vior

ch

ange

s com

mon

ly o

bser

ved

amon

g cl

ient

s or r

elat

ives

with

NC

Ds.

How

do

the

heal

th w

orke

rs h

andl

e th

ese

chan

ges?

Disc

uss t

he in

crea

sing

prev

alen

ce o

f m

enta

l hea

lth p

robl

ems e

spec

ially

am

ong

child

ren

and

adol

esce

nts.

Poin

t out

that

som

e m

enta

l diso

rder

s ar

e am

ong

the

risk

fact

ors o

f N

CD

s an

d th

at th

ere

are

evid

ence

s tha

t lin

k m

enta

l hea

lth p

robl

ems a

s co

nseq

uenc

es o

f chr

onic

con

ditio

ns

and

NC

Ds.

Disc

uss t

he im

pact

of m

enta

l hea

lth

on th

e de

velo

pmen

t of m

ajor

NC

Ds

and

vice

ver

sa.

Slid

e pr

esen

tatio

n

Loca

l dat

a on

men

tal

heal

th p

robl

ems (

if av

aila

ble)

Part

icip

ants

mus

t be

able

to

:

• Id

entif

y m

ajor

NC

Ds

that

are

ass

ocia

ted

to p

sych

osoc

ial a

nd

men

tal h

ealth

.•

Disc

uss t

he

rela

tions

hip

of

com

mon

risk

fact

ors

in N

CD

s and

men

tal

heal

th•

Disc

uss t

he im

pact

of

men

tal h

ealth

on

the

deve

lopm

ent o

f maj

or

NC

Ds a

nd v

ice

vers

a.

88

2.

Expl

ain

the

bene

fits o

f pr

omot

ing

men

tal h

ealth

an

d w

elln

ess.

BEN

EFIT

S O

F P

RO

MO

TIN

G

MEN

TAL

HEA

LTH

Prom

otin

g m

enta

l hea

lth

invo

lves

look

ing

beyo

nd

prev

entio

n; lo

oks a

t the

re

latio

nshi

p be

twee

n m

enta

l w

ell-b

eing

and

phy

sical

hea

lth. I

t em

phas

izes t

wo

key

conc

epts:

• Po

wer

: pe

rson

’s, g

roup

’s or

co

mm

unity

’s se

nse

of c

ontro

l ov

er li

fe a

nd th

e ab

ility

to b

e re

silie

nt.

• Re

silie

nce:

abi

lity

to m

anag

e or

cop

e w

ith si

gnifi

cant

ad

vers

ity o

r stre

ss in

way

s th

at a

re n

ot o

nly

effec

tive

but m

ay re

sult

in a

n in

crea

sed

abili

ty to

resp

ond

to fu

ture

adv

ersit

y.

Men

tal h

ealth

pro

mot

ion

wor

ks

at th

ree

leve

ls:•

Stre

ngth

enin

g in

divi

dual

s•

Stre

ngth

enin

g co

mm

uniti

es•

Redu

cing

stru

ctur

al b

arrie

rs

to m

enta

l hea

lth

Star

t disc

ussio

n by

ask

ing

part

icip

ants

thei

r vie

w o

f men

tal

heal

th. P

oint

out

that

men

tal h

ealth

is

an im

port

ant a

spec

t in

defin

ing

the

heal

th st

atus

of a

n in

divi

dual

.

Expl

ain

the

two

impo

rtan

t con

cept

s re

late

d to

men

tal h

ealth

pro

mot

ion.

Pr

ovid

e co

ncre

te si

tuat

ions

to

illus

trat

e ke

y co

ncep

ts.

Disc

uss h

ow m

enta

l hea

lth

prom

otio

n w

orks

in e

ach

of th

e th

ree

leve

ls.

Slid

e pr

esen

tatio

nPa

rtic

ipan

ts m

ust b

e ab

le

to:

• Ap

prec

iate

men

tal

heal

th a

s an

impo

rtan

t asp

ect o

f th

e he

alth

stat

us o

f an

indi

vidu

al.

• An

alyz

e th

e co

ncep

ts of

pow

er

and

resil

ienc

e as

es

sent

ial e

lem

ents

in

mai

ntai

ning

men

tal

heal

th.

• D

eter

min

e po

ssib

le

inte

rven

tion

com

pone

nts o

f di

ffere

nt le

vels

of m

enta

l hea

lth

prom

otio

n.

89

3.

Disc

uss f

acto

rs th

at

cont

ribut

e to

psy

chos

ocia

l im

bala

nce

or m

enta

l he

alth

pro

blem

s

FAC

TO

RS

TH

AT

CO

NT

RIB

UT

E T

O M

ENTA

L H

EALT

H P

RO

BLE

MS

The

follo

win

g fa

ctor

s inc

reas

e th

e pe

ople’

s vul

nera

bilit

y to

m

enta

l hea

lth p

robl

ems:

(WH

O,

2004

)•

Expe

rienc

e of

inse

curit

y an

d ho

pele

ssne

ss•

Rap

id so

cial

cha

nge

• R

isks o

f vio

lenc

e•

Phys

ical

ill-h

ealth

Risk

fact

ors f

or m

enta

l hea

lth

prob

lem

s inc

lude

:(WH

O, 2

004)

• D

rugs

/alc

ohol

• La

ck o

f edu

catio

n•

Poor

nut

ritio

n•

Pove

rty

• R

acia

l inj

ustic

e•

Vio

lenc

e/de

linqu

ency

• W

ar•

Wor

k str

ess

• U

nem

ploy

men

t

Sum

mar

ize a

nd sy

nthe

size

with

a

lect

ure.

In sm

all g

roup

s, or

usin

g m

eta

card

s, di

scus

s the

diff

eren

t fac

tors

th

at c

ontr

ibut

e to

men

tal h

ealth

pr

oble

ms

Slid

e pr

esen

tatio

n

Met

acar

ds, t

ear s

heet

,pe

ntel

, mas

king

tape

, whi

tebo

ard

Part

icip

ants

mus

t be

able

to

:•

Anal

yze

issue

s of

vuln

erab

ility

in th

e co

mm

unity

that

pr

edisp

ose

peop

le

to m

enta

l hea

lth

prob

lem

s.•

Det

erm

ine

pres

ence

of

fact

ors t

hat i

ncre

ase

the

risk

of m

enta

l he

alth

pro

blem

s am

ong

vuln

erab

le

grou

ps.

90 4.

Disc

uss p

rinci

ples

and

gu

idel

ines

in d

evel

opin

g pr

ogra

ms f

or p

rom

otin

g m

enta

l hea

lth a

nd w

elln

ess

acro

ss th

e lif

e sp

an.

PR

OM

OT

ING

MEN

TAL

HEA

LTH

AC

RO

SS T

HE

LIFE

SP

AN

M

enta

l hea

lth a

nd w

elln

ess

prog

ram

s sho

uld

build

on

the

follo

win

g pr

inci

ples

: •

Con

sider

s the

dev

elop

men

tal

task

s of a

par

ticul

ar a

ge

grou

p to

enh

ance

soci

al,

emot

iona

l as w

ell a

s oth

er

inte

llige

nce

• En

hanc

es th

e lif

e sk

ills t

o fa

cilit

ate

deve

lopm

ent a

nd

prog

ress

ive

mat

urat

ion

• Fa

cilit

ates

effe

ctiv

e co

ping

m

echa

nism

s to

faci

litat

e re

silie

nce

in th

e fa

ce o

f ad

vers

ity

Disc

uss t

he p

rinci

ples

and

gu

idel

ines

in d

evel

opin

g pr

ogra

ms

for p

rom

otin

g m

enta

l h

ealth

and

w

elln

ess c

onsid

erin

g ag

e gr

oups

and

se

tting

s.

Mat

ch p

rinci

ples

and

inte

rven

tions

in

pro

mot

ing

men

tal h

ealth

.

Slid

e pr

esen

tatio

nPa

rtic

ipan

ts m

ust b

e ab

le

to:

• Ap

ply

prin

cipl

es in

de

velo

ping

pro

gram

s to

pro

mot

e m

enta

l he

alth

and

wel

lnes

s ac

ross

age

gro

ups a

nd

setti

ngs.

5.

Dev

elop

stra

tegi

es to

pr

omot

e m

enta

l hea

lth

and

wel

lnes

s am

ong:

a.

scho

ol-b

ased

p

opul

atio

n

b. w

orkp

lace

pop

ulat

ion

STR

ATEG

IES

FOR

P

RO

MO

TIN

G M

ENTA

L H

EALT

H I

N D

IFFE

REN

T

SET

TIN

GS

Scho

ol-b

ased

men

tal h

ealth

and

w

elln

ess a

ctiv

ities

con

trib

ute

in

Disc

uss v

ario

us st

rate

gies

to p

rom

ote

men

tal h

ealth

and

wel

lnes

s in

Slid

e pr

esen

tatio

nPa

rtic

ipan

ts m

ust b

e ab

le

to:

91

c.

com

mun

ity-b

ased

p

opul

atio

nde

velo

ping

stud

ents

to;

• H

ave

posit

ive

sens

e of

self

• H

elp

faci

litat

e de

velo

pmen

t of

wel

l-rou

nded

pe

rson

aliti

es•

Build

pos

itive

rela

tions

hip

with

par

ents

nece

ssar

y to

ch

ild’s

self-

este

em•

Gui

de a

nd su

ppor

t the

stu

dent

as h

e go

es th

roug

h va

rious

phy

sical

and

ps

ycho

soci

al c

hang

es.

Scho

ol-b

ased

act

iviti

es sh

ould

in

volv

e:•

pare

nts/

guar

dian

s,•

clas

s adv

isers

• gu

idan

ce c

ouns

elor

s as

part

ners

in p

rom

otin

g ps

ycho

soci

al w

ell-b

eing

.

Wor

kpla

ce-b

ased

men

tal h

ealth

ac

tiviti

es sh

ould

:•

Enha

nce

the

adul

t’s g

ood

copi

ng m

echa

nism

s as

they

gai

n m

ore

task

s and

re

spon

sibili

ties

• M

aint

ain

over

all h

ealth

and

w

ork

effici

ency

of w

orke

rs.

diffe

rent

setti

ngs.

Cite

exa

mpl

es

and

allo

w p

artic

ipan

ts to

shar

e ex

perie

nces

on

effor

ts to

pro

mot

e m

enta

l hea

lth a

nd w

elln

ess i

n di

ffere

nt se

tting

s.

• fo

rmul

ate

an a

ctiv

ity

plan

for p

rom

otin

g m

enta

l hea

lth a

nd

wel

lnes

s fo

r a sp

ecifi

c gr

oup/

sect

or in

the

com

mun

ity

92

• Fa

cilit

ate

good

in

terp

erso

nal r

elat

ions

am

ong

wor

kers

• Pr

ovid

e fo

r a st

ress

-free

ph

ysic

al e

nviro

nmen

t

Com

mun

ity-b

ased

men

tal

heal

th a

nd w

elln

ess a

ctiv

ities

:•

Mus

t be

rele

vant

, su

stain

able

, and

resp

onsiv

e to

the

need

of i

ts m

embe

rs•

Shou

ld le

ad to

es

tabl

ishm

ent o

f sup

port

gr

oups

for e

ach

of th

e po

pula

tion

grou

p in

the

com

mun

ity•

Shou

ld p

rovi

de a

dequ

ate

atte

ntio

n to

psy

chos

ocia

l ne

eds o

f chi

ldre

n.•

Incl

ude

prov

ision

of s

port

s an

d re

crea

tion

faci

litie

s to

enco

urag

e in

terp

erso

nal

rela

tions

and

foste

r ca

mar

ader

ie

• M

ust i

nclu

de te

achi

ng

of st

ress

man

agem

ent

tech

niqu

es to

com

mun

ity

grou

ps.

93

6.

Perfo

rm st

rate

gies

for

prom

otio

n of

psy

chos

ocia

l w

ell-b

eing

and

men

tal

heal

th a

mon

g in

divi

dual

s w

ith c

hron

ic c

ondi

tions

PR

OM

OT

ING

MEN

TAL

HEA

LTH

AM

ON

G

IND

IVID

UA

LS W

ITH

C

HR

ON

IC C

ON

DIT

ION

S

Chr

onic

con

ditio

ns a

re o

ften

the

resu

lt of

long

time

purs

uit o

f un

heal

thy

and

abus

ive

lifes

tyle

. Tr

eatm

ent a

nd/o

r cor

rect

ive

inte

rven

tions

mus

t tak

e in

to

cons

ider

atio

n ex

tent

of h

arm

as

wel

l as r

epai

rs d

one

on th

ese

body

org

ans o

r sys

tem

s.

Stra

tegi

es to

pro

mot

e m

enta

l hea

lth a

nd w

elln

ess

of in

divi

dual

s with

chr

onic

co

nditi

ons s

houl

d co

nsid

er

stren

gth

and

capa

bilit

ies a

s wel

l as

restr

ictio

ns a

nd li

mita

tions

of

the

indi

vidu

als.

• St

ress

man

agem

ent

• As

sert

ive

com

mun

icat

ion

• An

ger m

anag

emen

t•

Wor

k-lif

e ba

lanc

e•

Posit

ive

thin

king

• Sp

iritu

ality

• So

cial

supp

ort

• M

edita

tion

Disc

uss t

he d

iffer

ent s

trat

egie

s in

pro

mot

ing

men

tal h

ealth

and

w

elln

ess.

Dem

onstr

ate

som

e of

the

strat

egie

s by

inte

grat

ing

som

e of

them

into

th

e tr

aini

ng li

ke a

llow

ing

pers

onal

tim

e to

exp

ress

spiri

tual

ity, p

erfo

rm

med

itatio

n an

d re

laxa

tion

tech

niqu

es

in b

etw

een

sess

ions

.

Do

role

pla

ys fo

r sel

ecte

d str

ateg

ies.

Slid

e / p

ower

poin

t pr

esen

tatio

nPa

rtic

ipan

ts ar

e ab

le to

:•

Dem

onstr

ate

strat

egie

s in

prom

otin

g m

enta

l he

alth

and

wel

lnes

s am

ong

clie

nts w

ith

chro

nic

cond

ition

s.

94

Enha

ncin

g co

ping

mec

hani

sms

for p

atie

nts w

ith:

• O

besit

y•

Car

diov

ascu

lar d

iseas

es•

Dia

bete

s mel

litus

• H

yper

tens

ion

• C

OPD

/Asth

ma

7.

Cre

ate

a su

ppor

tive

envi

ronm

ent f

or

psyc

hoso

cial

wel

l-bei

ng

and

men

tal h

ealth

w

elln

ess

CR

EAT

ING

A S

UP

PO

RT

IVE

ENV

IRO

NM

ENT

TO

P

RO

MO

TE

MEN

TAL

HEA

LTH

Men

tal h

ealth

pro

mot

ion

and

wel

lnes

s mus

t be

incl

uded

in th

e so

cial

and

hea

lth p

olic

y ag

enda

of

LG

Us.

To

achi

eve

this,

ac

tiviti

es sh

ould

incl

ude:

• R

aisin

g m

enta

l hea

lth

liter

acy

• Li

fe sk

ills e

duca

tion

• Ad

voca

cy a

nd p

olic

y•

Inte

rsec

tora

l alli

ance

s

Disc

uss t

he a

ctiv

ities

that

the

heal

th

wor

kers

nee

d to

car

ry o

ut in

ord

er

to c

reat

e a

supp

ortiv

e en

viro

nmen

t fo

r men

tal h

ealth

and

wel

lnes

s.

Cite

exi

sting

pol

icie

s and

ava

ilabl

e fa

cilit

ies a

nd p

rogr

ams r

elat

ed to

m

enta

l hea

lth w

elln

ess.

Slid

e pr

esen

tatio

nPa

rtic

ipan

ts ar

e ab

le to

:•

Des

crib

e pr

ogra

ms

and

polic

ies t

hat

supp

ort p

rogr

ams a

nd

polic

ies f

or m

enta

l he

alth

and

wel

lnes

s

95

Appendix A

PRETEST / POSTTEST FOR TRAINING PARTICIPANTS

Name: ____________________________________ Sex: ______ Birthdate: __________________Profession: _____________________________________ Job Position: __________________________

Instructions: Please answer the following questions to the best of your ability. You will be given a time limit so do not take too long per item.

I. TRUE or FALSE: Put your answer on the space before the number. Write T if the statement is correct, and write F if it is incorrect.

Obesity is a major risk factor for:1. Hypertension 2. Diabetes Mellitus 3. Cancer 4. Chronic Lung Disease 5. Asthma

Smoking is a risk factor of/contributes to: 6. Hypertension 7. Diabetes Mellitus 8. Cancer 9. Chronic Lung Disease 10. Asthma

Inadequate intake of dietary fiber is associated with development of: 11. Hypertension 12. Diabetes Mellitus 13. Cancer 14. Chronic Lung Disease

Major risk factors of cardiovascular diseases is/are:15. Obesity16. Diabetes Mellitus17. Smoking

96

18. Sedentary lifestyle or lack of physical exercise19. Eating salty foods

Risk factors for Diabetes Mellitus is/are:20. Obesity21. Smoking22. Sedentary lifestyle or lack of physical exercise23. Eating salty foods

These persons are at risk for developing hypertension:24. Elderly persons25. Pregnant women26. Adolescents27. Persons with diabetes

Which has higher fat content:28. Fried chicken has higher fat content than broiled chicken.29. Chicken wings have higher fat content than the breast.30. Chicken egg has higher cholesterol content than duck egg.31. Chicken meat has higher cholesterol content than pork.32. Butter has higher fat content than margarine.33. The recommended daily fat intake for a child is higher than an adult.

The following foods are rich sources of good cholesterol34. Beef35. Olive oil36. Soya37. Fish38. Chicken liver

The following foods have high sodium content39. Corned beef40. Processed cheese41. Soy sauce42. Monosodium glutamate43. Instant noodles44. Canned meat45. Fresh shellfish

97

These statements about EXERCISE are TRUE:46. Exercise helps in losing weight.47. Exercise helps control blood pressure.48. Exercise can reduce total blood cholesterol level.49. Exercise reduces risk for lung cancer.50. Persons with cardiovascular disease should avoid exercise.51. Hypertensive persons should avoid exercise until blood pressure is normal.

The following activities are aerobic exercises52. Dancing53. Cycling or biking54. Walking briskly55. Strolling in Luneta for 30 minutes56. Basketball57. Weight lifting

The following statements about mental health are true58. Mental health is related to development of NCDs.59. Life skills and effective coping mechanism across life span are essential to mental health and wellness.60. Strategies for managing stress are not proven effective measures in promoting mental health and wellness.

II. MULTIPLE CHOICE: Encircle the letter that corresponds to your answer.

Note: The first 9 questions are for doctors, nurses and midwives only. Other participants proceed to question #10.

1. When measuring the blood pressure of an adult, how much of the upper arm circumference should be covered by the cuff?

a. One-third b. Two-third c. Three-fourths d. Entire upper arm

2. When monitoring an adult’s blood pressure, the cuff should be inflated to: a. 250 mm Hg b. 300 mm Hg

98

c. 50 mm Hg above the last recorded d. 30 mm Hg above the obliteration of the pulse

3. Based on guidelines, how many times should the BP be measured per visit? a. Once b. Twice c. Three times d. Take a second reading only if the first reading is very high

4. In children 13 years or younger, the best indicator of diastolic blood pressure is: a. The initial appearance of sounds upon deflation of cuff b. The disappearance of sounds upon deflation of cuff c. The distinct muffling of sounds upon deflation of cuff d. None of the above

5. Prior to BP measurement, it is important to minimize extraneous factors that may affect the accuracy of the reading. In general, a client should not smoke or ingest caffeine within ____ before BP measurement.

a. 5 minutes b. 10 minutes c. 15 minutes d. 30 minutes

6. In most healthy subjects, there is little difference between BP taken in sitting, standing or lying down position.

a. True b. False

7. Philippine Clinical Guidelines recommend routine use of the diaphragm of the stethoscope for BP auscultation.

a. True b. False

8. Patients with normal readings should have blood pressure evaluations every: a. Six months b. One Year c. Two years d. Five years

99

9. In an adult, which of the following BP readings will be considered possible hypertension? a. 146/92 b. 128/80 c. 110/76 d. 134/86

10. A person with hypertension will usually have: a. Headache b. Dizziness c. Weight loss d. No symptoms

11. The most common cause of essential hypertension is: a. Atherosclerosis b. Renal disease c. Diabetic vessel change d. Heart disease

12. Which of the following is the “bad” cholesterol? a. VLDL b. LDL c. HDL d. Triglycerides

13. Which of the following is the “good” cholesterol? a. VLDL b. LDL c. HDL d. Triglycerides

14. For Filipinos, the recommended daily allowance for sodium is no more than 2000 mg. of sodium or 5 gms sodium chloride (table salt). This is equivalent to ____ of salt:

a. one level teaspoon b. one heaping teaspoon c. one level tablespoon d. one heaping tablespoon

15. To improve cardiovascular fitness, what type of exercise is recommended?

100

a. Aerobic exercise b. Anaerobic exercise c. Isometric exercise d. Any kind of exercise

16. How many minutes should the warm-up phase of exercise be? a. 15 minutes b. 20 minutes c. 30 minutes d. 45 minutes 17. For physical activity to be beneficial, it should be done at least: a. Once a week b. Twice a week c. Three times a week d. Everyday

18. Maximum heart rate for a person aged 25 years is __ per minute. a. 200 b. 195 c. 190 d. 185

19. The target heart rate for exercise of a healthy adult is usually ___ of the maximum heart rate. a. 50-60% b. 60-70% c. 50-70% d. 60-90%

20. For the elderly person, the target heart rate is: a. lower than the average adult b. same as the average adult c. higher than the average adult d. lower than someone with heart disease

21. In women, a waist-hip ratio of greater than ____ indicates increased risk of health complications associated with obesity.

a. 0.70 b. 0.75

101

c. 0.85 d. 1.00

22. The best indicator of obesity is: a. Weight b. Body Mass Index (BMI) c. Waist circumference d. Waist-hip ratio

23. A person is considered obese if the weight is ___ greater than the desired or ideal body weight. a. 15% b. 20% c. 25% d. 30%

24. Data needed to compute body mass index (BMI) are: a. Weight b. Height and weight c. Skinfold measurement d. Abdominal girth

25. Which of the following BMI values indicate obesity? a. 30.1 b. 22.5 c. 21.3 d. 24.9

26. The recommended laboratory test to screen for diabetes is: a. 8 hour fasting blood sugar (FBS) b. 6 hour fasting blood sugar c. 2 hour post-prandial blood sugar d. Random blood sugar

27. For screening purposes, which one of the following laboratory tests would you recommend? a. Triglyceride b. LDL c. HDL d. Total cholesterol

102

28. Breast self-examination (BSE) is best performed: a. Any day of the month b. 2-3 days before menstruation c. 1 week before menstruation d. 1 week after menstruation

29. Pap smear should be done yearly for women at high risk, to include all of the following EXCEPT: a. Aged 18-21 years old b. Those with multiple partners c. Those who are sexually active d. Those who had hysterectomy with cervix intact

30. Which of these chemicals or gases contained in tobacco is addicting? a. Tar b. Nicotine c. Carbon monoxide d. Metamphetamine

31. Who among the following is NOT a passive smoker? a. Persons with family members who smoke b. Persons who frequent smoke-filled rooms c. Pregnant woman who smokes d. Fetus of a pregnant woman who smokes

32. Which of the following statements about smoking cessation is true? a. “Tapering off” is the best way to stop smoking completely b. Switching to “low-tar, low-nicotine” cigarettes makes it easier to stop c. Both are true d. Neither one is true

33. Which of the following statements about smoking cessation is true? a. If you have tried to stop smoking and failed, you probably can’t stop b. There is nothing your physician can do to help you to stop smoking c. Both are true d. Neither one is true

34. School-based programs increase the likelihood of children and families to commit to positive life skills and effective coping mechanisms.

103

a. True b. False

35. Physical education classes not only promote physical activity but also: a. manage stress b. force teamwork c. fosters obedience d. disciplines

36. Group work encourages: a. creativity b. independence c. social interaction d. bullying

37. Use of well-designed reward system can facilitate: a. competition b. self-esteem c. inferiority d. independence

38. Sources of stress in the workplace include: a. physical environment b. interpersonal relations c. work policies d. all of the above

39. Workplace activities that promote mental health: a. no bundy clock b. daily meetings c. team-building activities d. all of the above

40. Community resilience is part of promoting mental health a. true b. false

104

ANSWER KEY ON THE PRETEST/POSTTEST

TEST I1. True2. True3. True4. False5. False6. True7. True8. True9. True10. True11. False12. False13. True14. False15. True16. True17. True18. True19. False20. True21. True22. True23. False24. True25. True26. False27. True28. True29. True30. False

TEST II1. B 2. D 3. B 4. C 5. D6. A7. B 8. C 9. A 10. D 11. A12. B 13. C 14. A 15. A 16. A 17. C 18. B 19. C 20. A

31. False32. True33. True 34. False 35. True 36. True 37. True 38. False 39. True 40. True41. True42. True 43. True 44. True 45. False 46. True 47. True 48. True 49. False 50. False 51. True 52. True 53. True 54. True 55. False 56. True 57. False 58. True 59. True 60. False

21. C 22. B23. B 24. B 25. A 26. A 27. D 28. D 29. A 30. B 31. C 32. D 33. D34. A35. B36. C37. B38. D39. C40. A

105

Appendix B

Daily Evaluation Sheet

The course design team would like to solicit your help in improving this training program. While the team exerted all possible efforts to ensure that requirements for a good training are addressed, we believe that there will always be room for improvement. Help us improve this training by giving us your feedback on several areas of course implementation.

A. Course content: (Please give your feedback and recommendation as to appropriateness, relevance, coverage, or depth. You are free to add other areas of evaluation)_________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________B. Course organization: (Please give your feedback and recommendation as to sequence, coverage, and content of modules. Feel free to add other areas of evaluation)._________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________C. Teaching – learning strategies: (Please give your feedback and recommendation as to appropriateness and effectiveness. Feel free to add other areas of evaluation)._________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________D. Time allotment: (Please give your feedback as to appropriateness. Feel free to add other areas of evaluation)._________________________________________________________________________________________ _________________________________________________________________________________________ ________________________________________________________________________

106

E. Materials: (Please give your feedback as to appropriateness, coverage, language, and legibility. Feel free to add other areas of evaluation.)_________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________

Thank You!

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