Improving Medication Adherence in the Alabama Black Belt
Phase: NA
Conditions: Diabetes Mellitus, Medication Adherence
Sponsor: Weill Medical College of Cornell University

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Table of Contents 
STUDY TEAM ROSTER 
4 
BACKGROUND AND SIGNIFICANCE 
5 
STUDY AIMS 
10 
STUDY HYPOTHESIS 
11 
STUDY DESIGN 
11 
STUDY POPULATION 
12 
INCLUSION CRITERIA 
12 
EXCLUSION CRITERIA 
12 
STUDY OUTCOMES AND MEASURES 
13 
PRIMARY OUTCOMES 
13 
SECONDARY OUTCOMES 
13 
ADDITIONAL MEASURES 
13 
PROCESS MEASURES 
14 
RANDOMIZATION 
14 
PROGRAM DESCRIPTIONS 
15 
CONTROL PARTICIPANTS: GENERAL HEALTH VIDEOS 
15 
INTERVENTION PARTICIPANTS: LIVING WELL WITH DIABETES 
15 
PEER ADVISORS RECRUITMENT 
15 
PEER ADVISOR RETENTION 
15 
LIVING WELL WITH DIABETES PROGRAM DESCRIPTION 
16 
RECRUITMENT OF PARTICIPANTS 
18 
RECRUITMENT METHODS 
18 
ELIGIBILITY SCREENING 
19 
STUDY ENROLLMENT, INFORMED CONSENT, AND DATA COLLECTION 
20 
TELEPHONE INTERVIEW 
20 
IN-PERSON BIOMETRIC DATA COLLECTION VISIT 
21 
PARTICIPANT COMPENSATION 
22 
PARTICIPANT RETENTION 
22 
ANALYSIS 
24 
DATA MANAGEMENT 
24 
POWER CALCULATIONS AND SAMPLE SIZE 
24 
DATA ANALYSIS 
24 
 
  Living Well with Diabetes Study Protocol | 2 

SAFETY ASSESSMENTS 
25 
REFERENCES 
27 
APPENDICES 
30 
 
 
 
  Living Well with Diabetes Study Protocol | 3 

Study Team Roster  
 
Principal Investigator:  
Monika Safford, MD 
1300 York Avenue, F2006 
New York, NY 10065 
T.212.746.3026  
F.212.746.1014 
mms9024@med.cornell.edu  
 
 
Site Principal Investigator: 
Andrea Cherrington, MD MPH 
 
 
 
 
1717 11th Ave South 
 
 
 
 
Medical Towers 612 
 
 
 
 
Birmingham, AL 35205 
 
 
 
 
T. 205.996.2885 
 
 
 
 
F. 205.975.6753    
 
 
 
 
acherrington@uabmc.edu  
 
 
Biostatistician:  
 
Joshua Richman, MD PhD 
1922 7th Ave South 
 
 
 
 
KB 428 
Birmingham, AL 35233 
T. 205.97501932 
jrichman@uabmc.edu  
 
 
Consultant:  
 
 
Debra Clark, MS 
Director 
Health and Wellness Education Center of Sumter County 
P.O. Box 1247 
Livingston, AL 35470 
T. 205.652.6557 
clarkdeb@uab.edu  
 
 
  Living Well with Diabetes Study Protocol | 4 

Background and Significance 
Medication nonadherence is both common and costly. In diabetes, clinical trials have proven that 
medications that lower blood glucose, lipids and blood pressure can lower risks for blindness, kidney disease, 
amputation, stroke and heart attack.1-3 However, adherence to these medications is suboptimal; in many health 
systems, as many as half of diabetic patients do not take recommended medications as directed.4 The annual costs 
of medication nonadherence have been estimated to total $290 billion.5 For diabetes, one analysis estimated that 
the VA alone could save between $0.66-1.16 billion annually if medication nonadherence could be eliminated.6  
Despite the modest success of some interventions, decades of research on how to improve nonadherence have not 
yielded substantial changes in medication adherence rates.  A 2008 Cochrane review of interventions to improve 
medication adherence concluded: “Current methods of improving adherence for chronic health problems are 
mostly complex and not very effective, so that the full benefits of treatment cannot be realized. High 
priority should be given to fundamental and applied research concerning innovations to assist patients to 
follow medication prescriptions for long-term medical disorders.”7  
 
Medication nonadherence is especially problematic in hard-to-reach populations living with diabetes. For 
example, the Southeast has the highest stroke and coronary heart disease mortality in the US, along with the 
highest prevalence of obesity and diabetes.8 These problems hit black Americans the hardest: blacks have both 
higher stroke and coronary heart disease mortality in the Southeast than whites, and blacks are more likely to have 
diabetes.8 Nowhere is this situation more dire than in rural areas, which typically have very scarce resources for 
chronic disease management. One such area is the Alabama Black Belt, whose residents simultaneously fall into 3 
high risk groups targeted by AHRQ’s Health Disparities report: minority, poor and rural.9,10 The region has the 
highest prevalence of diabetes in the state, one third of the population lives below the federal poverty line, 
functional illiteracy is high, and distances and travel are major barriers to good health care.10 The Black Belt 
includes Tuskegee, site of the infamous 1932-1972 syphilis study, thus deep-seated mistrust of the healthcare 
system remains common among today’s Black Belt residents, 75% of whom are black. Internet connections are 
sporadic, and most families do not have access to computers. Table 1 shows the substantial mismatch of need and 
resources in this region. In 2011, there were 2 certified diabetes educators in an 8-county area that includes our 
community partners; all are Health Professional Shortage Areas. The result of this mismatch is sobering: fully 29 
of the 32 Alabama counties with the highest diabetes mortality rates are rural counties.11 The Black Belt Action 
Committee reported that in 2007, diabetes mortality was 38.7/100,000 population, contrasted to the US rate of 
24.6/100,000.11 Worse, this rate is 50% higher among Alabama’s blacks compared to whites.11 Further, these 
communities have requested diabetes programs at every community coalition meeting held by UAB researchers 
over the pat 15 years; these statistics and the call from the community informed our original selection of 
community partners.  
Table 1. Characteristics of our target communities in rural Alabama Black Belt counties 
Population 
% Black1 
% <Poverty1 
Diabetes Prevalence2 
PCP/10,0003 
Target Counties 
 
 
 
 
 
  Choctaw  
15,922 
44.4 
24.5 
13.5 
3.4 
  Dallas  
46,365 
69.4 
34.7 
11.9 
10.1   
  Lowndes 
11,147 
73.7 
31.4 
12.2 
1.5 
  Marengo 
20,692 
52.0 
25.9 
11.7 
5.5 
  Perry 
11,861 
68.8 
35.4 
17.5 
4.3 
  Pickens 
19,746 
43.0 
27.7 
14.9 
5.0 
  Sumter  
14,798 
73.6 
38.7 
12.2 
3.6 
  Wilcox 
13,183 
72.2 
39.9 
12.2 
3.1 
ALABAMA 
4,802,740 
26.3 
19.0 
11.8 
20.6 
US 
314,918,000 
12.6 
15.9 
8.3 
25.7                
12010 Census; 22008 Alabama Department of Public Health and BRFSS; 3PCP=Primary Care Providers per 10,000 people, from Board of 
Medical Examiners of Alabama and Kaiser Family Foundation.  
 
  Living Well with Diabetes Study Protocol | 5 

People living with diabetes in the Black Belt have a high prevalence of medication nonadherence. Diabetic black 
individuals participating in the national population-based REasons for Geographic And Racial Differences in 
Stroke (REGARDS) epidemiology study are contrasted with those participating in the Encourage study in Table 
2.12 Medication nonadherence as assessed by Morisky’s scale was more prevalent in the Black Belt sample, as 
were lower levels of education and income, demonstrating that diabetic black Americans living in the Black Belt 
are particularly disadvantaged.13 However, there is currently little understanding of the barriers to better 
adherence in this population, and no data on effective strategies to improve the situation. 
 
Potential for improving health care and 
outcomes. To improve medication adherence, we 
may need a fundamental re-examination of the 
model within which adherence is conceptualized. 
The biomedical model views medications as 
biochemical substances that modify diseased 
biological processes, improving disease outcomes. 
From this perspective, failing to take medications 
that have been proven effective is irrational. 
However, patients do not view medications this 
way, and failing to understand the patient 
perspective may be one reason why adherence interventions have demonstrated such modest success to date.  
An alternative perspective is a biopsychosocial framework based on the work of Corbin and Strauss, and of 
Charmaz.14,15 Corbin and Strauss interviewed hundreds of people living with chronic disease, thus their 
framework is highly patient-centered. They proposed that three essential elements interactively stabilize and 
reinforce each other to create the sense of well-being: 1) our Body, 2) our personal vision of our Biography 
through life, and 3) our Conceptions of self. This inter-related triad has been called the BBC chain to emphasize 
how interlinked each element is (Figure 1). Our conceptions of self are how we view ourselves, including our 
roles in the family, at work and in our communities, as well as our social and spiritual identities. Our biography, 
referred to by Corbin and Strauss as biographical time, is our image of what our lives will look like into the future 
in order to fulfill our conceptions of ourselves. Illness causes our bodies to fail, impacting this biography and 
forcing us to rewrite it and reconfigure our conception of self. Three types of work are created: work to preserve, 
restore and recast our self-image and identity; work to rewrite the biography; and the work of mourning for the 
passing of our old self and its previous hopes, dreams and identities. The reconfiguration of our self-view is 
extremely stressful, and people take varying amounts of time to establish a new equilibrium, with some never 
achieving enough balance to feel well again. This could explain why so many people deny that they have the 
disease, and don’t take medications as recommended even years after their diagnosis.  
Viewed from this perspective, we can make sense of the decision not to take beneficial medicines. Adams 
interviewed asthmatics to better understand why so many fail to take effective medications as prescribed.16 Three 
groups of patients emerged: the deniers, the accepters and those in between. The deniers refused to acknowledge 
that they had asthma at all, despite admitting that they had symptoms and needed rescue therapy; some had been 
doing this for years. For these people, taking the preventive medication would legitimize their diagnosis, which 
they equated with debility and unacceptable biographies. On the other hand, the accepters had integrated their 
body failure into their lives and viewed medications as the route to maintaining their concept of self and 
biography. In between were those who had not fully accepted their condition and the attendant medications, but 
who did not fully deny it either. On hearing about the Corbin and Strauss model, one of our peer supporter 
community members said:  
“This is really what it’s like. I have diabetes myself and I went through 
that. In the beginning you don’t want to accept it, you say I don’t believe 
it, I don’t want it. Then slowly you come around. I see it a lot in my 
clients. I tell them my own story and they do like that. It makes them feel 
like they’re not alone. You just keep at it and eventually they do get it. I 
think it’s a really good idea.” 
Table 2. Black individuals with diabetes from the REGARDS 
(national, 2003-7) and Encourage (Alabama Black Belt, 2010) studies. 
Characteristics 
REGARDS 
Encourage 
N 
3692 
337 
Mean Age, years+SD 
65.0+8.6 
58.7+12.5 
Female, % 
60.8 
77.1 
Education ≤ High School, 
% 
53.9 
75.8 
Income < $20,000, % 
31.3 
46.0 
Insulin Use, % 
31.9 
40.9 
Nonadherent, % 
30.7 
56.4 
Figure 1. The Body-Biography-Conceptions of 
Self (BBC) chain. 
 
  Living Well with Diabetes Study Protocol | 6 

It is not clear that any interventions have been designed from this patient-centered perspective. A 
workshop on Patient-Centered Medication Management was convened by the AHRQ-sponsored Centers on 
Research and Education in Therapeutics in October 2012 and included patients, health system managers, 
pharmacists, Pharmaceutical companies and researchers. Attendees heard results of a literature review on patient-
centered medication adherence interventions using the Institute of Medicine and Planetree organization’s 
definitions of patient-centered care/approaches.17-19 The results were striking: the voluminous literature on 
medication adherence and several excellent reviews revealed very few studies on patient-centered interventions, 
none using Corbin and Strauss’ framework. Conference attendees brainstormed and prioritized research gaps, 
including a call for studies on the trajectory of chronic medication-taking behavior and factors that can favorably 
influence that trajectory. Our study directly responds to this call from this multi-stakeholder group, including 
many patients. 
We briefed our community partners about this conference, and together we developed this proposal. They thought 
that hearing the stories of “people like me with problems like mine” could be a powerful influence on the 
trajectory of mediation taking behavior. Bandura’s Social Cognitive Theory posits that behavior is influenced by 
watching others and the consequences of their behavior, a concept which underlies the power of peer 
storytelling.20 Many people living with chronic diseases actively seek out others struggling with similar issues as 
demonstrated by websites like Patientslikeme.com, saying, “I joined because I didn’t want to feel alone 
anymore. Simply put. And I knew that I could be helpful [by sharing] my experience.”21  
The peer supporters who worked with us in past studies were very enthusiastic about including 
videotaped storytelling in this intervention. They thought that watching the stories of how others overcame their 
resistance to having diabetes and how they overcame barriers to medication adherence would be intensely 
reassuring to people struggling to do the same. Viewers of peers telling stories often develop para-social 
relationships with the storytellers, “a sense of friendship, attraction, and involvement with the person or 
character.”22-24 The more engaging the story, the more listeners are transported into the story and achieve 
“homophily”, or a feeling of relatedness to the storyteller. Thus, unscripted stories told by peers that show how 
they overcame similar real-world struggles are most engaging.25 Peer story telling had a remarkable effect on 
lowering blood pressure in an urban setting, but peer story telling has not been examined for diabetes or in rural 
settings.26,27 We will videotape community members with diabetes discussing their perceptions of common 
barriers to disease acceptance and medication adherence (emerging from the focus groups, see below), and to tell 
their own story of how they overcame them. 
 
Our community partners strongly recommended that our program 
should provide education. Knowledge of diabetes and self-care is extremely 
limited in our partnering communities; 55% of Encourage participants had 
diabetes knowledge scores below 50% at baseline. We agree that because of 
the complexity of self-management for diabetes, viewing stories of how 
other people overcame barriers to medication adherence (including accepting 
their disease) may be most impactful if they are integrated into an education 
program.  
 
According to Adult Learning Theory, adults learn best when they 
can build on experiences from their own lives. Although education is a 
critical first step, community members strongly advised adding a one-on-one 
coaching component to assure that the educational content was understood 
and to engage participants in discussions about the stories they heard. In our 
past work, education was incorporated better after a discussion with a peer 
coach. Peer coaches, sometimes called community health workers (CHW), 
peer advisors or promotoras, are here conceptualized as people with diabetes 
who live in the same community and who have in-depth understanding of the 
day-to-day challenges of living with diabetes. They receive training, 
including motivational interviewing, to coach other community members with diabetes on how to improve self-
management within the context of their own lives, helping them to overcome challenges within their community 
Figure 2. Conceptual model of 
Community Health Workers (CHW) and 
their roles. 
 
  Living Well with Diabetes Study Protocol | 7 

(Figure 1). Interacting with a live peer coach is a potent experience because participants have discussions with 
someone like them, facilitating the process of internalizing the DVD content and stories they heard, and working 
on an action plan to overcome their barriers to medication adherence. Therefore, we will add telephonic 
individualized peer coaching to the educational/storytelling DVD. 
Peer support is being more widely evaluated for diabetes,28,29 but, to our knowledge, not within the Corbin 
and Strauss framework to improve medication adherence. Two RCTs of peer support interventions for diabetes 
showed improvement in A1c with peer support compared to nurse case managers or usual care, suggesting 
that peer supporters can help others in their community to optimize their self-care practices.30,31 One trial was 
limited to veterans, and the other was conducted in a group of city clinics, so their generalizability to rural settings 
without a health system is unclear. Nevertheless, these studies suggest that peers could be powerful motivators to 
help people with self-regulation and recognize their medicines as a powerful strategy for staying as well as they 
can as long as they can. 
Among the Institute of Medicine’s top quartile of priority areas for comparative effectiveness research 
were interventions to reduce health disparities in diabetes using community-based approaches. In July 2013, CMS 
announced that CHW services could be covered by state Medicaid programs, and CHW interventions are 
increasingly being integrated into health systems.32-43 CHW interventions hold great hope for the elimination of 
health disparities, since people within the communities are the agents of change, overcoming trust barriers. 
Although we will study a specific population that demonstrates dramatic disparities in health outcomes (i.e., rural 
black Americans with diabetes), this intervention would serve as a model that could be adapted to other cultures, 
communities, disease states and health systems. Improved medication adherence would improve the physiologic 
measures that are used to assess the quality of healthcare provided, and these measures include the proportion of 
diabetes patients with controlled A1c levels. Clinical trials like the Diabetes Control and Complications Trial and 
the United Kingdom Prospective Diabetes Study showed that control of A1c lowers microvascular outcomes, and 
other clinical trials have shown that blood pressure and lipid control lower cardiovascular disease outcomes.3,44-49 
Improved adherence would therefore not only impact health care performance as currently assessed and publically 
reported, it would also delay or avoid complications of diabetes, improving quality of life and functioning, which 
are the ultimate measures of healthcare performance. The impact on healthcare performance would therefore be 
profound; as mentioned above, it could lower healthcare costs by as much as $290 billion.5 
 
Technical merit . Project Overview.  We will build on our ongoing partnerships with people living in 
Alabama’s Black Belt, learning together how to improve outcomes for individuals with diabetes. In the first year 
of the study we will conduct focus groups with people with diabetes and medication nonadherence to learn more 
about their beliefs and attitudes toward living with diabetes and the medications used to treat the disease. Using 
this information and working within the Corbin and Strauss framework, we will collaboratively create DVDs of 
peer storytelling integrated into a diabetes education experience, and the peer coaching protocol, drawing on 
Social Cognitive Theory and Adult Learning Theory. We will pilot test the intervention, and we will implement 
the randomized controlled trial (RCT) comparing the effectiveness of the intervention with usual care. In years 2 
and 3, we will recruit 500 individuals with diabetes who report medication nonadherence, group randomize them 
to one of the 2 trial arms, and collect baseline and follow-up data 6 months later. Control patients will receive 
comprehensive diabetes education on conclusion of the 6 month period. During all 3 years, we will also work 
with community coalitions in our partnering communities to obtain ongoing input, share knowledge of 
community resources, create a resource bank website to facilitate the peer coaches’ work, and plan for 
dissemination of the interventions. 
 
 
 
  Living Well with Diabetes Study Protocol | 8 

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Study Aims 
 
Improving medication adherence is one of the greatest challenges in modern medicine. Despite decades of 
research on the topic, as many as half of patients with chronic diseases are not taking medications as 
recommended, and costs of nonadherence have been estimated at $290 billion annually. One reason for this 
persistent finding could be that interventions rarely acknowledge medications within the larger context of the 
lived experience of illness. Drawing on hundreds of patient interviews, Corbin and Strauss showed that chronic 
illness is a fundamentally destabilizing influence that forces us to confront the potential limitations of our “new”, 
chronically ill self. Accepting our illness may be a crucial step in embracing medication adherence and other self-
management behaviors as ways to restore balance following this disruption. The Corbin and Strauss framework is 
not often used to develop and test interventions to improve medication adherence, and this is the central objective 
of this proposal. 
 
Medication adherence is especially critical in regions like rural Alabama, where residents have among the worst 
health outcomes in the US. Rates of cardiovascular mortality, diabetes and obesity are very high, but resources are 
scarce and the area’s predominately black residents have deep-seated mistrust of the healthcare system (the region 
includes Tuskegee, site of the infamous syphilis study). This project was designed in collaboration with our 
community member partners and builds on a 5-year partnership of community-engaged research on diabetes peer 
coaching interventions and our experience with peer storytelling. We will test the hypothesis that an intervention 
designed within the Corbin and Strauss framework can improve adherence and health outcomes compared to 
usual care.  
 
Our Aims are: 
                                                                                                                                                                                                  
Aim 1: With our community partners, using qualitative research methods, build on already developed culturally 
tailored education material to develop the medication adherence intervention. The intervention will consist of 
educational DVDs with integrated storytelling about how community members accepted their disease and 
overcame barriers to medication adherence, plus one-on-one telephonic peer coaching. Activities include 
conducting focus groups with patients; creating the DVDs and the coaching intervention protocol; training peer 
coaches; and pilot testing.  
 
Aim 2: Conduct a randomized controlled trial with 500 individuals with type 2 diabetes and medication 
nonadherence. The trial will compare the effect of usual care and the intervention on medication adherence and 
physiologic risk factors including A1c, blood pressure and low density lipoprotein cholesterol (primary 
outcomes), and quality of life and self-efficacy (secondary outcomes). 
 
This innovative approach would be a major shift in how we help patients in under resourced areas living with 
chronic diseases commit to taking medications, improving health and eventually reducing health disparities.  
 
  Living Well with Diabetes Study Protocol | 10 

Study Hypothesis 
 
An intervention designed within the Corbin and Strauss framework can improve adherence and health outcomes 
compared to usual care.  
 
Aim 1: Collaborative intervention development. 
 
Aim 2: Cluster RCT with 500 individuals with type 2 diabetes and medication nonadherence, test the hypothesis. 
 
Outcomes:  
Primary = medication adherence, A1c, blood pressure, low density lipoprotein cholesterol 
 
Secondary = quality of life, self-efficacy 
  
 
 
 
 
Study Design  
 
We will compare usual care to viewing an educational DVD including peer storytelling and a 6-month telephone-
delivered peer coaching intervention. We propose to use an RCT design because we aim to test the effectiveness 
of the intervention on medication adherence and A1c, blood pressure and cholesterol.  
 
The trial will be cluster-randomized to reflect the clustering of patients within tightly knit small rural 
communities. People talk frequently within these communities, and if two participants from the same town are in 
different trial arms and compare notes, this could change their behavior and threaten the validity of the study. 
Each of the anticipated 80-100 towns will therefore be group-randomized in blocks to avoid contamination across 
trial arms. We considered using physician practices as clusters, but we have learned that it is common for different 
family members to attend different practices many miles from home. 
 
 
  Living Well with Diabetes Study Protocol | 11 

Study population 
 
The priority population for this project lives in rural counties located in the Alabama Black Belt, which is heavily 
burdened by diabetes and lacking in primary health care providers and resources. 
 
Inclusion Criteria  
Individuals who meet the following criteria will be eligible to participate in the study. 
• 
Adults aged 18 or older 
• 
Have been told by a doctor or nurse that they have diabetes  
• 
Take oral medications for their diabetes 
• 
Medication non-adherent 
• 
Has a primary care doctor 
 
Exclusion Criteria  
• 
Not community-dwelling  
• 
Less than 18 years of age  
• 
Are pregnant 
• 
Have end-stage medical conditions with limited life expectancy 
• 
Do not have a primary care doctor 
• 
Expect to move out of the area in the next 6 months  
• 
Cannot speak English 
  
 
  Living Well with Diabetes Study Protocol | 12 

Study Outcomes and Measures 
Primary Outcomes 
The primary outcomes will include medication adherence. We will use the Morisky scale, which has been widely 
used and corresponds well to physiologic measures,13 but self-report is subject to recall and social desirability 
biases. Because of all the shortcomings related to assessment of adherence, we will also assess the result of 
improved adherence: better risk factor control. Three physiologic measures, A1c, blood pressure and LDL-
cholesterol make up the “A-B-C’s” of diabetes care, which will be assessed here. The “A-B-C’s” of diabetes are a 
central focus of diabetes education, and the intervention will address medication adherence to control all three risk 
factors.  
 
Secondary Outcomes 
Secondary outcomes will be health-related quality of life and self-efficacy. Quality of life will be assessed through 
the validated Short-Form 12 (SF-12), a generic measure of health-related quality of life. We will assess diabetes-
specific quality of life using the validated Diabetes Distress Scale.52 Self-efficacy in taking medications will be 
assessed using the Self-efficacy for Appropriate Medication Use53 and the Perceived Diabetes Self-Management 
Scale,54 which is associated with A1c.   
 
We will also assess the number of physician office visits, hospital stays and emergency visits in the previous 6 
months, but do not anticipate that the short duration of the study will be able to detect significant differences 
between trial arms. Nevertheless, we will collect these data to build toward future longer term intervention 
studies. In addition, during the in-home visit we will transcribe the name and dose of all diabetes, blood pressure 
and lipid medications at baseline and follow-up to detect whether regimens have been intensified as a result of 
exposure to the interventions.  
 
Additional Measures 
To understand the pathways through which the intervention is exerting its effects, we will collect additional 
measures guided by our conceptual framework. Our initial list of candidate measures is organized by theoretical 
construct and the Corbin and Strauss framework. Where available, we have selected validated scales that have 
been tested in low-literacy populations. 
 
Patient characteristics 
Age, sex, race, ethnicity, income, education, internet use, smoking status 
Duration of diabetes 
Insulin use 
Comorbidities 
Health Care Access 
Health insurance 
Distance from home to doctor 
Access to care question 
Medication Adherence 
4-item Morisky Medication Adherence Scale  
Barriers to medication adherence 
Medication Barriers Scale 
Diabetes distress 
Diabetes Distress Scale (DDS4) 
Diabetes knowledge 
Spoken Knowledge in Low Literacy in Diabetes (SKILLD)  
Depressive Symptoms 
Personal Health questionnaire (PHQ8) 
Health related quality of life 
Short-Form 12 (SF12) 
Perceived stress 
Perceived Stress Scale (PSS-10) 
 
  Living Well with Diabetes Study Protocol | 13 

Self Efficacy 
Self Efficacy for Appropriate Medication Use Scale (SEAMS)  
Perceived Diabetes Self-Management Scale (PDSMS) 
Self care behaviors 
Diet questions 
Exercise Questions 
Social Support 
Chronic Illness Resources Survey 
Social Support Scale 
Trust 
Trust in medical researchers 
Numeracy 
Subjective Numeracy Scale (SNS) 
 
Process Measures 
A careful assessment of intervention implementation can provide insights into which aspects of the intervention 
were particularly effective.  We will use cell phones provided by the study to track the frequency and amount of 
time spent on coaching sessions, as well as how closely they were implemented on schedule. Additional process 
measures will come from the peer coach Workbooks for each participant. These will include notes from each 
session as well as data entered for specific activities. We provide a chapter from our current trial’s Peer Coach 
Workbook in the Appendix to give a general idea of how these workbooks capture process data. We also monitor 
intervention implementation on an ongoing basis through weekly teleconferences with peer coaches, and weekly 
outreach to each peer coach individually throughout the intervention period. We provide updates on the progress 
of the study, collaboratively troubleshoot problems, and provide ongoing advice, which often stems from other 
peers or the community coordinators. We also address specific concerns with the help of our community 
coordinators (e.g., finding participants whose telephone numbers have changed).  
 
 
Randomization 
 
We will use a block randomization scheme for randomization. The units of randomization are towns identified by 
zip codes. We will group towns by size (small and not small) within each of the 4 regions, resulting in 8 strata. 
We will balance the strata so that at least 3 towns are in each stratum. With 55 towns in the two regions 
participating in the 400-member Encourage study, we conservatively estimate at 80-100 towns with the addition 
of two more regions, providing sufficient sample as well as clusters 
 
As participants agree to enroll and provide informed consent, they will be randomized as a representative of their 
town. That is, the first member of a given town will determine the randomization status of that town. All 
subsequent town residents will be placed into the same trial arm as the first participant from that town.  
Informed consent will be obtained from all participants. We will obtain verbal consent over the telephone at the 
time of the baseline telephone interview. Formal written informed consent will be obtained at the time of the in-
home data collection visit. Participants will view a video providing information about the study with the 
opportunity to call a toll-free number for questions.  
 
 
 
  Living Well with Diabetes Study Protocol | 14 

Program Descriptions 
 
Control Participants: General Health Videos 
Participants in the control arm will receive a general health education DVD and handout. The DVD contains 
videos on the following topics: Dementia and Alzheimer’s, Breast Cancer, Colorectal Cancer, Osteoporosis and 
Fall Prevention, Eye Health, Oral Health, Foot Care, and Driving Safety. A copy of the handout is included as 
Appendix A. 
 
Intervention Participants: Living Well with Diabetes 
Peer Advisors Recruitment 
Peer advisors are individuals who live and work in our target communities. Peer advisors are hired by Health and 
Wellness Education Center in Livingston Alabama. Peer advisors will be trained in motivational interviewing, 
basics of communication and goal setting. In addition, peer advisors will complete an 8-week study protocol 
training supervised by Ms. Debra Clark of Health and Wellness Education Center and lead by Dr. Cherrington 
and study staff.  
 
Peer advisor candidates are recruited by 3 methods.  
1. 
Community coordinators identify individuals in their community or social networks who they believe 
would be great peer advisors. 
2. 
Current peer advisors refer individuals from their communities or social networks. 
3. 
Participants of previous studies with peer advisors express interest in being a peer advisor. 
 
After an individual is referred, UAB staff or the local community coordinator completes a Peer Advisor Candidate 
Screening Form (see Appendix B). 
 
After the screening form is completed, the principal investigator, community coordinator, study coordinator, and 
the UAB staff (who completed the screener) meet to review the form and discuss each candidate.  
• 
If the candidate is not asked to move forward in the training, the reason is documented. These individuals 
are notified in person by the community coordinator.  
• 
If the individual is considered to be a good candidate but is unavailable for the scheduled training, 
permission is obtained from the individual to contact them for future programs.  
• 
Individuals who are considered a good candidate to a be peer advisor is scheduled for an upcoming 
training.  
 
Peer Advisor Retention 
 
As is the recruitment efforts, peer advisor retention efforts will be coordinated between UAB Birmingham-based 
staff, UAB community-based staff (community coordinators), and the Health and Wellness Education Center.  
Retention activities consist of the following:  
  
1. Ensure timely payment for work  
2. Provide ongoing support and continuing education/retraining with opportunities for practicing skills 
a. UAB Birmingham staff: Weekly group conference calls  
b. UAB Birmingham staff: Weekly individual calls to collect process measures, monitor progress 
 
  Living Well with Diabetes Study Protocol | 15 

c. Community coordinator: weekly individual contact to provide support, identify issues early 
d. Provide support and identify ways to reduce/help with workload during periods of stress in peer’s 
lives.  
3. Be respectful of peer advisors’ time and schedules 
a. Keep mandatory conference calls and individual calls on time, short as possible, and reschedule 
only if necessary.  
b. Provide assistance as needed in scheduling sessions with participants 
4. Recognize and thank peers for their work 
a. Holiday celebrations: 
i. face-to-face dinner or lunch 1-2 times per year 
ii. send notes/cards for birthdays and holidays 
b. Identify ways to celebrate in the local media the peer advisor’s work in the community 
5. Engage peers in leading and presenting for other community activities (ex: Black Belt Institute, Coalition 
meetings, and as opportunities become available) 
 
Living Well with Diabetes Program Description 
Participants enrolled in the intervention arm will receive a Living Well DVD, which contains 6 video lessons that 
cover 6 content areas (1-diabetes basics, 2-healthy eating, 3-physical activity, 4-diabetes medications, 5-blood 
pressure & cholesterol medications, and 6-stress and your health), and an Activity Workbook. The participant will 
use the activity book when communicating with their peer advisors during the sessions.  
 
Every session, the peer and participant will discuss the participant’s medication goals. During week 1, the 
participant will set a medication related goal. During week 2, the participant will set a goal related to healthy 
eating. During week 3, the participant will set a goal related to exercise. The peer and participant will review the 
previous week’s goal and progress of the goal. If the participant met the goal and ready to extend the goal, the 
peer advisor will help the participant set a new goal. If session has a video, the peer and participant will discuss 
the educational content in the video. 
 
During the check-in sessions, no new topic areas are introduced. The peer advisor will review the previous week’s 
goals. Peer will review goal’s progress and assess barriers and help problem solve any barriers. New goals will be 
set if the participant is ready to extend the goal.  
 
Intervention participants also receive 13-16 telephone contacts from a Peer Advisor.  
 
Months 1-3 are the intensive phase. During the first 8 weeks of the intensive phase, peer advisor contacts will 
occur weekly. During weeks 9-12, the peer contact will occur bi-weekly. 
 
Months 3-6 are the maintenance phase. During this phase, the peer contacts will occur monthly. No new content 
areas are introduced. Participant will continue to work on the goals set during the first 3 months of the program. 
The peer advisor will call monthly during the “check-in session”. During these sessions, the peer and participant 
will review goals set, goal progress, assess barriers and help problem solve barriers. If participant is having 
trouble with their health goals during this phase, the peer and participant can decide that more contacts than 
monthly contacts are needed. For these participants, the peer advisor will provide a ‘mini-intensive’ phase, during 
which calls will be increased to weekly. 
 
The participants will be allowed to telephone the peer advisors with questions or concerns between sessions. 
During session 1, the peer advisor makes sure that the participant has the correct contact number. The peer will let 
the participant know that it’s okay to call between sessions if they have questions. They will let them know that 
they may not be able to take the participant calls all the time, but the peer will return their calls as soon as they 
can. 
 
  Living Well with Diabetes Study Protocol | 16 

The schedule and topics for each week are listed below. 
Mon 
Week 
Session Topic 
Mon 
Week 
Session Topic 
1 
1 
Introduction to the program, diabetes basics 
4 
13 
 No session* 
2 
Healthy eating 
14 
 No session* 
3 
Physical activity 
15 
 No session* 
4 
Diabetes medications 
16 
Check-in session 3 (no new topic) 
2 
5 
Blood pressure & cholesterol medications 
5 
17 
No session* 
6 
Stress and your health 
18 
No session* 
7 
Check-in session 1 (no new topic) 
19 
No session* 
8 
Practice and planning for the future, part 1 
20 
Check-in session 4 (no new topic) 
3 
9 
No session 
6 
21 
No session* 
10 
Check-in session 2 (no new topic) 
22 
No session* 
11 
 No session 
23 
No session* 
12 
Practice and planning for the future, part 2 
24 
Check-in session 5 (no new topic) 
Months 1-3 = Intensive phase; Weeks 1-8 weekly contact; weeks 9-12 biweekly contact 
Months 4-6 = Maintenance phase; monthly contacts 
*The last 3 months of the program is the maintenance phase during which no new content areas are introduced. The participant continues 
to work on the goals (3 goals – 1) goal to overcome barriers to taking medications, 2) health eating goal, 3) exercise goal) set during the 
first 3 months of the program. The Peer Advisor will check in with the participant monthly. If participant is having trouble with their health 
goals during this phase, the peer and participant can decide that more contacts than monthly contacts are needed. For these participants, 
the peer advisor will provide a ‘mini-intensive’ phase, during which calls will be increased to weekly. 
 
Copies of the tools used by the peer advisors (Peer Advisor Manual and Client Plan Book) and participants’ 
Activity Book are included in Appendix C. 
 
 
  Living Well with Diabetes Study Protocol | 17 

Recruitment of Participants 
 
We will use respondent-driven sampling for recruitment. Flyers and interest cards are distributed by the 
community coordinators to their recruitment team. Flyers include the general purpose of the study and inclusion 
and exclusion criteria. Interested individuals sign an interest card with their contact information, which is 
forwarded to the research team based in Birmingham.  
 
Prospective participants are screened for eligibility by a member of the research team over the telephone. Adults 
age >18 years with type 2 diabetes who respond “yes” to any question on the 4-item Morisky scale who are 
willing to watch a DVD and work with a peer coach to improve their diabetes self-care will be eligible for the 
study. Exclusion criteria include nursing home residence, plans to move away in the next year, and advanced 
illnesses such as hemodialysis, cancer or dementia. The participant eligibility screening script is included in 
appendix D. 
 
Recruitment Methods 
Participants will be recruited by 4 methods. 
1. Community member calls UAB after seeing an advertisement (i.e., radio ad, newspaper ad, flyers, heard 
about the study at a community event or community meeting) 
2. Community recruiter 
a. Individuals calls UAB after hearing about the study from a recruiter 
b. Individual completes a participant interest card and the card is submitted to a community 
coordinator 
3. Community Coordinator 
a. Have individuals complete interest cards  
b. Collects interest cards from community recruiters. 
c. Collects interest cards from primary care practices / community organizations who recruit 
4. Primary care practices 
a. Flyers will be posted in local partner practices.  
b. Research assistant in the waiting room 
 
Community Recruiters. Community recruiters have been identified the community coordinators or peer advisors. 
Recruiters are asked to identify individuals in their social networks that may be interested in participating in a 
study to help them better care for their diabetes. Before they begin recruitment, community recruiters are given an 
orientation by the community coordinator and if needed, study coordinator. The recruiters are provided 
instructions and a checklist on how to complete the information sheet. 
 
Community recruiter submits interest cards to their community coordinator who submits the cards to UAB staff. 
The community coordinator meets each community recruiter at minimum 1 time per week to arrange card pick-
ups.   
 
Community Coordinators. Community coordinators present the study to groups at local community events, health 
fairs, churches, etc. The individuals that they recruit complete an interest card or are asked to call the study’s 
phone number.  
 
During weekly calls, coordinators and study staff discuss upcoming opportunities in the communities to recruit 
participants for the study. A recruitment calendar is maintained with the event’s name, the date and time, and the 
responsible study member who is attending the event.  
 
  Living Well with Diabetes Study Protocol | 18 

 
Community coordinators also coordinate these following recruitment activities: radio announcements, putting up 
flyers, newspaper ads, church announcements, and working with local primary care providers. 
 
Community coordinators or recruiter will call us with the individual’s name and submit the interest cards. UAB 
staff will add the names to the recruitment tracking log. 
 
For every individual referred that enrolls in the study, community recruiters receive a $5.00 VISA gift cards. 
These cards are bundled and sent periodically.  
 
Recruitment at Primary Care Practices. Passive recruitment at practices will consist of flyers posted in primary 
care practices in the local communities. Interest cards and interest card boxes will be placed in secure and 
monitored locations. Community coordinators will check-in with the practices and the boxes at minimum once 
per week.  
 
Active recruitment at willing practice via site visits by UAB research staff. As practice schedules allows, research 
assistant or community coordinators will sit in the waiting room of the practice. Practice staff will walk interested 
patients to the research assistant who will present the study and complete the screening if the participant is 
interested in the study. The community coordinator will arrange for specific days in which the research assistants 
can visit the practices.  
 
Recruitment Flyer is included in appendix D. 
 
Eligibility Screening 
After the potential participants sign the interest card or call UAB, study staff will conduct an eligibility screening 
over the telephone using the “Telephone Eligibility Screening Script” in appendix D.  If individuals are eligible 
for the study and interested in enrolling in the study, he or she will be scheduled for the telephone interview. 
 
  Living Well with Diabetes Study Protocol | 19 

Study Enrollment, Informed Consent, and Data Collection 
Telephone Interview 
A waiver of documentation of informed consent for the telephone interview has been approved. The potential 
participant will be mailed the informed consent form that will be reviewed prior to the interview. The telephone 
interviews will be scheduled at the earliest date and time after the screening interview that the participant is 
available, allowing for 2-3 days needed for the participant to receive the informed consent document in the mail. 
Trained UAB study staff members will conduct the telephone interviews.  
 
The telephone interview will begin with the interviewer reviewing the informed consent form with the participant. 
If the participant agrees to participate in the study, the interviewer will complete the baseline assessments.  
Telephone interview is included in appendix E. 
 
Interviews will be completed in the Preventive Medicine Research 510 suite. As such, the program coordinator 
and/or data coordinator will listen to interviews in progress. Furthermore, a random selection of interviews will be 
quality checked. For these interviews, the program coordinator or data coordinator will listen in to the entire 
interview.  
 
 
  Living Well with Diabetes Study Protocol | 20 

In-Person Biometric Data Collection Visit 
After the interview is completed, the in-person data collection visit will be scheduled. Participants will be given 
the option of meeting at a community location or have UAB staff members come into the home to collect 
biometric data. Community locations most convenient for the participants and have private spaces available will 
be selected. Example locations include private rooms in community centers and church meeting rooms. UAB staff 
members, trained in the biometric study protocols will attend the biometric data collections. Data collectors for 
the study are trained and certified by study investigators. Training and certification for each data collection 
component are outlined in the biometric protocol. In summary, the data collector to be trained and certified, the 
following is necessary: 
 
1. Read the biometric protocol (Biometric protocol included in appendix F.) 
2. Attend Living Well training session on techniques 
3. Practice on other staff or volunteers 
4. To be certified, complete exam on 2 volunteers, observed by study investigator 
 
During the screening, participants will be asked not to not drink any caffeine (from coffee, tea, or soda), should 
not eat or do any heavy physical activity, smoke, ingest alcohol for 30 minutes prior to recording the blood 
pressure. 
 
During the in-person data collection visit, the participant will sign the informed consent. The following measures 
are collected during this visit: hemoglobin a1c, LDL-cholesterol, blood pressure, weight, and height.  
 
Hemoglobin A1c will be measured using the A1cNow+ system, National Gycohemoglobin Standarization 
Program Certified, CLIA-waived system that provides Hba1c results using a fingerstick test.   
 
LDL-Cholesterol will me measured using the Cardiochek PA analyzer, CLIA-waived system that provides LDL 
cholesterol results using a fingerstick test. 
 
Blood pressures will be measured using the following protocol. Patient will be asked to sit quietly for 5 minutes. 2 
BP measures, using an automated BP machine, will be taken. Measures will be taken 1 minute apart. 
 
Data will be collected in this order.  
1. Blood pressure: 
a. 5 minute rest 
b. blood pressure measurement 1 taken 
c. 1 minute rest 
d. blood pressure measure 2 taken 
2. Fingerstick for A1c and LDL cholesterol measurements 
a. A1c measured using the A1cNow+ machine 
b. LDL cholesterol measured using the Cardiochek PA analyzer 
3. During this visit, we will also make a list of all medications the participant is currently taking.  
4. Provide participant with health report card  
 
After the completion of the in-person data collection, the participant will be given the materials for the program. If 
the participant is in the control condition, they will be given a general health education DVD. Participants in the 
intervention condition will be matched with their peer advisor and given an activity book that they will use during 
their sessions with their peer advisors. All participants will receive their portable DVD player at the end of the 
data collection visit. Participants will receive a Health Report Card that provides their a1c, LDL-cholesterol, 
blood pressure, and weight data. If needed, participant in the intervention arm will receive a study phone. 
 
  Living Well with Diabetes Study Protocol | 21 

Participants will be asked by the research staff at the in person data collection visit if they would like to use a 
study phone. Study phones will be taken back at the 2nd in-person study visit. Copies of the consent, in-person 
data collection form, and Health report card are included in Appendix F.  
 
Participant Compensation 
Participants will receive a portable DVD player and a $20.00 VISA giftcard. Participants will receive the DVD 
player at the first in-person data collection visit and the giftcard at the second in-person data collection visit. 
 
Participant Retention 
During the 6 months of the trial, UAB staff will contact all participants 2-3 times. During these brief 5-minute 
calls, the staff will answer participant questions, update contact information, and provide help if needed in 
accessing study education materials. Participant retention plan will be a mixture of telephone and mail contacts as 
shown below: 
 
Month 
Control Participants 
Month 
Intervention Participants 
1 
Phone Call: Welcome to the study, answer questions 
1 
No contact 
2 
Postcard: Reminder to look at videos 
2 
Phone Call: answer questions, identify problems, 
update contact information 
3 
Phone Call: answer questions, identify problems, update 
contact information 
3 
No contact 
4 
Postcard: Keep in touch post card card 
4 
No contact 
5 
Phone Call: answer questions, identify problems, update 
contact information 
5 
Phone Call: answer questions, identify problems, 
update contact information 
6 
Postcard: reminder of upcoming data collection 
6 
No contact 
 
All participants will receive postcards for birthdays, holiday cards (Thanksgiving, Christmas) 
 
During month 6 (control participants) or after the final session with the peer advisor (intervention participants), 
study staff will contact the participant to schedule their follow-up telephone interview and in-person data 
collection. Copies of postcards and telephone contact scripts are included in Appendix G. 
 
 
  Living Well with Diabetes Study Protocol | 22 

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Analysis 
 
Data management 
Data is being entered into a Redcap Database. Validity checks and skip patterns maximize the quality of data 
entry and text entry is minimized. In-home visit data will be transcribed onto a form during the visit and faxed 
daily to the UAB research office. A tracking system will be implemented to monitor study progress using Redcap. 
 
 
Power Calculations and Sample Size 
This study is powered to detect clinically meaningful differences in changes in medication adherence, A1c, blood 
pressure and LDL-cholesterol between either of the intervention arms compared with the usual care arm. The 
secondary outcomes are based on surveys (disease acceptance, quality of life). To consider the clustering of 
patients within town, we used a variance inflation factor D = [1 + ρ(m – 1)], where m is the number of 
participants per community and ρ is the intra-class correlation (ICC). We conservatively estimate that we will 
have at least 80 clusters, corresponding to an average of 6-8 participants per cluster, with ICC=0.01 and 0.05 
yielding D=1.084 and 1.419, respectively. Dividing the sample size per group N by D gives NEff, the effective 
sample size. In the Encourage study, those reporting nonadherence at baseline demonstrated ICCs in the range of 
0.001-0.015 for most measures. To be conservative because we include new communities, we present power 
calculations for ICC=0.01-0.05. We observed 20% attrition over one year in the Encourage study and although 
attrition is likely to be lower over 6 months, we assume 20% attrition here, leaving 200 participants per group. 
Table 7 displays the detectable differences in adherence proportions and the difference in mean changes between 
groups detectable with 80% power using 2-sided Χ2 and t-tests with α=0.05. We used variances based on the 
Encourage sample reporting nonadherence at baseline. We hypothesize that the intervention will result in 
improved medication adherence. Because eligibility requires low adherence at baseline, we expect low acceptance 
at baseline. Starting with low baseline values by design eliminates ceiling effects and allows us to reasonably 
anticipate large changes in the intervention groups and only modest changes in the control arm, as was seen in a 
storytelling intervention directed at blood pressure.27 For N=200 per group, the difference in rates of medication 
adherence treated as a binary outcome detectable with 80% power depends on the proportion observed in the 
intervention group. If adherence is only 20% in the intervention group, then we can detect as different rates 
among the control group of 8.8-10.1%, depending on ICC. These rates are both lower than we anticipate for the 
intervention group and considerably higher than we expect in the control group. Assuming 200 participants per 
group we will have 80% power using 2-sided t-tests to detect differences of 0.28-0.32 standard deviations for 
continuous outcomes. Using variance estimates from Encourage data for change in the Diabetes Distress Score, 
another validated psychometric instrument, this translates into detecting differences as small as 3.7-4.4% of the 
range. Similarly, detectable differences for change in A1c are in a clinically meaningful range from 0.41-0.48%. 
We anticipate detectable differences for systolic blood pressure of 3-4 mmHg, and for LDL-cholesterol of 6.7-8.1 
mg/dL. 
 
 
Data Analysis 
The main hypothesis to be tested is that participants in the intervention group will have higher medication 
adherence and significantly greater improvement in A1c, blood pressure, LDL-cholesterol, and measures of 
quality of life; and fewer barriers to adherence compared to control patients. While medication adherence can be 
considered as a continuous variable, we will follow the literature and treat adherence as a binary outcome by 
classifying participants as non-adherent if measured adherence is <80% and adherent otherwise. Therefore, 
unadjusted testing of the main hypothesis will use two-sided Χ2 tests and statistical modeling will use logistic 
 
  Living Well with Diabetes Study Protocol | 24 

regression. The other primary outcomes (A1c, blood pressure, LDL-cholesterol) and the secondary study 
outcomes of physical and mental functioning, as measured by the SF-12, diabetes distress, and barriers to 
adherence are all continuous or ordinal measures. As such unadjusted hypothesis tests for these outcomes will use 
t-tests or the Wilcoxon-Mann-Whitney test, as appropriate, and statistical modeling will use linear regression. 
Analysis will begin by calculating ICCs for each outcome to assess the magnitude of clustering; if the ICCs are 
found to be significantly non-zero with p<0.05 or with a point estimate greater than 0.01, testing of main 
hypotheses will use unadjusted regression models (logistic or linear, as appropriate) with Generalized Estimating 
Equations (GEE) to account for clustering.  All regression models for outcomes with non-negligible ICCs will use 
GEE to account for clustering due to randomization at the town level, and will be repeated using mixed models 
treating the towns as random effects with results examined for consistency. 
The primary analysis will test the hypothesis that medication adherence treated as a binary outcome will be 
greater in the treatment arm than the control arm at follow-up. As above, the primary unadjusted hypothesis test 
will use either a Χ2 test or logistic regression with GEE depending on the magnitude of observed ICCs. Statistical 
significance will be judged by p<0.05 for either the Χ2 test or the coefficient for study group in regression models. 
The intervention group will be compared to the control group; further analyses will use logistic regression with 
GEE to model adjusting for any covariates that were imbalanced between groups at baseline, and will then 
proceed to examine regression models adjusted for the covariates described in Table 6. 
Analysis for A1c, blood pressure and LDL-cholesterol and the secondary outcomes will be very similar to the 
analysis of medication adherence described above. We note that we will also be able to analyze adherence as a 
continuous outcome as a secondary analysis using the following approach. For each of these continuous or ordinal 
measures, we will begin by calculating the change from baseline to 6-month follow-up for each participant. These 
change scores will be the units of analysis and we hypothesize greater change among the intervention groups 
compared to the control group. We will proceed to examine summary statistics, histograms, and scatter plots of 
the measured outcomes for outliers and data trends. We will then test for unadjusted differences in changes 
between the intervention and control groups using t-tests, Mann-Whitney-Wilcoxon tests, or regression models 
with GEE to account for clustering, as appropriate for the variable and ICC. Similar to above, we will then 
proceed with more sophisticated analyses in stages, first adjusting for baseline values of outcome variables, then 
for any factors that were imbalanced at baseline and finally adjusting for covariates mentioned above. 
 
 
Safety Assessments 
This study does not involve any new treatments of care, but rather focuses on standard care delivered in a new 
way. It is possible that the interventions will result in better compliance with medication treatment, resulting in 
over-control of diabetes or blood pressure. This could result in low blood sugar or low blood pressure and 
resultant symptoms. Therefore, we will monitor potential adverse events of this nature. We will monitor 
symptoms of low blood sugar in both trial arms at the follow-up data collection point as well as at ongoing 
contacts during the 12-week intervention phase, by peer coaches. During these contacts, symptoms of low blood 
sugar and low blood pressure will be assessed and reported to the investigators and to the participant’s physician. 
If symptoms are present, the peer coach will refer participants to their primary care provider for evaluation 
immediately, assisting with the telephone call if needed.  
 
Data on safety endpoints will be reviewed by a board convened for this purpose. Quarterly reports will be 
presented to the board over the course of the trial. The board will be constituted by 3 individuals experienced in 
the conduct of clinical trials and the safety of human subjects. Adverse events will be reported to the UAB IRB, 
and the NIH Office of Biotechnology Activities (OBA) in accordance with regulations, by the PI.  
 
Dr. Safford and project investigators, including our community team members, will have an initial organizational 
meeting or conference call to discuss the protocol development, review of scientific, safety and ethical issues 
 
  Living Well with Diabetes Study Protocol | 25 

related to the study design and approve plans for data integrity.  After the initial planning meeting project 
investigators will be convened monthly in a meeting or conference call throughout the project period. 
 
Dr. Safford will be responsible for monitoring the safety and efficacy of the study, executing the data and safety 
monitoring plan, and complying with the reporting requirements. She will provide a summary of the DSM report 
to PCORI on an annual basis as part of the progress report. The report will include participant’s 
sociodemographic characteristics, expected versus actual recruitment rates, any quality assurance or regulatory 
issues that occurred during the past year, summary of adverse events, and any actions or changes with respect to 
the protocol. The DSM report to PCORI will also include, when available, the results of any efficacy data analysis 
conducted.  
 
Project investigators will be primarily responsible for protecting the safety of the study participants and the 
scientific credibility of the project, and the validity of the assessment of the efficacy of the interventions used in 
the projects. The project investigators will also formulate recommendations relating to the selection, recruitment 
and retention of participants, their management, improving adherence to protocol-specified regimens, and the 
procedures for data management and quality control. 
 
The entire project team will monitor success of recruitment, assess data integrity, and most importantly monitor 
for adverse events. Risks to study participants relate mostly to misinterpretation of what is research and what is 
usual care and loss of confidentiality. Project investigators will carefully evaluate how the study is described and 
assure that study subjects are informed not to report urgent symptoms (chest pain) through email communications. 
Any hospitalizations or deaths discovered by the research team will be promptly reported to the DSMB with an 
assessment of whether any study procedures may have contributed to these outcomes.  
 
The risks of the study are low, and thus the safety monitoring plan has been matched to the risk to subjects in this 
study. Risks to physician study participants relate mostly to misinterpretation of what is research and what is 
usual care and loss of confidentiality. We are encouraging physicians and their staff to increase their provision of 
care related to diabetes, osteoarthritis and chronic pain to be consistent with current guidelines.  However, we are 
not asking the physicians or their staff to provide services beyond those in standard, high-quality medical 
practices.  
 
For this study, we plan interim data analysis twice annually to assess probability of statistically significant group 
differences. We will first compare baseline data to assure adequacy of randomization. We will then conduct 
interim analyses that will coincide with practice data intervals, and set intervals for patient data collection for 
outcomes data. Prior to interim analyses, investigators will assign stopping rules. Safety data to be included in 
these reports include hospitalization rates as well as Emergency Room utilization. 
 
 
 
  Living Well with Diabetes Study Protocol | 26 

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  Living Well with Diabetes Study Protocol | 29 

Appendices 
 
 
Appendix 
Item Description 
Page Number 
A 
General Health Education Video Handout 
31 
B 
Peer Advisor Candidate Screening Form 
33 
C 
Peer Advisor Manual (Tool for Peer Advisor) 
40 
Client Plan Book (Tool for Peer Advisor) 
198 
Participant Activity Book (Used by Study Participant) 
228 
D 
Recruitment Flyer and Interest Card 
265 
Participant Eligibility Screening Script 
269 
E 
Telephone Interview 
274 
F 
Biometric Protocol 
293 
Consent Form 
325 
In-person Data Collection Form 
332 
Health Report Card 
345 
G 
Participant Retention Postcards 
347 
Participant Retention Scripts 
354 
 
 
  Living Well with Diabetes Study Protocol | 30 

Appendix A 
 
General Health Education Video Handout 
 
 
Appendix Page |  31

 
Appendix Page |  32

Appendix B 
 
Peer Advisor Candidate Screening Form 
 
 
Appendix Page |  33

v 2015-07-09
1
 
Peer Advisor Interest 
Talking Points / Screening Form 
Date of Discussion:  
 
 
 
 
 
Name of Potential Peer:  
 
 
 
 
 
Peer’s Community:  
 
 
 
 
 
Phone Number:   
 
 
 
 
 
Phone Number:   
 
 
 
 
 
What is Living Well with Diabetes? 
Diabetes is a big problem in rural Alabama, especially in the Black Belt.  The Black Belt has among the 
highest rates for diabetes and diabetes complications such as heart attack, stroke, kidney disease, 
amputation, and eye problems. Many people who have diabetes do not take their medications every day. 
Taking your diabetes medications every day as directed by your doctor is one of the ways that can help 
you live as well as you can, as long as you can.  
 
The goal of the study is to help people take care of their diabetes by taking their medications every day 
as directed by their doctor, eating healthy foods, exercising, having effective interactions with their 
healthcare team, reducing stress, and getting positive support from family and friends. We think that this 
program will help people with diabetes live as well as they can, as long as they can.  
 
What is a Peer Advisor? 
Peer Advisors are people who live in the Black Belt and want to help their communities. We are looking 
for people with diabetes, or people who care for someone who has diabetes. The essentials: you care 
about your community, you want to help, and you have familiarity with what it is like to live with 
diabetes day in and day out. 
 
How long would I be involved? 
The Living Well with Diabetes study will last approximately 1 to 1.5 years.  
 
Do I have to participate until the program ends? 
We are looking for people who would be willing to work with us for at least one year. 
 
What would I need to do?  
Getting Trained and Certified as a Peer Advisor 
§ Attend 2 days of in-person training, followed by a10-week telephone training. 
o Costs you nothing  
o Learn about diabetes basics, motivational interviewing, talking to the doctor, medications 
for diabetes, blood pressure, and cholesterol 
o Practice your new skills. NOTE: It is easier for some people to develop these skills 
than it is for others. There will be a test at the end of the 2 days of in-person training 
to see how much you have mastered. Unfortunately, some people may not move on 
to become Peer Advisors.  
 
 
 
 
 
Appendix Page |  34

v 2015-07-09
2
§ Time Commitment for Training: 
o 2 In-person trainings: 6 hours each day, lunch will be provided 
o 10-Week Telephone Training: 2 to 4 hours each week, depending on the week 
§ 30-60 minutes listening to audio recording of the session and watching session 
video 
§ 30-60 minute telephone call with the other peer advisor candidates 
§ 30 minutes roleplaying as a client 
§ 30 minutes roleplaying as peer 
§ 30-60 minutes talking with UAB staff, providing feedback on the program, and 
completing certifications 
§ (as needed) additional practice time with the community coordinator in order to 
complete certification 
 
Working as a Peer Advisor 
§ Work with someone with diabetes on the phone for 5 months, one-on-one, over the phone.  
§ Time Commitment as a Peer Advisor: 
o First 2 months: talk with client on the telephone weekly (30-45 minutes per call) 
o Last 3 months: bi-weekly or monthly (10-20 minutes per call) 
o Special call before and after a doctor visit (10-15 minutes each call) 
§ Attend a weekly group call with other peer advisors  (30-45 minutes) 
§ Speak with a UAB staff member every 1-2 weeks (15-30 minutes) 
 
What’s in it for me? 
Peer advisors will be UAB employees. 
§ $50 Gift card for completing the 1st in person training, whether or not you pass the test (1 day) 
§ $50 Gift card for completing the 2nd in person training, whether or not you pass the test (1 day) 
§ $250 Gift card for completing the 10 week telephone training, whether or not you pass the test  
§ $150 for completing the program with each study participant. 
When does it start? 
The first in-person training will be July. 
The second in-person training and 10-week telephone training will start late summer/early fall.  
 
I have trouble with transportation. Does that matter? 
Most of the Living Well with Diabetes program is done over the phone. We can arrange transportation 
for training. 
I only have a cell phone. Is this OK? 
You will receive an UAB cell phone for use for the study. 
How much travel will I need to do? 
You will need to attend the 2-day training in person. 
You will have to meet with your community coordinator regularly to receive / turn in study materials.  
 
Appendix Page |  35

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v 2015-07-09
6
Now that we have shared our expectations for the project, we want to give you a chance to tell us why 
you decided to participate. Take a minute and write down the top 3 reasons why you are interested in 
becoming a Peer Advisor. 
 
I am interested in becoming a Peer Advisor because: 
 
1.   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
2.   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
3.   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
	  	  
 
Appendix Page |  39

Appendix C 
 
Peer Advisor’s Program Tools  
(Peer Advisor Manual) 
 
Appendix Page |  40

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2
 You will receive the name and study cell phone number of your client from your community 
coordinator or one of the research team members form UAB. 
 Write them into the areas below. You’ll get additional information during the first session call. 
 You will call the client to set up the appointment for the first session. 
 Try to have the first session within 7 days of receiving the client’s name. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Additional people that would know how to get in touch with the client: 
 
 
 
 You should have this information filled out based on information that the Living Well with 
Diabetes research assistants have already collected. 
 During the first call, fill in any missing information, especially additional phone numbers of 
people that might know how to get in touch with the client. 
 You will continue to update this information during the next 12 weeks. 
Client Information 
 
Client name: 
1. Phone number and the person at this number and how she/he is related to client: 
 
UPDATE AS NEEDED 
2. Phone number and the person at this number and how she/he is related to client: 
 
Study cell phone number: 
Home number: 
Work number: 
Notes: 
Appendix Page |  42

 
3
REMEMBER! Session 1 should be within 7 days of receiving the client’s 
name. If unable to reach the client, note your attempt(s) in the log below. 
 If you do reach the client, follow the script below. 
Scheduling Session 1 
 
 
 
Appendix Page |  43

 
4
 
 Hello, Ms. / Mr. (__________), I'm (___________), your peer advisor from the Living Well 
with Diabetes Program. 
 I’ll be working with you during the next six months to help you with the program. Is this a 
good time for a five-minute call? If not, schedule a time to call the client back. 
 Great! When you met the research assistant for this program, she asked you a lot of 
questions and checked your blood pressure and other things. 
 She also left with you an Activity Book, DVDs and a DVD player, and your study phone. 
You watched the first session on the DVD at that time. 
 Now, I’d like to set up an appointment to talk with you on the phone sometime this week for 
about 45 minutes. When would be a good time for that? 
 
 Let me give you my contact information in case you need to reschedule. If you don’t mind 
grabbing your Activity Book, there is a place in the front where you can write my name and 
my phone number. Let the client fetch the Activity Book and write your information. 
 
 OK, my name is (___________), and my phone number is (___________). If something 
comes up and you can’t talk at the time we just scheduled, just give me a call and let me 
know, and we’ll reschedule. 
 Now, when we talk again, I’d like to go over the materials that the research assistant left 
with you. So, please have your Activity Book handy when I call. Also, you may want to re-
watch the first session on the DVD.  
 We’re also going to talk briefly about your diabetes medications, so please have with you 
your diabetes medications in their pill bottles when we talk again.  
 OK, I look forward to speaking with you then! 
 
 
 
 
 
Date of Session 1: 
Time: 
Appendix Page |  44

 
5
Reminder!! 
 Cover and check off all of the session 
content. 
 Any text in GRAY BOXES is 
instructions for you: don’t read those 
sections aloud to the client. 
Session Goals: 
 Introduction to the program, review of schedule, commitment to the program 
 Diabetes basics 
 Setting a goal for diabetes medication taking 
 Assign homework 
 
 
Week 1, Session 1: “Introduction to Living Well with Diabetes” 
 
 
Before Calling the Client ----------------------------------------------------------------------------------- 
 
 From the in-person training, review the 
experiences that you, a family member, or 
someone you know have had while living with 
diabetes. Review client’s diabetes medications 
and medication barriers in client plan book. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Appendix Page |  45

 
6
Potential Talking Points 
 Where you are from and where you live 
 How long you and your family have lived in your area 
 What you do for a living, or what you used to do if you are now retired 
 How many children or grandchildren you have 
 Whether you are married and for how long 
 Your hobbies 
 Your previous experience with the Encourage and Living Healthy programs and/or how you have 
been helping people with diabetes take care of their health 
Getting to Know Your Client ---------------------------------------------------------------------------- 
 
 Hello, Ms. / Mr. (__________), this is (___________) from the Living Well with Diabetes 
Program. How are you doing today? 
 We had scheduled this time to talk for about 45 minutes. Is this still a good time? 
 Great! Do you have your Activity Book and your diabetes medications in front of you? If 
needed, let client fetch the Activity Book and medications. 
 OK, let’s get started. First, let me make sure I have your contact information. I already have 
your study phone number, but in case it runs out of battery, would you give me the number 
of two people who would know how to reach you? Verify that the information on page 1 of 
your manual is correct, and fill in any spaces that are empty. 
 Now, you may have questions between our sessions, so I want to make sure that you can call 
me. Do you still have my telephone number written on the front page of your Activity Book? 
 If you do call me between our sessions, I might not be able to take your call all the time, but 
I’ll call you back as soon as I can. Is that okay? Make sure the client has your number 
written on the front page of the Activity Book. 
 Great. We will be talking today for about 45 minutes. Do you feel okay with that today? 
 Wonderful. I would like to begin by getting to know each other better. Let me tell you a little 
about myself. 
 Can you tell me a little bit about yourself?  
 If needed, ask questions to 
get the client to open up. 
 Write down some notes 
about things like their 
spouse’s name, children’s 
names, hobbies, etc. 
 You will refer back to this 
section throughout the 
program. 
 
 
 
 
 Thank you for sharing that with me! I’m glad that we’re getting to know each other better. 
Appendix Page |  46

 
7
Refer to the FAQs for answers, or write down the question and let the client know that you will find out 
the answer and let them know next week. 
 
 
 
If needed, suggest events such as the wedding of a grandchild, the birth of a great grandchild, travel, 
or a special reunion. 
 
Try to get at least 2 to 3 long-term, meaningful events or goals that motivate them. 
 
Write goals on page 3 of the Client Plan Book. 
 An important part of this program is looking ahead positively. As part of that, would you 
mind sharing with me some things that you are looking forward to in the future, maybe a few 
years from now? 
 Those are wonderful things to look forward to! This is the reason why I enjoy being a part of 
this program, because its goal is to help people like you and me live a full and healthy life. 
 During this program, we’ll discuss diabetes, healthy eating, exercise, and other health topics, 
providing information that can let you live longer, better.  
 Now, it’s very important that you understand that I am not a doctor or a nurse. 
 I am a health coach, and I’ve been trained to work with you to complete this program. If you 
have a question that I can’t answer, I will get the correct answer from the study doctors. 
How does that sound? Let client answer. 
 
Introducing the Living Well with Diabetes Program ------------------------------------------------ 
 Great, now that we know a little bit about each other, let’s talk about the program, which is 
called, “Living Well with Diabetes.” 
 We know that diabetes is very common and has a big effect on how you live. You will be 
taking care of your diabetes for the rest of your life. 
 There are a lot of things you need to do every day to take care of yourself when you have 
diabetes, but people with diabetes can still live a full and active life. 
 So, this program will help you learn what to do to take care of yourself the best you can, 
every single day. You will learn these things through our discussions and watching videos. 
 Speaking of the videos, when you first met the research assistant for this program, she left 
with you a DVD player and program DVDs, and you watched a video on this program. 
 You will watch a video each week between our telephone sessions, so I want to make sure 
you’re comfortable with the DVD player and the DVDs. Do you have any questions about 
the DVDs or how to use the DVD player? 
 
Appendix Page |  47

 
8
If needed, remind your client that diabetes can cause blindness, stroke, heart attack, kidney failure, 
amputation, impotence, and nerve damage. 
 OK, another item that you will use during the program is the Activity Book, which you have 
in front of you right now. During our sessions, we will learn about ways to live well with 
diabetes, and between sessions, we’ll ask you to practice what you’ve learned. 
 The Activity Book will help you practice, so let’s turn to page 2. Here you can see some of 
the points made on the DVD. Let your client get to the page. 
 
Reviewing the DVD: Introduction to Living Well with Diabetes----------------------------------- 
 What did you think about the video for this week? Listen supportively. 
 Let’s review. We learned that diabetes is a problem with the body’s ability to handle blood 
sugar. When the blood sugar stays too high, it can cause all sorts of problems. 
 The video also talked about why some people get diabetes and others don’t, and how long it 
takes for most people to develop diabetes. What did you think about that? Let the client 
answer. 
 Another thing the video talked about was the health problems that people with diabetes may 
experience. This is shown with the figure in the middle at the bottom of page 2. Do you see 
all the arrows pointing to different parts of the body that diabetes can affect? Can you 
remember some of those problems that diabetes can cause? 
 Was any of this information new to you? Let the client answer and listen supportively. 
 There is a lot to take in, isn’t there? For many people, learning that they have diabetes can be 
overwhelming at first. 
 Do you remember the person in the video and what she went through when she first found 
out she had diabetes? What did you think about that? How did you feel when you first 
learned you had diabetes? 
 Thanks for sharing your experience with me! Different people react differently when they’re 
first diagnosed, but most people find that living with diabetes has a big impact on their life. 
 For most people, diabetes will never go away, so you’ll need to manage your diabetes for the 
rest of your life. The good news is that there’s a lot that you can do to keep your diabetes 
under control. 
 An important point to remember is that much of what you should do to take care of your 
diabetes is good for everyone, not just people with diabetes. So, your healthy choices will 
not only help you, but it will also help the people that you care about. 
Notes: 
Appendix Page |  48

 
9
Step 1. Go to page 4 of the Client Plan Book, where UAB staff will have provided the names of all the 
diabetes medications your client is taking. Read out loud the name of the first diabetes medication. 
Step 2. Ask how the client is taking the medication. 
 You will see that even small changes can have a big impact on your health and the health of 
the people around you. How do you feel about that? Listen supportively. 
 You are making a wonderful start by joining this program! We have some easy ways to help 
you remember the important parts of taking care of your diabetes.  
 OK, now find the box with “ABCDE” in it on page 2. The video also talked about the 
ABCDEs of diabetes. Do you remember what the ABCDEs stood for? If needed, remind 
client the ABCDEs: A1c, or blood sugar; blood pressure; cholesterol; diet; and exercise.  
 Do you see the 3-legged stool, on the left-hand side of page 2, that the video talked about? 
Can you remind me what those 3 parts were? If needed, remind client the 3 parts: healthy 
eating, being physically active, and taking medications as prescribed by the doctor.  
 
 
 
Activity 1a: Checking for Side Effect or Cost Issues for Diabetes Medications ---------------- 
 As we just talked about, taking medications is an important part of living well with diabetes. 
However, many people have trouble taking their medications, and there are a lot of reasons 
why this may be. 
 I’d like to begin by focusing on the medications that you take for your diabetes and see if 
you have any questions. You told the research assistant what medicine you’re taking, and 
I’m looking at this list right now. 
 One medicine that you’re taking for your diabetes is [read off first diabetes medication if 
there is more than one].  
 Tell me how you take this medicine. How many times a day do you take it? How many pills 
each time? What are the times you take it? 
Compare what the client tells you to what is written in the Client Plan Book for dose and 
frequency (and other directions, if any). For that medication, mark down whether the client 
is taking the medicine as directed by checking “Yes” or “No” in the column headed “Taking 
as Prescribed.” If they are not taking it correctly, explain how to take it. Then, have the 
client repeat back to you, at least once, how to take it correctly. Write notes in the space as 
needed so you can remember what the problem is. You’ll go over this in future sessions. 
 Remember, once daily is usually in the morning at breakfast.  
 Twice daily is about 12 hours apart, morning and evening (for example, 8 a.m. and 8 
p.m. 
 Three times daily is about 8 hours apart (8 a.m., 4 p.m., midnight, or bedtime).  
 
Appendix Page |  49

 
10
Step 3. Now ask about side effects for the first diabetes medication. 
Step 4. Now ask about cost for the first diabetes medication. 
 
 Are you having any side effects from this medicine? 
Check off “Yes” or “No” next to “Side Effects.”  
If they say, “No” (they are not having a side effect), move on to Step 4. 
If they say, “Yes” (they are having a side effect), then ask: What’s the side effect? 
 Note down any side effects in the space provided in the client plan book. Then ask: 
 Do you ever miss any doses of the medicine because of side effects?  
 Check off “Yes” or “No” next to “Is the side effect causing missed doses?” 
 Often people can live with minor side effects, so having a side effect doesn’t mean they 
aren’t able to take the medicine. If they say, “No” (they are taking the medicine even 
though they are having a side effect), praise them and move on to Step 4. 
 If they say “Yes” (they are missing doses due to the side effect), tell them: 
 Having side effects can make it hard for us to take our medicines! But, we are going to 
make a plan to see what we can do about that. 
 Are you having any trouble affording this medicine? 
Check off “Yes” or “No” next to “Is medicine affordable?” 
If they say, “No” (they are not having trouble affording the medicine), move on to Step 5. 
If they say, “Yes” (they are having trouble affording the medicine), then say:  
 OK, can you tell me more about this? In the client plan book, write down details about 
what makes it hard to afford this medication. 
 Many people find it hard to afford their medicines! But, you and I are going to make a 
plan to see what we can do about that. 
 
 
 
 
Step 5. Repeat Steps 1, 2, 3 and 4 for each diabetes medication. 
Step 6. This step depends on what the client has told you during Steps 1-5 for each 
diabetes medication: 
 If the client has trouble with side effects and/or cost, 
1. Complete Activity 1b, “Making a Plan for Side Effects and/or Cost Issues.” 
2. Then, go to Activity 2 and continue with the rest of the session.  
 If the client does not have trouble with side effects and/or cost, 
1. Skip Activity 1b, “Making a Plan for Side Effects and/or Cost Issues.” 
2. Go to Activity 2 and continue with the rest of the session. 
Appendix Page |  50

 
11
Go to page 8 of the Client Plan Book to review other barriers to taking diabetes medications. 
 Read aloud each issue marked “Very Often.” 
 If there are no issues marked “Very Often,” then read aloud each issue marked “Often.” 
 If there are no issues marked “Often,” then read aloud each issue marked “Sometimes.” 
 
For example, you might say: “I see that you told the research assistant that you very often just forget to 
take your diabetes medication. Is that still true?” 
 
 
Activity 1b: Making a Plan for Side Effects and/or Cost Issues ----------------------------------- 
 OK, you are having trouble taking your medicine because of… [repeat the side effect and/or 
cost issue from page 4 of the Client Plan Book]. 
 Your medicine can’t help you if you can’t take it. Let’s make a plan today to reach out to 
your doctor this week to see what can be done. The doctor can switch you to a different 
medicine, cut back the dose, or both. Go to page 5 of the Client Plan Book. Write today’s 
month, day, and year under “Date of plan.” 
 First, let’s decide who is going to call the doctor. Will you be comfortable calling by 
yourself? If you’d like to have somebody else on the phone with you, who will it be? Write 
down who will be calling the doctor. 
 OK, now, when will you make this call? Write down the day and time for the call. 
 Finally, let’s rehearse what you’ll say to the doctor. Write down what the client will say to 
the doctor. Have the client repeat what they will say if they hesitate the first time. 
 OK, that sounds like we are beginning to get a plan. Let’s think about how hard this may be 
for you to do. What are some things that might make it hard for you to carry out this plan? 
Write down potential barriers. 
 What do you think you can do to overcome these things? Help clients think of possible ways 
to overcome these barriers, and write down those solutions. 
 This is great. I look forward to hearing how it went when we talk next week. 
 
 
Activity 2: Checking for Other Diabetes Medication Issues and Making a Plan --------------- 
 OK, let’s move on. 
 I’d like to go over some other issues that you mentioned to the research assistant about your 
diabetes medicines.  
 Let’s see. I see that you told the research assistant... Follow the directions below. 
 
Appendix Page |  51

 
12
Listen supportively. Assess how receptive they are to tackling this issue. If they are not very receptive, 
move on to the next issue until you find one they want to work on. Once the client decides on the issue 
they want to work on, go to page 9 in the Client Plan Book and write down today’s date and the issue.  
 OK, it sounds like you’ve got some issues that prevent the medicine from working for you. 
So what should we work on first? If client hesitates, ask: How about… [pick the first on the 
list]? What do you think about working on this issue? 
 OK, let’s talk about this a bit. I’d like to understand this issue better. Can you tell me more 
about this issue? Let them tell you why they have this issue, or why they feel this way. Listen 
supportively. If the issue is one that was mentioned by someone on the DVD, mention that. 
Or, if one of your clients has had a similar issue, mention that also. Let your client know that 
others have this issue also – they are not alone. 
 Can you think of some things that you can do to overcome this issue? Brainstorm with them. 
Offer suggestions only after you first make sure they want suggestions. Refer to the table of 
potential solutions to each problem starting on page 27 in the Client Plan Book. 
 OK, so what would you like to try to do this week to work on this problem? If they listed 
more than one strategy, ask them to pick one. Make sure to help client come up with a plan 
that is SMART (specific, measurable, achievable, relevant, and time-bound). Write down the 
strategy in the Client Plan Book in the space provided. 
 OK, that sounds like we are beginning to get a plan. Let’s think about how hard this may be 
for you to do. What are some things that might make it hard for you to carry out this plan? 
Write down potential barriers. 
 What do you think you can do to overcome these things? Help clients think of possible ways 
to overcome these barriers, and write down those solutions. 
 This sound great! I look forward to hearing how it went when we talk next week. 
 
 
Tracking Your Progress ---------------------------------------------------------------------------------- 
 Now, let’s look at the chart on page 4 in your Activity Book. 
On the left side of the page, do you see the column with a 
picture of a pill bottle at the top?  
 Your homework is to check “Yes” for every day that you take 
your diabetes medications exactly the way they are 
prescribed. If you weren’t able to take your diabetes 
medications that day, then mark “No” for that day. 
 It’s important that you are honest when you fill out this chart 
every day. The goal of the program is to help you take charge 
of your diabetes, and I can’t help you if we can’t track your 
progress together. 
Appendix Page |  52

 
13
 Many people have a lot of problems with their medicines, so I need to understand when 
things are not going as planned. Do you understand? Make sure they are committed to letting 
you know if the answers are “no” on the chart. 
 Do you have any questions about what to do? Make sure client understands what to do. 
 
 Great! This homework is an important part of the program. Research has shown that tracking 
our progress by monitoring how we’re doing can help us achieve our goals. 
 You’ll monitor something every day during the program, but what you’ll monitor will vary. 
Honesty is really important here, otherwise I can’t help you. We’ll talk a lot more about 
monitoring in each session. 
 Do you have any questions? Give client a few seconds. 
 
 
Rules and Responsibilities -------------------------------------------------------------------------------- 
 OK. Now, for this program to help you, you have to commit to it. So, please go back to page 
3 in your Activity Book. There, you’ll see rules for both of us to follow during the program. 
 Here is what I will need to do: 
 I will call you every week in the beginning, then less often to go over our sessions. 
 We will schedule our phone appointments together. If I can’t make an appointment, I’ll let 
you know, and we’ll reschedule. 
 When I call you, I’ll be on time. 
 I will help you learn, and I will listen to you. 
 Here is what you will need to do: 
 Be on time. If you can’t make it, call me, and we’ll reschedule. 
 Use the phone provided by the study for our calls. Please don’t use the phone for personal 
calls. Also, please be careful with it, because we’ll need it back at the end of the study.  
 Tell me if you’re not feeling well or if you don’t feel up to having a session. We can 
reschedule. 
 Participate actively. Try your best. This is a training program to help you help yourself, so if 
you don’t try, the program won’t help you.  
 Between our phone sessions, practice and monitor your progress and watch the videos. 
 Finally, tell me if you have any concerns. 
 Remember, this program does not include: 
 Financial support, medical advice, or medication management. 
 As I said before, I am not a doctor or a nurse. I am a person from the community who has 
been trained to help you with this program. 
Appendix Page |  53

 
14
Write down where client will store the Activity Book: 
 
 
 
 This program is six months long. 
 Please stay on page 3 and look at the chart on the left side of the page. As you can see, I’ll be 
calling you every week for the first six weeks. After that, I’ll be calling you every other 
week for the next six weeks. Then, for the last three months, I’ll be calling you once a 
month. Each phone session will last about a half hour to forty-five minutes. 
 Since this is a research study, the researchers for this program will use the information you 
provide to see how well the program worked. They may also record some of the sessions to 
make sure everything is going on as planned. 
 However, our discussions will be kept between you, the research team, and me. 
 When the program is over, you don’t get to keep the phone, but you do get to keep the DVD 
player and the DVDs. 
 Do you have any questions about how this program works? Let client ask questions. 
 
Signing the Contract -------------------------------------------------------------------------------------- 
 OK. Research has shown that making a commitment to the program really helps people. 
 Are you ready to make this commitment? Give client a few seconds. Wonderful! Then, 
please stay on page 3 in your Activity Book and look at the bottom right-hand corner. Let 
client get to the box. 
 Take a moment to sign on the line showing that you are making a commitment to the 
program. Let client take a moment to sign on the line. 
 
Storing the Program Materials -------------------------------------------------------------------------- 
 OK, we’re almost through! Let’s take a second to figure out where you’ll keep your study 
materials between our phone sessions. 
 Remember, you’ll use your Activity Book to track your progress between our sessions. 
 So, can you think of a place to keep it where you’ll see it every day and where you can 
easily get to it to do your homework and to bring to our phone calls? 
 
 
 
Appendix Page |  54

 
15
 Try to make this date as close to 7 
days from now as possible. 
 Allow at least 7 days between 
sessions, but no more than 10 days. 
Write down where client will store the DVD player: 
 
 
 
 Now, where do you think you can keep your DVD player? It would be good to keep it close 
to your Activity Book and in a place away from children until you’re done with the program. 
 
 
This Week’s Homework ----------------------------------------------------------------------------------- 
 Great! Let’s make sure we’re clear on this week’s homework and then schedule our next 
phone session. 
 For your homework this week, you’ll use the chart on page 4 to keep track of how you’re 
doing with taking your diabetes medicine exactly as prescribed. Check “Yes” for every day 
that you took your diabetes medicine like the doctor prescribed. On the other hand, you’ll 
check “No” if you weren’t able to take your diabetes medicine as prescribed that day. 
 You’ll tackle the issue with your diabetes medicine that we talked about earlier. I want to 
hear all about how that went when we talk next week. 
 Finally, you’ll watch the Healthy Eating video and we’ll be talking about that at our next 
phone session, too. Do you have any questions? Let the client answer. 
 
Scheduling Next Session ---------------------------------------------------------------------------------- 
 OK, when would you like to talk next week? 
 OK, please write down the date and time in the box at the bottom of page 4. 
 I look forward to speaking next week and hearing how things went! 
 
 
 
 
 
 
 
 Session 1 
completed ______/______/______ 
      month              day               year 
_______/______ 
    start time         end time 
______ 
peer initials 
 
 
 
 
 
 
 
 
 
 
Next appointment date and time: 
 
Appendix Page |  55

 
16
Reminder!! 
 Cover and check off all of the session content. 
 Any text in GRAY BOXES is instructions for 
you: don’t read those texts aloud to the client. 
Session Goals: 
 Brief review of last week’s session 
 Review DVD: Healthy eating 
 Apply the 3 rules of eating healthy to our diet 
 Review homework 
 Homework – SMART Goal for healthy eating 
 
Learn more content: Tips for Shopping Healthy at the Dollar Store/Convenience Store 
 
Week 2, Session 2: “Healthy Eating Strategies” 
 
 
Before Calling the Client ----------------------------------------------------------------------------------- 
 
 Review last week’s assignment and the 
medication barriers and strategies to 
overcome them. 
 Once you’ve reviewed this, place the call. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Appendix Page |  56

 
17
Say hello and make sure the client is 
still okay with speaking for about a half 
hour to forty minutes today. 
 If they did not watch the DVD, tell them to watch it 
now, and you’ll call back in a half hour. 
 
Greeting ----------------------------------------------------------------------------------------------------- 
 
 Great, do you have your Activity Book handy? 
If not, let them get the Activity Book before going on. 
 OK, please turn to page 5 in the Activity Book. 
Today, we’ll review what we learned last week and talk about how your homework went. 
 We’ll also learn about healthy eating and diabetes. To do this, we’ll review the video on 
Healthy Eating and talk about some simple rules that you can follow to help you eat healthy. 
 Finally, we’ll talk about your homework for this week. 
 Can I ask if you’ve watched the DVD? 
 
 
Review Last Week’s Session ----------------------------------------------------------------------------- 
 OK, let’s review what we learned last time. Please turn to page 5 in your Activity Book. 
 Please look at the review section of the page. We talked about diabetes, which means the 
body can’t handle blood sugar. 
 When the body can’t use blood sugar normally, there’s too much sugar in the blood stream. 
That’s uncontrolled diabetes, and it makes you tired, thirsty, and run to the bathroom a lot. 
 Over many years, diabetes can cause complications like heart attack, stroke, kidney 
problems like dialysis, blindness, nerve damage, and amputations. Uncontrolled diabetes 
increases your chances of getting these things, sometimes called “diabetes complications.” 
 You can see all the organs that diabetes affects in the cartoon in the middle of the page. 
 We also learned that for most people, diabetes is an illness that develops over many years. 
That’s the picture in the middle of the right side of the page, where diabetes didn’t happen 
until after many years of eating unhealthy and being too inactive. 
 For most people, even if they eat right, exercise, and take their medicines, diabetes won’t go 
away. But there’s a lot you can do to control diabetes and decrease your chances of getting 
the problems listed in the review section of the page.  
 That means that you’ll probably need to take care of your diabetes for the rest of your life. 
 Taking care of your diabetes means eating healthy, getting enough exercise, taking 
medications, and going to the doctor regularly for check-ups to keep the ABCDEs of 
diabetes in check. Do you remember what that stands for? Point out the box on the bottom of 
page 5. 
 You can remember what you need to do every day at home to take care of your diabetes by 
thinking of the 3-legged stool on the bottom right of page 5. Can you remind me what the 3-
legged stool is? Let client answer. If needed, tell client the 3 legs: eating healthy, being 
physically active, and taking your medications as prescribed. 
Appendix Page |  57

 
18
 We learned that we need to do all 3 things in order for us to live better, longer, with diabetes. 
 Does that sound right? Let client answer. Did you have any questions? Let client answer. 
Appendix Page |  58

 
19
Let client answer. If needed, remind client that 
 Half of the plate should be fruits and vegetables. 
 A quarter of the plate should be protein, like red meat, pork, fish, chicken, and beans. 
 The last quarter of the plate should be starchy foods, like brown rice, pasta, potatoes, corn, and peas. 
Review DVD: Healthy Eating --------------------------------------------------------------------------- 
 
Great! Let’s move on and talk about the DVD you watched 
this week. How did you like it? Let the client answer and listen 
supportively. 
 
OK, please turn to page 6 in your Activity Book. Let’s 
review some of the things we saw on the DVD. Let the client get to 
the page. 
 
So, we learned why eating healthy is so important. First, 
eating healthy provides your body with the nutrients you need to 
be active and healthy. 
 Eating healthy also helps you to better manage your weight and to control diabetes.  
 A healthy diet can make us feel good now and in the future, because eating healthy helps 
keep the blood sugar down to keep you feeling well, and it also decreases the chances of 
diabetes complications, like heart attack, stroke, dialysis, and amputations.  
 In the video, several people spoke about how eating healthy makes them feel, like how it 
affects their mood and their ability to do the things they need to do and to enjoy life. Have 
you noticed this yourself? Do you think healthy eating makes a difference in how you feel 
day-to-day? How about what you are able to do on a daily basis? 
 Now, the DVD shared three simple rules to help you eat healthy every day. Do you 
remember any of the three rules? Let them tell you any or all of the 3 rules. 
 OK, let’s review. Rule Number One was to avoid second helpings. We can remember this 
rule by thinking, “One and done.” 
 Rule Number Two was to use the healthy eating plate as a guide to eating the right 
balance of foods, and to not overload the plate. You can remember this rule by thinking, 
“Respect the border,” so that you can see the pretty border of the plate and not overload. 
 Can you remember how we should divide up the plate? 
 An important part of this rule is not to overload your healthy plate, right? You want to be 
able to see the border of the plate – respect that border. 
Notes: 
Appendix Page |  59

 
20
 Last but not least, Rule Number Three was to eat less fried foods and fats, and drink 
fewer sugar-sweetened beverages. You can remember this rule by thinking, “Be sweet on 
yourself.” Avoiding unhealthy foods is definitely being sweet on yourself. 
 How do these three rules sound? Let the client answer and listen supportively. 
 These rules can not only help you eat healthy and live well, but they also can help your 
family and friends, too! If they don’t already have diabetes, eating healthy can help prevent 
diabetes. 
 As the DVD said, people with diabetes don’t need to fix themselves “special” meals while 
having to fix something different for the rest of the family. 
 Do you remember the person in the video that talked about how she felt when she thought 
she had to cook differently for herself, while the rest of the family ate what they wanted? 
Have you experienced that yourself or known anybody that has gone through that? 
 That person also talked about how her cooking and eating healthy ended up helping her 
whole family, like how her husband’s blood pressure went down from eating healthier. What 
about you? Have you known anyone that has gotten healthier because their family or friends 
changed how they ate? 
 Thanks for sharing your thoughts about this! Like the video said, these three rules—one and 
done, respect the border, and be sweet on yourself—will help the entire family eat healthy 
and live well. How do you feel about that? Let the client answer and listen supportively. 
 Great! Now that we know the three rules are good for the whole family, we can use these 
three rules to guide us as we shop and prepare foods for healthy meals and snacks. 
 As you know, it can be challenging to shop and prepare healthy foods, because we have to 
drive far to get to the grocery store, and fresh fruits and vegetables can cost a lot and spoil 
quickly. 
 Plus, we are often very busy taking care of our families and friends, working, and 
volunteering. This can make it hard to find the time to take care of our diabetes. 
Notes: 
Notes: 
Appendix Page |  60

 
21
 We are going to work together to figure out what works best for you and your family so that 
you can eat healthy and live as well as you can, as long as you can. 
 Also, you might enjoy reading the information on page 8 of your activity book, which shares 
some tips about how you can shop at your local Dollar Store or other convenience store and 
make healthier choices. 
 Great! Do you have any questions so far? Let client answer. 
 
 
 
Activity 1: Assess Your Healthy Eating: What did I eat in the past day? ------------------------- 
 OK, let’s check out what you’re eating and talk about what you could do to eat a little 
healthier. 
 It’s hard to make a change if we don’t know what we’re doing well and where we could use 
a little help. 
 So, please think about what you ate yesterday. Go to page 12 in the Client Plan Book and fill 
in the chart by following the script on the next page. 
 
 
 
 
 
 
Appendix Page |  61

 
22
 Let’s begin with breakfast. 
 Did you have more than one helping of a meat or a starch? Remember: starches are 
“white foods” like potatoes, bread, bagels, rice, grits, pasta, cereal. If yes, then ask: How 
many helpings in all? Write down the number over 1; for example, if they had 2 helpings 
of grits, that’s one second helping and you would write down 1 under breakfast. 
 Did you have any fruit? If yes, then ask: How many servings? Write down the number of 
fruits under breakfast. 
 Did you have any vegetables? If yes, then ask: How many servings? 
 Did you drink any sugar-sweetened drinks? If they sweeten coffee with sugar, that’s a 
sugar-sweetened drink. Soda pop is sugar-sweetened. Fruit juice counts as sugar-
sweetened. If yes, then ask: How many? 
 Did you have any dessert? If yes, then ask: How many servings? 
 Did you have any fried food? If yes, then ask: How many servings? 
 Now, let’s talk about lunch. 
 Did you have more than one helping of a meat or a starch? Note: a sandwich is usually 
two pieces of bread; the second piece counts as a second helping! 
 Did you have any fruit? If yes, then ask: How many servings? 
 Did you have any vegetables? If yes, then ask: How many servings? 
 Did you drink any sugar-sweetened drinks? If yes, then ask: How many? 
 Did you have any dessert? If yes, then ask: How many? 
 Did you have any fried food? If yes, then ask: How many servings? 
 OK, let’s now talk about dinner. 
 Did you have more than one helping of a meat or a starch? 
 Did you have any fruit? If yes, then ask: How many servings? 
 Did you have any vegetables? If yes, then ask: How many servings? 
 Did you drink any sugar-sweetened drinks? If yes, then ask: How many? 
 Did you have any dessert? If yes, then ask: How many? 
 Did you have any fried food? If yes, then ask: How many servings? 
 Finally, think about your snacks. 
 Did you have more than one helping of a meat or a starch? 
 Did you have any fruit? If yes, then ask: How many servings? 
 Did you have any vegetables? If yes, then ask: How many servings? 
 Did you drink any sugar-sweetened drinks? If yes, then ask: How many? 
 Did you have any dessert? If yes, then ask: How many? 
 Did you have any fried food? If yes, then ask: How many servings? 
 
 
Appendix Page |  62

 
23
 Add across in each row and enter the total in the “Total” column. 
o For example, if they had 1 second helping of starch at breakfast, no second helpings at 
lunch, 1 second helping at dinner, and no second helpings at snack, that’s 1 + 1 = 2. 
o You would enter a “2” in the “Total” box for “Second helpings of meat or starch.” 
 Repeat for each line (number of fruits, number of vegetables, number of sugar-sweetened drinks, 
number of desserts, number of fried foods).  
 Repeat for each line (number of fruits, number of vegetables, number of sugar-sweetened drinks, 
number of desserts, number of fried foods).  
 Keep your voice neutral and don’t make the client feel bad. 
 OK, that’s great. Now, give me a minute to total this up. 
 OK, now let’s see how healthy your eating was. Please turn to page 6 in your Activity Book, 
and write down these numbers in the chart under where it says “Me”. Do you see that? 
 OK, under “Me” in the line that says “Number of second helpings of meat or starch”, please 
write down … say the number in the Total box for “Number of second helpings of meat or 
starch” from the chart on page 12 in the Client Plan Book. 
 
 
This is what they see in their Activity Book: 
 
 
 
 
 
     ME 
    Goal 
Number of second helpings of 
meat or starch 
 
0 
Number of fruits 
 
3-4 
Number of vegetables 
 
3-4 
Number of sugar-sweetened 
drinks 
 
0 
Number of desserts 
 
0-1 
Number of servings of fried foods  
0 
 
 
 
 
 
 
Appendix Page |  63

 
24
Listen supportively. Use “OARS” (open-ended questions, affirmations, reflective listening, summaries) 
to help them recognize areas in need of improvement. 
 Go to page 13 of the Client Plan Book and write today’s date next to “Date of plan.” 
 Help the client set a specific, measurable, achievable, relevant, and time-bound goal. 
 Once a plan has been made, summarize it. For example, a summary could go like this: 
“OK, let me make sure I got this right. So, you noticed that you aren’t eating enough fruits and 
vegetables, you’re taking too many second helpings of starches, eating too much fried food, and you 
drink a lot of sugar-sweetened drinks. This week, you would like to make a change by cutting back 
on your sugar-sweetened drinks. Rather than drinking sweet tea at dinner, you’re going to switch to 
water. You feel that you’re going to be able to do this during weeknights to start with, so you are 
going to follow your goal Monday through Friday, starting tonight. Did I get that right”? 
 Once the client confirms the plan, write it down in the space provided in the Client Plan Book. Be 
sure to write down specific meal(s) and days during which client will follow the goal. 
 You will encourage the client to also write down their goal in the box to the right of the chart on 
page 6 of their Activity Book. 
Activity 2: Set a SMART Goal to Improve Healthy Eating ----------------------------------------- 
 OK, did you write down those numbers? Why don’t you read them back to me? Let the 
client confirm. What are your thoughts as you look at this? 
 OK, so what would you like to do over the next week to make a change? 
 
 OK, so that you remember, why don’t you jot down this plan in the space on page 6 in the 
box marked “My Goal Is”. Do you see that? 
 Ok, let’s think about how hard this may be for you to do. It’s pretty challenging to change 
what we eat. What are some things that might make it hard for you to carry out this plan? 
Write down potential barriers in the space in the Client Plan Book. 
 OK, what do you think you can do to overcome these things? Help clients think of possible 
solutions to these barriers, and write down those solutions in the space in the Client Plan 
Book. 
 This is great! You’ll monitor your progress every day this week, and I can’t wait to hear how 
this went for you. Please turn to page 7 and look at the column marked “Eat Healthy?”. Each 
day that you keep to your plan, you’ll mark off “yes”. If you were not able to keep your plan, 
you’ll mark off “no.” Is that clear? Make sure they understand what to do. 
 
 
 
 
Appendix Page |  64

 
25
Continue with Days 2 through 7 before stopping to discuss. 
 For each day, check “Yes” or “No.” 
 For each day, ask client if they took their diabetes medicine, 
even if their blood sugar was normal. Praise them for every  
“yes” 
 If they didn’t take their diabetes medicine every day, 
discuss what happened. Avoid being judgmental. 
 Reassure client that taking medicine every day 
the way the doctor prescribed is hard for a lot of people. 
Tell them that you will work together to develop a plan 
 for this week to help them take the medicine every day. 
 Write down what happened in the box below. 
 
 
 
 
 
 
Notes: 
Review of Last Week’s Homework ---------------------------------------------------------------------- 
 OK, let’s now go over your homework from last week. Can you turn to page 4? Let the client 
get to the page. 
 For homework, you monitored whether you took all your diabetes medication each day. I’d 
like to go over it, day by day, and see how it went.  
 Let’s start with Day 1. Did you take all of your diabetes medication just like the doctor 
prescribed on Day 1?   
 
 Now, last week, we talked about… [go to Client Plan Book on page 5 and check if the plan 
focused on side effects or cost; if not, go to page 9 and check if the plan focused on Other 
Barriers. Read out loud the diabetes medication issue that they chose to work on last week. 
We made a plan together to overcome this so you can get the most out of your medicines. 
Let’s review how things went. 
 To overcome this issue, you decided to… [read out loud the medication-taking plan from 
last week]. 
 You thought that it might be hard for you to carry out this plan, because… [read 
potential barriers]. 
 To go around the problem, you decided to… [read how client decided to go around 
potential barriers]. 
Appendix Page |  65

 
26
Notes: 
 If their plan worked and last week’s issue is resolved, encourage them to tackle a new issue this 
week. If you try hard and they don’t want to tackle another issue and they took their medicine each 
day, praise them again for their success and tell them you’d like to discuss tackling a new issue next 
time. 
 If they are ready to tackle a new issue, go back to page 4 of the Client Plan Book to the diabetes 
medication list. 
 If there are remaining issues related to side effects or cost, then help the client make a plan to 
address them this week. 
 If there are no remaining issues related to side effects or cost, go to page 8 to the chart on Other 
Barriers. Look at the list of statements that are marked “Very Often,” or “Often” if there are no 
“Very Often” statements to address, and “Sometimes” if there are no “Often” statements to 
address. 
 Help them decide which new goal they would like to tackle for the coming week. 
 Summarize to confirm their new goal. For example, you could say: 
“OK, let me see if I got this straight. Last week, you … [repeat last week’s goal]. You did well 
with that, so this week, you’ll … [repeat this week’s goal]. Did I get that right?” 
 
 If they were not able to meet their medication goal, then let them stick to the same goal. 
 Be supportive, and let them know you’ll revisit the goal next week to see how it went this time. 
 Strategize what they will do differently this week to succeed. Make it a SMART goal. 
 
 
Record this week’s strategy in the Client Plan Book. 
 If the strategy addresses side effects/and or cost, record this week’s strategy on page 5, “Plan for 
Diabetes Medication Side Effects and/or Cost”. 
 If the strategy addresses other barriers besides side effects or cost, then record this week’s 
strategy on page 9, “Plan for Other Diabetes Medication Barriers”. 
 So, how did this go? Listen supportively and take notes in the box below. If things did not go 
well, discuss what to do differently this week. If the problem is solved, praise them! 
 OK, so let’s talk about what you’d like to do for the next week. 
 
 OK, let’s think about how hard this may be to do. What are some things that might make it 
hard for you to carry out this plan? Write down barriers in the Client Plan Book. 
 OK, what do you think you can do to overcome these things? Help clients think of possible 
solutions to these barriers, and write down those solutions in the Client Plan Book. 
 OK, let’s review that. It looks like you’ll… repeat the medication goal. Then, review 
potential barriers and how client will go around those barriers. Let client confirm. 
 I look forward to hearing how this plan worked when we talk next time! 
 
Appendix Page |  66

 
27
 Try to make this date as close to 7 
days from now as possible. 
 Allow at least 7 days between 
sessions, but no more than 10 days. 
This Week’s Homework ----------------------------------------------------------------------------------- 
 Now, let’s go over your homework for the coming week. Please turn to page 7 in your 
Activity Book. There, you’ll see the chart where you’ll monitor your progress until our next 
session. 
 First, you’re going to continue tracking how you’re 
doing with your diabetes medication. 
 Every day, under the column with the picture of a pill 
bottle, you’re going to mark “Yes” if you took all of 
your diabetes medication that day. If you weren’t 
able to take all of your diabetes medication, then 
you’ll mark “No” for that day.  
 Remember to be honest. I can’t help you if I don’t 
know where you need help. 
 You’ll carry out the plan we discussed that will help you get the most out of your medicines. 
 You’re also going to mark down whether you succeeded with your healthy eating plan. 
Remember, you were going to…Repeat the healthy eating goal you developed today and 
recorded on page 13 of the Client Plan Book. 
 So, under the column with a picture of apples, you’re going to mark “Yes” if you were able 
to follow your healthy eating plan as we discussed. 
 Finally, you’ll watch the DVD on Getting Exercise, which we’ll talk about next time. 
 Do you have any questions about what to do? Make sure client knows what to do. 
 
Scheduling the next session------------------------------------------------------------------------------- 
 OK, when would you like to talk next week? 
 OK, please write down the date and time in your Activity Book at the bottom of page 7. 
 I look forward to speaking next week and hearing how things went! 
 
 
 
 
 
 
 
 Session 2 
completed ______/______/______ 
      month              day               year 
_______/______ 
    start time         end time 
______ 
peer initials 
 
 
 
 
 
 
 
 
 
 
Next appointment date and time: 
Appendix Page |  67

 
28
Reminder!! 
 Cover and check off all of the session 
content. 
 Any text in GRAY BOXES is instructions for 
you: don’t read the text aloud to the client. 
Session Goals: 
 Brief review of last week’s session 
 Review DVD: Physical Activity and Your Health 
 Review last week’s homework 
 Homework – SMART Goal for physical activity 
 
Learn more content: Chair Exercises, Walking in Place 
 
Week 3, Session 3: “Physical Activity and Your Health” 
 
 
Before Calling the Client ----------------------------------------------------------------------------------- 
  
 Review last week’s assignment and the 
barriers and strategies to overcome them. 
 Once you’ve reviewed this, place the call. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Appendix Page |  68

 
29
Say hello and make sure the client 
is still okay with speaking for about 
a half hour to forty minutes today. 
 If they did not watch the DVD, tell them to watch it 
now, and you’ll call back in a half hour. 
Greeting ----------------------------------------------------------------------------------------------------- 
 
 Great, do you have your Activity Book handy? 
If not, let them get the Activity Book before going on. 
 OK, please turn to page 9. Today, we’ll review what we 
learned last week and talk about how your homework went. 
 We’ll also learn about physical activity. To do this, we’ll review the DVD on physical 
activity and talk about some simple rules that you can follow to help you add physical 
activity to your life. Finally, we’ll talk about your homework for this week. 
 Can I ask if you’ve watched the DVD? 
 
Review Last Week’s Session ----------------------------------------------------------------------------- 
 OK, let’s review what we learned last time. Please stay on page 9 in your Activity Book. 
 We talked about healthy eating, which is one of the legs of the three-legged stool. 
 Eating healthy will not only help you get the nutrients you need to be active and healthy, but 
it also will help you better manage your weight and your diabetes. 
 We learned 3 rules to help us eat healthy – can you name them? Let the client answer. If 
needed, remind the client that the 3 rules of healthy eating are “One and Done,” “Respect 
the Border,” and “Be Sweet on Yourself.” Be sure to review what each of these rules means.  
 We also went over how things were going taking your medicines, and made a plan for how 
you’ll try to get the most out of your medicines to Live Well with Diabetes. 
 Does that sound right? Let the client answer. Did you have any questions? Let the client 
answer. 
 
 
Review DVD: Physical Activity ------------------------------------------------------------------------- 
 Great! Let’s move on and talk about the DVD you watched this week. How did you like it? 
Let the client answer and listen supportively. 
 OK, let’s turn to page 10 in your Activity Book and review some of the things we saw on the 
DVD. 
 Now, just as there were 3 rules for healthy eating, the DVD talked about 3 rules for physical 
activity. 
 The first rule is, “Be Smart, Exercise Your Heart.” This rule will help you to remember 
the many benefits of physical activity. 
 Physical activity can help us feel less tired and more energetic; improve our mood and 
reduce stress and anxiety; help us think better as we age; and help us live better longer by 
reducing chronic aches and pains and lowering our risk of future health problems. 
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Notes: 
Notes: 
 In the video for the past week, there were several people that talked about how exercise 
helps them in a variety of ways. Can you remember some of those things? (If needed, remind 
client of some of the benefits that people mentioned: exercise lifts their spirits, exercise helps 
them sleep better, and exercise helps get stiffness and pain out of their joints.) What did you 
think about that? Have you or anyone you know benefited from exercise like this? 
 Exercise has lots of benefits beyond helping you lose weight, which is what many people 
think exercise is only good for. The video mentioned that it’s actually not common for 
people to lose weight when they begin an exercise program. 
 Now, the combination of diet and exercise can lead to weight loss, but remember that 
exercise has many other benefits! It’s a critical part of living a long and healthy life. 
 For instance, do you remember the pastor from the video talking about how he thinks about 
his body like a car? Can you remember how he described the heart? How did that strike you? 
 Now, the second rule is, “Walk Down Your Blood Sugar.” This rule will help you to 
remember that walking and other kinds of physical activity can help lower your blood sugar. 
 The DVD told you that adults should try to get at least 30 minutes of moderate-level exercise 
on 5 or more days per week. If you’re exercising at a moderate level, you can talk but you 
can’t sing.  
 If you are not used to getting any exercise, work up to the 30 minutes gradually. It’s fine to 
start small, for example, just 10 minutes a day, and add 5 or 10 minutes every couple of 
weeks. 
 Since exercise lowers your blood sugar, a great time to take a brisk walk is after a meal, 
when your blood sugar goes up. If you monitor your blood sugar, try testing your blood 
sugar before and after you exercise to see the difference. 
 OK, last but not least, our third rule is, “Sitting is the New Smoking.” This rule will help 
you remember that it is very unhealthy to sit too long. 
 So, try to incorporate 2 minutes of light activity every hour. The DVD discussed several 
strategies for doing this. For example, if you’re watching TV, you can get up during the 
commercials and walk briskly around the house until your show comes back on. 
 How do these three rules sound? Let the client answer and listen supportively. 
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 Go to page 16 in the Client Plan Book and write today’s date next to “Date of plan.” 
 Next to “Current exercise,” write down what they are doing currently for exercise and how much. 
 Include minutes per day and level of activity. 
 For example, if they are doing 5 minutes of slow walking, write that down. 
 
Be reassuring and supportive if they don’t do any exercise now, or if they do very little.  
 What’s nice about these rules is that they can not only help you exercise and live well, but 
they also can help your family and friends, too! 
 As the DVD said, getting at least 30 minutes of moderate-intensity exercise, 5 days per 
week, is recommended for all adults, so you can improve the health of your family and 
friends by having them exercise with you. 
 You also don’t need to get fancy equipment or go anywhere special to exercise. Our goal is 
to help you be physically active in a way that is manageable for you. 
 So if walking around your neighborhood works best for you, your schedule, and your 
budget, that’s fine! Walking is a great way to reach your physical activity goal. 
 Also, you might enjoy the chair exercises video and the walk in place video. These videos 
show how we can do chair exercises if we are in too much pain to walk very much, or how 
we can walk in place indoors if we’re not able to go outside. 
 Great! Do you have any questions so far? Let the client answer. 
 
Activity 1: Set a SMART Goal for Exercise ----------------------------------------------------------- 
 Great! Now that we’ve discussed how important exercise is, let’s come up with a plan that 
will help you get enough exercise. 
 Some people with diabetes find it hard to walk because of painful joints, amputations, or 
other limitations. However, that doesn’t mean that you can’t exercise. One option is to 
exercise in a chair. Like walking, chair exercises can improve your health. Also, if your 
joints are hurting, chair exercises can improve your pain. 
 There is a “Learn More” video that shows you how to do chair exercises when you are 
unable to be on your feet for a long time. You can do the chair exercises with the DVD 
running, so you might want to give it a try. 
 Now, let’s think about your own exercise program. Remember, we want to work toward a 
total of 30 minutes of brisk walking or other similar exercise at least 5 days of the week. 
 Let’s start with what you do right now to get exercise. Can you tell me what kind of activity 
you are doing now? Many people do no exercise at all, so, if that’s you, don’t be shy. 
 OK, thanks for sharing that with me! Now, look at the the top right-hand corner of page 10, 
and you will see a clock and a small calendar. 
 This will help you remember that that the recommended amount of exercise is 30 minutes of 
brisk walking on at least 5 days per week. So what do you think? 
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 In the Client Plan Book on page 16, help client set a SMART goal that includes these details: 
 Next to “What client will do this week,” write down what they’ll do, for example, walking, or 
chair exercises. 
 Next to “Where client will do it,” write down where the client will exercise. 
 Next to “When during the day,” write down at what time in the day the client will exercise, for 
example, after dinner or 7pm. 
 Next to “How many minutes each time,” write down how many minutes of exercise they will do. 
 Next to “Which days of the week,” write down specific days the client will exercise. 
 For clients that don’t exercise at all right now, start with 5-10 minutes per day at a slow pace. If 
they do well with that, then add another 5 minutes after 2 weeks, and then have them try to pick up 
the pace. Build slowly toward the 30 minutes, 5 days a week goal! 
Note: if the client has not done some of the homework 2 sessions in a row, talk about what is making it 
hard to monitor. Let them know that since this is a research project, the investigators may want to help 
the person to succeed. Let them know that someone from the research team will be in touch. 
 Call the research team within 24 hours and let them know what is happening. 
 UAB staff will brief you on the conversation and the plan so that you can reinforce it next week. 
 What would you like to do to improve? What kind of activity do you want to do this coming 
week? 
 OK, let’s think about how hard this may be to do. What are some things that might make it 
hard for you to carry out this plan? Write down barriers. 
 OK, what do you think you can do to overcome these things? Help clients think of possible 
solutions to these barriers, and write down those solutions. 
 OK, let’s review that. It looks like you’ll… repeat the type of exercise, how many minutes on 
which days, when and where they’ll do it, and with whom, if they plan to exercise with 
another person. Then, review potential barriers and how client will go around those 
barriers. Let the client confirm. 
 
 Great, I look forward to hearing how this went when we talk next week! 
 
Review of Last Week’s Homework ---------------------------------------------------------------------- 
 OK, now let’s go over your homework from last week. 
 Can you turn to page 7 in your Activity Book? Let the client get to the page. 
 
 
 
 
 
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Notes: 
Continue with Days 2 through 7 before stopping to discuss. 
 For each day, check “Yes” or “No.” 
 For each day, ask client if they took their diabetes medicine, 
even if their blood sugar was normal. Praise them for every  
“yes” 
 If they didn’t take their diabetes medicine every day, 
discuss what happened. Avoid being judgmental. 
 Reassure client that taking medicine every day 
the way the doctor prescribed is hard for a lot of people. 
Tell them that you will work together to develop a plan 
 for this week to help them take the medicine every day. 
 Write down what happened in the box below. 
 
 
 
 
 
 
Notes: 
Homework #1: Medications 
 OK, let’s review how things went with your diabetes medication. Let’s start with Day 1. Did 
you take all of your diabetes medication on Day 1? Don’t review healthy eating at this point. 
 Now, I’d like to follow up on the plan that we made last week to help you get the most out of 
your medications by taking them every day.  
 Let me see, last week, the issue you wanted to work on was… [go to Client Plan Book on 
page 5 and check if the plan focused on side effects or cost; if not, go to page 9 and check if 
the plan focused on Other Barriers. Read out loud the diabetes medication issue that they 
chose to work on last week]. 
 To overcome this issue, you decided to… [read out loud the medication-taking plan from 
last week]. 
 You thought that it might be hard for you to carry out this plan, because… [read 
potential barriers]. 
 To go around the problem, you decided to… [read how client decided to go around 
potential barriers]. 
 Now, how did it go? Listen supportively and take notes in the box below. Assess how well 
this worked. If it did not work well, talk about why not. If it did go well, praise them. 
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 If their plan worked and last week’s issue is resolved, encourage them to tackle a new issue this 
week. If you try hard and they don’t want to tackle another issue and they took their medicine each 
day, praise them and let them know you’ll be talking again about this next time.  
 If they are willing to work on something new, go back to the Client Plan Book on page 4, the 
diabetes medication list. 
 If there are remaining issues related to side effects or cost, then help the client make a plan to 
address them this week. 
 If there are no remaining issues related to side effects or cost, turn to page 8 to the Other 
Barriers list and look at the list of statements that are marked “Very Often,” or “Often” if there 
are no “Very Often” statements to address, or “Sometimes” if there are no “Often” statements to 
address. 
 Help them decide which new goal they would like to add for the coming week. 
 Summarize to confirm their new goal. For example, you could say: 
“OK, let me see if I got this straight. Last week, you … [repeat last week’s goal]. You did well 
with that, so this week, you’ll … [repeat this week’s goal]. Did I get that right?” 
 
 If they were not able to meet their medication goal, then let them stick to the same goal. 
 Be supportive, and let them know you’ll revisit the goal next week to see how it went this time. 
 Strategize what they will do differently this week to succeed. Make it a SMART goal. 
 
 
Record this week’s strategy in the Client Plan Book. 
 If the strategy addresses side effects/and or cost, record this week’s strategy on the page, “Plan 
for Diabetes Medication Side Effects and/or Cost,” in the Client Plan Book. 
 If the strategy addresses other barriers besides side effects or cost, then record this week’s 
strategy on the page, “Plan for Other Diabetes Medication Barriers,” in the Client Plan Book. 
 OK, so what would you like to do over the next week to help you get the most out of your 
medications?  
 
 OK, let’s think about how hard this may be to do. What are some things that might make it 
hard for you to carry out this plan? Write down barriers. 
 OK, what do you think you can do to overcome these things? Help clients think of possible 
solutions to these barriers, and write down those solutions. 
 OK, let’s review that. It looks like you’ll… repeat the medication goal. Then, review 
potential barriers and how the client will go around those barriers. Let the client confirm. 
 I look forward to hearing how this plan worked when we talk next time! 
 
 
 
 
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35
 If they met their healthy eating goal, 
 Explore if they are ready to add another goal this week. Ask them to turn to page 6 in their 
Activity Book and look at the chart. Help them decide which new goal they would like to add for 
the coming week. 
 Go to page 13 in the Client Plan Book and write down details in the space provided. Be sure to 
include all the information necessary for the goal. 
 Summarize to confirm their new goal. For example, you could say: 
“OK, let me see if I got this straight. Last week, you … [repeat last week’s goal]. You did well 
with that, so now you’d like to add another healthy eating goal. So, this week, you’ll … 
[repeat this week’s goal]. Did I get that right?” 
 If they were not able to meet their healthy eating goal, 
 Let client stick to the same eating goal, but be sure to modify the plan if needed. 
 Go to page 13 in the Client Plan Book and write down details in the space provided. Be sure to 
include all the information necessary for the goal. 
 Be supportive, but do remind your client that you’ll revisit the goal next week to see how it went 
this time. 
Homework #2: Healthy Eating 
 OK, great! Let’s talk about your plans for healthier eating. 
How did things go with your diet? Listen supportively. 
 Let’s review what you wanted to do to eat healthier. Last 
week, you decided to…  [go to Client Plan Book page 13 
and read the healthy eating goal that they chose to work on 
last week]. 
 How did that go on Day 1? For each day, check “yes” or 
“no” for the Healthy Eating column.  
 
 
 
 OK, so let’s talk about this.  
 
 OK, let’s think about how hard this may be to do. What are some things that might make it 
hard for you to carry out this plan? Write down potential barriers. 
 OK, what do you think you can do to overcome these things? Help clients think of possible 
solutions to these barriers, and write down those solutions. 
 OK, let’s review that. It looks like you’ll… repeat the healthy eating goal. Then, review 
potential barriers and how client will go around those barriers. Let the client confirm. 
 Great, I look forward to hearing how this plan worked when we talk next time! 
 
This Week’s Homework ----------------------------------------------------------------------------------- 
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36
 Try to make this date as close to 7 
days from now as possible. 
 Allow at least 7 days between 
sessions, but no more than 10 days. 
 Now, let’s go over your homework for the coming week. Please turn to page 11 in your 
Activity Book. 
 This week, you’re going to have 3 types of homework, one for each leg of the 3-legged 
stool. 
 First, you’re going to continue keeping track of how you’re doing with your diabetes 
medication. Every day, under the column with the picture of a pill bottle, you’re going to 
mark “Yes” if you took all of your diabetes medication that day. If you weren’t able to take 
all of your diabetes medication, then you’re going to mark “No” for that day. 
 Remember to be honest. I can’t help you if I don’t know where you need help. 
 You’ll carry out the plan we discussed that will help you get the most out of your medicines. 
 Second, you’re going to mark down whether you kept to your heathy eating goal on the days 
that we discussed. Your plan is to …Repeat the healthy eating goal from today on page 13 of 
the Client Plan Book. 
 So, under the column with a picture of apples, you’re going to mark “Yes” if you were able 
to follow your healthy eating goal on the days we discussed. 
 The goal is to eat healthy every day, so if you are able to follow your healthy eating goal on 
the other days, mark “Yes” on those days, too. 
 Third, you’re going to monitor the number of minutes of exercise every day. You decided 
that you would try …Repeat the exercise goal from page 16 of the Client Plan Book. 
 So, under the column with a picture of a person walking, you’re going to write down the 
number of minutes of exercise you were able to do on the days we discussed. 
 If you are doing well with your goal and were able to exercise on the other days, write down 
the number of minutes of exercise on those days, too. 
 Finally, you’ll watch the DVD on Diabetes Medications, which we’ll talk about next time. 
 Do you have any questions about what to do? Make sure client knows what to do. 
 OK, when would you like to talk next week? 
 
 OK, please write down the date and time in your Activity Book at the bottom of page 11. 
 I look forward to speaking next week and hearing how things went! 
 
 
 
 
 
 
 
 
Session 3 
completed ______/______/______ 
      month              day               year 
_______/______ 
    start time         end time 
______ 
peer initials 
 
 
 
 
 
 
 
Next appointment date and time: 
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37
Reminder!! 
 Cover and check off all of the session 
content. 
 Any text in GRAY BOXES is instructions for 
you: don’t read the text aloud to the client. 
Session Goals: 
 Brief review of last week’s session 
 Review DVD: Diabetes Medications 
 Review homework 
 Learn to connect medicines to future goals 
 Your A1c number 
 
 
 
Week 4, Session 4: “Diabetes Medications” 
 
 
Before Calling the Client ----------------------------------------------------------------------------------- 
  
 Review last week’s assignment and the 
barriers and strategies to overcome them. 
 Once you’ve reviewed this, place the call. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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38
Say hello and make sure the client 
is still okay with speaking for about 
a half hour to forty minutes today. 
 If they did not watch the DVD, tell them to watch it 
now, and you’ll call back in a half hour. 
Notes: 
Greeting ----------------------------------------------------------------------------------------------------- 
 
 Great, do you have your Activity Book handy? 
If not, let them get the Activity Book before going on. 
 Please turn to page 12. Today, we’ll review what we 
learned last week, review your homework, and learn about diabetes medications. 
 We’ll review what you learned on the DVD, and we’ll get new homework for this week. 
 OK, let’s get started. Can I ask if you’ve 
watched the DVD? 
 
Review Last Week’s Session ----------------------------------------------------------------------------- 
 OK, let’s review what we learned last time. Please stay on page 12. 
 We talked about the importance of physical activity, which is one of the legs of the three-
legged stool. Remember – if you ignore any one of the three legs, it all comes tumbling 
down! 
 We learned 3 rules to help us be physically active – can you name them? Let client answer. 
If needed, remind client that the 3 rules of physical activity are “Be Smart, Exercise Your 
Heart,” “Walk Down Your Blood Sugar,” and “Sitting is the New Smoking.”  
 We also checked on how you were doing with your medicines, and with healthy eating. You 
are now actively working on all 3 legs of that stool. 
 Does that sound right? Let client answer. Did you have any questions? Let client answer. 
 
Review DVD: Diabetes Medications ------------------------------------------------------------------- 
 Great! Let’s move on and talk about the DVD you watched this week. How did you like it? 
Let the client answer and listen supportively. 
 Let’s review some of the things we saw on the DVD. Please stay on page 12. Let the client 
get to the page. 
 During this week’s video and the first video you watched for this program, you heard some 
people talk about diabetes medications and how they felt when they were first given 
medications for their diabetes. What did you think about that? Listen to their response. Bring 
out that many people feel reluctant to take medications after finding out that they have 
diabetes. Emphasize how common it is that people in your communities feel this way at first 
and don’t realize how important medicines are for keeping them well. However, it’s never 
too late to get the benefits of medicines.  
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Notes: 
Notes: 
 One of the important points made on the video is that the medications are really important 
for keeping down your blood sugar, but they aren’t perfect.  
 We learned that diabetes progresses even on medications. This is why you may eventually 
need a second or third medication even if you’re doing everything right. 
 Also, we learned that diabetes progresses much more quickly off medications, shortening 
your life and increasing risks for disabling conditions like stroke, dialysis, heart attack, and 
amputations. 
 These complications can be prevented or delayed with medications, diet, and exercise. 
 There are many types of diabetes medications available, so you should be able to get on a 
medication that both controls your sugar and lets you feel well. 
 Side effects can be a problem, but you should discuss with your doctor before stopping. In 
the video, do you remember what happened with the person that had trouble with her 
medications at first? If needed, remind client that she had trouble with her sugar going too 
low and experiencing stomach upset. However, instead of stopping her medications on her 
own, she worked with her doctor to find the right medicine for her. 
 Finally, the video mentioned how generic medications work as well as brand name drugs, 
but generics can be more affordable. 
 Did you have any questions about what you learned? If the client has questions that weren’t 
covered in the video, write down the questions and ask the research team. Tell the client 
you’ll ask the doctors in the study and let them know the answer next time. Or, coach the 
client to ask their doctor their questions. Write down questions in the box below. 
 
 
Activity 1: How Medications Can Help Me Live Better, Longer----------------------------------- 
 Now, let’s review some of the things we talked about at our first session. Please turn to page 
13. Go to page 3 in the Client Plan Book and look at what the client told you were some of 
their hopes for the future.  
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1. If they are skeptical about the value of the medicines, talk about others like them who you have helped. 
You may also want to discuss the video clips of Black Belt residents talking about their diabetes and 
medicines. 
2. Be supportive and don’t criticize. Encourage them to see the value of medicine. 
3. If they don’t want to, be supportive and move on. There will be more opportunities to talk about this 
later in the program. 
 If the client didn’t share anything during the first session, encourage them to share something now. 
Future plans could include something they want to do in retirement, watching a grandchild grow up, 
attending a family reunion, etc. 
 If needed, ask them about their loved ones, especially grandchildren or great grandchildren. Suggest 
something they may want to look forward to in the future, for example, see their great grandchild get 
married. Add what client shares with you to what you already wrote on page 3 in the Client Plan Book. 
 You told me that you wanted to... read one of their long term goals from page 3. Is that still 
important to you? Listen supportively. 
 After watching the video, now you know how diabetes medications are supposed to work for 
you. How do you think taking the medicines will let you… [restate their long-term goal]? 
 So, taking your diabetes medication will help you live well now and live well in the future, 
so that you can do the things we just talked about. 
 Your diabetes medication will help you have less symptoms of high blood sugar. If you stop 
your medicine, within a few days, you may feel very tired and thirsty, and you may run to 
the bathroom all the time. 
 On top of you feeling better, day to day, your diabetes medication will help you reach your 
long-term, future plans so that you’re well enough to do what you want to do and to enjoy it. 
 If you stop your diabetes medication, in the long run, you’ll have higher risks for stroke, 
heart attack, dialysis, and amputation. 
 Many people who have these complications can’t live alone anymore. 
 Independence is so important for us as we get older. It’s great to know there are so many 
things we can do to improve our chances for remaining independent as long as possible. 
 Do you know anyone who lost their independence because of diabetes, or because of a 
diabetes complication like stroke, amputation, or dialysis? Encourage them to tell you about 
a family member or acquaintance who lost their independence. If they don’t know anyone, 
share a personal story of someone you know who lost their independence. Relate this 
person’s story to the client’s own future plans. Ask them how they would feel if this 
happened to them. Ask them whether they’d like to avoid this if possible. 
 If you make sure you are on medicines that you can afford and that agree with you, and you 
take them every day, you’ll feel better now and you’ll increase your chances of being well 
for… restate the long-term goal again. How does that sound? Listen supportively. 
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41
Activity 2: Are My Diabetes Medications Working for Me? --------------------------------------- 
 OK, let’s be sure that your medicines are working for you. 
 The way we tell whether they’re working is your A1c number. From your report card that 
you got at the start of the study, I see that your A1c number was… read out loud the A1c 
number on page 2 in the Client Plan Book. 
 On page 13, write in your A1c number into the box. 
 Can you tell me what that number means? Encourage them to tell you how to interpret the 
number and reinforce what it means. Use the chart below. This is also in their Activity Book. 
 OK, so your number is… read the category of A1c number, which means it’s… read “what 
it means”. 
 Let’s talk about what this means in terms of what you should do. 
 
A1c number 
What it means What you should do 
Less than 7 
Great control 
Praise, encourage to keep taking medicine, emphasize if 
they stop it, A1c will go up 
7-8 
OK, not 
perfect 
Review diet, exercise, and whether they are taking 
medicines right. Reinforce importance of taking medicine. 
8-9 
Cause for 
concern 
Review diet, exercise, how they are taking the medicines. 
Coach them to talk to their doctor if there has not been a 
change in the medicines since the A1c was taken. Coach 
them to call the doctor and ask for more medicine if they are 
taking it correctly. 
9 or higher 
Bigger cause 
for concern 
Review diet, exercise, how they are taking medicines. If they 
are taking medicines correctly, coach them to call the 
doctor and request more medicine. 
 If the number is less than 7, you want to do whatever you can to keep it there. Can you tell 
me what that is? Discuss that this is healthy eating, exercise, and taking the medicines as the 
doctor prescribed. 
 When it’s over 7, it’s time for action. That’s a sign that you may need to make more efforts 
to eat healthier, exercise more, or get better at taking the medicines. 
 Sometimes you are doing all of those things well, but the number is still high. Do you know 
what that means? Explain that this happens as diabetes progresses, and some people may 
have uncontrolled diabetes even if they are doing everything right. It may be time to increase 
a dose or get another medicine added – both requiring a talk with the doctor. 
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42
If you decided together that they should reach out to the doctor, discuss in detail how the client will do 
that. 
 Many people won’t want to call the doctor themselves and may need help. Discuss who in their family 
can make the call if they don’t feel comfortable. 
 Write down the date of the call and what they’ll say when the client calls the doctor in the box below. 
 
 
 
 
 
Note: if the client has not done some of the homework 2 sessions in a row, talk about what is making it 
hard to monitor. Let them know that since this is a research project, the investigators may want to help 
the person to succeed. Let them know that someone from the research team will be in touch. 
 Call the research team within 24 hours and let them know what is happening. 
 UAB staff will brief you on the conversation and the plan so that you can reinforce it next week. 
 
If you make a plan to reach out to the doctor, call back the day after the planned call by the 
client/family member to check how things went. If needed, plan together what to do next if 
things did not go well (for example, if the client never called, or if they never got to talk to the 
doctor). They may need to make an appointment, and may need help figuring out how to get 
there. Help them with this. 
 
Review of Last Week’s Homework ---------------------------------------------------------------------- 
 OK, now let’s go over your homework from last week. 
 Can you turn back to page 11 in your Activity Book? Let client get to the page.  
 Were you able to complete the homework? 
 
 
 
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43
Notes: 
Continue with Days 2 through 7 before stopping to discuss. 
 For each day, check “Yes” or “No.” 
 For each day, ask client if they took their diabetes medicine, 
even if their blood sugar was normal. Praise them for every  
“yes” 
 If they didn’t take their diabetes medicine every day, 
discuss what happened. Avoid being judgmental. 
 Reassure client that taking medicine every day 
the way the doctor prescribed is hard for a lot of people. 
Tell them that you will work together to develop a plan 
 for this week to help them take the medicine every day. 
 Write down what happened in the box below. 
 
 
 
 
 
 
Notes: 
Homework #1: Medications 
 OK, let’s review your 3 kinds of homework, starting with your medicines. 
 How did things go with your diabetes medication? Let’s start with Day 1. Did you take all of 
your diabetes medication on Day 1? 
 Now, I’d like to follow up on the plan that we made last week to help you get the most out of 
your medications by taking them every day.  
 Last week, the issue you wanted to work on was… [go to Client Plan Book and read out 
loud the diabetes medication issue that they chose to work on last week]. 
 To overcome this issue, you decided to… [read out loud the medication-taking plan from 
last week]. 
 You thought that it might be hard for you to carry out this plan, because… [read 
potential barriers]. 
 To go around the problem, you decided to… [read how client decided to go around 
potential barriers]. 
 Now, how did it go? Listen supportively and take notes in the box below. Assess how well 
this worked. If it did not work well, talk about why not. If it did go well, praise them. 
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 If their plan worked and last week’s issue is resolved, encourage them to tackle a new issue this 
week. If you try hard and they don’t want to tackle another issue and they took their medicine each 
day: 
 Go back to the Client Plan Book. 
 If there are remaining issues related to side effects or cost, then help the client make a plan to 
address them this week. 
 If there are no remaining issues related to side effects or cost, look at the list of statements on 
Page 8 that are marked “Very Often” (or “Often” if there are no “Very Often” statements to 
address, or “Sometimes” if there are no “Often” statements to address). 
 Help them decide which new goal they would like to add for the coming week. 
 Summarize to confirm their new goal. For example, you could say: 
“OK, let me see if I got this straight. Last week, you … [repeat last week’s goal]. You did well 
with that, so this week, you’ll … [repeat this week’s goal]. Did I get that right?” 
 
 If they were not able to meet their medication goal, then let them stick to the same goal. 
 Be supportive, and let them know you’ll revisit the goal next week to see how it went this time. 
 Strategize what they will do differently this week to succeed. Make it a SMART goal. 
 
 
Record this week’s strategy in the Client Plan Book. 
 If the strategy addresses side effects/and or cost, record this week’s strategy on the page, “Client 
Plan for Diabetes Medication Side Effects and/or Cost,” in the Client Plan Book. 
 If the strategy addresses other barriers besides side effects or cost, then record this week’s 
strategy on the page, “Client Plan for Other Diabetes Medication Barriers,” in the Client Plan 
Book. 
 OK, so what would you like to do over the next week to help you get the most out of your 
medications?  
 
 OK, let’s think about how hard this may be to do. What are some things that might make it 
hard for you to carry out this plan? Write down barriers. 
 OK, what do you think you can do to overcome these things? 
Help clients think of possible solutions to these barriers, and 
write down those solutions. 
 OK, let’s review that. It looks like you’ll… repeat the 
medications goal. Then, review potential barriers and how 
client will go around those barriers. Let client confirm. 
 I look forward to hearing how this plan worked when we talk 
next time! 
 
 
Homework #2: Healthy Eating 
 OK, now, let’s talk about your healthy eating. 
 Were you able to eat healthy on Day 1? For each day, check 
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 If they met their healthy eating goal, 
 Explore if they are ready to add another goal this week. Ask them to turn to page 9 in their 
Activity Book and look at the chart. Help them decide which new goal they would like to add for 
the coming week. 
 Go to “Plan for Healthy Eating” in the Client Plan Book and write down details in the space 
provided. Be sure to include all the information necessary for the goal. 
 Summarize to confirm their new goal. For example, you could say: 
“OK, let me see if I got this straight. Last week, you … [repeat last week’s goal]. You did well 
with that, so now you’d like to add another healthy eating goal. So, this week, you’ll … 
[repeat this week’s goal]. Did I get that right?” 
 If they were not able to meet their healthy eating goal, 
 Let client stick to the same eating goal, but be sure to modify the plan if needed. 
 Go to page “Plan for Healthy Eating” in the Client Plan Book and write down details in the 
space provided. Be sure to include all the information necessary for the goal. 
 Be supportive, but do remind your client that you’ll revisit the goal next week to see how it went 
this time. 
“yes” or “no” for the Healthy Eating column. 
 Great! Now, I’d like to talk about the plan that we made last week to help you eat healthy 
every day. Last week, you planned to… [go to Client Plan Book and read out loud the 
healthy eating goal the client chose to work on last week]. 
 You thought that it might be hard for you to carry out this plan, because… [read potential 
barriers]. 
 To go around the problem, you decided to… [read how client decided to go around potential 
barriers].  
 Now, how did it go? If they were able to meet their goal, praise them profusely! However, if 
things did not go as planned, provide encouragement and tell them that you’ll come up with 
new strategies together, if new plans are needed. 
 OK, what would you like to do this week in terms of healthy eating? 
 
 OK, let’s think about how hard this may be to do. What are some things that might make it 
hard for you to carry out this plan? Write down potential barriers. 
 OK, what do you think you can do to overcome these things? Help clients think of possible 
solutions to these barriers, and write down those solutions. 
 OK, let’s review that. It looks like you’ll… repeat healthy eating goal. Then, review 
potential barriers and how client will go around those barriers. Let the client confirm. 
 Great, I look forward to hearing how this plan worked when we talk next time! 
 
 
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46
 If they met their goal and were doing less than 30 minutes per day, 5 days per week, then explore if 
they are ready to add another 5 minutes. 
 If they are not comfortable advancing the goal, let them stick to the same goal, but supportively 
warn that you’ll be discussing this again next week and remind them that the eventual goal is 30 
minutes per day. 
 Go to “Plan for Physical Activity” in the Client Plan Book and write the goal for this week. 
 If they were not able to meet their goal, 
 Let client stick to the same goal, but be sure to modify the plan if needed. 
 Summarize. For example, say: OK, let me see if I got this straight. Last week, you [repeat last week’s 
goal], and you did pretty well with that, so now you’d like to add another 5 minutes each day. That 
means that, this week, you’d like to [repeat this week’s goal]. Did I get that right? 
Homework #3: Physical Activity 
 OK, now, let’s talk about your exercise. 
 How many minutes of exercise were you able to get on Day 1? For 
each day, write number of minutes under the exercise column.  
 OK, now, I’d like to talk about the plan that we made last week to 
help you eat be more physically active. Last week, you planned to… 
[go to Client Plan Book and read out loud the exercise goal the 
client chose to work on last week]. 
 You thought that it might be hard for you to carry out this plan, 
because… [read potential barriers]. 
 To go around the problem, you decided to… [read how client decided to go around potential 
barriers].  
 Now, how did it go? If they were able to meet their goal, praise them profusely! However, if 
things did not go as planned, provide encouragement and tell them that you’ll come up with 
new strategies together, if new plans are needed. 
 Thanks for sharing that with me! We know that the recommendation is to get 30 minutes or 
more exercise at least 5 days each week, but we need to build up to that gradually. 
 OK, what would you like to do this week in terms of physical activity? 
 
 OK, let’s think about how hard this may be to do. What are some things that might make it 
hard for you to carry out this plan? Write down potential barriers. 
 OK, what do you think you can do to overcome these things? Help clients think of possible 
solutions to these barriers, and write down those solutions. 
 Great, I look forward to hearing how this plan worked when we talk next time! 
 
This Week’s Homework ----------------------------------------------------------------------------------- 
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 Try to make this date as close to 7 
days from now as possible. 
 Allow at least 7 days between 
sessions, but no more than 10 days. 
 Now, let’s go over your homework for the coming week. Please turn to page 13 in your 
Activity Book. 
 This week, we’ll again have homework for each leg of the 3-legged stool. 
 You’re going to continue keeping track of how you’re doing with your diabetes medication. 
So, every day, under the column with the picture of a pill bottle, you’re going to mark “Yes” 
if you took all of your diabetes medication that day. If you weren’t able to take all of your 
diabetes medication, then you’re going to mark “No” for that day. 
 Remember to be honest. I can’t help you if I don’t know where you need help. 
 You’ll carry out the plan we discussed that will help you get the most out of your medicines. 
 You’re also going to mark down whether you kept to your heathy eating goal on the days 
that we discussed. Your plan is to… repeat the healthy eating goal from today written down 
in the Client Plan Book. 
 So, under the column with a picture of apples, you’re going to mark “Yes” if you were able 
to follow your healthy eating goal on the days we discussed. 
 The goal is to eat healthy every day, so if you are able to follow your healthy eating goal on 
the other days, mark “Yes” on those days, too. 
 You’re going to monitor the number of minutes of exercise every day. You decided that you 
would try …Repeat the exercise goal from today written down in the Client Plan Book. 
 So, under the column with a picture of someone walking, you’re going to write down the 
number of minutes of exercise you were able to do on the days we discussed. 
 If you are doing well with your goal and were able to exercise on the other days, mark “Yes” 
on those days, too. 
 Finally, you’ll watch the DVD on Blood Pressure and Cholesterol Medications, which we’ll 
talk about next time. 
 Do you have any questions about what to do? Make sure client knows what to do. 
 OK, when would you like to talk next week? 
 
 OK, please write down the date and time in your Activity Book at the bottom of page 13. 
 I look forward to speaking next week and hearing how things went! 
 
 
 
 
 
 
 
 
Session 4 
completed ______/______/______ 
      month              day               year 
_______/______ 
    start time         end time 
______ 
peer initials 
 
 
 
 
 
 
 
Next appointment date and time: 
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48
Reminder!! 
 Cover and check off all of the session 
content. 
 Any text in GRAY BOXES is instructions for 
you: don’t read that text aloud to the client. 
Session Goals: 
 Brief review of last week’s session 
 Review DVD: Blood Pressure and Cholesterol Medications 
 Review homework 
 Learn to connect medicines to future goals 
 Your blood pressure and cholesterol numbers 
 
 
Week 5, Session 5: “Blood Pressure and Cholesterol Medications” 
 
 
Before Calling the Client ----------------------------------------------------------------------------------- 
  
 Review last week’s assignment and the 
barriers and strategies to overcome them. 
 Once you’ve reviewed this, place the call. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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49
Say hello and make sure the client 
is still okay with speaking for about 
a half hour to forty minutes today. 
 If they did not watch the DVD, tell them to watch it 
now, and you’ll call back in a half hour. 
Greeting ----------------------------------------------------------------------------------------------------- 
 
 Great, do you have your Activity Book handy? 
If not, let them get the Activity Book before going on. 
 Please turn to page 14. Today, we’ll review what we 
learned last week, learn about blood pressure and cholesterol medications, and review what 
you learned on the DVD. 
 We’ll also review your homework, and we’ll get new homework for this week. 
 OK, let’s get started. Can I ask if you’ve 
watched the DVD? 
 
Review Last Week’s Session ----------------------------------------------------------------------------- 
 OK, let’s review what we learned last time. Please stay on page 14. 
 We talked about the importance of taking our diabetes medications, which is one of the legs 
of the three-legged stool.  
 Can you remember some of the ways diabetes medications can help you? Let client answer. 
If needed, remind client that diabetes medications work to keep down their blood sugar; 
high blood sugar will make them feel bad - tired, going to the bathroom too often, and 
feeling thirsty all the time. Along with diet and exercise, medications also prevent or delay 
complications of diabetes like stroke, dialysis, heart attack, and amputations. 
 OK, we learned that medications aren’t perfect, and that your diabetes may continue to 
progress, even when you’re on medications. If you don’t take the medicine, your diabetes 
will progress faster. That’s why you may need a second or third medication, even if you’re 
doing everything right.  
 Diabetes medications may give you side effects, but many people won’t get any side effects. 
 There are many types of medications available, so you and your doctor should be able to 
find a medication that controls your sugar and lets you feel well. 
 We also checked on how you were doing with your diabetes medicines and with healthy 
eating and exercise. In the past two weeks, you have been working on all 3 legs of the stool! 
That’s great! 
 Does that sound right? Let client answer. Did you have any questions? Let client answer. 
 
Review DVD: Blood Pressure and Cholesterol Medications --------------------------------------- 
 OK. Let’s move on and talk about the DVD you watched this week. How did you like it? Let 
the client answer and listen supportively. 
 Let’s review some of the things we saw on the DVD. Please turn to page 15. Let the client 
get to the page. 
 You heard someone on the video talk about blood pressure medications. What did you think 
about that? Listen to their response. Bring out that she didn’t really understand how 
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Notes: 
important blood pressure medicines were until well after she experienced a complication. 
Emphasize that high blood pressure is very common in your communities, and that the 
consequences of not taking care of high blood pressure can be very serious. 
 There are some important numbers to remember. Do you remember the numbers that mean 
you have high blood pressure? 140 over 90 or higher is high blood pressure. 
 If you don’t get it under control, meaning lower than 140 over 90, high blood pressure can 
lead to serious complications. Do you remember any of these complications?  Complications 
include stroke, heart attack, dialysis, blindness.  
 One of the important points made on the video is that because it has no symptoms, high 
blood pressure can be especially dangerous. You may feel OK right up until you have a 
stroke. It’s the “silent killer.” 
 Sometimes it can feel like the doctor is experimenting because they often switch the 
medications and change the dose. But this isn’t experimenting, right? Many blood pressure 
medicines work better in some people than others, so it may take a while to get it right.   
 Just like for diabetes, there are many different medications available to treat high blood 
pressure, so you should be able to get on a medication that both controls your blood pressure 
and lets you feel well. 
 Some people do get side effects. Do you remember what the advice was if you get a side 
effect? Let them tell you. It should be “talk to the doctor.” You shouldn’t just stop. 
 Now, the video also talked about high cholesterol. We learned that high cholesterol causes 
health problems. Do you remember what those were? Answer: stroke and heart attack.   
 OK, here’s a trick question. Do you remember what symptoms high cholesterol causes? 
Answer: no symptoms with high cholesterol.  
 What about the “bad cholesterol”, do you remember what that was? Answer: LDL 
cholesterol. OK, do you remember the good number you want to be below? Answer: 100.  
 The main medicine for high cholesterol is a statin. Do you remember how many people feel 
well and have no side effects on statins? Answer: 3 of 4. 
 Finally, the video mentioned that, for both blood pressure and cholesterol medications, the 
generic versions work as well as the brand name drugs, but generics can be more affordable.  
 Did you have any questions about what you learned? If the client has questions that weren’t 
covered in the video, write down the questions and ask the research team. Tell the client 
you’ll ask the doctors in the study and let them know the answer next time. Or, coach the 
client to ask their doctor their questions. Write down questions in the box below. 
 
 
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51
 Encourage clients to think of other things they’d like to do in the future. Plans could include something 
they want to do in retirement, watching a grandchild grow up, attending a family reunion, etc. 
 If needed, ask them about their loved ones, especially grandchildren or great grandchildren. Suggest 
something they may want to look forward to in the future, for example, see their great grandchild get 
married. If client mentions anything new, add to what you already wrote on page 3. 
Activity 1: How Medications Can Help Me Live Better, Longer----------------------------------- 
 Now, let’s review some of the things we talked about at our first session as well as last time. 
Please turn to page 16. Here you see some events or occasions that many people look 
forward to. Can you tell me what you see? There are pictures of a 50th anniversary, a 
wedding, graduation, a baby, and a family reunion. 
 Go to page 3 in the Client Plan Book and look at what the client told you were some of their 
hopes for the future. Last time we talked, you told me that it was important for you to… read 
their long term goals from page 3. Since we talked, did you think of any other things that 
you’re looking forward to doing in the future? Listen supportively. 
 You learned a lot about how high blood pressure and high cholesterol affect the body, and 
how the medicines help to slow these changes down. 
 Now that you’ve watched the videos on medicines for diabetes, blood pressure, and 
cholesterol, you know how these medicines are supposed to work for you. How do you think 
taking the medicines will let you… [repeat their long-term goals]? Listen supportively. 
 If you stop your medication, in the long run, you’ll have higher risks for complications like 
stroke, heart attack, dialysis, and amputation. Do you know anyone with any of these 
conditions? Listen supportively.  
 Many people who have these complications can’t live alone anymore. During our last 
session, we talked a little about people we know that lost their independence because of 
these complications. 
 Since we talked, did you think of anyone else you know who can’t live alone anymore 
because of stroke, heart problems, dialysis or amputation? Encourage client to talk about 
another family member or acquaintance who lost their independence. If they don’t know 
anyone else, repeat or share another personal story of someone you know who lost their 
independence. Relate this person’s story to the client’s own future plans. Ask how they 
would feel if this happened to them. Ask whether they’d like to avoid this if possible. 
 Independence is so important for us as we get older. A lot of people don’t realize that taking 
these medicines for diabetes, high blood pressure, or cholesterol let us stay independent 
longer. Did you know that’s what the medicines are for? Listen supportively. 
 
 
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52
 If they are skeptical about the value of the medicines, talk about others like them whom you have 
helped. You may also want to discuss video clips of Black Belt residents talking about their medicines. 
 Be supportive and don’t criticize. Encourage them to see the value of medicine. 
 If they don’t want to, be supportive and move on.  
 If you make sure you are on medicines that you can afford and that agree with you, and you 
take them every day, you’ll increase your chances of being well for… repeat their future 
goal. You’ll also be able to live independently for longer. What do you think about that? 
 
Activity 2: How is My Blood Pressure? ---------------------------------------------------------------- 
 OK, let’s talk about your blood pressure. From your report card that you got at the start of 
the study, I see that your blood pressure was… read out loud the blood pressure number 
from the client report card on page 2 in the Client Plan Book. 
 OK, if you don’t mind, on page 16 of your Activity Book, write in your blood pressure 
numbers into the box. Do you see the box in the middle of the left-hand side of the page? 
First, write...read out the first number.  Then, write...read out the second number.  
 Can you tell me what these numbers mean? Is your blood pressure normal? Is it high? Let 
the client answer. If needed, remind client that 120/80 is normal, less than 140/90 is the 
goal, and 140/90 or higher is high. 
If the blood pressure is lower than 140/90, say:  
 Your blood pressure is in a great range. You’ll want to keep an eye on it because it 
may go up at some point in the future as you get older. Now, let’s stay on page 16 
and talk about your cholesterol. Go to ACTIVITY 3 on page 54 of your manual. 
If the blood pressure is 140/90 or higher: 
 OK, so your blood pressure is high. Did you know that over half of people with high 
blood pressure don’t have it under control? So you are not alone.  
 If you and your doctor can get it under control, under 140/90, it will help you meet 
your goals and stay independent.  
 Let’s go over your blood pressure medicines and make sure you are not having 
problems. Go to page 19 in the Client Plan Book to see if they’re taking any 
medications for blood pressure. 
If there are no blood pressure medicines listed, go to #1 on page 53 in your manual. 
If there are blood pressure medicines listed, go over each medicine: how they’re 
taking their medicine, whether they’re experiencing side effects that are causing them 
to miss doses, and whether they’re able to afford their medicine. 
1) If they are making mistakes in how they are taking it, or they are missing 
doses because of side effects or cost, go to #2 on page 53 in your manual.   
2) If they are taking it correctly and aren’t missing doses because of side effects 
or cost, go to #3 on page 54 in your manual. 
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53
 
1) IF NOT TAKING ANY BLOOD PRESSURE MEDICINES: 
 It looks like you are not taking any medicines for blood pressure, and it’s high. As you 
learned from the video, it’s very common to get high blood pressure as we get older.  
 Have you ever been told your pressure is high before? If this is the first time the pressure 
is high, suggest they get it rechecked at the pharmacy over the next week. Check back at 
the next session.  
If they have been told the pressure was high in the past, suggest they talk to the doctor 
about it. Go to page 20 in the Client Plan Book and help client come up with a plan 
on how to reach out to the doctor: who is calling the doctor, when they are calling, 
what the client will say, potential barrier for carrying out the plan, and how they will 
get around the barrier. Write down plan in the Client Plan Book and check back at the 
next session.  
When finished, go to ACTIVITY 3 on page 54 of your manual. 
 
 
2) IF ON MEDICINES BUT NOT TAKING CORRECTLY:  
If they are missing doses because of side effects or cost, be supportive and tell them this 
happens to a lot of people.  
Go to page 20 in the Client Plan Book and help client come up with plan on how to 
reach out to the doctor: who is calling the doctor, when they are calling, what they 
will say, potential barrier to the plan, and how to get around the barrier. Write down 
the plan in the Client Plan Book and check back at the next session.   
If they are not having issues with side effects or cost but still not taking it correctly, 
supportively correct any mistakes. Tell them a lot of people find this confusing.  
Go to page 21 in the Client Plan Book and help client make a plan for how to take 
correctly. Ask client to get their blood pressure rechecked after about a week, possibly 
at the pharmacist or at the doctor’s office with the nurse. Write down the plan in the 
Client Plan Book and check back at the next session.  
 OK, let’s see how that goes. I look forward to hearing about whether the blood pressure is 
better now that you are taking it like the doctor prescribed. 
Note: here are some common mistakes:  
 Twice daily means morning and evening (not 2 doses in the morning)  
 Many people skip doses of water pills if they are going out. If they do this, make sure 
they take it when they come back – don’t skip a whole day.  
 Some people only take them every other day. 
When finished, go to ACTIVITY 3 on page 54 of your manual. 
 
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54
 
 
3) IF ON MEDICINES AND THEY ARE TAKING CORRECTLY: 
 It looks like you are taking the medicines just like the doctor prescribed, but the medicine 
may not be enough. What would you like to do about your blood pressure to get it under 
control? Listen to what they would like to do. If they don’t know what to do, suggest they 
talk to the doctor. If they agree to talk to the doctor, go to page 22 in the Client Plan 
Book and help client come up with plan on how to reach out to the doctor. Decide: 
1. Who is calling the doctor, and when 
2. What the client will say to the doctor 
3. Whether the client needs a friend or family member with them to make sure their 
questions get answered; if yes, then who 
4. Possible barriers to the plan, and what client will do to go around barriers 
Check back at the next session.  
Note: About 1 in 5 people may need 4 or even 5 blood pressure medicines to get the blood 
pressure below 140/90, and some can’t get it down below 140/90. However, if the blood 
pressure is a lot lower than it used to be, that means the medicine is helping a lot and 
they are lowering risks, so you can praise them for getting it down, even if it’s not below 
140/90. 
When finished, go to ACTIVITY 3 on page 54 of your manual. 
 
Activity 3: How is My Cholesterol? --------------------------------------------------------------------- 
 OK, let’s make sure that your cholesterol is where it needs to be. 
 From your report card that you got at the start of the study, I see that your LDL cholesterol, 
or the “bad” cholesterol, was… read out loud the LDL cholesterol number from page 2 in 
the Client Plan Book. 
 OK, if you don’t mind, on page 16 of your Activity Book, write in your cholesterol number 
into the box at the bottom left-hand corner of the page. 
 Can you tell me what this number means? Is it OK or is it high? Let the client answer. If 
needed, remind client that less than 100 is the goal, whereas 100 or higher is high. 
If the LDL cholesterol is less than 100, say:  
 Your cholesterol is in a great range. Congratulations! Now, we can review your 
homework from last week. Please turn to page 13 in your Activity Book. 
Go to Review of Last Week’s Homework on page 57 of your manual. 
 
 
 
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55
If the LDL cholesterol is 100 or higher: 
 OK, so your cholesterol is high. Did you know that most people with diabetes have 
high cholesterol? So, you are not alone.  
 If you and your doctor can get it under control, which is under 100, it will help you 
meet your goals and stay independent as long as possible.  
 Let’s go over your cholesterol medicines and make sure you are not having any 
problems. Go to page 23 in the Client Plan Book to see if they’re taking any 
medications for cholesterol. 
If there are no cholesterol medicines listed, go to #1 on page 55 in your manual. 
If there are cholesterol medicines listed, go over each medicine: how they’re taking 
their medicine, whether they’re experiencing side effects that are causing them to 
miss doses, and whether they’re able to afford their medicine. 
1) If they are making mistakes in how they are taking it, or they are missing 
doses because of side effects or cost, go to #2 on page 56 in your manual. 
2) If they are taking it correctly and aren’t missing doses because of side effects 
or cost, go to #3 on page 56 in your manual.  
 
1) IF NOT TAKING ANY CHOLESTEROL MEDICINES: 
 It looks like you are not taking any medicines for cholesterol and it’s high. As I already 
told you, it’s very common for people with diabetes to have high cholesterol. The two 
sort of go hand in hand.  
 Have you ever been told your cholesterol is high before? Listen supportively.  
Note: Some people may have tried a medicine and it didn’t agree with them, or they 
could not afford it, or they just didn’t feel like taking it. 
If your client mentions any of these things, discuss what they learned about 
cholesterol on the video.  
Tell them about others in the community just like them who used to feel the way they 
do, but who now take cholesterol medicine.  
Remind them that most people feel normal when on cholesterol medicine.  
If they seem open to it, suggest making a plan to reach out to their doctor. Go to page 
24 in the Client Plan Book and help client client come up with a plan: who is calling 
the doctor, when they are calling, what the client will say, potential barrier for 
carrying out the plan, and how they will get around the barrier. Write down the plan 
in the Client Plan Book and check back at the next session.  
When finished, go to Review of Last Week’s Homework on page 57 of your manual. 
 
 
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56
 
2) IF ON MEDICINE BUT NOT TAKING CORRECTLY:  
If they are missing doses because of side effects or cost, be supportive and tell them this 
happens to a lot of people. 
Go to page 24 in the Client Plan Book and help client come up with plan on how to 
reach out to the doctor: who is calling the doctor, when they are calling, what they 
will say, potential barrier to the plan, and how to get around the barrier. Write down 
the plan in the Client Plan Book and check back at the next session. 
If they are not having issues with side effects or cost but still not taking it correctly, 
supportively correct any mistakes. Tell them a lot of people find this confusing. 
Go to page 25 in the Client Plan Book and help client make a plan for taking it 
correctly. Ask client to get cholesterol rechecked at the doctor’s office after about a 
month. They can wait until their next regularly scheduled visit, which may not be for 
several months. Write down the plan and check back at the next session. 
 OK, let’s see how that goes. I look forward to hearing about how it went and whether 
you got any side effects now that you will be taking the medicine every day like the 
doctor prescribed. If you do, we’ll make a plan for how to handle that. How does that 
sound? Let the client answer. 
When finished, go to Review of Last Week’s Homework on page 57 of your manual. 
 
 
3) IF ON MEDICINES AND THEY ARE TAKING CORRECTLY: 
 It looks like you are taking the medicines just like the doctor prescribed, but the medicine 
may not be enough. What would you like to do about your cholesterol to get it under 
control? Listen to what they would like to do. If they don’t know what to do, suggest they 
talk to the doctor. If they agree, go to page 26 in the Client Plan Book and help client 
come up with plan on how to reach out to the doctor. Decide: 
1. Who is calling the doctor, and when 
2. What the client will say to the doctor 
3. Whether the client needs a friend or family member with them to make sure 
their questions get answered; if yes, then decide who will call with them. 
4. Possible barriers to the plan, and what client will do to go around barriers 
Check back at the next session.  
Note: About 1 in 5 people may get muscle cramps on statin medicines. This can be 
controlled by reducing the dose, or taking it every other day. The doctor may suggest 
one of these strategies. 
When finished, go to Review of Last Week’s Homework on page 57 of your manual.  
 
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57
Note: if the client has not done some of the homework 2 sessions in a row, talk about what is making it 
hard to monitor. Let them know that since this is a research project, the investigators may want to help 
the person to succeed. Let them know that someone from the research team will be in touch. 
 Call the research team within 24 hours and let them know what is happening. 
 UAB staff will brief you on the conversation and the plan so that you can reinforce it next week. 
Continue with Days 2 through 7 before stopping to discuss. 
 For each day, check “Yes” or “No.” 
 For each day, ask client if they took their diabetes medicine, 
even if their blood sugar was normal. Praise them for every  
“yes.” 
 If they didn’t take their diabetes medicine every day, 
discuss what happened. Avoid being judgmental. 
 Reassure client that taking medicine every day 
the way the doctor prescribed is hard for a lot of people. 
Tell them that you will work together to develop a plan 
 for this week to help them take the medicine every day. 
 Write down what happened in the box below. 
 
 
 
 
 
 
Notes: 
Review of Last Week’s Homework ---------------------------------------------------------------------- 
 OK, now let’s go over your homework from last week. 
 Can you turn to page 13 in your Activity Book? Let client get to the page.  
 Were you able to complete the homework? 
 
Homework #1: Medications 
 OK, let’s start with your medicines, beginning with Day 1. 
 Did you take all of your diabetes medication on Day 1? 
 Now, I’d like to follow up on the plan that we made last week to help you get the most out of 
your diabetes medications by taking them every day.  
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Notes: 
 If their plan worked and last week’s issue is resolved, encourage them to tackle a new issue this 
week. If you try hard and they don’t want to tackle another issue and they took their medicine each 
day, try this:  
 Go back to the Client Plan Book. 
 If there are remaining issues related to side effects or cost, then help the client make a plan to 
address them this week. 
 If there are no remaining issues related to side effects or cost, look at the list of statements that 
are marked “Very Often” (or “Often” if there are no “Very Often” statements to address, and 
“Sometimes” if there are no “Often” statements to address). 
 Help them decide which new goal they would like to add for the coming week. 
 Summarize to confirm their new goal. For example, you could say: 
“OK, let me see if I got this straight. Last week, you … [repeat last week’s goal]. You did well 
with that, so this week, you’ll … [repeat this week’s goal]. Did I get that right?” 
 
 If they were not able to meet their medication goal, then let them stick to the same goal. 
 Be supportive, and let them know you’ll revisit the goal next week to see how it went this time. 
 Strategize what they will do differently this week to succeed. Make it a SMART goal. 
 
 
Record this week’s strategy in the Client Plan Book. 
 If the strategy addresses side effects/and or cost, record this week’s strategy on the page, “Plan 
for Diabetes Medication Side Effects and/or Cost,” in the Client Plan Book. 
 If the strategy addresses other barriers besides side effects or cost, then record this week’s 
strategy on the page, “Plan for Other Diabetes Medication Barriers,” in the Client Plan Book. 
 
 Last week, the issue you wanted to work on was… [go to Client Plan Book and read out 
loud the diabetes medication issue that they chose to work on last week]. 
 To overcome this issue, you decided to… [read out loud the medication-taking plan from 
last week]. 
 You thought that it might be hard for you to carry out this plan, because… [read 
potential barriers]. 
 To go around the problem, you decided to… [read how client decided to go around 
potential barriers]. 
 Now, how did it go? Listen supportively and take notes in the box below. Assess how well 
this worked. If it did not work well, talk about why not. If it did go well, praise them. 
 OK, so what would you like to do over the next week to help you get the most out of your 
medications?  
 
 
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59
 
 OK, let’s think about how hard this may be to do. What are some things that might make it 
hard for you to carry out this plan? Write down barriers. 
 OK, what do you think you can do to overcome these things? Help clients think of possible 
solutions to these barriers, and write down those solutions. 
 OK, let’s review that. It looks like you’ll… repeat the medications goal. Then, review 
potential barriers and how client will go around those barriers. Let client confirm. 
 I look forward to hearing how this plan worked when we talk next time! 
 
 
Homework #2: Healthy Eating 
 OK, now, let’s go over what happened with your healthy 
eating. 
 So, were you able to eat healthy on Day 1? For each day, 
check “yes” or “no” for the Healthy Eating column. 
 
 
 
 
 
 
 
 Let’s review what you wanted to do to eat healthier. Last week, you decided to…  [go to 
Client Plan Book and read the healthy eating goal that they chose to work on last week]. 
 You thought that it might be hard for you to carry out this plan, because… [read potential 
barriers]. 
 To go around the problem, you decided to… [read how client decided to go around potential 
barriers].  
 Now, how did it go? If they were able to meet their goal, praise them profusely! However, if 
things did not go as planned, provide encouragement and tell them that you’ll come up with 
new strategies together, if new plans are needed. 
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60
 If they met their healthy eating goal, 
 Explore if they are ready to add another goal this week. Ask them to turn to page 9 in their 
Activity Book and look at the chart. Help them decide which new goal they would like to add for 
the coming week. 
 Go to the Client Plan Book and write down details in the space provided. Be sure to include all 
the information necessary for the goal. 
 Summarize to confirm their new goal. For example, you could say: 
“OK, let me see if I got this straight. Last week, you … [repeat last week’s goal]. You did well 
with that, so now you’d like to add another healthy eating goal. So, this week, you’ll … 
[repeat this week’s goal]. Did I get that right?” 
 If they were not able to meet their healthy eating goal, 
 Let client stick to the same eating goal, but be sure to modify the plan if needed. 
 Go to the Client Plan Book and write down details in the space provided. Be sure to include all 
the information necessary for the goal. 
 Be supportive, but do remind your client that you’ll revisit the goal next week to see how it went 
this time. 
 OK, what would you like to do this week in terms of healthy eating? 
 
 OK, let’s think about how hard this may be to do. What are some things that might make it 
hard for you to carry out this plan? Write down potential barriers. 
 OK, what do you think you can do to overcome these things? Help clients think of possible 
solutions to these barriers, and write down those solutions. 
 Great, I look forward to hearing how this plan worked when we talk next time! 
 
 
Homework #3: Physical Activity 
 OK, now, let’s go over how you did with exercise. 
 How much exercise were you able to get on Day 1? For each 
day, write number of minutes under the exercise column.  
 
 Great! Now, Let’s review what you wanted to do to get more 
exercise. Last week, you decided to…  [go to Client Plan Book 
and read the exercise goal that they chose to work on last 
week].  
 You thought that it might be hard for you to carry out this plan, 
because… [read potential barriers]. 
 To go around the problem, you decided to… [read how client 
decided to go around potential barriers].  
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61
 If they met their goal and were doing less than 30 minutes per day, 5 days per week, then explore if 
they are ready to add another 5 minutes. 
 If they are not comfortable advancing the goal, let them stick to the same goal, but supportively 
warn that you’ll be discussing this again next week and remind them that the eventual goal is 30 
minutes per day. 
 Write the goal for this week in the space provided in the Client Plan Book. 
 If they were not able to meet their goal, 
 Let client stick to the same goal, but be sure to modify the plan if needed. 
 Summarize. For example, say: OK, let me see if I got this straight. Last week, you [repeat last week’s 
goal], and you did pretty well with that, so now you’d like to add another 5 minutes each day. That 
means that, this week, you’d like to [repeat this week’s goal]. Did I get that right? 
 Now, how did it go? If they were able to meet their goal, praise them profusely! However, if 
things did not go as planned, provide encouragement and tell them that you’ll come up with 
new strategies together, if new plans are needed. 
 Thanks for sharing that with me! We know that the recommendation is to get 30 minutes or 
more exercise at least 5 days each week, but we need to build up to that gradually. 
 OK, what would you like to do this week in terms of physical activity? 
 
 OK, let’s think about how hard this may be to do. What are some things that might make it 
hard for you to carry out this plan? Write down potential barriers. 
 OK, what do you think you can do to overcome these things? Help clients think of possible 
solutions to these barriers, and write down those solutions. 
 OK, let’s review that. It looks like you’ll… repeat the type of exercise, how many minutes on 
which days, when and where they’ll do it, and with whom, if they plan to exercise with 
another person. Then, review potential barriers and how client will go around those 
barriers. Let the client confirm. 
 Great, I look forward to hearing how this plan worked when we talk next time! 
 
This Week’s Homework ----------------------------------------------------------------------------------- 
 You are doing so much to maintain your health – it’s really great! 
 Now, let’s keep up the momentum and let’s go over your homework for the coming week. 
Please turn to page 16 in your Activity Book. 
 This week, we’ll again have homework for each leg of the 3-legged stool. 
 You’re going to continue keeping track of how you’re doing with your diabetes medication. 
So, every day, under the column with the picture of a pill bottle, you’re going to mark “Yes” 
if you took all of your diabetes medication that day. If you weren’t able to take all of your 
diabetes medication, then you’re going to mark “No” for that day. 
 Remember to be honest. I can’t help you if I don’t know where you need help. 
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 Try to make this date as close to 7 
days from now as possible. 
 Allow at least 7 days between 
sessions, but no more than 10 days. 
 You’ll carry out the plan we discussed that will help you get the most out of your medicines. 
 You’re also going to mark down whether you kept to your healthy eating goal on the days 
that we discussed. Your plan is to… repeat the healthy eating goal from today written in the 
Client Plan Book. 
 So, under the column with a picture of apples, you’re going to mark “Yes” if you were able 
to follow your healthy eating goal as we discussed. 
 The goal is to eat healthy every day, so if you are able to follow your healthy eating goal 
every day, mark “Yes” on each day. 
 You’re going to monitor the number of minutes of exercise every day. You decided that you 
would try …Repeat the exercise goal from today written in the Client Plan Book. 
 So, under the column with a picture of a person walking, you’re going to write down the 
number of minutes of exercise you were able to do on the days we discussed. 
 If you are doing well with your goal and were able to exercise on the other days, mark “Yes” 
on those days, too. 
 Finally, you’ll watch the DVD on Stress and Your Health, which we’ll talk about next time. 
 Do you have any questions about what to do? Make sure client knows what to do. 
 Remember, although it’s not homework, we’ll also talk about your blood pressure and 
cholesterol to make sure you’re doing everything you can to keep those numbers in control. 
 OK, when would you like to talk next week? 
 
 OK, please write down the date and time in your Activity Book at the bottom of page 16. 
 I look forward to speaking next week and hearing how things went! 
 
 
 
 
 
 
 
 Session 5 
completed ______/______/______ 
      month              day               year 
_______/______ 
    start time         end time 
______ 
peer initials 
 
 
 
 
 
 
 
 
 
 
 
Next appointment date and time: 
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Reminder!! 
 Cover and check off all of the session 
content. 
 Any text in GRAY BOXES is instructions for 
you: don’t read that text aloud to the client. 
Session Goals: 
 Brief review of last week’s session 
 Review DVD: Stress and Your Health 
 Learn stress reduction techniques 
 Review homework 
 
Week 6, Session 6: “Stress and Your Health” 
 
 
Before Calling the Client ----------------------------------------------------------------------------------- 
  
 Review last week’s assignment and the 
barriers and strategies to overcome them. 
 Once you’ve reviewed this, place the call. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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64
Say hello and make sure the client 
is still okay with speaking for about 
a half hour to forty minutes today. 
 If they did not watch the DVD, tell them to watch it 
now, and you’ll call back in a half hour. 
Greeting ----------------------------------------------------------------------------------------------------- 
 
 Great, do you have your Activity Book handy? 
If not, let them get the Activity Book before going on. 
 Please turn to page 17. Today, we’ll review what we 
learned last week, review the DVD, and learn more about stress and your health, including 
some specific strategies you can take to reduce stress. 
 We’ll also review your homework and what you learned on the DVD, and we’ll get new 
homework for two weeks.  
 I will give you a quick call next week, just to check in and see how you’re doing, but it 
won’t be a full session. We will talk more in two weeks. 
 OK, let’s get started. Can I ask if you’ve 
watched the DVD? 
 
Review Last Week’s Session ----------------------------------------------------------------------------- 
 OK, let’s review what we learned last time. Please stay on page 17. 
 We talked about the importance of keeping our blood pressure and cholesterol under control. 
Can you remember some complications that can happen from having high blood pressure? 
Let client answer. If needed, remind client that high blood pressure can cause complications 
like stroke, heart attack, dialysis, and blindness. 
 And can you remember some complications of high cholesterol? Let client answer. If 
needed, remind client that high cholesterol can cause heart attacks and strokes. 
 This is why it’s so important for us to keep both of these things under control. Can you 
remind me what is our goal for blood pressure? Let client answer. If needed, remind client 
that our goal is to be below 140/90. What about a normal blood pressure, do you remember 
what that number was? 120/80 is a normal blood pressure. 
 And can you remind me what is our goal for LDL, or “bad,” cholesterol? Let client answer. 
If needed, remind client that our goal is to be below 100. 
 Now, for blood pressure, we learned that there are many different medications available to 
treat high blood pressure. This is why it can take some time to find the right one for you. 
 For cholesterol, on the other hand, there is one main type of medication, the “statins.” 
 As with diabetes medicines, there may be some side effects with blood pressure and 
cholesterol medicines. However, you and your doctor should be able to find a medication 
that works to control your blood pressure and cholesterol and that lets you feel well. 
Remember, don’t just stop – talk to your doc! 
 We also checked on how you were doing with your diabetes medicines and with healthy 
eating and exercise. In the past few weeks, you have been working on all 3 legs of the stool. 
 Does that sound right? Let client answer. Did you have any questions? Let client answer. 
 
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Review DVD: Stress and Your Health ----------------------------------------------------------------- 
 Great! Let’s move on and talk about the DVD you watched this week. How did you like it? 
Let the client answer and listen supportively. 
 Let’s review some of the things we saw on the DVD. Please turn to page 18. Let the client 
get to the page. 
 The video talked about how being stressed over long periods of time, or having chronic 
stress, can cause problems for our health. 
 People experiencing chronic stress can experience upset stomach, irritability, bad mood, or 
fatigue. Chronic stress can worsen arthritis symptoms, cause weight gain or loss, or cause 
you to have trouble sleeping or concentrating. 
 It can even increase your chances of getting some health conditions. Do you remember what 
those were? Answer: high blood pressure and heart disease. 
 We learned several tips for managing stress in a healthy way. Please stay on page 18. 
 First, it’s important to recognize when we’re stressed. Becoming aware of how stress makes 
us feel physically and emotionally is an important step towards dealing with stress in a 
healthy way. How does stress make you feel? Listen supportively.  
 Second, it’s important to identify the sources of stress in our lives. If we’re aware of the 
things and situations that cause us to feel stressed, then we can prepare ourselves ahead of 
time to deal with the stressful situation. What are some of the things in your life that make 
you feel stressed? Listen supportively. 
 Third, know what helps you relax. Some things that relax you are not so healthy, like 
smoking, or overeating.  These things cause even more health problems in the long run. 
 So it’s important to have healthy ways of dealing with stress so that you can live as well as 
you can, as long as you can. 
 The video mentioned some healthy strategies to relax. Can you remember any of the 
strategies? Let client answer. If needed, remind client that being physically active and 
practicing deep breathing are two great ways to relax. Other talking points:  
 Exercising decreases the level of stress hormones in your body so that you feel less 
stressed and anxious, improving your mood and allowing you to sleep better. 
 In addition to exercise and deep breathing, other helpful things might include: 
calling a friend or a loved one; taking a long, relaxing bath; working in your garden; 
reading a good book; listening to music; or prayer. 
 We’re going to practice one of these strategies together next. Before we do that, did you 
have any questions so far? Let client answer. 
 
 
 
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Activity 1: Deep Breathing Stress Reduction Technique -------------------------------------------- 
 OK, please stay on page 18 in your Activity Book. Let’s practice together the deep breathing 
exercise that you saw on the DVD. 
 This exercise can remove a lot of the stress from our bodies, and you can do it just about 
anywhere. 
 OK, the first step is to get comfortable. Are you comfortable? 
 OK, take some deep and very slow breaths. In…and out…and in…and out. 
 Now, let’s start from the top and work our way down. We’re going to relax every muscle in 
our bodies. Remember to breathe deeply and slowly throughout. 
 Let’s focus on the neck muscles, which are often very tense when we are stressed, and we 
don’t even know it. Focus on relaxing them. 
 Now the upper back…the shoulders…the arms…the chest and stomach. 
 Concentrate on relaxing your back…your thighs…your legs. 
 We’re continuing to breathe deeply…and slowly. 
 Now, we’re going to relax our brain. 
 Our brain is part of our body, and it is working all the time, especially when we are stressed. 
 Now, we’re going to relax our brain, breathing deeply…and slowly. 
 Many people have never relaxed their brains. Let’s begin by focusing on our senses. 
 First, let’s relax and not have any thoughts in response to what I’m saying. 
 Breathing in…and out…deeply…and slowly. 
 Now, do not let your brain respond to anything that I’m saying. Don’t have any thoughts in 
response to what I’m saying. 
 Try to let the sound and the words flow right over you. You hear them, but don’t react to 
them. Just breathe deeply…and slowly. 
 Now, concentrate on your thoughts. Become aware of your thoughts, and then just let them 
flow up…and out…and away. Just like a water fountain…a beautiful water fountain in the 
sunshine. 
 Every new thought that comes, think of it like a sparkling drop of water, floating up…and 
out…and away from you. 
 Don’t react to it…don’t respond to it…it is a 
new thought that flows away. 
 Breathe in…and out…deeply…and slowly. 
 
 
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 Share that you feel great when you do this exercise. 
 Emphasize how good it feels to be rid of stress. 
 Talk about how often we have a lot of stress, and we don’t even know it. 
 Think of a big movie screen that’s blank and white. 
 
 
 
 
 
 
 
 
 Think of your thoughts being images on the movie screen, and as soon as the image is there, 
you let it flow away, disappearing and leaving the screen blank again. 
 Let your mind become blank and white as fewer and fewer new thoughts come, letting each 
of them barely come onto the movie screen before they begin to disappear again. 
 All the time breathing in…and out…deeply…and slowly. 
 OK, that was great! I feel really relaxed! How do you feel?  
 The great thing about this breathing exercise is that you can do it anywhere. If you feel 
stressed at work, you can do this at your desk, or go to the restroom if you really need to get 
away. If the grandkids are really getting to you, go in the kitchen away from them and 
practice deep breathing.  
 
Review of Last Week’s Homework ---------------------------------------------------------------------- 
 OK, now let’s go over your homework from last week and talk about your homework for the 
next two weeks. Like I mentioned earlier, we won’t be having a full session for two weeks, 
but you’ll continue working on your homework, just like you’ve been doing. 
 Over these two weeks, it will be a great time to start thinking about how you will carry on 
after this program is finished. 
 You’ve been focusing on your health and living in a way that will keep you healthy. 
 You’ve learned about the importance of the three-legged stool: eating healthy, being 
physically active, and taking your medications as prescribed by the doctor. 
 You’ve also been setting goals for yourself so that you can tend to all three legs of the stool, 
and you’ve been keeping track of your progress between our sessions. 
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Note: if the client has not done some of the homework 2 sessions in a row, talk about what is making it 
hard to monitor. Let them know that since this is a research project, the investigators may want to help 
the person to succeed. Let them know that someone from the research team will be in touch. 
 Call the research team within 24 hours and let them know what is happening. 
 UAB staff will brief you on the conversation and the plan so that you can reinforce it next week. 
 You also took small steps forward, week to week, so that you can continue to live even more 
healthy and do the things that are important to you. 
 Now, we won’t be talking for two weeks. So, if you’ve been able to carry out your plan 
successfully during the upcoming week, you can consider taking another small step forward 
on your own during the second week. 
 For example, you could add another 5 minutes to your exercise plan. 
 You also could add another step towards healthy eating on top of those steps that you’ve 
already taken. You can go back to page 6 in your Activity Book to see your healthy eating 
goals that we discussed a few weeks back. 
 Now, let’s discuss how you did on your homework last week. Can you turn to page 16 in 
your Activity Book? Let client get to the page.  
 Were you able to complete the homework? 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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69
Notes: 
Continue with Days 2 through 7 before stopping to discuss. 
 For each day, check “Yes” or “No.” 
 For each day, ask client if they took their diabetes medicine, 
even if their blood sugar was normal. Praise them for every  
“yes” 
 If they didn’t take their diabetes medicine every day, 
discuss what happened. Avoid being judgmental. 
 Reassure client that taking medicine every day 
the way the doctor prescribed is hard for a lot of people. 
Tell them that you will work together to develop a plan 
 for this week to help them take the medicine every day. 
 Write down what happened in the box below. 
 
 
 
 
 
 
Notes: 
Homework #1: Medications 
 OK, let’s start with your medicines, beginning with Day 1. 
 Did you take all of your diabetes medication on Day 1? 
 Now, I’d like to follow up on the plan that we made last week to help you get the most out of 
your diabetes medications by taking them every day.  
 Last week, the issue you wanted to work on was… [go to Client Plan Book and read out 
loud the diabetes medication issue that they chose to work on last week]. 
 To overcome this issue, you decided to… [read out loud the medication-taking plan from 
last week]. 
 You thought that it might be hard for you to carry out this plan, because… [read 
potential barriers]. 
 To go around the problem, you decided to… [read how client decided to go around 
potential barriers]. 
 Now, how did it go? Listen supportively and take notes in the box below. Assess how well 
this worked. If it did not work well, talk about why not. If it did go well, praise them. 
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 If their plan worked and last week’s issue is resolved, encourage them to tackle a new issue this 
week. If you try hard and they don’t want to tackle another issue and they took their medicine each 
day, try this:  
 Go back to the Client Plan Book. 
 If there are remaining issues related to side effects or cost, then help the client make a plan to 
address them this week. 
 If there are no remaining issues related to side effects or cost, look at the list of statements that 
are marked “Very Often” (or “Often” if there are no “Very Often” statements to address, and 
“Sometimes” if there are no “Often” statements to address). 
 Help them decide which new goal they would like to add for the coming week. 
 Summarize to confirm their new goal. For example, you could say: 
“OK, let me see if I got this straight. Last week, you … [repeat last week’s goal]. You did well 
with that, so this week, you’ll … [repeat this week’s goal]. Did I get that right?” 
 
 If they were not able to meet their medication goal, then let them stick to the same goal. 
 Be supportive, and let them know you’ll revisit the goal next week to see how it went this time. 
 Strategize what they will do differently this week to succeed. Make it a SMART goal. 
 
 
Record this week’s strategy in the Client Plan Book. 
 If the strategy addresses side effects and/or cost, record this week’s strategy on the page, “Plan 
for Diabetes Medication Side Effects and/or Cost,” in the Client Plan Book. 
 If the strategy addresses other barriers besides side effects or cost, then record this week’s 
strategy on the page, “Plan for Other Diabetes Medication Barriers,” in the Client Plan Book. 
 
 OK, so what would you like to do over the next week to help you get the most out of your 
medications?  
 
 OK, let’s think about how hard this may be to do. What are some things that might make it 
hard for you to carry out this plan? Write down barriers. 
 OK, what do you think you can do to overcome these things? Help clients think of possible 
solutions to these barriers, and write down those solutions. 
 OK, let’s review that. It looks like you’ll… repeat the medications goal. Then, review 
potential barriers and how client will go around those barriers. Let client confirm. 
 I look forward to hearing how this plan worked when we talk next time! 
 
 
 
 
 
 
 
 
 
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 If they met their healthy eating goal, 
 Explore if they are ready to add another goal this week. Ask them to turn to page 6 in their 
Activity Book and look at the chart. Help them decide which new goal they would like to add for 
the coming week. 
 Go to the Client Plan Book and write down details in the space provided. Be sure to include all 
the information necessary for the goal. 
 Summarize to confirm their new goal. For example, you could say: 
“OK, let me see if I got this straight. Last week, you … [repeat last week’s goal]. You did well 
with that, so now you’d like to add another healthy eating goal. So, this week, you’ll … 
[repeat this week’s goal]. Did I get that right?” 
 If they were not able to meet their healthy eating goal, 
 Let client stick to the same eating goal, but be sure to modify the plan if needed. 
 Go to the Client Plan Book and write down details in the space provided. Be sure to include all 
the information necessary for the goal. 
 Be supportive, but do remind your client that you’ll revisit the goal next week to see how it went 
this time. 
Homework #2: Healthy Eating 
 OK, now, let’s go over what happened with your healthy 
eating.  
 So, were you able to eat healthy on Day 1? For each day, 
check “yes” or “no” in the Healthy Eating column. 
 Great! Now, I’d like to talk about the plan that we made 
last week to help you eat healthy every day. Last week, you 
planned to… [go to Client Plan Book and read out loud the 
healthy eating goal the client chose to work on last week]. 
 You thought that it might be hard for you to carry out this 
plan, because… [read potential barriers]. 
 To go around the problem, you decided to… [read how 
client decided to go around potential barriers].  
 Now, how did it go? If they were able to meet their goal, 
praise them profusely! However, if things did not go as planned, provide encouragement and 
tell them that you’ll come up with new strategies together, if new plans are needed. 
 OK, what would you like to do this week in terms of healthy eating? 
 
 
 OK, let’s think about how hard this may be to do. What are some things that might make it 
hard for you to carry out this plan? Write down potential barriers. 
 OK, what do you think you can do to overcome these things? Help clients think of possible 
solutions to these barriers, and write down those solutions. 
 Great, I look forward to hearing how this plan worked when we talk next time! 
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 If they met their goal and were doing less than 30 minutes per day, 5 days per week, then explore if 
they are ready to add another 5 minutes. 
 If they are not comfortable advancing the goal, let them stick to the same goal, but supportively 
warn that you’ll be discussing this again next week and remind them that the eventual goal is 30 
minutes per day. 
 Write the goal for this week in the space provided in the Client Plan Book. 
 If they were not able to meet their goal, 
 Let client stick to the same goal, but be sure to modify the plan if needed. 
 Summarize. For example, say: OK, let me see if I got this straight. Last week, you [repeat last week’s 
goal], and you did pretty well with that, so now you’d like to add another 5 minutes each day. That 
means that, this week, you’d like to [repeat this week’s goal]. Did I get that right? 
 
Homework #3: Physical Activity 
 OK, now, let’s go over how you did with exercise.  
 How much exercise were you able to get on Day 1? For 
each day, write number of minutes under the exercise 
column.  
 OK, now, let’s review the plan that we made last week to 
help you eat be more physically active. Last week, you 
planned to… [go to Client Plan Book and read out loud the 
exercise goal the client chose to work on last week]. 
 You thought that it might be hard for you to carry out this 
plan, because… [read potential barriers]. 
 To go around the problem, you decided to… [read how 
client decided to go around potential barriers].  
 Now, how did it go? If they were able to meet their goal, praise them profusely! However, if 
things did not go as planned, provide encouragement and tell them that you’ll come up with 
new strategies together, if new plans are needed. 
 Thanks for sharing that with me! We know that the recommendation is to get 30 minutes or 
more exercise at least 5 days each week, but we need to build up to that gradually. 
 OK, what would you like to do this week in terms of healthy eating? 
 
 OK, let’s think about how hard this may be to do. What are some things that might make it 
hard for you to carry out this plan? Write down potential barriers. 
 OK, what do you think you can do to overcome these things? Help clients think of possible 
solutions to these barriers, and write down those solutions. 
 Great, I look forward to hearing how this plan worked when we talk next time! 
 
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If your client had high blood pressure and you set a goal last week: 
 Go to Homework #4: High Blood Pressure Plan on page 74 in your manual 
and follow the script for your client’s situation. 
 Once you’re finished, go to This Week’s Homework on page 78. 
 
If your client had high cholesterol and you set a goal last week: 
 Go to Homework #5: High Cholesterol Plan on page 76 in your manual and 
follow the script for your client’s situation. 
 Once you’re finished, go to This Week’s Homework on page 78. 
 
If your client had high blood pressure and high cholesterol and you set goals 
last week: 
 Go to Homework #4: High Blood Pressure Plan on page 74 in your manual 
and follow the script for your client’s situation. 
 Then, go to Homework #5: High Cholesterol Plan on page 76 in your 
manual and follow the script for your client’s situation. 
 Once you’re finished, go to This Week’s Homework on page 78. 
 
 
If your client’s blood pressure and cholesterol were under control and you 
didn’t set goals last week, then go to This Week’s Homework on page 78 in 
your manual. 
 
 
 
 
 
 
 
 
 
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 If they were not on blood pressure medication and were not able to talk with doctor 
about starting medication: 
 Be encouraging and help them set a new plan for reaching out to the doctor. Write the new plan 
in the Client Plan Book and let client know you’ll check back with them. 
 If they were not on blood pressure medication and were able to talk with doctor 
about starting medication: 
 Ask how it went and what the client and the doctor decided to do. 
 If client has decided to take blood pressure medication, be supportive and ask them if they have 
any questions about their new medication. Tell client you’ll check back to see how they’re doing. 
 If client has decided not to take blood pressure medication, be supportive, but encourage them to 
talk again with their doctor if their blood pressure is still high at their next appointment. Remind 
them that medications for high blood pressure can help them live longer and stay independent by 
helping to lower risk for serious health problems like stroke, heart attack, dialysis, or blindness. 
 
 
 
 
 
 
 
 
 
 If there were issues with side effects or cost, but not able to talk with the doctor: 
 Be encouraging and help them set a new plan for reaching out to the doctor. Write the new plan 
in the Client Plan Book and let client know you’ll check back with them. 
 If there were issues with side effects or cost and were able to talk with the doctor: 
 Praise them! Ask how it went and what the client and the doctor decided to do. Tell client you’ll 
check back to see how they’re doing with this the next time you talk. 
 
Notes: 
Notes: 
Homework #4: High Blood Pressure Plan (only if client is on medicine for high blood 
pressure or should talk to doctor about starting treatment) 
 OK, let’s discuss the plan we made last week for your high blood pressure. 
 Last week, you wanted to… [go to Client Plan Book and read out loud the blood pressure 
plan that they chose to work on last week]. 
 Now, how did it go?  
 
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 If there were issues other than side effects or cost, and their plan to overcome the 
problem did not work: 
 Be encouraging and help them set a new plan for overcoming the problem. Write the new plan in 
the Client Plan Book and let client know you’ll check back with them. 
 If there were issues other than side effects or cost, and their plan to overcome the 
problem worked: 
 Praise them! Ask them if they got their blood pressure rechecked. If not, encourage them to do so. 
 Make sure they aren’t having any other problems with taking their blood pressure medication, 
and tell client you’ll check back with them to see how they’re doing. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 If they were not able to talk with the doctor about having high blood pressure even 
though they were taking their medication correctly: 
 Be encouraging and help them set a new plan for reaching out to the doctor. Write the new plan 
in the Client Plan Book and let client know you’ll check back with them. 
 If they were able to talk with the doctor about having high blood pressure even 
though they were taking their medication correctly: 
 Praise them! Ask how it went and what the client and the doctor decided to do. Tell client you’ll 
check back to see how they’re doing with this the next time you talk. 
Notes: 
Notes: 
Homework #4: High Blood Pressure Plan (Continued – page 2) 
 
 
 
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76
 If they were not on cholesterol medication and were not able to talk with doctor 
about starting medication: 
 Be encouraging and help them set a new plan for reaching out to the doctor. Write the new plan 
in the Client Plan Book and let client know you’ll check back with them. 
 If they were not on cholesterol medication and were able to talk with doctor about 
starting medication: 
 Ask how it went and what the client and the doctor decided to do. 
 If client has decided to take cholesterol medication, be supportive and ask them if they have any 
questions about their new medication. Tell client you’ll check back to see how they’re doing. 
 If client has decided not to take cholesterol medication, be supportive, but encourage them to talk 
again with their doctor if their LDL cholesterol is still high at their next appointment. Remind 
them that medications for high cholesterol can help them live longer and stay independent by 
helping to lower risk for serious health problems like stroke and heart attack. 
 
 
 
 
 
 
 
 
 
 
 If there were issues with side effects or cost, but not able to talk with the doctor: 
 Be encouraging and help them set a new plan for reaching out to the doctor. Write the new plan 
in the Client Plan Book and let client know you’ll check back with them. 
 If there were issues with side effects or cost and were able to talk with the doctor: 
 Praise them! Ask how it went and what the client and the doctor decided to do. Tell client you’ll 
check back to see how they’re doing with this the next time you talk. 
Notes: 
Notes: 
Homework #5: High Cholesterol Plan (only if client is on cholesterol medicine or should talk 
to doctor about starting treatment) 
 OK, let’s discuss the plan we made last week for your high cholesterol. 
 Last week, you wanted to… [go to Client Plan Book and read out loud the cholesterol plan 
that they chose to work on last week]. 
 Now, how did it go?  
 
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 If there were issues other than side effects or cost, and their plan to overcome the 
problem did not work: 
 Be encouraging and help them set a new plan for overcoming the problem. Write the new plan in 
the Client Plan Book and let client know you’ll check back with them. 
 If there were issues other than side effects or cost, and their plan to overcome the 
problem worked: 
 Praise them! Ask them to get their LDL cholesterol rechecked after a month, if possible. They can 
wait until their next regularly scheduled appointment. 
 Make sure they aren’t having any other problems with taking their cholesterol medication, and 
tell client you’ll check back with them to see how they’re doing. 
 
 
 
 
 
 
 
 
 
 
 
 
 If they were not able to talk with the doctor about having high cholesterol even 
though they were taking their medication correctly: 
 Be encouraging and help them set a new plan for reaching out to the doctor. Write the new plan 
in the Client Plan Book and let client know you’ll check back with them. 
 If they were able to talk with the doctor about having high cholesterol even though 
they were taking their medication correctly: 
 Praise them! Ask how it went and what the client and the doctor decided to do. Tell client you’ll 
check back to see how they’re doing with this the next time you talk. 
Notes: 
Notes: 
Homework #4: High Cholesterol Plan (Continued – page 2) 
 
 
 
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78
This Week’s Homework ----------------------------------------------------------------------------------- 
 Now, let’s go over your homework for the next two weeks. Please turn to page 19 in your 
Activity Book. 
 For the next two weeks, you’ll continue our homework for each leg of the 3-legged stool. 
 You’re going to continue keeping track of how you’re doing with your diabetes medication. 
So, every day, under the column with the picture of a pill bottle, you’re going to mark “Yes” 
if you took all of your diabetes medication that day. If you weren’t able to take all of your 
diabetes medication, then you’re going to mark “No” for that day. 
 Remember to be honest. I can’t help you if I don’t know where you need help. 
 You’ll carry out the plan we discussed that will help you get the most out of your medicines. 
 You’re also going to mark down whether you kept to your heathy eating goal on the days 
that we discussed. Your plan is to… repeat the healthy eating goal from today written in the 
Client Plan Book. 
 So, under the column with a picture of apples, you’re going to mark “Yes” if you were able 
to follow your healthy eating goal on the days we discussed. 
 The goal is to eat healthy every day, so if you are able to follow your healthy eating goal on 
the other days, mark “Yes” on those days, too. 
 Remember, if you do well with your goal this week, you could add another step towards 
healthy eating. You can go back to page 6 in your Activity Book to see your healthy eating 
goals and see if you would like to work on another goal for the second week. 
 You’re going to monitor the number of minutes of exercise every day. You decided that you 
would try …Repeat the exercise goal from today written in the Client Plan Book. 
 So, under the column with a picture of a person walking, you’re going to write down the 
number of minutes of exercise you were able to do on the days we discussed. 
 If you are doing well with your goal and were able to exercise on the other days, mark “Yes” 
on those days, too. 
 Remember, if you do well with your goal this week, you could also add another step towards 
being physically active. For example, you could add another 5 minutes to your exercise plan 
during the second week. 
 Do you have any questions about what to do? Make sure client knows what to do. 
 Now, remember, we’re not going to have a full session for two weeks, but I am going to give 
you a quick call next week, just to check in and see how you’re doing. 
 
 
 
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 Try to make the dates as close to 7 
and 14 days from now as possible. 
 Allow at least 7 days between 
sessions, but no more than 10 days. 
 OK, when would you like to talk next week? How about in 2 weeks? 
 
 
 
 OK, please write down the dates and times in your Activity Book at the bottom of page 19. 
 I look forward to speaking next week briefly, and then longer in 2 weeks. I look forward to 
hearing how things went! 
 
 
 
 
 
 
 
 
Session 6 
completed ______/______/______ 
      month              day               year 
_______/______ 
    start time         end time 
______ 
peer initials 
 
 
 
 
 
 
 
 
 
 
 
Next appointment date and time in 1 week: 
 
 
Next appointment date and time in 2 weeks: 
 
 
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80
Reminder!! 
 Cover and check off all of the session 
content. 
 Any text in GRAY BOXES is instructions for 
you: don’t read that text aloud to the client. 
Session Goals: 
 Brief encouragement to client 
 Brief troubleshooting if client is having difficulty with any of the homework   
 Brief reminder to client about upcoming Session 7 in one week 
Week 7, Check-In Session 1 (One Week After Session 6) 
 
 
Before Calling the Client ----------------------------------------------------------------------------------- 
  
 Review last session’s assignment and the 
barriers and strategies to overcome them. 
 Once you’ve reviewed this, place the call. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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Say hello and make sure the client 
is still okay with speaking for about 
ten minutes today. 
 If client has been doing well: 
o Provide lots of praise, and encourage them to keep it up during the upcoming week. 
 If client has been struggling: 
o Quickly review their goal from last session 
o Encourage client to think about what they can do to troubleshoot. Try to encourage client to 
come up with a solution themselves (we are working to build their confidence to overcome 
difficulties and set goals for themselves). 
 
 
 
 
 
 
 
Notes: 
Check In ---------------------------------------------------------------------------------------------------- 
 
 So, it’s been about a week since we talked. 
 I know that we’re not supposed to have a full session 
until next week, but I just wanted to give you a quick 
call to see how you were doing.  
 How are you? Has everything been going okay with you since we talked? Listen 
supportively. 
 And how has it been going with your homework? 
 
Remind Client of Next Session -------------------------------------------------------------------------- 
 Now, we’ll have a full session [repeat the date and time for Session 7 from page 79 in your 
manual]. 
 Between now and when we talk again, you are going to continue doing your homework, just 
like you did in the past week. 
 You’ll keep track of your progress on page 19 of your Activity Book, just like you’ve been 
doing. Do you have any questions? Make sure client understands what to do. 
 All right, then! I look forward to hearing how things went when we talk next week! 
 
 
 
 
 
 
 
 Check In 
completed ______/______/______ 
      month              day               year 
_______/______ 
    start time         end time 
______ 
peer initials 
 
 
 
 
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Reminder!! 
 Cover and check off all of the session 
content. 
 Any text in GRAY BOXES is instructions for 
you: don’t read that text aloud to the client. 
Session Goals: 
 Brief review of previous session 
 Review homework 
 Discuss what client has learned and how activities have helped 
 Help client identify a Health Buddy 
Week 8, Session 7: “Practice and Planning for the Future – Part 1” 
 
 
Before Calling the Client ----------------------------------------------------------------------------------- 
  
 Review last session’s assignment and the 
barriers and strategies to overcome them. 
 Once you’ve reviewed this, place the call. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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Say hello and make sure the client 
is still okay with speaking for about 
a half hour to forty minutes today. 
Greeting ----------------------------------------------------------------------------------------------------- 
 
 Great, do you have your Activity Book handy? 
If not, let them get the Activity Book before going on. 
 Please turn to page 20. Today, we’ll review what we 
learned during our last session, and then we’ll talk about how your homework went. 
 After today’s session, our next full session will be in four weeks. 
 So, today, we’ll talk about what you’ll be doing for homework for the next four weeks. 
 Now, I will give you a quick call in two weeks, just to check in and see how you’re doing, 
but it won’t be a full session. Like I said, we’ll talk more in four weeks. 
 Do you have any questions? Let client ask questions.  Great, let’s get started! 
 
 
Review Last Session --------------------------------------------------------------------------------------- 
 First, let’s review what we learned last time. Please stay on page 20. 
 We talked about the importance of managing stress. Can you remember some of the things 
that people feel if they are stressed over long periods of time? Let client answer. If needed, 
remind client that people with chronic stress can have upset stomach, irritability, bad mood, 
or fatigue. Chronic stress can worsen arthritis symptoms, cause weight gain or loss, or 
cause people to have trouble sleeping or concentrating. 
 And having chronic stress can even increase your chances of getting some health conditions. 
Can you remember what they were? Let client answer. If needed, remind client that chronic 
stress can increase your chances of developing high blood pressure and heart disease. 
 Because it’s so important for us to manage our stress in a healthy way, the video gave us 
several tips for doing this. Can you remember what some of those tips were? Let client 
answer. If needed, remind client of these tips: 1) recognize when we’re stressed and how we 
feel, physically and emotionally, when we’re stressed; 2) identify the sources of stress in our 
lives so that we can prepare ourselves ahead of time; and 3) know what healthy things we 
can do to help us relax and reduce our stress.  
 We talked about some healthy things that people can do to relax, such as being physically 
active, practicing deep breathing, and calling a friend. We also practiced deep breathing 
together over the telephone. 
 Were you able to try any of these things the last two weeks to help manage your stress? Let 
client answer. If yes, praise client and ask them how it went. If no, share with client how 
these things have helped you, and encourage client to give them a try before the next call. 
 We also checked on how you were doing with your diabetes medicines and with healthy 
eating and exercise. In the past few weeks, you have been working on all 3 legs of the stool. 
 Does that sound right? Let client answer. Did you have any questions? Let client answer. 
 
 
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Note: if the client has not done some of the homework 2 sessions in a row, talk about what is making it 
hard to monitor. Let them know that since this is a research project, the investigators may want to help 
the person to succeed. Let them know that someone from the research team will be in touch. 
 Call the research team within 24 hours and let them know what is happening. 
 UAB staff will brief you on the conversation and the plan so that you can reinforce it next week. 
Review Homework For Last Two Weeks --------------------------------------------------------------- 
 OK, now let’s go over your homework from the past two weeks and talk about your 
homework for the next four weeks. 
 Like I mentioned earlier, we won’t be having a full session for four weeks, but you’ll 
continue working on your homework, just like you’ve been doing. 
 These four weeks will be a great way to see how you are able to do your homework on your 
own and make a plan for how you can carry on after the program is finished. 
 In a few minutes, we’ll talk about some things that will help you continue doing the great 
work you’ve been doing to take care of yourself. 
 But first, let’s discuss how you did on your homework during the past two weeks. Can you 
turn to page 19 in your Activity Book? Let client get to the page.  
 Were you able to complete the homework? 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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85
Continue with Days 2 through 7 before stopping to discuss. 
 For each day, check “Yes” or “No.” 
 For each day, ask client if they took their diabetes medicine, 
even if their blood sugar was normal. Praise them for every  
“yes” 
 If they didn’t take their diabetes medicine every day, 
discuss what happened. Avoid being judgmental. 
 Reassure client that taking medicine every day 
the way the doctor prescribed is hard for a lot of people. 
Tell them that you will work together to develop a plan 
 for this week to help them take the medicine every day. 
 Write down what happened in the box below. 
 
 
 
 
 
 
Notes: 
Continue with Days 2 through 7 before stopping to discuss. 
 For each day, check “Yes” or “No.” 
 For each day, ask client if they took their diabetes medicine, 
even if their blood sugar was normal. Praise them for every  
“yes” 
 If they didn’t take their diabetes medicine every day, 
discuss what happened. Avoid being judgmental. 
 Reassure client that taking medicine every day 
the way the doctor prescribed is hard for a lot of people. 
Tell them that you will work together to develop a plan 
 for this week to help them take the medicine every day. 
 Write down what happened in the box below. 
 
 
 
 
 
 
Notes: 
Homework #1: Medications 
 OK, let’s start with your medicines and how you did with them that first week. 
 Let’s start with Day 1. Did you take all of your diabetes medication on Day 1? 
 Now, let’s talk about how you did with your medicines during the second week. On Day 1 of 
the second week, did you take all of your diabetes medication? 
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Notes: 
If your client 1) took their diabetes medication every day as directed in the past two weeks 
and 2) has successfully overcome all of the diabetes medication barriers identified at the 
beginning of the program: 
 Praise profusely! Tell them to keep up the great work by continuing to take their 
medications every day as directed. 
 Then, go to page 88 and continue with Homework #2, Healthy Eating. 
 
If your client was not able to take their diabetes medication every day as directed in the past 
two weeks: 
 Stay on page 86 in your manual and continue with setting a diabetes medication goal. 
 Then, go on with the rest of the session. 
 
If your client took their diabetes medication every day as directed in the past two weeks, but 
still has diabetes medication barriers that haven’t been addressed: 
 Check page 8 in the Client Plan Book and see what issues are remaining. Then, remind 
client about these remaining issues and ask which one they would like to work on next. 
 Go to page 87 in your manual and continue with setting a diabetes medication goal. 
 Then, go on with the rest of the session. 
 Now, I’d like to follow up on the plan that we made at our last session to help you get the 
most out of your diabetes medications by taking them every day.  
 Last time we talked, the issue you wanted to work on was… [go to Client Plan Book and 
read out loud the diabetes medication issue that they chose to work on last time]. 
 To overcome this issue, you decided to… [read out loud the medication-taking plan from 
last time]. 
 You thought that it might be hard for you to carry out this plan, because… [read 
potential barriers]. 
 To go around the problem, you decided to… [read how client decided to go around 
potential barriers]. 
 Now, how did it go? Listen supportively and take notes in the box below. Assess how well 
this worked. If it did not work well, talk about why not. If it did go well, praise them. 
 
 
 
 
 
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87
 If their plan worked and last session’s issue is resolved, encourage them to tackle a new issue this 
week. If you try hard and they don’t want to tackle another issue and they took their medicine each 
day, try this:  
 Go back to the Client Plan Book. 
 If there are remaining issues related to side effects or cost, then help the client make a plan to 
address them this week. 
 If there are no remaining issues related to side effects or cost, look at the list of statements that 
are marked “Very Often” (or “Often” if there are no “Very Often” statements to address, and 
“Sometimes” if there are no “Often” statements to address). 
 Help them decide which new goal they would like to add for the coming week. 
 Summarize to confirm their new goal. For example, you could say: 
“OK, let me see if I got this straight. Last week, you … [repeat last week’s goal]. You did well 
with that, so this week, you’ll … [repeat this week’s goal]. Did I get that right?” 
 
 If they were not able to meet their medication goal, then let them stick to the same goal. 
 Be supportive, and let them know you’ll revisit the goal next week to see how it went this time. 
 Strategize what they will do differently this week to succeed. Make sure it is a SMART goal. 
 
 
Record this week’s strategy in the Client Plan Book. 
 If the strategy addresses side effects/and or cost, record this week’s strategy on the page, “Plan 
for Diabetes Medication Side Effects and/or Cost,” in the Client Plan Book. 
 If the strategy addresses other barriers besides side effects or cost, then record this week’s 
strategy on the page, “Client Plan for Other Diabetes Medication Barriers,” in the Plan Book. 
 
 OK, so what would you like to do over the next four weeks to help you get the most out of 
your medications?  
 
 OK, let’s think about how hard this may be to do. What are some things that might make it 
hard for you to carry out this plan? Write down barriers. 
 OK, what do you think you can do to overcome these things? Help clients think of possible 
solutions to these barriers, and write down those solutions. 
 OK, let’s review that. It looks like you’ll… repeat the new medication goal. Then, review 
potential barriers and how client will go around those barriers. Let client confirm. 
 This is a great plan! I look forward to hearing how this plan worked when we talk next time! 
 
 
 
 
 
 
 
 
 
 
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 Discuss how this went and provide encouragement and praise. If client was not able to take another 
step, discuss together what happened. Check the correct box below: 
 Did not evaluate goal after 1st week 
 Evaluated goal after 1st week, did not increase goal for 2nd week 
 Evaluated goal after 1st week, increased goal for 2nd week 
 
 
 
Notes and new healthy eating goal for 2nd week, if client increased goal: 
Homework #2: Healthy Eating 
 OK, let’s talk about how your healthy eating went during the first 
week. How did it go on Day 1? For each day, check “yes” or 
“no” for the Healthy Eating column. 
 
 
 
 
 
 
 Great! Now, during the second week, were you able to take 
another step to eat healthier? 
 OK, let’s take a look at how you did with healthy eating during the second week. How did it 
go on Day 1 of the second week? For each day, check “yes” or “no” for the Healthy Eating 
column.  
 Great! Now, the last time we made a plan to help you eat healthy 
every day, you planned to… [go to Client Plan Book and 
read out loud the healthy eating goal the client chose to work 
on last time]. 
 You thought that it might be hard for you to carry out this 
plan, because… [read potential barriers]. 
 To go around the problem, you decided to… [read how client 
decided to go around potential barriers].  
 Now, during the first week, you were able to… [based on 
what client told you about Week 1, describe what happened]. 
 During the second week, you were able to… [based on what 
client told you about Week 2, describe what happened]. 
Week 1
Week 2
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 If they met their healthy eating goal, 
 Explore if they are ready to add another goal this week. Ask them to turn to page 6 in their 
Activity Book and look at the chart. Help them decide which new goal they would like to add for 
the coming week. 
 Go to the Client Plan Book and write down details in the space provided. Be sure to include all 
the information necessary for the goal. 
 Summarize to confirm their new goal. For example, you could say: 
“OK, let me see if I got this straight. Last week, you … [repeat last week’s goal]. You did well 
with that, so now you’d like to add another healthy eating goal. So, this week, you’ll … 
[repeat this week’s goal]. Did I get that right?” 
 If they were not able to meet their healthy eating goal, 
 Let client stick to the same eating goal, but be sure to modify the plan if needed. 
 Go to the Client Plan Book and write down details in the space provided. Be sure to include all 
the information necessary for the goal. 
 Be supportive, but do remind your client that you’ll revisit the goal next week to see how it went 
this time. 
 OK, what would you like to do this week in terms of healthy eating? 
 
 OK, let’s think about how hard this may be to do. What are some things that might make it 
hard for you to carry out this plan? Write down potential barriers. 
 OK, what do you think you can do to overcome these things? Help clients think of possible 
solutions to these barriers, and write down those solutions. 
 Great, I look forward to hearing how this plan worked when we talk next time! 
 
 
Homework #3: Physical Activity 
 OK, now, let’s talk about how your exercise went during the 
first week. How did it go on Day 1? For each day, write 
number of minutes under the exercise column. 
 
 
 
 
 
 
 
 
Week 1
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90
 Discuss how this went and provide encouragement and praise. If client was not able to take another 
step, discuss together what happened. Check the correct box below: 
o Did not evaluate goal after 1st week 
o Evaluated goal after 1st week, did not increase goal for 2nd week 
o Evaluated goal after 1st week, increased goal for 2nd week 
 
 
 
Notes and new exercise goal for 2nd week, if client increased goal: 
 Great! Now, during the second week, were you able to take another step to become more 
physically active? 
 OK, let’s take a look at how you did with exercise during the second week. How did it go on 
Day 1 of the second week? For each day, write number of minutes under the Exercise 
column. 
 
 
 
 
 
 
 
 
 
 
 
 Great! Now, the last time we made a plan to help you exercise every day, you planned to… 
[go to Client Plan Book and read out loud the exercise goal the client chose to work on last 
time]. 
 You thought that it might be hard for you to carry out this plan, because… [read potential 
barriers]. 
 To go around the problem, you decided to… [read how client decided to go around potential 
barriers].  
 Now, during the first week, you were able to… [based on what client told you about Week 1, 
describe what happened]. 
 During the second week, you were able to… [based on what client told you about Week 2, 
describe what happened]. 
Week 2
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91
If your client had high blood pressure and you set a goal during Session 6: 
 Go to Homework #4: High Blood Pressure Plan on page 92 in your manual. 
 Once you’re finished, continue with the session on page 93. 
 
If your client had high cholesterol and you set a goal last week: 
 Go to Homework #5: High Cholesterol Plan on page 92 in your manual. 
 Once you’re finished, continue with the session on page 93. 
 
If your client had high blood pressure and high cholesterol and you set goals last week: 
 Go to Homework #4: High Blood Pressure Plan on page 92 in your manual. 
 Then, continue on to Homework #5: High Cholesterol Plan on the same page. 
 Once you’re finished, continue with the session on page 93. 
 
If your client’s blood pressure and cholesterol were under control and you didn’t set goals 
last week, then go to Activity 1 on page 93 in your manual. 
 If they met their goal and were doing less than 30 minutes per day, 5 days per week, then explore if 
they are ready to add another 5 minutes. 
 If they are not comfortable advancing the goal, let them stick to the same goal, but supportively 
warn that you’ll be discussing this again next week and remind them that the eventual goal is 30 
minutes per day. 
 Write the goal for this week in the space provided in the Client Plan Book. 
 If they were not able to meet their goal, 
 Let client stick to the same goal, but be sure to modify the plan if needed. 
 Summarize. For example, say: OK, let me see if I got this straight. Last week, you [repeat last week’s 
goal], and you did pretty well with that, so now you’d like to add another 5 minutes each day. That 
means that, this week, you’d like to [repeat this week’s goal]. Did I get that right? 
 OK, what would you like to do this week in terms of exercise? 
 
 OK, let’s think about how hard this may be to do. What are some things that might make it 
hard for you to carry out this plan? Write down potential barriers. 
 OK, what do you think you can do to overcome these things? Help clients think of possible 
solutions to these barriers, and write down those solutions. 
 Great, I look forward to hearing how this plan worked when we talk next time! 
 
 
 
 
 
 
 
 
 
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 Listen supportively and praise client’s effort in the past week. 
 Encourage client to continue working with their doctor to control their blood pressure. 
 If they are taking medication for their blood pressure, tell them that the strategies they have used to 
take their diabetes medication can also help them take their blood pressure medication. 
 If needed, remind client that controlling blood pressure is important for reducing their chances of 
developing serious illnesses such as heart attack, stroke, dialysis, and blindness. Medications can 
help them live longer and stay independent by lowering their risk for such health problems. 
Notes: 
 Listen supportively and praise client’s effort in the past week. 
 Encourage client to continue working with their doctor to control their cholesterol. 
 If they are taking medication for their cholesterol, tell them that the strategies they have used to take 
their diabetes medication can also help them take their cholesterol medication. 
 If needed, remind client that controlling cholesterol is important for reducing their chances of 
developing serious illnesses such as heart attack and stroke. Medications can help them live longer 
and stay independent by lowering their risk for such health problems. 
Notes: 
Homework #4: High Blood Pressure Plan (only if client is on medicine for high blood 
pressure or should have talked to doctor about starting treatment) 
 OK, let’s discuss the plan we made last time for your high blood pressure. 
 Last time, you wanted to… [go to Client Plan Book and read out loud the blood pressure 
plan that they chose to work on last session]. 
 Now, how did it go? 
 
Homework #5: High Cholesterol Plan (only if client is on medicine for high cholesterol or 
should have talked to doctor about starting treatment) 
 OK, let’s discuss the plan we made last time for your high cholesterol. 
 Last time, you wanted to… [go to Client Plan Book and read out loud the cholesterol plan 
that they chose to work on last session]. 
 Now, how did it go? 
 
 
 
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If needed, you can talk with client about the three rules of eating healthy: 
1. One and Done – this rule reminds us to avoid second helpings 
2. Respect the Border – this rule reminds us to not overload our plate, and divide up the plate so 
that half of the plate is fruit and vegetables, a quarter of the plate is protein, and a quarter of the 
plate is starchy foods 
3. Be Sweet On Yourself – this rule reminds us to eat less fried foods and fats, and drink fewer 
sugar-sweetened drinks 
If needed, you can talk about the client about the three rules of physical activity: 
1. Be Smart, Exercise Your Heart – this rule reminds us that exercise has many benefits 
2. Walk Down Your Blood Sugar – this rule reminds us that walking and other kinds of physical 
activity can help lower our blood sugar 
3. Sitting is the New Smoking – this rule reminds us that it is unhealthy to sit too long, and we 
should try to be active throughout the day, even if it’s just 2 minutes of light activity every hour 
If needed, you can talk about some of the basics of diabetes medications: 
 Medications are important for diabetes, but they aren’t perfect – diabetes progresses, even on 
medications. So, even if you’re doing everything right, you may eventually need a second or third 
medication. 
 However, diabetes progresses much more quickly without medications. Medications, together 
with diet and exercise, can prevent or delay complications like stroke, dialysis, heart attack, and 
amputations. 
 Side effects can be a problem, but you should discuss with your doctor before stopping. 
Remember that there are many types of diabetes medications available, so you should be able to 
get on a medication that controls your sugar and lets you feel well. 
 Another problem with medications can be how much they cost. However, there are generic 
medications for diabetes that work as well as brand-name drugs and cost much less. 
Activity 1. What Have I Learned, and How Are the Activities Helping?  ------------------------ 
 You have been doing great to take care of yourself for the past month and a half! Now that 
you’ve been tending to all three legs of the three-legged stool, how do you feel? Listen 
supportively, and provide praise and encouragement. 
 Can you tell me some things that you have learned about how to eat healthy? 
 
 How about exercise? What have you learned about living a physically active life? 
 
 And what have you learned about your diabetes medications and what they can do for you? 
 
 
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If needed, you can remind them these things about medications for blood pressure and cholesterol: 
 Like with diabetes, there are many different medications available to treat high blood pressure. 
 So, if you have high blood pressure, you should be able to get on a medication that controls your 
blood pressure and lets you feel well. 
 For high cholesterol, there is one main type of medicine, called statins. Most people taking a 
statin to treat their high cholesterol feel well and have no side effects. 
 However, if you ever feel side effects with either blood pressure or cholesterol medicine, don’t 
just stop: always reach out to your doctor first. 
 Finally, if you are worried about the cost of these medications, there are generic medications for 
blood pressure and cholesterol that work as well as brand-name drugs and cost much less. 
 And can you recall what medications can do for you if you have high blood pressure or high 
cholesterol? 
 
 Great! It’s good to keep in mind that paying attention to all three legs of the stool – eating 
healthy, being physically active, and taking your medications – can make a big difference in 
how you are able to live now as well as your life many years down the road. 
 Now that you’ve been working on the three-legged stool for the past month and a half, let’s 
think about how it’s helping you. Please turn to page 21 in your Activity Book. 
 On that page, you can see some of the ways that people have been helped by eating healthy, 
exercising, and taking their medications. 
 How about you? Have you been helped in these ways? Let’s go down the list together and 
check the boxes that apply to you.  
 How about your blood sugar? Has your blood sugar gotten better? 
 How about your weight? 
 How about your energy? 
 How about your mood? 
 How about your ability to take care of your family? 
 How about your ability to do your job? 
 How about going out? 
 Now, the things that we’ve been talking about are some of the ways that eating healthy, 
exercising, and taking your medications are helping you live well now. Take a minute and 
think about how taking care of the three-legged stool can help you a bit further down the line 
 How about your chances of experiencing complications from your diabetes? Do you 
think taking care of the three-legged stool is helping you achieve that? 
 How about your chances of being there for important events down the road, like [repeat 
long-term goals from page 3 in the Client Plan Book]? Do you think taking care of the 
three-legged stool is helping you achieve that? 
 
 
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Notes: 
Activity 2: How Can I Keep Going in the Future? Health Buddy --------------------------------- 
 Thanks so much for sharing with me what you have learned about eating healthy, exercising, 
and taking your medications. You have done such a great job, and made a lot of progress. 
 Now, we have one more full session, in four weeks’ time. I’ll be calling you in two weeks, 
but it’ll be just a brief call to check in and see how you’re doing. 
 So, in the next month, you’ll practice setting goals and taking care of the three-legged stool, 
mostly on your own. 
 I mention this, because research has shown that, once a program like this comes to an end, 
people may stop doing the good things that helped them during the program. 
 This is understandable! It can be hard to keep going all on your own. 
 One thing that may help is to have a Health Buddy, or a person in your life that can support 
you as you continue practicing those things to live well with diabetes. 
 So, let’s turn to page 22 in your Activity Book and look at the image. 
 
 
 
 
 
 
 
 
 Now, think about the main person in your family that supports you. Can you tell me who this 
is? Let client answer. OK, let’s write their name in the blank box labeled, “family.” 
 Now, who is the main person in your community that supports you? Let client answer. OK, 
let’s write their name in the blank box labeled, “community.” 
 OK, can you tell me a little bit about them and how they support you? Let client answer. If 
needed, share your experience with the main people that support you and how they help you 
live a full, healthy life. 
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96
 Write down the name of potential health buddy in the box below. 
 
 
 
 
 
 If client has a hard time thinking of a support person in their family or their community, 
o Ask them to think of a person in the community that they reach out to when they need support 
for their diabetes. Explore if the client can find a Health Buddy with the help of this person. 
o If they can’t think of anyone from the community who could help, offer to help the client find a 
person in the Living Well with Diabetes Program that could be their Health Buddy. 
 If the client asks for this option, call the UAB team TODAY after your session to 
discuss how to find a Health Buddy for this client.  
Name of potential health buddy: 
 
When they will reach out to health buddy: 
 Now, who do you think could be your Health Buddy, or a person that can help you keep 
living well once the program ends? 
 Do you see the smaller box in the middle of the left-hand side? In that box, write down the 
name of your Health Buddy. 
 OK, when would you like to approach them and see if they would be willing to help you out 
like this? It may be a good idea to do this soon, perhaps this week or next week. 
 Now, do you see the larger box on the bottom left-hand corner of the page? Write down 
when you’re going to ask this person to be your Health Buddy. 
 
 Wonderful! I’ll ask you about how that went when we talk next time. 
 
 
Homework for Next Four Weeks ------------------------------------------------------------------------ 
 Now, let’s go over your homework for the next four weeks. Please turn to page 23 in your 
Activity Book. 
 For the next four weeks, you’ll continue your homework for each leg of the 3-legged stool. 
 You’ll carry out the plan we discussed that will help you get the most out of your medicines. 
 You’re also going to mark down whether you kept to your heathy eating goal on the days 
that we discussed. Your plan is to… repeat the healthy eating goal from today written in the 
Client Plan Book. 
 So, under the column with a picture of apples, you’re going to mark “Yes” if you were able 
to follow your healthy eating goal on the days we discussed. 
 The goal is to eat healthy every day, so if you are able to follow your healthy eating goal on 
the other days, mark “Yes” on those days, too. 
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97
 Try to make the dates as close to 14 
and 28 days from now as possible. 
 For the quick check-in call in 2 
weeks, schedule it at least 14 days 
from today, but no more than 17 
days. 
 For the full session in 4 weeks, 
schedule it at least 28 days from 
today, but no more than 31 days. 
 If you do well with your goal this week, you could add another step towards healthy eating 
the following week. You can go back to page 6 in your Activity Book to see your healthy 
eating goals and see if you would like to work on another goal for the following week. 
 You’re going to monitor the number of minutes of exercise every day. You decided that you 
would try… repeat the exercise goal from today written in the Client Plan Book. 
 So, under the column with a picture of a person walking, you’re going to write down the 
number of minutes of exercise you were able to do on the days we discussed. 
 If you are doing well with your goal and were able to exercise on the other days, write down 
the number of minutes of exercise you did on those days, too. 
 Also, if you do well with your goal this week, you could add another step towards being 
physically active, like adding 5 more minutes to your plan during the following week. 
 Do you have any questions about what to do? Make sure client knows what to do. 
 Now, remember, we’re not going to have a full session for four weeks, but I am going to 
give you a quick call in two weeks, just to check in and see how you’re doing. 
 OK, when would you like to talk in two weeks? How about in four weeks? 
 
 
 
 Great! Please go ahead and write down both dates and times in your Activity Book on page 
24. So, our appointment in two weeks is [read aloud the date and time in 2 weeks], and our 
appointment in four weeks is [read aloud the date and time in four weeks]. 
 All right, then. I will be speaking briefly with you in two weeks, and then longer in four 
weeks. I look forward to hearing how things went! 
 
 
 
 
 
 
 
 Session 7 
completed ______/______/______ 
      month              day               year 
_______/______ 
    start time         end time 
______ 
peer initials 
 
 
 
 
 
 
 
 
 
 
Next appointment date and time in 2 weeks: 
 
 
 
 
Next appointment date and time in 4 weeks: 
 
 
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98
Reminder!! 
 Cover and check off all of the session 
content. 
 Any text in GRAY BOXES in instructions for 
you: don’t read that text aloud to the client. 
Session Goals: 
 Brief encouragement to client 
 Brief troubleshooting if client is having difficulty with any of the homework   
 Brief reminder to client about upcoming Session 8 in two weeks 
Week 10, Check-In Session 2 (Two Weeks After Session 7) 
 
 
Before Calling the Client ----------------------------------------------------------------------------------- 
  
 Review last session’s assignment and the 
barriers and strategies to overcome them. 
 Once you’ve reviewed this, place the call. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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99
Say hello and make sure the client 
is still okay with speaking for about 
ten minutes today. 
 If client has been doing well: 
o Provide lots of praise, and encourage them to keep it up for the next two weeks. 
 If client has been struggling: 
o Quickly review their goal from last session 
o Encourage client to think about what they can do to troubleshoot. Try to encourage client to 
come up with a solution themselves (we are working to build their confidence to overcome 
difficulties and set goals for themselves). 
 
 
 
 
 
 
 
Notes: 
Check In ---------------------------------------------------------------------------------------------------- 
 
 So, it’s been about two weeks since we talked. 
 I know that we’re not supposed to have a full session for 
another two weeks, but I just wanted to give you a quick 
call to see how you were doing.  
 How are you? Has everything been going okay with you since we talked? Listen 
supportively. 
 And how has it been going with your homework? 
 
Remind Client of Next Session -------------------------------------------------------------------------- 
 Now, we’ll have a full session [repeat the date and time for Session 8 from page 97 in your 
manual]. 
 Between now and when we talk again, you are going to continue doing your homework, just 
like you did in the past two weeks. 
 You’ll keep track of your progress on page 24 of your Activity Book, just like you’ve been 
doing. Do you have any questions? Make sure client understands what to do. 
 All right, then! I look forward to hearing how things went when we talk in two weeks! 
 
 
 
 
 
 
 
 Check In 
completed ______/______/______ 
      month              day               year 
_______/______ 
    start time         end time 
______ 
peer initials 
 
 
 
 
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100
Reminder!! 
 Cover and check off all of the session 
content. 
 Any text in GRAY BOXES is instructions for 
you: don’t read that text aloud to the client. 
Session Goals: 
 Brief review of last week’s session 
 Review homework 
 Discuss how the Health Buddy can help the client keep going when the program ends 
 
Week 12, Session 8: “Practice and Planning for the Future – Part 2” 
 
 
Before Calling the Client ----------------------------------------------------------------------------------- 
  
 Review last session’s assignment and the 
barriers and strategies to overcome them. 
 Once you’ve reviewed this, place the call. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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101
Note: if the client has not done some of the homework 2 sessions in a row, talk about what is making it 
hard to monitor. Let them know that since this is a research project, the investigators may want to help 
the person to succeed. Let them know that someone from the research team will be in touch. 
 Call the research team within 24 hours and let them know what is happening. 
 UAB staff will brief you on the conversation and the plan so that you can reinforce it next week. 
Say hello and make sure the client 
is still okay with speaking for about 
a half hour to forty minutes today. 
Greeting ----------------------------------------------------------------------------------------------------- 
 
 Great, do you have your Activity Book handy? 
If not, let them get the Activity Book before going on. 
 Please turn to page 25. Today, we’ll talk about how your 
homework went, and then we’ll talk about some things that you can do to help you keep 
going when the program ends.  
 After today’s session, we’re going to have three more scheduled calls. 
 Those will be calls lasting about thirty minutes, where I will check in on you and see how 
you’re doing with the three-legged stool. Our next call will be in four weeks. 
 Do you have any questions about that? Let client ask questions.  Great, let’s get started! 
 
Review Last Session --------------------------------------------------------------------------------------- 
 First, let’s review what we talked about last time. Please stay on page 25 in your Activity 
Book. 
 We talked about what we have learned from this program to take care of the three-legged 
stool so that we can live well with diabetes. 
 We also talked about how healthy eating, exercising, and taking our medications are helping 
us live well now and live longer so that we can reach our long-term goals, like [repeat long-
term goals on page 3 in the Client Plan Book]. 
 Does that sound right? Let client answer. Did you have any questions? Let client answer. 
Review Homework For Last Four Weeks -------------------------------------------------------------- 
 OK, now, I’d like to go over your homework from the past four weeks and then talk about 
your homework for the next four weeks. 
 First, let’s discuss how you did on your homework during the past four weeks. Can you turn 
to page 23 in your Activity Book? Let client get to the page.  
 Were you able to complete the homework? 
 
 
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102
Continue with Days 2 through 7 before stopping to discuss. 
 For each day, check “Yes” or “No.” 
 For each day, ask client if they took their diabetes medicine, 
even if their blood sugar was normal. Praise them for every  
“yes” 
 If they didn’t take their diabetes medicine every day, 
discuss what happened. Avoid being judgmental. 
 Reassure client that taking medicine every day 
the way the doctor prescribed is hard for a lot of people. 
Tell them that you will work together to develop a plan 
 for this week to help them take the medicine every day. 
 Write down what happened in the box below. 
 
 
 
 
 
 
Notes: 
Continue with Days 2 through 7 before stopping to discuss. 
 For each day, check “Yes” or “No.” 
 For each day, ask client if they took their diabetes medicine, 
even if their blood sugar was normal. Praise them for every  
“yes” 
 If they didn’t take their diabetes medicine every day, 
discuss what happened. Avoid being judgmental. 
 Reassure client that taking medicine every day 
the way the doctor prescribed is hard for a lot of people. 
Tell them that you will work together to develop a plan 
 for this week to help them take the medicine every day. 
 Write down what happened in the box below. 
 
 
 
 
 
 
Notes: 
Homework #1: Medications 
 OK, let’s start with your medicines and how you did with them that first week. 
 Let’s start with Day 1. Did you take all of your diabetes medication on Day 1? 
 
 Now, let’s talk about how you did with your medicines during the second week. On Day 1 of 
the second week, did you take all of your diabetes medication? 
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103
Continue with Days 2 through 7 before stopping to discuss. 
 For each day, check “Yes” or “No.” 
 For each day, ask client if they took their diabetes medicine, 
even if their blood sugar was normal. Praise them for every  
“yes” 
 If they didn’t take their diabetes medicine every day, 
discuss what happened. Avoid being judgmental. 
 Reassure client that taking medicine every day 
the way the doctor prescribed is hard for a lot of people. 
Tell them that you will work together to develop a plan 
 for this week to help them take the medicine every day. 
 Write down what happened in the box below. 
 
 
 
 
 
 
Notes: 
Continue with Days 2 through 7 before stopping to discuss. 
 For each day, check “Yes” or “No.” 
 For each day, ask client if they took their diabetes medicine, 
even if their blood sugar was normal. Praise them for every  
“yes” 
 If they didn’t take their diabetes medicine every day, 
discuss what happened. Avoid being judgmental. 
 Reassure client that taking medicine every day 
the way the doctor prescribed is hard for a lot of people. 
Tell them that you will work together to develop a plan 
 for this week to help them take the medicine every day. 
 Write down what happened in the box below. 
 
 
 
 
 
 
Notes: 
 Great! Let’s continue with the third week. On Day 1 of the third week, did you take all of 
your diabetes medication? 
 
 Finally, let’s talk about how you did with your diabetes medication during the fourth week. 
On Day 1 of the fourth week, did you take all of your diabetes medication? 
 
 
 
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104
If your client 1) took their diabetes medication every day as directed in the past four weeks 
and 2) has successfully overcome all of the diabetes medication barriers identified at the 
beginning of the program: 
 Praise profusely! Tell them to keep up the great work by continuing to take their 
medications every day as directed. 
 Then, go to page 106 and continue with Homework #2, Healthy Eating. 
 
If your client was not able to take their diabetes medication every day as directed in the past 
four weeks: 
 Stay on page 104 in your manual and continue with setting a diabetes medication goal. 
 Then, go on with the rest of the session. 
 
If your client took their diabetes medication every day as directed in the past four weeks, but 
still has diabetes medication barriers that haven’t been addressed: 
 Check page 8 in the Client Plan Book and see what issues are remaining. Then, remind 
client about these remaining issues and ask which one they would like to work on next. 
 Go to page 105 in your manual and continue with setting a diabetes medication goal. 
 Then, go on with the rest of the session. 
Notes: 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 Now, I’d like to follow up on the plan that we made at our last session to help you get the 
most out of your diabetes medications by taking them every day.  
 Last time we talked, the issue you wanted to work on was… [go to Client Plan Book and 
read out loud the diabetes medication issue that they chose to work on last time]. 
 To overcome this issue, you decided to… [read out loud the medication-taking plan from 
last time]. 
 You thought that it might be hard for you to carry out this plan, because… [read 
potential barriers]. 
 To go around the problem, you decided to… [read how client decided to go around 
potential barriers]. 
Now, how did it go? Listen supportively and take notes in the box below. Assess how well this 
worked. If it did not work well, talk about why not. If it did go well, praise them. 
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 If their plan worked and last session’s issue is resolved, encourage them to tackle a new issue this 
week. If you try hard and they don’t want to tackle another issue and they took their medicine each 
day, try this:  
 Go back to the Client Plan Book. 
 If there are remaining issues related to side effects or cost, then help the client make a plan to 
address them this week. 
 If there are no remaining issues related to side effects or cost, look at the list of statements that 
are marked “Very Often” (or “Often” if there are no “Very Often” statements to address, and 
“Sometimes” if there are no “Often” statements to address). 
 Help them decide which new goal they would like to add for the coming week. 
 Summarize to confirm their new goal. For example, you could say: 
“OK, let me see if I got this straight. Last week, you … [repeat last week’s goal]. You did well 
with that, so this week, you’ll … [repeat this week’s goal]. Did I get that right?” 
 
 If they were not able to meet their medication goal, then let them stick to the same goal. 
 Be supportive, and let them know you’ll revisit the goal next week to see how it went this time. 
 Strategize what they will do differently this week to succeed. Make sure it is a SMART goal. 
 
 
Record this week’s strategy in the Client Plan Book. 
 If the strategy addresses side effects/and or cost, record this week’s strategy on the page, “Plan 
for Diabetes Medication Side Effects and/or Cost,” in the Client Plan Book. 
 If the strategy addresses other barriers besides side effects or cost, then record this week’s 
strategy on the page, “Plan for Other Diabetes Medication Barriers,” in the Client Plan Book. 
 
 OK, so what would you like to do over the next four weeks to help you get the most out of 
your medications?  
 
 OK, let’s think about how hard this may be to do. What are some things that might make it 
hard for you to carry out this plan? Write down barriers. 
 OK, what do you think you can do to overcome these things? Help clients think of possible 
solutions to these barriers, and write down those solutions. 
 OK, let’s review that. It looks like you’ll… repeat the new medication goal. Then, review 
potential barriers and how client will go around those barriers. Let client confirm. 
 This is a great plan! I look forward to hearing how this plan worked when we talk next time! 
 
 
 
 
 
 
 
 
 
 
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 Discuss how this went and provide encouragement and praise. If 
client was not able to take another step, discuss together what 
happened. Check the correct box below: 
 Did not evaluate goal after 1st week 
 Evaluated goal after 1st week, did not increase goal for 2nd 
week 
 Evaluated goal after 1st week, increased goal for 2nd week 
 
 
 
New healthy eating goal for 2nd week, if client increased goal: 
 Discuss how this went and provide encouragement and praise. If 
client was not able to take another step, discuss together what 
happened. Check the correct box below: 
 Did not evaluate goal after 2nd week 
 Evaluated goal after 2nd week, did not increase goal for 
3rd week 
 Evaluated goal after 2nd week, increased goal for 3rd week 
 
 
 
New healthy eating goal for 3rd week, if client increased goal: 
Homework #2: Healthy Eating 
 OK, let’s talk about how your healthy eating went during the first 
week. How did it go on Day 1? For each day, check “yes” or 
“no” for the Healthy Eating column. 
 
 Great! Now, during the second week, were you able to take 
another step to eat healthier? 
 
 
 
 
 
 
 OK, let’s take a look at how you did with healthy eating during the 
second week. How did it go on Day 1 of the second week? 
For each day, check “yes” or “no” for the Healthy Eating 
column.  
 
 Great! Now, during the third week, were you able to take 
another step to eat healthier? 
 
 
Week 1
Week 2
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 Discuss how this went and provide encouragement and praise. If 
client was not able to take another step, discuss together what 
happened. Check the correct box below: 
 Did not evaluate goal after 3rd week 
 Evaluated goal after 3rd week, did not increase goal for 4th 
week 
 Evaluated goal after 3rd week, increased goal for 4th week 
 
 
 
New healthy eating goal for 4th week, if client increased goal: 
 OK, let’s talk about how your healthy eating went during the third 
week. How did it go on Day 1? For each day, check “yes” or 
“no” for the Healthy Eating column. 
 
 Great! Now, during the fourth week, were you able to take 
another step to eat healthier? 
 
 
 
 
 
 
 OK, let’s take a look at how you did with healthy eating during the 
fourth week. How did it go on Day 1? For each day, check 
“yes” or “no” for the Healthy Eating column.  
 
 Great! Now, the last time we made a plan to help you eat 
healthy every day, you planned to… [go to Client Plan Book 
and read out loud the healthy eating goal the client chose to 
work on last time]. 
 You thought that it might be hard for you to carry out this 
plan, because… [read potential barriers]. 
 To go around the problem, you decided to… [read how client 
decided to go around potential barriers].  
 Now, during the first week, you were able to… [based on 
what client told you about Week 1, describe what happened]. 
 During the second week, you were able to… [based on what client told you about Week 2, 
describe what happened]. 
 During the third week, you were able to… [based on what client told you about Week 3, 
describe what happened]. 
 During the fourth week, you were able to… [based on what client told you about Week 4, 
describe what happened]. 
Week 3
Week 4
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 Discuss how this went and provide encouragement and praise. If 
client was not able to take another step, discuss together what 
happened. Check the correct box below: 
o Did not evaluate goal after 1st week 
o Evaluated goal after 1st week, did not increase goal for 2nd week 
o Evaluated goal after 1st week, increased goal for 2nd week 
 
 
 
Notes and new exercise goal for 2nd week, if client increased goal: 
 If they met their healthy eating goal, 
 Explore if they are ready to add another goal this week. Ask them to turn to page 6 in their 
Activity Book and look at the chart. Help them decide which new goal they would like to add for 
the coming week. 
 Go to the Client Plan Book and write down details in the space provided. Be sure to include all 
the information necessary for the goal. 
 Summarize to confirm their new goal. For example, you could say: 
“OK, let me see if I got this straight. Last week, you … [repeat last week’s goal]. You did well 
with that, so now you’d like to add another healthy eating goal. So, this week, you’ll … 
[repeat this week’s goal]. Did I get that right?” 
 If they were not able to meet their healthy eating goal, 
 Let client stick to the same eating goal, but be sure to modify the plan if needed. 
 Go to the Client Plan Book and write down details in the space provided. Be sure to include all 
the information necessary for the goal. 
 Be supportive, but remind client that you’ll revisit the goal next week to see how it went this time. 
 OK, what would you like to do this week in terms of healthy eating? 
 
 OK, let’s think about how hard this may be to do. What are some things that might make it 
hard for you to carry out this plan? Write down potential barriers. 
 OK, what do you think you can do to overcome these things? Help clients think of possible 
solutions to these barriers, and write down those solutions. 
 Great, I look forward to hearing how this plan worked when we talk next time! 
 
Homework #3: Physical Activity 
 Now, let’s talk about how your exercise went during the first 
week. How much exercise were you able to do on Day 1? For 
each day, write down number of minutes. 
 
 Great! Now, during the second week, were you able to take 
another step to become more physically active? 
 
 
 
Week 1
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109
 Discuss how this went and provide encouragement and praise. If 
client was not able to take another step, discuss together what 
happened. Check the correct box below: 
o Did not evaluate goal after 2nd week 
o Evaluated goal after 2nd week, did not increase goal for 3rd 
week 
o Evaluated goal after 2nd week, increased goal for 3rd week 
 
 
 
Notes and new exercise goal for 3rd week, if client increased goal: 
 Discuss how this went and provide encouragement and praise. If 
client was not able to take another step, discuss together what 
happened. Check the correct box below: 
o Did not evaluate goal after 3rd week 
o Evaluated goal after 3rd week, did not increase goal for 4th week 
o Evaluated goal after 3rd week, increased goal for 4th week 
 
 
 
Notes and new exercise goal for 4th week, if client increased goal: 
 OK, let’s take a look at how you did with exercise during the second week. How did it go on 
Day 1 of the second week? For each day, write down number of minutes. 
 
 Great! Now, during the third week, were you able to take 
another step to become more physically active? 
 
 
 
 
 OK, let’s take a look at how you did with exercise during the third week. How did it go on 
Day 1 of the third week? For each day, write down number of minutes. 
 
 Great! Now, during the fourth week, were you able to take 
another step to become more physically active 
 
Week 2
Week 3
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110
 OK, let’s take a look at how you did with exercise during the fourth week. How did it go on 
Day 1 of the fourth week? For each day, write down number of minutes. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 Great! Now, the last time we made a plan to help you exercise every day, you planned to… 
[go to Client Plan Book and read out loud the exercise goal the client chose to work on last 
time]. 
 You thought that it might be hard for you to carry out this plan, because… [read potential 
barriers]. 
 To go around the problem, you decided to… [read how client decided to go around potential 
barriers].  
 Now, during the first week, you were able to… [based on what client told you about Week 1, 
describe what happened]. 
 During the second week, you were able to… [based on what client told you about Week 2, 
describe what happened]. 
 During the third week, you were able to… [based on what client told you about Week 3, 
describe what happened]. 
 During the fourth week, you were able to… [based on what client told you about Week 4, 
describe what happened]. 
 
 
 
Week 4
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If you and your client talked about high blood pressure during Session 7: 
 Go to Homework #4: High Blood Pressure on page 112 in your manual. 
 Once you’re finished, continue with the session on page 113. 
 
If you and your client talked about high cholesterol during Session 7: 
 Go to Homework #5: High Cholesterol on page 112 in your manual. 
 Once you’re finished, continue with the session on page 113. 
 
If you and your client talked about high blood pressure and high cholesterol during Session 7: 
 Go to Homework #4: High Blood Pressure on page 112 in your manual. 
 Then, continue on to Homework #5: High Cholesterol on the same page. 
 Once you’re finished, continue with the session on page 113. 
 
If your client’s blood pressure and cholesterol were under control and you didn’t set goals 
last week, then go to Activity 1 on page 113 in your manual. 
 If they met their goal and were doing less than 30 minutes per day, 5 days per week, then explore if 
they are ready to add another 5 minutes. 
 If they are not comfortable advancing the goal, let them stick to the same goal, but supportively 
warn that you’ll be discussing this again next week and remind them that the eventual goal is 30 
minutes per day. 
 Write the goal for this week in the space provided in the Client Plan Book. 
 If they were not able to meet their goal, 
 Let client stick to the same goal, but be sure to modify the plan if needed. 
 Summarize. For example, say: OK, let me see if I got this straight. Last week, you [repeat last week’s 
goal], and you did pretty well with that, so now you’d like to add another 5 minutes each day. That 
means that, this week, you’d like to [repeat this week’s goal]. Did I get that right? 
 OK, what would you like to do this week in terms of exercise? 
 
 OK, let’s think about how hard this may be to do. What are some things that might make it 
hard for you to carry out this plan? Write down potential barriers. 
 OK, what do you think you can do to overcome these things? Help clients think of possible 
solutions to these barriers, and write down those solutions. 
 Great, I look forward to hearing how this plan worked when we talk next time! 
 
 
 
 
 
 
 
 
 
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112
 Listen supportively and praise client’s effort in the past week. 
 Encourage client to continue working with their doctor to control their blood pressure. 
 If they are taking medication for their blood pressure, tell them that the strategies they have used to 
take their diabetes medication can also help them take their blood pressure medication. 
 If needed, remind client that controlling blood pressure is important for reducing their chances of 
developing serious illnesses such as heart attack, stroke, dialysis, and blindness. Medications can 
help them live longer and stay independent by lowering their risk for such health problems. 
Notes: 
 Listen supportively and praise client’s effort in the past week. 
 Encourage client to continue working with their doctor to control their cholesterol. 
 If they are taking medication for their cholesterol, tell them that the strategies they have used to take 
their diabetes medication can also help them take their cholesterol medication. 
 If needed, remind client that controlling cholesterol is important for reducing their chances of 
developing serious illnesses such as heart attack and stroke. Medications can help them live longer 
and stay independent by lowering their risk for such health problems. 
Notes: 
Homework #4: High Blood Pressure (only if client is on medicine for high blood pressure or 
should have talked to doctor about starting treatment) 
 Now, I’d like to follow up on the talk we had last time about your high blood pressure. 
 Last time, you wanted to… [review your notes from page 92 in your manual]. 
 Now, how did it go? 
 
Homework #5: High Cholesterol Plan (only if client is on medicine for high cholesterol or 
should have talked to doctor about starting treatment) 
 Now, I’d like to follow up on the talk we had last time about your high cholesterol. 
 Last time, you wanted to… [review your notes from page 92 in your manual]. 
 Now, how did it go? 
 
 
 
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113
 If they succeeded in getting a Health Buddy, discuss how that went. 
 If they did not succeed in getting a Health Buddy, ask them if they want to try the same person again 
or if they want to try another person. Write down what they decide in the box below: 
 
 
 
 
 
 
 If they cannot think of a person to be their Health Buddy, contact UAB staff or your community 
coordinator at the end of today’s session. 
 Note: 
o Sometimes a client may want to have more than one Health Buddy (for example, one Health 
Buddy to help them be physically active, another Health Buddy to go shopping for healthy 
foods and preparing healthy meals, or another Health Buddy to remind each other to refill 
medications or accompany each other to their doctor’s appointment). 
o Encourage your client to have one main Health Buddy. 
o However, if they feel like they would be helped more by having more than one Health Buddy, 
that is fine. Be sure to write that down in the box above. 
Notes: 
Activity 1. Planning for the Future with Your Health Buddy -------------------------------------- 
 You’ve spent another month doing a great job to take care of yourself! As you continue to 
work on eating healthy, being physically active, and taking your medications, how do you 
feel? Listen supportively, and provide praise and encouragement. 
 Over the past three months, you have learned about the importance of the three-legged stool 
for living well with diabetes. Healthy eating, exercise, and medications will help you live 
well now so that you can do what you need to do, day to day. 
 Doing these things also will help you stay well so that you can accomplish your long-term 
goals and be there for important events in the future. 
 You learned how to eat healthy, get exercise, and take medications in ways that work for you 
and your life, and you kept track of how you’re able to do these things so that you can see 
the progress that you’re making. 
 Now, our hope is that you can keep going once the program ends. But, research has shown 
that, once a program like this ends, it can be hard for people to keep doing the good things 
that helped them during the program. 
 This is understandable! It can be hard to keep going all on your own. 
 Now, during our last session, we talked about a Health Buddy, or a person in your life that 
can help you to keep living well once the program ends. 
 Let’s talk about how things went with your Health Buddy. So the last time we talked, you 
were going to contact [name of Health Buddy on page 96 in your manual] and talk to them 
about being your Health Buddy. How did that go?  
 
 
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114
 If needed, use your motivational interviewing skills to help them figure out how they can engage the 
Health Buddy to help them with eating healthy, being physically active, and taking medications. 
 
 Here are some suggestions for how the Health Buddy can help: 
o Someone to talk to when feeling stressed, or feeling down or blue. 
o Someone to exercise with. 
o Someone to help you eat healthy (for example, go shopping for healthy foods, swapping healthy 
recipes, preparing healthy meals, making healthy choices when you go out to eat or when you’re 
attending a party) 
o Someone to help you to take your medications (for example, getting refills on time, accompanying 
you to doctor’s visits, talking to the pharmacist with you) 
 
 It’s also good to remind your client that they will be helping their Health Buddy live well, too! 
o Your client will help their Health Buddy live well now, so that they can do what they need to 
do, day to day. 
o Your client also will help their Health Buddy to stay well so that they can accomplish their 
long-term goals and be there for important events in the future. 
 As I mentioned before, it can be very helpful to have a Health Buddy to help you continue 
living well after the program ends. 
 Now, can you think of some things you could do with your Health Buddy to help you keep 
taking care of the three-legged stool? 
 
 
Homework for Next Four Weeks ------------------------------------------------------------------------ 
 Great! We’re almost done. The only thing left to do is go over your homework for the next 
four weeks. Please turn to page 26 in your Activity Book. 
 For the next four weeks, you’ll continue your homework for each leg of the 3-legged stool. 
 You’ll carry out the plan we discussed that will help you get the most out of your medicines. 
 You’re also going to mark down whether you kept to your heathy eating goal on the days 
that we discussed. Your plan is to… repeat the healthy eating goal from today written in the 
Client Plan Book. 
 So, under the column with a picture of apples, you’re going to mark “Yes” if you were able 
to follow your healthy eating goal on the days we discussed. 
 The goal is to eat healthy every day, so if you are able to follow your healthy eating goal on 
the other days, mark “Yes” on those days, too. 
 If you do well with your goal this week, you could add another step towards healthy eating 
the following week. You can go back to page 6 in your Activity Book to see your healthy 
eating goals and see if you would like to work on another goal for the following week. 
 You’re going to monitor the number of minutes of exercise every day. You decided that you 
would try… repeat the exercise goal from today written in the Client Plan Book. 
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 Try to make the dates as close to 28 
days from now as possible. 
 Schedule it at least 28 days from 
today, but no more than 31 days. 
 So, under the column with a picture of a person walking, you’re going to write down the 
number of minutes of exercise you were able to do on the days we discussed. 
 If you are doing well with your goal and were able to exercise on the other days, write down 
the number of minutes of exercise you did on those days, too. 
 Also, if you do well with your goal this week, you could add another step towards being 
physically active, like adding 5 more minutes to your plan during the following week. 
 Do you have any questions about what to do? Make sure client knows what to do. 
 OK, remember that we’re not going to talk again for four weeks. When we do talk, we’ll be 
talking for thirty minutes or so to make sure everything is going well with your homework. 
 Now, if you are having trouble with your homework, we’ll talk until we figure out what we 
can do to help you get back on track. Do you have any questions? Let client answer. 
 OK, when would you like to talk in four weeks? 
 
 
 
 Great! Please go ahead and write down the date and time in your Activity Book on page 27. 
 I will be speaking with you in four weeks. I look forward to hearing how things went! 
 
 
 
 
 
 
 
 
Session 8 
completed ______/______/______ 
      month              day               year 
_______/______ 
    start time         end time 
______ 
peer initials 
 
 
 
 
 
 
 
 
 
 
Next appointment date and time in 4 weeks: 
 
 
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116
Reminder!! 
 Cover and check off all of the session 
content. 
 Any text in GRAY BOXES is instructions for 
you: don’t read that text aloud to the client. 
Session Goals: 
 Review homework from past four weeks 
 Brief troubleshooting if client is having difficulty with any of the homework   
 Schedule next session in four weeks 
Week 16, Session 9 (Checking In, Four Weeks After Session 8) 
 
 
Before Calling the Client ----------------------------------------------------------------------------------- 
  
 Review last session’s assignment and the 
barriers and strategies to overcome them. 
 Once you’ve reviewed this, place the call. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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117
Say hello and make sure the client 
is still okay with speaking for about 
thirty minutes today. 
Note: if the client has not done some of the homework 2 sessions in a row, talk about what is making it 
hard to monitor. Let them know that since this is a research project, the investigators may want to help 
the person to succeed. Let them know that someone from the research team will be in touch. 
 Call the research team within 24 hours and let them know what is happening. 
 UAB staff will brief you on the conversation and the plan so that you can reinforce it next week. 
Check In ---------------------------------------------------------------------------------------------------- 
 
 So, it’s been about four weeks since we talked, and I just 
wanted to give you a call to see how you were doing and 
how it was going with your homework. 
 Great, do you have your Activity Book handy? If not, let 
them get the Activity Book before going on. 
 Today, we’ll go over your homework for the past four weeks to see how you’ve been doing 
with that.  
 Then, we’ll schedule our next call, which will be a check-in call, just like the one we’re 
having today. Our next call will be in four weeks. 
 Do you have any questions about that? Let client ask questions.  Great, let’s get started! 
 
Review Homework For Last Four Weeks -------------------------------------------------------------- 
 OK, now, I’d like to go over your homework from the past four weeks and then talk about 
your homework for the next four weeks. 
 First, let’s discuss how you did on your homework during the past four weeks. Can you turn 
to page 26 in your Activity Book? Let client get to the page.  
 Were you able to complete the homework? 
 
 
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118
Continue with Days 2 through 7 before stopping to discuss. 
 For each day, check “Yes” or “No.” 
 For each day, ask client if they took their diabetes medicine, 
even if their blood sugar was normal. Praise them for every  
“yes” 
 If they didn’t take their diabetes medicine every day, 
discuss what happened. Avoid being judgmental. 
 Reassure client that taking medicine every day 
the way the doctor prescribed is hard for a lot of people. 
Tell them that you will work together to develop a plan 
 for this week to help them take the medicine every day. 
 Write down what happened in the box below. 
 
 
 
 
 
 
Notes: 
Continue with Days 2 through 7 before stopping to discuss. 
 For each day, check “Yes” or “No.” 
 For each day, ask client if they took their diabetes medicine, 
even if their blood sugar was normal. Praise them for every  
“yes” 
 If they didn’t take their diabetes medicine every day, 
discuss what happened. Avoid being judgmental. 
 Reassure client that taking medicine every day 
the way the doctor prescribed is hard for a lot of people. 
Tell them that you will work together to develop a plan 
 for this week to help them take the medicine every day. 
 Write down what happened in the box below. 
 
 
 
 
 
 
Notes: 
Homework #1: Medications 
 OK, let’s start with your medicines and how you did with them that first week. 
 Let’s start with Day 1. Did you take all of your diabetes medication on Day 1? 
 
 Now, let’s talk about how you did with your medicines during the second week. On Day 1 of 
the second week, did you take all of your diabetes medication? 
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119
Continue with Days 2 through 7 before stopping to discuss. 
 For each day, check “Yes” or “No.” 
 For each day, ask client if they took their diabetes medicine, 
even if their blood sugar was normal. Praise them for every  
“yes” 
 If they didn’t take their diabetes medicine every day, 
discuss what happened. Avoid being judgmental. 
 Reassure client that taking medicine every day 
the way the doctor prescribed is hard for a lot of people. 
Tell them that you will work together to develop a plan 
 for this week to help them take the medicine every day. 
 Write down what happened in the box below. 
 
 
 
 
 
 
Notes: 
Continue with Days 2 through 7 before stopping to discuss. 
 For each day, check “Yes” or “No.” 
 For each day, ask client if they took their diabetes medicine, 
even if their blood sugar was normal. Praise them for every  
“yes” 
 If they didn’t take their diabetes medicine every day, 
discuss what happened. Avoid being judgmental. 
 Reassure client that taking medicine every day 
the way the doctor prescribed is hard for a lot of people. 
Tell them that you will work together to develop a plan 
 for this week to help them take the medicine every day. 
 Write down what happened in the box below. 
 
 
 
 
 
 
Notes: 
 Great! Let’s continue with the third week. On Day 1 of the third week, did you take all of 
your diabetes medication? 
 
 Finally, let’s talk about how you did with your diabetes medication during the fourth week. 
On Day 1 of the fourth week, did you take all of your diabetes medication? 
 
 
 
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120
If your client 1) took their diabetes medication every day as directed in the past four weeks 
and 2) has successfully overcome all of the diabetes medication barriers identified at the 
beginning of the program: 
 Praise profusely! Tell them to keep up the great work by continuing to take their 
medications every day as directed. 
 Then, go to page 122 and continue with Homework #2, Healthy Eating. 
 
If your client was not able to take their diabetes medication every day as directed in the past 
four weeks: 
 Stay on to page 120 in your manual and continue with setting a diabetes medication goal. 
 Then, go on with the rest of the session. 
 
If your client took their diabetes medication every day as directed in the past four weeks, but 
still has diabetes medication barriers that haven’t been addressed: 
 Go to page 121 in your manual and continue with setting a diabetes medication goal. 
 Then, go on with the rest of the session. 
Notes: 
 
 
 
 
 
 
 
 
 
 
 
 
 
 Now, I’d like to follow up on the plan that we made at our last session to help you get the 
most out of your diabetes medications by taking them every day.  
 Last time we talked, the issue you wanted to work on was… [go to Client Plan Book and 
read out loud the diabetes medication issue that they chose to work on last time]. 
 To overcome this issue, you decided to… [read out loud the medication-taking plan from 
last time]. 
 You thought that it might be hard for you to carry out this plan, because… [read 
potential barriers]. 
 To go around the problem, you decided to… [read how client decided to go around 
potential barriers]. 
 Now, how did it go? Listen supportively and take notes in the box below. Assess how well 
this worked. If it did not work well, talk about why not. If it did go well, praise them. 
 
 
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121
 If their plan worked and last session’s issue is resolved, encourage them to tackle a new issue this 
week. If you try hard and they don’t want to tackle another issue and they took their medicine each 
day, try this:  
 Go back to the Client Plan Book. 
 If there are remaining issues related to side effects or cost, then help the client make a plan to 
address them this week. 
 If there are no remaining issues related to side effects or cost, look at the list of statements that 
are marked “Very Often” (or “Often” if there are no “Very Often” statements to address, and 
“Sometimes” if there are no “Often” statements to address). 
 Help them decide which new goal they would like to add for the coming week. 
 Summarize to confirm their new goal. For example, you could say: 
“OK, let me see if I got this straight. Last week, you … [repeat last week’s goal]. You did well 
with that, so this week, you’ll … [repeat this week’s goal]. Did I get that right?” 
 
 If they were not able to meet their medication goal, then let them stick to the same goal. 
 Be supportive, and let them know you’ll revisit the goal next week to see how it went this time. 
 Strategize what they will do differently this week to succeed. Make sure it is a SMART goal. 
 
 
Record this week’s strategy in the Client Plan Book. 
 If the strategy addresses side effects/and or cost, record this week’s strategy on the page, “Plan 
for Diabetes Medication Side Effects and/or Cost,” in the Client Plan Book. 
 If the strategy addresses other barriers besides side effects or cost, then record this week’s 
strategy on the page, “Client Plan for Other Diabetes Medication Barriers,” in the Plan Book. 
 
 OK, so what would you like to do over the next four weeks to help you get the most out of 
your medications?  
 
 OK, let’s think about how hard this may be to do. What are some things that might make it 
hard for you to carry out this plan? Write down barriers. 
 OK, what do you think you can do to overcome these things? Help clients think of possible 
solutions to these barriers, and write down those solutions. 
 OK, let’s review that. It looks like you’ll… repeat the new medication goal. Then, review 
potential barriers and how client will go around those barriers. Let client confirm. 
 This is a great plan! I look forward to hearing how this plan worked when we talk next time! 
 
 
 
 
 
 
 
 
 
 
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122
 Discuss how this went and provide encouragement and praise. If 
client was not able to take another step, discuss together what 
happened. Check the correct box below: 
 Did not evaluate goal after 1st week 
 Evaluated goal after 1st week, did not increase goal for 2nd 
week 
 Evaluated goal after 1st week, increased goal for 2nd week 
 
 
 
New healthy eating goal for 2nd week, if client increased goal: 
 Discuss how this went and provide encouragement and praise. If 
client was not able to take another step, discuss together what 
happened. Check the correct box below: 
 Did not evaluate goal after 2nd week 
 Evaluated goal after 2nd week, did not increase goal for 
3rd week 
 Evaluated goal after 2nd week, increased goal for 3rd week 
 
 
 
New healthy eating goal for 3rd week, if client increased goal: 
Homework #2: Healthy Eating 
 OK, let’s talk about how your healthy eating went during the first 
week. How did it go on Day 1? For each day, check “yes” or 
“no” for the Healthy Eating column. 
 
 Great! Now, during the second week, were you able to take 
another step to eat healthier? 
 
 
 
 
 
 
 OK, let’s take a look at how you did with healthy eating during the 
second week. How did it go on Day 1 of the second week? 
For each day, check “yes” or “no” for the Healthy Eating 
column.  
 
 Great! Now, during the third week, were you able to take 
another step to eat healthier? 
 
 
Week 1
Week 2
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123
 Discuss how this went and provide encouragement and praise. If 
client was not able to take another step, discuss together what 
happened. Check the correct box below: 
 Did not evaluate goal after 3rd week 
 Evaluated goal after 3rd week, did not increase goal for 4th 
week 
 Evaluated goal after 3rd week, increased goal for 4th week 
 
 
 
New healthy eating goal for 4th week, if client increased goal: 
 OK, let’s talk about how your healthy eating went during the third 
week. How did it go on Day 1? For each day, check “yes” or 
“no” for the Healthy Eating column. 
 
 Great! Now, during the fourth week, were you able to take 
another step to eat healthier? 
 
 
 
 
 
 
 OK, let’s take a look at how you did with healthy eating during the 
fourth week. How did it go on Day 1? For each day, check 
“yes” or “no” for the Healthy Eating column.  
 
 Great! Now, the last time we made a plan to help you eat 
healthy every day, you planned to… [go to Client Plan Book 
and read out loud the healthy eating goal the client chose to 
work on last time]. 
 You thought that it might be hard for you to carry out this 
plan, because… [read potential barriers]. 
 To go around the problem, you decided to… [read how client 
decided to go around potential barriers].  
 Now, during the first week, you were able to… [based on 
what client told you about Week 1, describe what happened]. 
 During the second week, you were able to… [based on what client told you about Week 2, 
describe what happened]. 
 During the third week, you were able to… [based on what client told you about Week 3, 
describe what happened]. 
 During the fourth week, you were able to… [based on what client told you about Week 4, 
describe what happened]. 
Week 3
Week 4
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124
 Discuss how this went and provide encouragement and praise. If 
client was not able to take another step, discuss together what 
happened. Check the correct box below: 
o Did not evaluate goal after 1st week 
o Evaluated goal after 1st week, did not increase goal for 2nd week 
o Evaluated goal after 1st week, increased goal for 2nd week 
 
 
 
Notes and new exercise goal for 2nd week, if client increased goal: 
 If they met their healthy eating goal, 
 Explore if they are ready to add another goal this week. Ask them to turn to page 6 in their 
Activity Book and look at the chart. Help them decide which new goal they would like to add for 
the coming week. 
 Go to the Client Plan Book and write down details in the space provided. Be sure to include all 
the information necessary for the goal. 
 Summarize to confirm their new goal. For example, you could say: 
“OK, let me see if I got this straight. Last week, you … [repeat last week’s goal]. You did well 
with that, so now you’d like to add another healthy eating goal. So, this week, you’ll … 
[repeat this week’s goal]. Did I get that right?” 
 If they were not able to meet their healthy eating goal, 
 Let client stick to the same eating goal, but be sure to modify the plan if needed. 
 Go to the Client Plan Book and write down details in the space provided. Be sure to include all 
the information necessary for the goal. 
 Be supportive, but remind client that you’ll revisit the goal next week to see how it went this time. 
 OK, what would you like to do this week in terms of healthy eating? 
 OK, let’s think about how hard this may be to do. What are some things that might make it 
hard for you to carry out this plan? Write down potential barriers. 
 OK, what do you think you can do to overcome these things? Help clients think of possible 
solutions to these barriers, and write down those solutions. 
 Great, I look forward to hearing how this plan worked when we talk next time! 
 
Homework #3: Physical Activity 
 Now, let’s talk about how your exercise went during the first 
week. How much exercise were you able to do on Day 1? For 
each day, write down number of minutes. 
 
 Great! Now, during the second week, were you able to take 
another step to become more physically active? 
 
 
 
Week 1
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125
 Discuss how this went and provide encouragement and praise. If 
client was not able to take another step, discuss together what 
happened. Check the correct box below: 
o Did not evaluate goal after 2nd week 
o Evaluated goal after 2nd week, did not increase goal for 3rd 
week 
o Evaluated goal after 2nd week, increased goal for 3rd week 
 
 
 
Notes and new exercise goal for 3rd week, if client increased goal: 
 Discuss how this went and provide encouragement and praise. If 
client was not able to take another step, discuss together what 
happened. Check the correct box below: 
o Did not evaluate goal after 3rd week 
o Evaluated goal after 3rd week, did not increase goal for 4th week 
o Evaluated goal after 3rd week, increased goal for 4th week 
 
 
 
Notes and new exercise goal for 4th week, if client increased goal: 
 OK, let’s take a look at how you did with exercise during the second week. How did it go on 
Day 1 of the second week? For each day, write down number of minutes. 
 
 Great! Now, during the third week, were you able to take 
another step to become more physically active? 
 
 
 
 
 OK, let’s take a look at how you did with exercise during the third week. How did it go on 
Day 1 of the third week? For each day, write down number of minutes. 
 
 Great! Now, during the fourth week, were you able to take 
another step to become more physically active 
 
Week 2
Week 3
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126
 OK, let’s take a look at how you did with exercise during the fourth week. How did it go on 
Day 1 of the fourth week? For each day, write down number of minutes. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 Great! Now, the last time we made a plan to help you exercise every day, you planned to… 
[go to Client Plan Book and read out loud the exercise goal the client chose to work on last 
time]. 
 You thought that it might be hard for you to carry out this plan, because… [read potential 
barriers]. 
 To go around the problem, you decided to… [read how client decided to go around potential 
barriers].  
 Now, during the first week, you were able to… [based on what client told you about Week 1, 
describe what happened]. 
 During the second week, you were able to… [based on what client told you about Week 2, 
describe what happened]. 
 During the third week, you were able to… [based on what client told you about Week 3, 
describe what happened]. 
 During the fourth week, you were able to… [based on what client told you about Week 4, 
describe what happened]. 
 
 
 
Week 4
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127
If you and your client talked about high blood pressure during the previous session 
 Go to Homework #4: High Blood Pressure on page 128 in your manual. 
 Once you’re finished, continue with the session on page 129. 
 
If you and your client talked about high cholesterol during the previous session: 
 Go to Homework #5: High Cholesterol on page 128 in your manual. 
 Once you’re finished, continue with the session on page 129. 
 
If you and your client talked about high blood pressure and high cholesterol during the 
previous session: 
 Go to Homework #4: High Blood Pressure on page 128 in your manual. 
 Then, continue on to Homework #5: High Cholesterol on the same page. 
 Once you’re finished, continue with the session on page 129. 
 
If your client’s blood pressure and cholesterol were under control and you didn’t set goals 
during the previous session, then continue with the session on page 129 in your manual. 
 If they met their goal and were doing less than 30 minutes per day, 5 days per week, then explore if 
they are ready to add another 5 minutes. 
 If they are not comfortable advancing the goal, let them stick to the same goal, but supportively 
warn that you’ll be discussing this again next week and remind them that the eventual goal is 30 
minutes per day. 
 Write the goal for this week in the space provided in the Client Plan Book. 
 If they were not able to meet their goal, 
 Let client stick to the same goal, but be sure to modify the plan if needed. 
 Summarize. For example, say: OK, let me see if I got this straight. Last week, you [repeat last week’s 
goal], and you did pretty well with that, so now you’d like to add another 5 minutes each day. That 
means that, this week, you’d like to [repeat this week’s goal]. Did I get that right? 
 OK, what would you like to do this week in terms of exercise? 
 
 OK, let’s think about how hard this may be to do. What are some things that might make it 
hard for you to carry out this plan? Write down potential barriers. 
 OK, what do you think you can do to overcome these things? Help clients think of possible 
solutions to these barriers, and write down those solutions. 
 Great, I look forward to hearing how this plan worked when we talk next time! 
 
 
 
 
 
 
 
 
 
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128
 Listen supportively and praise client’s effort in the past week. 
 Encourage client to continue working with their doctor to control their blood pressure. 
 If they are taking medication for their blood pressure, tell them that the strategies they have used to 
take their diabetes medication can also help them take their blood pressure medication. 
 If needed, remind client that controlling blood pressure is important for reducing their chances of 
developing serious illnesses such as heart attack, stroke, dialysis, and blindness. Medications can 
help them live longer and stay independent by lowering their risk for such health problems. 
Notes: 
 Listen supportively and praise client’s effort in the past week. 
 Encourage client to continue working with their doctor to control their cholesterol. 
 If they are taking medication for their cholesterol, tell them that the strategies they have used to take 
their diabetes medication can also help them take their cholesterol medication. 
 If needed, remind client that controlling cholesterol is important for reducing their chances of 
developing serious illnesses such as heart attack and stroke. Medications can help them live longer 
and stay independent by lowering their risk for such health problems. 
Notes: 
Homework #4: High Blood Pressure (only if client is on medicine for high blood pressure or 
should have talked to doctor about starting treatment) 
 Now, I’d like to follow up on the talk we had last time about your high blood pressure. 
 Last time, you wanted to… [review your notes from page 112 in your manual]. 
 Now, how did it go? 
 
Homework #5: High Cholesterol Plan (only if client is on medicine for high cholesterol or 
should have talked to doctor about starting treatment) 
 Now, I’d like to follow up on the talk we had last time about your high cholesterol. 
 Last time, you wanted to… [review your notes from page 112 in your manual]. 
 Now, how did it go? 
 
 
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129
 Try to make the dates as close to 28 
days from now as possible. 
 Schedule it at least 28 days from 
today, but no more than 31 days. 
Schedule Next Check-In Session ----------------------------------------------------------------------- 
 You have been doing a wonderful job with the three-legged stool! And keeping track of your 
progress is very helpful for seeing how well you’re doing with this. 
 OK, our next session will be four weeks from now. It will be just like today’s call, where 
we’ll talk for about a half hour to see how you’re doing with your homework. 
 If you can turn to page 28 in your Activity Book, you’ll see where you’ll monitor your 
homework for the next four weeks. Do you have any questions about what to do? 
 Great! Now, when would you like to talk in four weeks? 
 
 
 
 Great! Please go ahead and write down the date and time in your Activity Book on page 29. 
 I will be speaking with you in four weeks. I look forward to hearing how things went! 
 
 
 
 
 
 
 
 
Check In 
completed ______/______/______ 
      month              day               year 
_______/______ 
    start time         end time 
______ 
peer initials 
 
 
 
 
Next appointment date and time in 4 weeks: 
 
 
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130
Reminder!! 
 Cover and check off all of the session 
content. 
 Any text in GRAY BOXES is instructions for 
you: don’t read that text aloud to the client. 
Session Goals: 
 Review homework from past four weeks 
 Brief troubleshooting if client is having difficulty with any of the homework   
 Schedule next session in four weeks 
Week 20, Session 10 (Checking In, Four Weeks After Session 9) 
 
 
Before Calling the Client ----------------------------------------------------------------------------------- 
  
 Review last session’s assignment and the 
barriers and strategies to overcome them. 
 Once you’ve reviewed this, place the call. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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131
Say hello and make sure the client 
is still okay with speaking for about 
thirty minutes today. 
Note: if the client has not done some of the homework 2 sessions in a row, talk about what is making it 
hard to monitor. Let them know that since this is a research project, the investigators may want to help 
the person to succeed. Let them know that someone from the research team will be in touch. 
 Call the research team within 24 hours and let them know what is happening. 
 UAB staff will brief you on the conversation and the plan so that you can reinforce it next week. 
Check In ---------------------------------------------------------------------------------------------------- 
 
 So, it’s been about four weeks since we talked, and I just 
wanted to give you a call to see how you were doing and 
how it was going with your homework. 
 Great, do you have your Activity Book handy? If not, let 
them get the Activity Book before going on. 
 Today, we’ll go over your homework for the past four weeks to see how you’ve been doing 
with that.  
 Then, we’ll schedule our next call, which will be a check-in call, just like the one we’re 
having today. Our next call will be in four weeks. 
 Do you have any questions about that? Let client ask questions.  Great, let’s get started! 
 
Review Homework For Last Four Weeks -------------------------------------------------------------- 
 OK, now, I’d like to go over your homework from the past four weeks and then talk about 
your homework for the next four weeks. 
 First, let’s discuss how you did on your homework during the past four weeks. Can you turn 
to page 28 in your Activity Book? Let client get to the page.  
 Were you able to complete the homework? 
 
 
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132
Continue with Days 2 through 7 before stopping to discuss. 
 For each day, check “Yes” or “No.” 
 For each day, ask client if they took their diabetes medicine, 
even if their blood sugar was normal. Praise them for every  
“yes” 
 If they didn’t take their diabetes medicine every day, 
discuss what happened. Avoid being judgmental. 
 Reassure client that taking medicine every day 
the way the doctor prescribed is hard for a lot of people. 
Tell them that you will work together to develop a plan 
 for this week to help them take the medicine every day. 
 Write down what happened in the box below. 
 
 
 
 
 
 
Notes: 
Continue with Days 2 through 7 before stopping to discuss. 
 For each day, check “Yes” or “No.” 
 For each day, ask client if they took their diabetes medicine, 
even if their blood sugar was normal. Praise them for every  
“yes” 
 If they didn’t take their diabetes medicine every day, 
discuss what happened. Avoid being judgmental. 
 Reassure client that taking medicine every day 
the way the doctor prescribed is hard for a lot of people. 
Tell them that you will work together to develop a plan 
 for this week to help them take the medicine every day. 
 Write down what happened in the box below. 
 
 
 
 
 
 
Notes: 
Homework #1: Medications 
 OK, let’s start with your medicines and how you did with them that first week. 
 Let’s start with Day 1. Did you take all of your diabetes medication on Day 1? 
 
 Now, let’s talk about how you did with your medicines during the second week. On Day 1 of 
the second week, did you take all of your diabetes medication? 
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133
Continue with Days 2 through 7 before stopping to discuss. 
 For each day, check “Yes” or “No.” 
 For each day, ask client if they took their diabetes medicine, 
even if their blood sugar was normal. Praise them for every  
“yes” 
 If they didn’t take their diabetes medicine every day, 
discuss what happened. Avoid being judgmental. 
 Reassure client that taking medicine every day 
the way the doctor prescribed is hard for a lot of people. 
Tell them that you will work together to develop a plan 
 for this week to help them take the medicine every day. 
 Write down what happened in the box below. 
 
 
 
 
 
 
Notes: 
Continue with Days 2 through 7 before stopping to discuss. 
 For each day, check “Yes” or “No.” 
 For each day, ask client if they took their diabetes medicine, 
even if their blood sugar was normal. Praise them for every  
“yes” 
 If they didn’t take their diabetes medicine every day, 
discuss what happened. Avoid being judgmental. 
 Reassure client that taking medicine every day 
the way the doctor prescribed is hard for a lot of people. 
Tell them that you will work together to develop a plan 
 for this week to help them take the medicine every day. 
 Write down what happened in the box below. 
 
 
 
 
 
 
Notes: 
 Great! Let’s continue with the third week. On Day 1 of the third week, did you take all of 
your diabetes medication? 
 
 Finally, let’s talk about how you did with your diabetes medication during the fourth week. 
On Day 1 of the fourth week, did you take all of your diabetes medication? 
 
 
 
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134
If your client took 1) their diabetes medication every day as directed in the past four weeks 
and 2) has successfully overcome all of the diabetes medication barriers identified at the 
beginning of the program: 
 Praise profusely! Tell them to keep up the great work by continuing to take their 
medications every day as directed. 
 Then, go to page 136 and continue with Homework #2, Healthy Eating. 
 
If your client was not able to take their diabetes medication every day as directed in the past 
four weeks: 
 Stay on page 134 in your manual and continue with setting a diabetes medication goal. 
 Then, go on with the rest of the session. 
 
If your client took their diabetes medication every day as directed in the past four weeks, but 
still has diabetes medication barriers that haven’t been addressed: 
 Go to page 135 in your manual and continue with setting a diabetes medication goal. 
 Then, go on with the rest of the session. 
Notes: 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 Now, I’d like to follow up on the plan that we made at our last session to help you get the 
most out of your diabetes medications by taking them every day.  
 Last time we talked, the issue you wanted to work on was… [go to Client Plan Book and 
read out loud the diabetes medication issue that they chose to work on last time]. 
 To overcome this issue, you decided to… [read out loud the medication-taking plan from 
last time]. 
 You thought that it might be hard for you to carry out this plan, because… [read 
potential barriers]. 
 To go around the problem, you decided to… [read how client decided to go around 
potential barriers]. 
 Now, how did it go? Listen supportively and take notes in the box below. Assess how well 
this worked. If it did not work well, talk about why not. If it did go well, praise them. 
 
 
Appendix Page |  174

 
135
 If their plan worked and last session’s issue is resolved, encourage them to tackle a new issue this 
week. If you try hard and they don’t want to tackle another issue and they took their medicine each 
day, try this:  
 Go back to the Client Plan Book. 
 If there are remaining issues related to side effects or cost, then help the client make a plan to 
address them this week. 
 If there are no remaining issues related to side effects or cost, look at the list of statements that 
are marked “Very Often” (or “Often” if there are no “Very Often” statements to address, and 
“Sometimes” if there are no “Often” statements to address). 
 Help them decide which new goal they would like to add for the coming week. 
 Summarize to confirm their new goal. For example, you could say: 
“OK, let me see if I got this straight. Last week, you … [repeat last week’s goal]. You did well 
with that, so this week, you’ll … [repeat this week’s goal]. Did I get that right?” 
 
 If they were not able to meet their medication goal, then let them stick to the same goal. 
 Be supportive, and let them know you’ll revisit the goal next week to see how it went this time. 
 Strategize what they will do differently this week to succeed. Make sure it is a SMART goal. 
 
 
Record this week’s strategy in the Client Plan Book. 
 If the strategy addresses side effects/and or cost, record this week’s strategy on the page, “Client 
Plan for Diabetes Medication Side Effects and/or Cost,” in the Client Plan Book. 
 If the strategy addresses other barriers besides side effects or cost, then record this week’s 
strategy on the page, “Client Plan for Other Diabetes Medication Barriers,” in the Client Plan 
Book. 
 OK, so what would you like to do over the next four weeks to help you get the most out of 
your medications?  
 
 OK, let’s think about how hard this may be to do. What are some things that might make it 
hard for you to carry out this plan? Write down barriers. 
 OK, what do you think you can do to overcome these things? Help clients think of possible 
solutions to these barriers, and write down those solutions. 
 OK, let’s review that. It looks like you’ll… repeat the new medication goal. Then, review 
potential barriers and how client will go around those barriers. Let client confirm. 
 OK, let’s think about how hard this may be to do. What are some things that might make it 
hard for you to carry out this plan? Write down barriers in the left column in the box below. 
 OK, what do you think you can do to overcome these things? Help clients think of possible 
solutions to these barriers, and write those solutions in the right column in the box below. 
 This is a great plan! I look forward to hearing how this plan worked when we talk next time! 
 
 
 
 
 
 
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136
 Discuss how this went and provide encouragement and praise. If 
client was not able to take another step, discuss together what 
happened. Check the correct box below: 
 Did not evaluate goal after 1st week 
 Evaluated goal after 1st week, did not increase goal for 2nd 
week 
 Evaluated goal after 1st week, increased goal for 2nd week 
 
 
 
New healthy eating goal for 2nd week, if client increased goal: 
 Discuss how this went and provide encouragement and praise. If 
client was not able to take another step, discuss together what 
happened. Check the correct box below: 
 Did not evaluate goal after 2nd week 
 Evaluated goal after 2nd week, did not increase goal for 
3rd week 
 Evaluated goal after 2nd week, increased goal for 3rd week 
 
 
 
New healthy eating goal for 3rd week, if client increased goal: 
Homework #2: Healthy Eating 
 OK, let’s talk about how your healthy eating went during the first 
week. How did it go on Day 1? For each day, check “yes” or 
“no” for the Healthy Eating column. 
 
 Great! Now, during the second week, were you able to take 
another step to eat more healthy? 
 
 
 
 
 
 
 OK, let’s take a look at how you did with healthy eating during the 
second week. How did it go on Day 1 of the second week? 
For each day, check “yes” or “no” for the Healthy Eating 
column.  
 
 Great! Now, during the third week, were you able to take 
another step to eat more healthy? 
 
 
Week 1
Week 2
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137
 Discuss how this went and provide encouragement and praise. If 
client was not able to take another step, discuss together what 
happened. Check the correct box below: 
 Did not evaluate goal after 3rd week 
 Evaluated goal after 3rd week, did not increase goal for 4th 
week 
 Evaluated goal after 3rd week, increased goal for 4th week 
 
 
 
New healthy eating goal for 4th week, if client increased goal: 
 OK, let’s talk about how your healthy eating went during the third 
week. How did it go on Day 1? For each day, check “yes” or 
“no” for the Healthy Eating column. 
 
 Great! Now, during the fourth week, were you able to take 
another step to eat more healthy? 
 
 
 
 
 
 
 OK, let’s take a look at how you did with healthy eating during the 
fourth week. How did it go on Day 1? For each day, check 
“yes” or “no” for the Healthy Eating column.  
 
 Great! Now, the last time we made a plan to help you eat 
healthy every day, you planned to… [go to Client Plan Book 
and read out loud the healthy eating goal the client chose to 
work on last time]. 
 You thought that it might be hard for you to carry out this 
plan, because… [read potential barriers]. 
 To go around the problem, you decided to… [read how client 
decided to go around potential barriers].  
 Now, during the first week, you were able to… [based on 
what client told you about Week 1, describe what happened]. 
 During the second week, you were able to… [based on what client told you about Week 2, 
describe what happened]. 
 During the third week, you were able to… [based on what client told you about Week 3, 
describe what happened]. 
 During the fourth week, you were able to… [based on what client told you about Week 4, 
describe what happened]. 
Week 3
Week 4
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138
 Discuss how this went and provide encouragement and praise. If 
client was not able to take another step, discuss together what 
happened. Check the correct box below: 
o Did not evaluate goal after 1st week 
o Evaluated goal after 1st week, did not increase goal for 2nd week 
o Evaluated goal after 1st week, increased goal for 2nd week 
 
 
 
Notes and new exercise goal for 2nd week, if client increased goal: 
 If they met their healthy eating goal, 
 Explore if they are ready to add another goal this week. Ask them to turn to page 6 in their 
Activity Book and look at the chart. Help them decide which new goal they would like to add for 
the coming week. 
 Go to the Client Plan Book and write down details in the space provided. Be sure to include all 
the information necessary for the goal. 
 Summarize to confirm their new goal. For example, you could say: 
“OK, let me see if I got this straight. Last week, you … [repeat last week’s goal]. You did well 
with that, so now you’d like to add another healthy eating goal. So, this week, you’ll … 
[repeat this week’s goal]. Did I get that right?” 
 If they were not able to meet their healthy eating goal, 
 Let client stick to the same eating goal, but be sure to modify the plan if needed. 
 Go to the Client Plan Book and write down details in the space provided. Be sure to include all 
the information necessary for the goal. 
 Be supportive, but remind client that you’ll revisit the goal next week to see how it went this time. 
 OK, what would you like to do this week in terms of healthy eating? 
 OK, let’s think about how hard this may be to do. What are some things that might make it 
hard for you to carry out this plan? Write down potential barriers. 
 OK, what do you think you can do to overcome these things? Help clients think of possible 
solutions to these barriers, and write down those solutions. 
 Great, I look forward to hearing how this plan worked when we talk next time! 
 
Homework #3: Physical Activity 
 Now, let’s talk about how your exercise went during the first 
week. How much exercise were you able to do on Day 1? For 
each day, write down number of minutes. 
 
 Great! Now, during the second week, were you able to take 
another step to become more physically active? 
 
 
 
Week 1
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 Discuss how this went and provide encouragement and praise. If 
client was not able to take another step, discuss together what 
happened. Check the correct box below: 
o Did not evaluate goal after 2nd week 
o Evaluated goal after 2nd week, did not increase goal for 3rd 
week 
o Evaluated goal after 2nd week, increased goal for 3rd week 
 
 
 
Notes and new exercise goal for 2nd week, if client increased goal: 
 Discuss how this went and provide encouragement and praise. If 
client was not able to take another step, discuss together what 
happened. Check the correct box below: 
o Did not evaluate goal after 3rd week 
o Evaluated goal after 3rd week, did not increase goal for 4th week 
o Evaluated goal after 3rd week, increased goal for 4th week 
 
 
 
Notes and new exercise goal for 2nd week, if client increased goal: 
 OK, let’s take a look at how you did with exercise during the second week. How did it go on 
Day 1 of the second week? For each day, write down number of minutes. 
 
 Great! Now, during the third week, were you able to take 
another step to become more physically active? 
 
 
 
 
 OK, let’s take a look at how you did with exercise during the third week. How did it go on 
Day 1 of the third week? For each day, write down number of minutes. 
 
 Great! Now, during the fourth week, were you able to take 
another step to become more physically active 
 
Week 2
Week 3
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140
 OK, let’s take a look at how you did with exercise during the fourth week. How did it go on 
Day 1 of the fourth week? For each day, write down number of minutes. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 Great! Now, the last time we made a plan to help you exercise every day, you planned to… 
[go to Client Plan Book and read out loud the exercise goal the client chose to work on last 
time]. 
 You thought that it might be hard for you to carry out this plan, because… [read potential 
barriers]. 
 To go around the problem, you decided to… [read how client decided to go around potential 
barriers].  
 Now, during the first week, you were able to… [based on what client told you about Week 1, 
describe what happened]. 
 During the second week, you were able to… [based on what client told you about Week 2, 
describe what happened]. 
 During the third week, you were able to… [based on what client told you about Week 3, 
describe what happened]. 
 During the fourth week, you were able to… [based on what client told you about Week 4, 
describe what happened]. 
 
 
 
Week 4
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141
If you and your client talked about high blood pressure during the previous session: 
 Go to Homework #4: High Blood Pressure on page 142 in your manual. 
 Once you’re finished, continue with the session on page 143. 
 
If you and your client talked about high cholesterol during the previous session: 
 Go to Homework #5: High Cholesterol on page 142 in your manual. 
 Once you’re finished, continue with the session on page 143. 
 
If you and your client talked about high blood pressure and high cholesterol during the 
previous session: 
 Go to Homework #4: High Blood Pressure on page 142 in your manual. 
 Then, continue on to Homework #5: High Cholesterol on the same page. 
 Once you’re finished, continue with the session on page 143. 
 
If your client’s blood pressure and cholesterol were under control and you didn’t set goals 
during the previous session, then continue with the session on page 143 in your manual. 
 If they met their goal and were doing less than 30 minutes per day, 5 days per week, then explore if 
they are ready to add another 5 minutes. 
 If they are not comfortable advancing the goal, let them stick to the same goal, but supportively 
warn that you’ll be discussing this again next week and remind them that the eventual goal is 30 
minutes per day. 
 Write the goal for this week in the space provided in the Client Plan Book. 
 If they were not able to meet their goal, 
 Let client stick to the same goal, but be sure to modify the plan if needed. 
 Summarize. For example, say: OK, let me see if I got this straight. Last week, you [repeat last week’s 
goal], and you did pretty well with that, so now you’d like to add another 5 minutes each day. That 
means that, this week, you’d like to [repeat this week’s goal]. Did I get that right? 
 OK, what would you like to do this week in terms of exercise? 
 
 OK, let’s think about how hard this may be to do. What are some things that might make it 
hard for you to carry out this plan? Write down potential barriers. 
 OK, what do you think you can do to overcome these things? Help clients think of possible 
solutions to these barriers, and write down those solutions. 
 Great, I look forward to hearing how this plan worked when we talk next time! 
 
 
 
 
 
 
 
 
 
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142
 Listen supportively and praise client’s effort in the past week. 
 Encourage client to continue working with their doctor to control their blood pressure. 
 If they are taking medication for their blood pressure, tell them that the strategies they have used to 
take their diabetes medication can also help them take their blood pressure medication. 
 If needed, remind client that controlling blood pressure is important for reducing their chances of 
developing serious illnesses such as heart attack, stroke, dialysis, and blindness. Medications can 
help them live longer and stay independent by lowering their risk for such health problems. 
Notes: 
 Listen supportively and praise client’s effort in the past week. 
 Encourage client to continue working with their doctor to control their cholesterol. 
 If they are taking medication for their cholesterol, tell them that the strategies they have used to take 
their diabetes medication can also help them take their cholesterol medication. 
 If needed, remind client that controlling cholesterol is important for reducing their chances of 
developing serious illnesses such as heart attack and stroke. Medications can help them live longer 
and stay independent by lowering their risk for such health problems. 
Notes: 
Homework #4: High Blood Pressure (only if client is on medicine for high blood pressure or 
should have talked to doctor about starting treatment) 
 Now, I’d like to follow up on the talk we had last time about your high blood pressure. 
 Last time, you wanted to… [review your notes from page 128 in your manual]. 
 Now, how did it go? 
 
Homework #5: High Cholesterol Plan (only if client is on medicine for high cholesterol or 
should have talked to doctor about starting treatment) 
 Now, I’d like to follow up on the talk we had last time about your high cholesterol. 
 Last time, you wanted to… [review your notes from page 128 in your manual]. 
 Now, how did it go? 
 
 
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143
 Try to make the dates as close to 28 
days from now as possible. 
 Schedule it at least 28 days from 
today, but no more than 31 days. 
Schedule Next Check-In Session ----------------------------------------------------------------------- 
 You have been doing a wonderful job with the three-legged stool! And keeping track of your 
progress is very helpful for seeing how well you’re doing with this. 
 OK, our next session will be four weeks from now. It will be just like today’s call, where 
we’ll talk about thirty minutes to see how you’re doing with your homework. 
 If you can turn to page 30 in your Activity Book, you’ll see where you’ll monitor your 
homework for the next four weeks. Do you have any questions about what to do? 
 Great! Now, when would you like to talk in four weeks? 
 
 
 
 Great! Please go ahead and write down the date and time in your Activity Book at the 
bottom of page 31. 
 I will be speaking with you in four weeks. I look forward to hearing how things went! 
 
 
 
 
 
 
 
 
Check In 
completed ______/______/______ 
      month              day               year 
_______/______ 
    start time         end time 
______ 
peer initials 
 
 
 
 
Next appointment date and time in 4 weeks: 
 
 
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144
Reminder!! 
 Cover and check off all of the session 
content. 
 Any text in GRAY BOXES is instructions for 
you: don’t read that text aloud to the client. 
Session Goals: 
 Brief encouragement to client 
 Brief troubleshooting if client is having difficulty with any of the homework   
 Reinforcement of benefits of taking care of the three-legged stool 
 Help for client in creating plan to keep going 
Week 24, Session 11 (Final Session, 4 Weeks After Session 10) 
 
 
Before Calling the Client ----------------------------------------------------------------------------------- 
  
 Review last week’s assignment and the 
barriers and strategies to overcome them. 
 Once you’ve reviewed this, place the call. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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145
Say hello and make sure the client 
is still okay with speaking for about 
thirty minutes today. 
Continue with Days 2 through 7 before stopping to discuss. 
 For each day, check “Yes” or “No.” 
 For each day, ask client if they took their diabetes medicine, 
even if their blood sugar was normal. Praise them for every  
“yes” 
 If they didn’t take their diabetes medicine every day, 
discuss what happened. Avoid being judgmental. 
 Reassure client that taking medicine every day 
the way the doctor prescribed is hard for a lot of people. 
Tell them that you will work together to develop a plan 
 for this week to help them take the medicine every day. 
 Write down what happened in the box below. 
 
 
 
 
 
 
Notes: 
Check In ---------------------------------------------------------------------------------------------------- 
 
 Today is our last session! We’ll talk about how it’s been 
going with your homework since the last time we talked, 
which was about four weeks ago. 
 Now, do you have your Activity Book handy? 
If not, let them get the Activity Book before going on. 
 Great, let’s get started!  
 
Review Homework For Last Four Weeks -------------------------------------------------------------- 
 OK, now, I’d like to go over your homework from the past four weeks and then talk about 
your homework for the next four weeks. 
 First, let’s discuss how you did on your homework during the past four weeks. Can you turn 
to page 30 in your Activity Book? Let client get to the page.  
 
 
Homework #1: Medications 
 OK, let’s start with your medicines and how you did with them that first week. 
 Let’s start with Day 1. Did you take all of your diabetes medication on Day 1? 
 
 
 
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146
Continue with Days 2 through 7 before stopping to discuss. 
 For each day, check “Yes” or “No.” 
 For each day, ask client if they took their diabetes medicine, 
even if their blood sugar was normal. Praise them for every  
“yes” 
 If they didn’t take their diabetes medicine every day, 
discuss what happened. Avoid being judgmental. 
 Reassure client that taking medicine every day 
the way the doctor prescribed is hard for a lot of people. 
Tell them that you will work together to develop a plan 
 for this week to help them take the medicine every day. 
 Write down what happened in the box below. 
 
 
 
 
 
 
Notes: 
Continue with Days 2 through 7 before stopping to discuss. 
 For each day, check “Yes” or “No.” 
 For each day, ask client if they took their diabetes medicine, 
even if their blood sugar was normal. Praise them for every  
“yes” 
 If they didn’t take their diabetes medicine every day, 
discuss what happened. Avoid being judgmental. 
 Reassure client that taking medicine every day 
the way the doctor prescribed is hard for a lot of people. 
Tell them that you will work together to develop a plan 
 for this week to help them take the medicine every day. 
 Write down what happened in the box below. 
 
 
 
 
 
 
Notes: 
 Now, let’s talk about how you did with your medicines during the second week. On Day 1 of 
the second week, did you take all of your diabetes medication? 
 
 Great! Let’s continue with the third week. On Day 1 of the third week, did you take all of 
your diabetes medication? 
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147
Continue with Days 2 through 7 before stopping to discuss. 
 For each day, check “Yes” or “No.” 
 For each day, ask client if they took their diabetes medicine, 
even if their blood sugar was normal. Praise them for every  
“yes” 
 If they didn’t take their diabetes medicine every day, 
discuss what happened. Avoid being judgmental. 
 Reassure client that taking medicine every day 
the way the doctor prescribed is hard for a lot of people. 
Tell them that you will work together to develop a plan 
 for this week to help them take the medicine every day. 
 Write down what happened in the box below. 
 
 
 
 
 
 
Notes: 
 Finally, let’s talk about how you did with your diabetes medication during the fourth week. 
On Day 1 of the fourth week, did you take all of your diabetes medication? 
 
 
 
 
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148
If your client took 1) their diabetes medication every day as directed in the past four weeks 
and 2) has successfully overcome all of the diabetes medication barriers identified at the 
beginning of the program: 
 Praise profusely! Tell them to keep up the great work by continuing to take their 
medications every day as directed. 
 Then, go to page 150 and continue with Homework #2, Healthy Eating. 
 
If your client was not able to take their diabetes medication every day as directed in the past 
four weeks: 
 Stay on page 148 in your manual and continue with setting a diabetes medication goal. 
Since this is the last session, you will not record their goal in the Client Plan Book. 
 Then, go on with the rest of the session. 
 
If your client took their diabetes medication every day as directed in the past four weeks, but 
still has diabetes medication barriers that haven’t been addressed: 
 Go to page 149 in your manual and continue with setting a diabetes medication goal. 
Since this is the last session, you will not record their goal in the Client Plan Book. 
 Then, go on with the rest of the session. 
Notes: 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 Now, I’d like to follow up on the plan that we made at our last session to help you get the 
most out of your diabetes medications by taking them every day.  
 Last time we talked, the issue you wanted to work on was… [go to Client Plan Book and 
read out loud the diabetes medication issue that they chose to work on last time]. 
 To overcome this issue, you decided to… [read out loud the medication-taking plan from 
last time]. 
 You thought that it might be hard for you to carry out this plan, because… [read 
potential barriers]. 
 To go around the problem, you decided to… [read how client decided to go around 
potential barriers]. 
 Now, how did it go? Listen supportively and take notes in the box below. Assess how well 
this worked. If it did not work well, talk about why not. If it did go well, praise them. 
 
 
Appendix Page |  188

 
149
 If their plan worked and last session’s issue is resolved, encourage them to tackle a new issue this 
week. If you try hard and they don’t want to tackle another issue and they took their medicine each 
day, try this:  
 Go back to the Client Plan Book. 
 If there are remaining issues related to side effects or cost, then help the client make a plan to 
address them this week. 
 If there are no remaining issues related to side effects or cost, look at the list of statements that 
are marked “Very Often” (or “Often” if there are no “Very Often” statements to address, and 
“Sometimes” if there are no “Often” statements to address). 
 Help them decide which new goal they would like to add for the coming week. 
 Summarize to confirm their new goal. For example, you could say: 
“OK, let me see if I got this straight. Last week, you … [repeat last week’s goal]. You did well 
with that, so this week, you’ll … [repeat this week’s goal]. Did I get that right?” 
 
 If they were not able to meet their medication goal, then let them stick to the same goal. 
 Be supportive, and let them know you’ll revisit the goal next week to see how it went this time. 
 Strategize what they will do differently this week to succeed. Make sure it is a SMART goal. 
 OK, even though the program is over today, you can continue setting goals for yourself to 
continue taking your medications every day. So, what would you like to do next to help you 
get the most out of your medications?  
 
 OK, let’s think about how hard this may be to do. What are some things that might make it 
hard for you to carry out this plan? Write down barriers. 
 OK, what do you think you can do to overcome these things? Help clients think of possible 
solutions to these barriers, and write down those solutions. 
 OK, let’s review that. It looks like you’ll… repeat the new medication goal. Then, review 
potential barriers and how client will go around those barriers. Let client confirm. 
 OK, let’s think about how hard this may be to do. What are some things that might make it 
hard for you to carry out this plan? Write down barriers in the left column in the box below. 
 OK, what do you think you can do to overcome these things? Help clients think of possible 
solutions to these barriers, and write those solutions in the right column in the box below. 
 This is a great plan! 
 
 
 
 
 
 
 
 
Appendix Page |  189

 
150
 Discuss how this went and provide encouragement and praise. If 
client was not able to take another step, discuss together what 
happened. Check the correct box below: 
 Did not evaluate goal after 1st week 
 Evaluated goal after 1st week, did not increase goal for 2nd 
week 
 Evaluated goal after 1st week, increased goal for 2nd week 
 
 
 
New healthy eating goal for 2nd week, if client increased goal: 
 Discuss how this went and provide encouragement and praise. If 
client was not able to take another step, discuss together what 
happened. Check the correct box below: 
 Did not evaluate goal after 2nd week 
 Evaluated goal after 2nd week, did not increase goal for 
3rd week 
 Evaluated goal after 2nd week, increased goal for 3rd week 
 
 
 
New healthy eating goal for 3rd week, if client increased goal: 
Homework #2: Healthy Eating 
 OK, let’s talk about how your healthy eating went during the first 
week. How did it go on Day 1? For each day, check “yes” or 
“no” for the Healthy Eating column. 
 
 Great! Now, during the second week, were you able to take 
another step to eat more healthy? 
 
 
 
 
 
 
 OK, let’s take a look at how you did with healthy eating during the 
second week. How did it go on Day 1 of the second week? 
For each day, check “yes” or “no” for the Healthy Eating 
column.  
 
 Great! Now, during the third week, were you able to take 
another step to eat more healthy? 
 
 
Week 1
Week 2
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151
 Discuss how this went and provide encouragement and praise. If 
client was not able to take another step, discuss together what 
happened. Check the correct box below: 
 Did not evaluate goal after 3rd week 
 Evaluated goal after 3rd week, did not increase goal for 4th 
week 
 Evaluated goal after 3rd week, increased goal for 4th week 
 
 
 
New healthy eating goal for 4th week, if client increased goal: 
 OK, let’s talk about how your healthy eating went during the third 
week. How did it go on Day 1? For each day, check “yes” or 
“no” for the Healthy Eating column. 
 
 Great! Now, during the fourth week, were you able to take 
another step to eat more healthy? 
 
 
 
 
 
 
 OK, let’s take a look at how you did with healthy eating during the 
fourth week. How did it go on Day 1? For each day, check 
“yes” or “no” for the Healthy Eating column.  
 
 Great! Now, the last time we made a plan to help you eat 
healthy every day, you planned to… [go to Client Plan Book 
and read out loud the healthy eating goal the client chose to 
work on last time]. 
 You thought that it might be hard for you to carry out this 
plan, because… [read potential barriers]. 
 To go around the problem, you decided to… [read how client 
decided to go around potential barriers].  
 Now, during the first week, you were able to… [based on 
what client told you about Week 1, describe what happened]. 
 During the second week, you were able to… [based on what client told you about Week 2, 
describe what happened]. 
 During the third week, you were able to… [based on what client told you about Week 3, 
describe what happened]. 
 During the fourth week, you were able to… [based on what client told you about Week 4, 
describe what happened]. 
Week 3
Week 4
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152
 Discuss how this went and provide encouragement and praise. If 
client was not able to take another step, discuss together what 
happened. Check the correct box below: 
o Did not evaluate goal after 1st week 
o Evaluated goal after 1st week, did not increase goal for 2nd week 
o Evaluated goal after 1st week, increased goal for 2nd week 
 
 
 
Notes and new exercise goal for 2nd week, if client increased goal: 
 If they met their healthy eating goal, 
 Explore if they are ready to add another goal this week. Ask them to turn to page 6 in their 
Activity Book and look at the chart. Help them decide which new goal they would like to add for 
the coming week. 
 Summarize to confirm their new goal. For example, you could say: 
“OK, let me see if I got this straight. Last week, you … [repeat last week’s goal]. You did well 
with that, so now you’d like to add another healthy eating goal. So, this week, you’ll … 
[repeat this week’s goal]. Did I get that right?” 
 If they were not able to meet their healthy eating goal, 
 Let client stick to the same eating goal, but be sure to modify the plan if needed. 
 OK, even though the program is over today, you can continue setting goals for yourself to 
continue eating healthy every day. So, what would you like to do next to eat healthy?  
 
 OK, let’s think about how hard this may be to do. What are some things that might make it 
hard for you to carry out this plan? Write down potential barriers. 
 OK, what do you think you can do to overcome these things? Help clients think of possible 
solutions to these barriers, and write down those solutions. 
 This is a great plan! 
 
Homework #3: Physical Activity 
 Now, let’s talk about how your exercise went during the first 
week. How much exercise were you able to do on Day 1? For 
each day, write down number of minutes. 
 
 Great! Now, during the second week, were you able to take 
another step to become more physically active? 
 
 
 
Week 1
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153
 Discuss how this went and provide encouragement and praise. If 
client was not able to take another step, discuss together what 
happened. Check the correct box below: 
o Did not evaluate goal after 2nd week 
o Evaluated goal after 2nd week, did not increase goal for 3rd 
week 
o Evaluated goal after 2nd week, increased goal for 3rd week 
 
 
 
Notes and new exercise goal for 2nd week, if client increased goal: 
 Discuss how this went and provide encouragement and praise. If 
client was not able to take another step, discuss together what 
happened. Check the correct box below: 
o Did not evaluate goal after 3rd week 
o Evaluated goal after 3rd week, did not increase goal for 4th week 
o Evaluated goal after 3rd week, increased goal for 4th week 
 
 
 
Notes and new exercise goal for 2nd week, if client increased goal: 
 OK, let’s take a look at how you did with exercise during the second week. How did it go on 
Day 1 of the second week? For each day, write down number of minutes. 
 
 Great! Now, during the third week, were you able to take 
another step to become more physically active? 
 
 
 
 
 OK, let’s take a look at how you did with exercise during the third week. How did it go on 
Day 1 of the third week? For each day, write down number of minutes. 
 
 Great! Now, during the fourth week, were you able to take 
another step to become more physically active 
 
Week 2
Week 3
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154
 OK, let’s take a look at how you did with exercise during the fourth week. How did it go on 
Day 1 of the fourth week? For each day, write down number of minutes. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 Great! Now, the last time we made a plan to help you exercise every day, you planned to… 
[go to Client Plan Book and read out loud the exercise goal the client chose to work on last 
time]. 
 You thought that it might be hard for you to carry out this plan, because… [read potential 
barriers]. 
 To go around the problem, you decided to… [read how client decided to go around potential 
barriers].  
 Now, during the first week, you were able to… [based on what client told you about Week 1, 
describe what happened]. 
 During the second week, you were able to… [based on what client told you about Week 2, 
describe what happened]. 
 During the third week, you were able to… [based on what client told you about Week 3, 
describe what happened]. 
 During the fourth week, you were able to… [based on what client told you about Week 4, 
describe what happened]. 
 
 
 
Week 4
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155
If you and your client talked about high blood pressure during the previous session: 
 Go to Homework #4: High Blood Pressure on page 156 in your manual. 
 Once you’re finished, continue with the session on page 157. 
 
If you and your client talked about high cholesterol during the previous session: 
 Go to Homework #5: High Cholesterol on page 156 in your manual. 
 Once you’re finished, continue with the session on page 157. 
 
If you and your client talked about high blood pressure and high cholesterol during the 
previous session: 
 Go to Homework #4: High Blood Pressure on page 156 in your manual. 
 Then, continue on to Homework #5: High Cholesterol on the same page. 
 Once you’re finished, continue with the session on page 157. 
 
If your client’s blood pressure and cholesterol were under control and you didn’t set goals 
during the previous session, then continue with the session on page 157 in your manual. 
 If they met their goal and were doing less than 30 minutes per day, 5 days per week, then explore if 
they are ready to add another 5 minutes. 
 If they are not comfortable with immediately advancing the goal, let them stick to the same goal. 
Remind them that the eventual goal is 30 minutes per day. 
 If they were not able to meet their goal, 
 Let client stick to the same goal, but be sure to modify the plan if needed. 
 Summarize. For example, say: OK, let me see if I got this straight. Last week, you [repeat last week’s 
goal], and you did pretty well with that, so now you’d like to add another 5 minutes each day. That 
means that, this week, you’d like to [repeat this week’s goal]. Did I get that right? 
 OK, even though the program is over today, you can continue setting goals for yourself to 
continue being physically active. So, what would you like to do next for exercise? 
 
 OK, let’s think about how hard this may be to do. What are some things that might make it 
hard for you to carry out this plan? Write down potential barriers. 
 OK, what do you think you can do to overcome these things? Help clients think of possible 
solutions to these barriers, and write down those solutions. 
 This is a great plan! 
 
 
 
 
 
 
 
 
 
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156
 Listen supportively and praise client’s effort in the past week. 
 Encourage client to continue working with their doctor to control their blood pressure. 
 If they are taking medication for their blood pressure, tell them that the strategies they have used to 
take their diabetes medication can also help them take their blood pressure medication. 
 If needed, remind client that controlling blood pressure is important for reducing their chances of 
developing serious illnesses such as heart attack, stroke, dialysis, and blindness. Medications can 
help them live longer and stay independent by lowering their risk for such health problems. 
Notes: 
 Listen supportively and praise client’s effort in the past week. 
 Encourage client to continue working with their doctor to control their cholesterol. 
 If they are taking medication for their cholesterol, tell them that the strategies they have used to take 
their diabetes medication can also help them take their cholesterol medication. 
 If needed, remind client that controlling cholesterol is important for reducing their chances of 
developing serious illnesses such as heart attack and stroke. Medications can help them live longer 
and stay independent by lowering their risk for such health problems. 
Notes: 
Homework #4: High Blood Pressure (only if client is on medicine for high blood pressure or 
should have talked to doctor about starting treatment) 
 Now, I’d like to follow up on the talk we had last time about your high blood pressure. 
 Last week, you wanted to… [review your notes from page 142 in your manual]. 
 Now, how did it go? 
 
Homework #5: High Cholesterol Plan (only if client is on medicine for high cholesterol or 
should have talked to doctor about starting treatment) 
 Now, I’d like to follow up on the talk we had last time about your high cholesterol. 
 Last week, you wanted to… [review your notes from page 142 in your manual]. 
 Now, how did it go? 
 
 
Appendix Page |  196

 
157
Homework and Wrapping Up --------------------------------------------------------------------------- 
 You have been doing a wonderful job with the three-legged stool! And keeping track of your 
progress is very helpful for seeing how well you’re doing with this. 
 I know that we talked a few sessions ago about how eating healthy, being physically active, 
and taking your medications are helping you right now and helping you stay well so that you 
can achieve your goals down the line. Have you thought any more about that since we 
talked? If needed, share with client your own day-to-day efforts to live a healthy, active life 
and how that effort is paying off now, because you are able to do the things that you need to 
do right now, and paying off later, because you will be able to accomplish things that matter 
to you and be there for important events in the future. 
 I just want to tell you I’m so proud of the great work you have done in this program. 
 Now that you have completed the program, you’ll be in charge of your own homework from 
here on out! 
 You can continue to use the Activity Book if you find it helpful. 
 Also, research has shown that monitoring yourself, like the way you’ve been keeping track 
of your homework, can help you improve more than if you don’t monitor yourself. 
 If you turn to page 32 in your Activity Book, you can see that there are a lot more pages for 
you to use if you want to keep track of your homework. 
 Now that you know what to do, you can monitor on your own. 
 Also, your Health Buddy can help you with this, much like I did. 
 Now, you may stop keeping track of your homework and find yourself not taking care of 
your three-legged stool. 
 If that happens, then it may be helpful to keep track of your healthy eating, physical activity, 
and medications every day, just like you did during the program. 
 Don’t forget to reach out to your doctor if you have trouble taking care of any part of the 
three-legged stool, especially if you have trouble with your medications. 
 Just remember that taking care of the three-legged stool will help you live well now and live 
well in the future, so that you can accomplish things that are important to you, like [repeat 
long-term goals from page 3 in the Client Plan Book]. 
 Now, the study staff will be in touch to talk with you again within the next month. 
 Do you have any questions? Give client chance to ask questions. 
 I hope this program has helped you. It’s been a pleasure to work with you! 
 
 
 
 
 
 
 
 
Check In 
completed ______/______/______ 
      month              day               year 
_______/______ 
    start time         end time 
______ 
peer initials 
 
 
 
Appendix Page |  197

Peer Advisor’s Program Tools  
(Client Plan Book) 
 
Appendix Page |  198

Living Well with Diabetes – Client Plan Book 
 
Client Name: 
 
 
 
 
Peer Advisor Name: 
Notes: 
 
 
 
 
 
 
Table of Contents 
 
Client A1c, Blood Pressure, and Cholesterol  
 
 
 
 
 
page 2 
Client Long-term Goals   
 
 
 
 
 
 
 
 
page 3 
Diabetes Medications 
 
 
 
 
 
 
 
 
 
page 4 
Plan for Diabetes Medication Side Effects and/or Cost 
 
 
 
 
page 5 
Diabetes Medications – Other Barriers 
 
 
 
 
 
 
page 8 
Plan for Other Diabetes Medication Barriers  
 
 
 
 
 
page 9 
Client Healthy Eating Assessment 
 
 
 
 
 
 
 
page 12 
Plan for Healthy Eating  
 
 
 
 
 
 
 
 
page 13 
Plan for Physical Activity 
 
 
 
 
 
 
 
 
page 16 
Blood Pressure Medications 
 
 
 
 
 
 
 
 
page 19 
Plan for Blood Pressure: 
Not taking any, or Missing Doses Due to Side Effects or Cost 
 
 
page 20 
Plan for Blood Pressure Medications: 
No Issues with Side Effects or Cost, but Not Taking Medicine Correctly 
page 21 
Plan for Blood Pressure: 
Taking Correctly, but Blood Pressure Still High 
 
 
 
 
page 22 
Cholesterol Medications  
 
 
 
 
 
 
 
 
page 23 
Plan for Cholesterol 
Not taking any, or Missing Doses Due to Side Effects or Cost 
 
 
page 24 
Plan for Cholesterol: 
No Issues with Side Effects or Cost, but Not Taking Medicine Correctly 
page 25 
Plan for Cholesterol: 
Taking Correctly, but Cholesterol Still High  
 
 
 
 
page 26 
Examples of strategies to overcome each medication barrier 
 
 
 
page 27 
 
Appendix Page |  199

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3
Client Long-Term Goals 
 
-------Long-Term Goals--------------------------------------------------------------------------- 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Appendix Page |  201

  
4
Diabetes Medication Name 
Dose, Frequency , and Other 
Instructions 
Taking as 
Prescribed? 
1. 
 
 
 
 
 
 
Yes 
 
No 
 
 
Side effects?         Yes                No   
                               
If yes, what’s the side effect? 
 
 
Is the side effect causing missed doses? 
                             Yes                No   
                               
Is medicine            Yes             No  
affordable?  
 
Notes: 
Notes: 
 
2. 
 
 
 
 
 
 
Yes 
 
No 
 
Side effects?         Yes                No   
                               
If yes, what’s the side effect? 
 
 
Is the side effect causing missed doses? 
                             Yes                No   
                               
Is medicine            Yes             No  
affordable?  
 
Notes: 
Notes: 
 
3. 
 
 
 
 
 
 
Yes 
 
No 
 
Side effects?         Yes                No   
                               
If yes, what’s the side effect? 
 
 
Is the side effect causing missed doses? 
                             Yes                No   
                               
Is medicine            Yes             No  
affordable?  
 
Notes: 
Notes: 
 
4. 
 
 
 
 
 
 
Yes 
 
No 
 
Side effects?         Yes                No   
                               
If yes, what’s the side effect? 
 
 
Is the side effect causing missed doses? 
                             Yes                No   
                               
Is medicine            Yes             No  
affordable?  
 
Notes: 
Notes: 
   
Appendix Page |  202

  
5
Plan for Diabetes Medication Side Effects and/or Cost 
Date of plan (mm/dd/yy): 
Who is calling the doctor: 
 
 
When (day and time): 
What the client will say to the doctor: 
 
 
 
 
 
Potential barrier(s) to carrying out this plan: 
 
 
 
 
 
What client will do instead to get around barrier(s): 
 
 
Date of plan (mm/dd/yy): Who is calling the doctor: 
 
 
When (day and time): 
What the client will say to the doctor: 
 
 
 
 
 
Potential barrier(s) to carrying out this plan: 
 
 
 
 
 
What client will do instead to get around barrier(s): 
 
 
Date of plan (mm/dd/yy): Who is calling the doctor: 
 
 
When (day and time): 
What the client will say to the doctor: 
 
 
 
 
 
Potential barrier(s) to carrying out this plan: 
 
 
 
 
 
What client will do instead to get around barrier(s): 
 
 
Appendix Page |  203

  
6
Plan for Diabetes Medication Side Effects and/or Cost (Continued – page 2) 
Date of plan (mm/dd/yy): 
Who is calling the doctor: 
 
 
When (day and time): 
What the client will say to the doctor: 
 
 
 
 
 
Potential barrier(s) to carrying out this plan: 
 
 
 
 
 
What client will do instead to get around barrier(s): 
 
 
Date of plan (mm/dd/yy): Who is calling the doctor: 
 
 
When (day and time): 
What the client will say to the doctor: 
 
 
 
 
 
Potential barrier(s) to carrying out this plan: 
 
 
 
 
 
What client will do instead to get around barrier(s): 
 
 
Date of plan (mm/dd/yy): Who is calling the doctor: 
 
 
When (day and time): 
What the client will say to the doctor: 
 
 
 
 
 
Potential barrier(s) to carrying out this plan: 
 
 
 
 
 
What client will do instead to get around barrier(s): 
 
 
Appendix Page |  204

  
7
Plan for Diabetes Medication Side Effects and/or Cost (Continued – page 3) 
Date of plan (mm/dd/yy): 
Who is calling the doctor: 
 
 
When (day and time): 
What the client will say to the doctor: 
 
 
 
 
 
Potential barrier(s) to carrying out this plan: 
 
 
 
 
 
What client will do instead to get around barrier(s): 
 
 
Date of plan (mm/dd/yy): Who is calling the doctor: 
 
 
When (day and time): 
What the client will say to the doctor: 
 
 
 
 
 
Potential barrier(s) to carrying out this plan: 
 
 
 
 
 
What client will do instead to get around barrier(s): 
 
 
Date of plan (mm/dd/yy): Who is calling the doctor: 
 
 
When (day and time): 
What the client will say to the doctor: 
 
 
 
 
 
Potential barrier(s) to carrying out this plan: 
 
 
 
 
 
What client will do instead to get around barrier(s): 
 
 
 
Appendix Page |  205

  
8
Diabetes Medications – Other Barriers 
 
   
Never 
Rarely 
Sometimes 
Often 
Very 
often 
I just forget to take my diabetes medicine. 
1 
2 
3 
4 
5 
I forgot to fill my diabetes prescription in time. 
1 
2 
3 
4 
5 
I don’t know what dose of my diabetes medicine 
to take. 
1 
2 
3 
4 
5 
I’m not sure exactly what each medicine is for. 
1 
2 
3 
4 
5 
There are too many doses of my diabetes 
medicine to take each day 
1 
2 
3 
4 
5 
It’s too hard to keep track of what I am supposed 
to take when. 
1 
2 
3 
4 
5 
My diabetes medicine are unpleasant to take. 
1 
2 
3 
4 
5 
I have heard about side effects from diabetes 
medicines that I am afraid I might get. 
1 
2 
3 
4 
5 
Getting to the pharmacy to pick up my diabetes 
medicine is difficult. 
1 
2 
3 
4 
5 
The pharmacy could not fill my diabetes 
prescription. 
1 
2 
3 
4 
5 
My doctor or nurse forgot to write a new diabetes 
prescription. 
1 
2 
3 
4 
5 
I ran out of diabetes medication before I could 
call or visit my doctor or nurse. 
1 
2 
3 
4 
5 
I don’t have enough time to talk with my doctor or 
nurse about problems I am having with my 
diabetes medicines. 
1 
2 
3 
4 
5 
I sometimes forget to ask my doctor or nurse 
about problems that I am having with my diabetes 
medicines. 
1 
2 
3 
4 
5 
I don’t feel my diabetes medicines are helping 
me. 
1 
2 
3 
4 
5 
I just don’t like taking medicines in general. 
1 
2 
3 
4 
5 
Taking diabetes medicines makes my health 
worse. 
1 
2 
3 
4 
5 
I sometimes find it hard to ask my doctor or nurse 
questions about my diabetes medications. 
1 
2 
3 
4 
5 
If my blood sugar is normal in the morning, I don’t 
take my diabetes medications. 
1 
2 
3 
4 
5 
 
 
 
Appendix Page |  206

  
9
 
Plan for Other Diabetes Medication Barriers 
Date of plan (mm/dd/yy): 
Issue: 
 
 
Write down the strategy that the client wants to try to overcome the issue. Make sure it’s a SMART plan 
(specific, measurable, achievable, relevant, and time-bound): 
 
 
 
Potential barrier(s) to carrying out this plan: 
 
 
 
 
 
What client will do instead to get around 
barrier(s): 
 
 
Date of plan (mm/dd/yy): 
Issue: 
 
 
Write down the strategy that the client wants to try to overcome the issue. Make sure it’s a SMART plan 
(specific, measurable, achievable, relevant, and time-bound): 
 
 
 
Potential barrier(s) to carrying out this plan: 
 
 
 
 
 
What client will do instead to get around 
barrier(s): 
 
 
Date of plan (mm/dd/yy): 
Issue: 
 
 
Write down the strategy that the client wants to try to overcome the issue. Make sure it’s a SMART plan 
(specific, measurable, achievable, relevant, and time-bound): 
 
 
 
Potential barrier(s) to carrying out this plan: 
 
 
 
 
 
What client will do instead to get around 
barrier(s): 
 
 
 
 
Appendix Page |  207

  
10
 
Plan for Other Diabetes Medication Barriers (Continued – page 2) 
Date of plan (mm/dd/yy): 
Issue: 
 
 
Write down the strategy that the client wants to try to overcome the issue. Make sure it’s a SMART plan 
(specific, measurable, achievable, relevant, and time-bound): 
 
 
 
 
Potential barrier(s) to carrying out this plan: 
 
 
 
 
 
What client will do instead, or get around 
barrier(s): 
 
 
Date of plan (mm/dd/yy): 
Issue: 
 
 
Write down the strategy that the client wants to try to overcome the issue. Make sure it’s a SMART plan 
(specific, measurable, achievable, relevant, and time-bound): 
 
 
 
 
Potential barrier(s) to carrying out this plan: 
 
 
 
 
 
What client will do instead, or get around 
barrier(s): 
 
 
Date of plan (mm/dd/yy): 
Issue: 
 
 
Write down the strategy that the client wants to try to overcome the issue. Make sure it’s a SMART plan 
(specific, measurable, achievable, relevant, and time-bound): 
 
 
 
 
Potential barrier(s) to carrying out this plan: 
 
 
 
 
 
What client will do instead, or get around 
barrier(s): 
 
Appendix Page |  208

  
11
 
Plan for Other Diabetes Medication Barriers (Continued – page 3) 
Date of plan (mm/dd/yy): 
Issue: 
 
 
Write down the strategy that the client wants to try to overcome the issue. Make sure it’s a SMART plan 
(specific, measurable, achievable, relevant, and time-bound): 
 
 
 
 
Potential barrier(s) to carrying out this plan: 
 
 
 
 
 
What client will do instead, or get around 
barrier(s): 
 
 
Date of plan (mm/dd/yy): 
Issue: 
 
 
Write down the strategy that the client wants to try to overcome the issue. Make sure it’s a SMART plan 
(specific, measurable, achievable, relevant, and time-bound): 
 
 
 
 
Potential barrier(s) to carrying out this plan: 
 
 
 
 
 
What client will do instead, or get around 
barrier(s): 
 
 
Date of plan (mm/dd/yy): 
Issue: 
 
 
Write down the strategy that the client wants to try to overcome the issue. Make sure it’s a SMART plan 
(specific, measurable, achievable, relevant, and time-bound): 
 
 
 
 
Potential barrier(s) to carrying out this plan: 
 
 
 
 
 
What client will do instead, or get around 
barrier(s): 
 
Appendix Page |  209

  
12
Note: If yesterday was an unusual day (for example, they were traveling), then ask client to think back to 
the last normal day and what they ate then. 
Client Healthy Eating Assessment 
 
 
 
 
Breakfast 
Lunch 
Dinner 
Snack 
Total Goal 
Number of second helpings of meat or 
starch 
 
 
 
 
 
0 
Number of fruits 
 
 
 
 
 
3-4 
Number of vegetables 
 
 
 
 
 
3-4 
Number of sugar-sweetened drinks 
 
 
 
 
 
0 
Number of desserts 
 
 
 
 
 
0-1 
Number of servings of fried foods 
 
 
 
 
 
0 
 
 
 
 
Appendix Page |  210

  
13
 
Plan for Healthy Eating 
Date of plan (mm/dd/yy): 
 
Write down the strategy that the client wants to try to improve their healthy eating. Make sure it’s a SMART 
goal (specific, measurable, achievable, relevant, and time-bound): 
 
 
 
 
Meal(s) of the day:                                                           Days of the week: 
Potential barrier(s) to carrying out this plan: 
 
 
 
 
 
What client will do instead to get around barrier(s): 
 
 
Date of plan (mm/dd/yy): 
 
Write down the strategy that the client wants to try to improve their healthy eating. Make sure it’s a SMART 
goal (specific, measurable, achievable, relevant, and time-bound): 
 
 
 
 
Meal(s) of the day:                                                           Days of the week: 
Potential barrier(s) to carrying out this plan: 
 
 
 
 
 
What client will do instead to get around barrier(s): 
 
 
Date of plan (mm/dd/yy): 
 
Write down the strategy that the client wants to try to improve their healthy eating. Make sure it’s a SMART 
goal (specific, measurable, achievable, relevant, and time-bound): 
 
 
 
 
Meal(s) of the day:                                                           Days of the week: 
Potential barrier(s) to carrying out this plan: 
 
 
 
 
 
What client will do instead to get around barrier(s): 
 
Appendix Page |  211

  
14
Plan for Healthy Eating (Continued – page 2) 
Date of plan (mm/dd/yy): 
 
Write down the strategy that the client wants to try to improve their healthy eating. Make sure it’s a SMART 
goal (specific, measurable, achievable, relevant, and time-bound): 
 
 
 
 
Meal(s) of the day:                                                           Days of the week: 
Potential barrier(s) to carrying out this plan: 
 
 
 
 
 
What client will do instead to get around barrier(s): 
 
 
Date of plan (mm/dd/yy): 
 
Write down the strategy that the client wants to try to improve their healthy eating. Make sure it’s a SMART 
goal (specific, measurable, achievable, relevant, and time-bound): 
 
 
 
 
Meal(s) of the day:                                                           Days of the week: 
Potential barrier(s) to carrying out this plan: 
 
 
 
 
 
What client will do instead to get around barrier(s): 
 
 
Date of plan (mm/dd/yy): 
 
Write down the strategy that the client wants to try to improve their healthy eating. Make sure it’s a SMART 
goal (specific, measurable, achievable, relevant, and time-bound): 
 
 
 
 
Meal(s) of the day:                                                           Days of the week: 
Potential barrier(s) to carrying out this plan: 
 
 
 
 
 
What client will do instead to get around barrier(s): 
 
Appendix Page |  212

  
15
Plan for Healthy Eating (Continued – page 3) 
Date of plan (mm/dd/yy): 
 
Write down the strategy that the client wants to try to improve their healthy eating. Make sure it’s a SMART 
goal (specific, measurable, achievable, relevant, and time-bound): 
 
 
 
 
Meal(s) of the day:                                                           Days of the week: 
Potential barrier(s) to carrying out this plan: 
 
 
 
 
 
What client will do instead to get around barrier(s): 
 
 
Date of plan (mm/dd/yy): 
 
Write down the strategy that the client wants to try to improve their healthy eating. Make sure it’s a SMART 
goal (specific, measurable, achievable, relevant, and time-bound): 
 
 
 
 
Meal(s) of the day:                                                           Days of the week: 
Potential barrier(s) to carrying out this plan: 
 
 
 
 
 
What client will do instead to get around barrier(s): 
 
 
Date of plan (mm/dd/yy): 
 
Write down the strategy that the client wants to try to improve their healthy eating. Make sure it’s a SMART 
goal (specific, measurable, achievable, relevant, and time-bound): 
 
 
 
 
Meal(s) of the day:                                                           Days of the week: 
Potential barrier(s) to carrying out this plan: 
 
 
 
 
 
What client will do instead to get around barrier(s): 
 
 
Appendix Page |  213

  
16
 
Plan for Physical Activity 
 
 
Date of plan (mm/dd/yy): 
Current exercise (what is it and how much): 
 
 
 
What client will do this week: 
 
 
 
Where client will do it: 
 
When during the day: 
 
 
How many minutes each time: 
Which days of the week: 
Potential barrier(s) to carrying out this plan: 
 
 
 
 
 
What client will do instead to get around barrier(s): 
 
 
Date of plan (mm/dd/yy): 
 
What client will do this week: 
 
 
 
Where client will do it: 
 
When during the day: 
 
 
How many minutes each time: 
Which days of the week: 
Potential barrier(s) to carrying out this plan: 
 
 
 
 
 
What client will do instead to get around barrier(s): 
 
 
Date of plan (mm/dd/yy): 
 
What client will do this week: 
 
 
 
Where client will do it: 
 
When during the day: 
 
 
How many minutes each time: 
Which days of the week: 
Potential barrier(s) to carrying out this plan: 
 
 
 
 
 
What client will do instead to get around barrier(s): 
 
 
Appendix Page |  214

  
17
Plan for Physical Activity (Continued – page 2) 
Date of plan (mm/dd/yy): 
 
What client will do this week: 
 
 
 
Where client will do it: 
 
When during the day: 
 
 
How many minutes each time: 
Which days of the week: 
Potential barrier(s) to carrying out this plan: 
 
 
 
 
 
What client will do instead to get around barrier(s): 
 
 
Date of plan (mm/dd/yy): 
 
What client will do this week: 
 
 
 
Where client will do it: 
 
When during the day: 
 
 
How many minutes each time: 
Which days of the week: 
Potential barrier(s) to carrying out this plan: 
 
 
 
 
 
What client will do instead to get around barrier(s): 
 
 
Date of plan (mm/dd/yy): 
 
What client will do this week: 
 
 
 
Where client will do it: 
 
When during the day: 
 
 
How many minutes each time: 
Which days of the week: 
Potential barrier(s) to carrying out this plan: 
 
 
 
 
 
What client will do instead to get around barrier(s): 
 
 
Appendix Page |  215

  
18
Plan for Physical Activity (Continued – page 3) 
Date of plan (mm/dd/yy): 
 
What client will do this week: 
 
 
 
Where client will do it: 
 
When during the day: 
 
 
How many minutes each time: 
Which days of the week: 
Potential barrier(s) to carrying out this plan: 
 
 
 
 
 
What client will do instead to get around barrier(s): 
 
 
Date of plan (mm/dd/yy): 
 
What client will do this week: 
 
 
 
Where client will do it: 
 
When during the day: 
 
 
How many minutes each time: 
Which days of the week: 
Potential barrier(s) to carrying out this plan: 
 
 
 
 
 
What client will do instead to get around barrier(s): 
 
 
Date of plan (mm/dd/yy): 
 
What client will do this week: 
 
 
 
Where client will do it: 
 
When during the day: 
 
 
How many minutes each time: 
Which days of the week: 
Potential barrier(s) to carrying out this plan: 
 
 
 
 
 
What client will do instead to get around barrier(s): 
 
 
Appendix Page |  216

  
19
Blood Pressure Medication Name 
Dose, Frequency , and Other 
Instructions 
Taking as 
Prescribed? 
1. 
 
 
 
 
 
 
Yes 
 
No 
 
 
Side effects?         Yes                No   
                               
If yes, what’s the side effect? 
 
 
Is the side effect causing missed doses? 
                             Yes                No   
                               
Is medicine            Yes             No  
affordable?  
 
Notes: 
Notes: 
 
2. 
 
 
 
 
 
 
Yes 
 
No 
 
Side effects?         Yes                No   
                               
If yes, what’s the side effect? 
 
 
Is the side effect causing missed doses? 
                             Yes                No   
                               
Is medicine            Yes             No  
affordable?  
 
Notes: 
Notes: 
 
3. 
 
 
 
 
 
 
Yes 
 
No 
 
Side effects?         Yes                No   
                               
If yes, what’s the side effect? 
 
 
Is the side effect causing missed doses? 
                             Yes                No   
                               
Is medicine            Yes             No  
affordable?  
 
Notes: 
Notes: 
 
4. 
 
 
 
 
 
 
Yes 
 
No 
 
Side effects?         Yes                No   
                               
If yes, what’s the side effect? 
 
 
Is the side effect causing missed doses? 
                             Yes                No   
                               
Is medicine            Yes             No  
affordable?  
 
Notes: 
Notes: 
 
Appendix Page |  217

  
20
Plan for Blood Pressure – Not taking any, or Missing doses due to side effects or cost 
Date of plan (mm/dd/yy): 
Who is calling the doctor: 
 
 
When (day and time): 
What the client will say to the doctor: 
 
 
 
 
 
Potential barrier(s) to carrying out this plan: 
 
 
 
 
 
What client will do instead, or get around barrier(s): 
 
 
Date of plan (mm/dd/yy): Who is calling the doctor: 
 
 
When (day and time): 
What the client will say to the doctor: 
 
 
 
 
 
Potential barrier(s) to carrying out this plan: 
 
 
 
 
 
What client will do instead, or get around barrier(s): 
 
 
Date of plan (mm/dd/yy): Who is calling the doctor: 
 
 
When (day and time): 
What the client will say to the doctor: 
 
 
 
 
 
Potential barrier(s) to carrying out this plan: 
 
 
 
 
 
What client will do instead, or get around barrier(s): 
 
 
Appendix Page |  218

  
21
 
Plan for Blood Pressure Medications – No Issues with Side Effects or Cost, but Not 
Taking Medicine Correctly 
Date of plan (mm/dd/yy): 
Issue: 
 
 
Write down the strategy that the client wants to try to overcome the issue. Make sure it’s a SMART plan 
(specific, measurable, achievable, relevant, and time-bound): 
 
 
 
Potential barrier(s) to carrying out this plan: 
 
 
 
 
 
What client will do instead, or get around 
barrier(s): 
 
 
Date of plan (mm/dd/yy): 
Issue: 
 
 
Write down the strategy that the client wants to try to overcome the issue. Make sure it’s a SMART plan 
(specific, measurable, achievable, relevant, and time-bound): 
 
 
 
Potential barrier(s) to carrying out this plan: 
 
 
 
 
 
What client will do instead, or get around 
barrier(s): 
 
 
Date of plan (mm/dd/yy): 
Issue: 
 
 
Write down the strategy that the client wants to try to overcome the issue. Make sure it’s a SMART plan 
(specific, measurable, achievable, relevant, and time-bound): 
 
 
 
Potential barrier(s) to carrying out this plan: 
 
 
 
 
 
What client will do instead, or get around 
barrier(s): 
 
 
 
Appendix Page |  219

  
22
Plan for Blood Pressure – Taking Correctly, but Blood Pressure Still High 
Date of plan (mm/dd/yy): 
Who is calling the doctor: 
 
 
When (day and time): 
What the client will say to the doctor: 
 
 
 
 
 
Potential barrier(s) to carrying out this plan: 
 
 
 
 
 
What client will do instead, or get around barrier(s): 
 
 
Date of plan (mm/dd/yy): Who is calling the doctor: 
 
 
When (day and time): 
What the client will say to the doctor: 
 
 
 
 
 
Potential barrier(s) to carrying out this plan: 
 
 
 
 
 
What client will do instead, or get around barrier(s): 
 
 
Date of plan (mm/dd/yy): Who is calling the doctor: 
 
 
When (day and time): 
What the client will say to the doctor: 
 
 
 
 
 
Potential barrier(s) to carrying out this plan: 
 
 
 
 
 
What client will do instead, or get around barrier(s): 
 
 
 
Appendix Page |  220

  
23
Cholesterol Medication Name 
Dose, Frequency , and Other 
Instructions 
Taking as 
Prescribed? 
1. 
 
 
 
 
 
 
Yes 
 
No 
 
 
Side effects?         Yes                No   
                               
If yes, what’s the side effect? 
 
 
Is the side effect causing missed doses? 
                             Yes                No   
                               
Is medicine            Yes             No  
affordable?  
 
Notes: 
Notes: 
 
2. 
 
 
 
 
 
 
Yes 
 
No 
 
Side effects?         Yes                No   
                               
If yes, what’s the side effect? 
 
 
Is the side effect causing missed doses? 
                             Yes                No   
                               
Is medicine            Yes             No  
affordable?  
 
Notes: 
Notes: 
 
3. 
 
 
 
 
 
 
Yes 
 
No 
 
Side effects?         Yes                No   
                               
If yes, what’s the side effect? 
 
 
Is the side effect causing missed doses? 
                             Yes                No   
                               
Is medicine            Yes             No  
affordable?  
 
Notes: 
Notes: 
 
4. 
 
 
 
 
 
 
Yes 
 
No 
 
Side effects?         Yes                No   
                               
If yes, what’s the side effect? 
 
 
Is the side effect causing missed doses? 
                             Yes                No   
                               
Is medicine            Yes             No  
affordable?  
 
Notes: 
Notes: 
 
Appendix Page |  221

  
24
Plan for Cholesterol – Not taking any, or Missing doses due to side effects or cost 
Date of plan (mm/dd/yy): 
Who is calling the doctor: 
 
 
When (day and time): 
What the client will say to the doctor: 
 
 
 
 
 
Potential barrier(s) to carrying out this plan: 
 
 
 
 
 
What client will do instead, or get around barrier(s): 
 
 
Date of plan (mm/dd/yy): Who is calling the doctor: 
 
 
When (day and time): 
What the client will say to the doctor: 
 
 
 
 
 
Potential barrier(s) to carrying out this plan: 
 
 
 
 
 
What client will do instead, or get around barrier(s): 
 
 
Date of plan (mm/dd/yy): Who is calling the doctor: 
 
 
When (day and time): 
What the client will say to the doctor: 
 
 
 
 
 
Potential barrier(s) to carrying out this plan: 
 
 
 
 
 
What client will do instead, or get around barrier(s): 
 
 
Appendix Page |  222

  
25
 
Plan for Cholesterol Medications – No Issues with Side Effects or Cost, but Not Taking 
Medicine Correctly 
Date of plan (mm/dd/yy): 
Issue: 
 
 
Write down the strategy that the client wants to try to overcome the issue. Make sure it’s a SMART plan 
(specific, measurable, achievable, relevant, and time-bound): 
 
 
 
Potential barrier(s) to carrying out this plan: 
 
 
 
 
 
What client will do instead, or get around 
barrier(s): 
 
 
Date of plan (mm/dd/yy): 
Issue: 
 
 
Write down the strategy that the client wants to try to overcome the issue. Make sure it’s a SMART plan 
(specific, measurable, achievable, relevant, and time-bound): 
 
 
 
Potential barrier(s) to carrying out this plan: 
 
 
 
 
 
What client will do instead, or get around 
barrier(s): 
 
 
Date of plan (mm/dd/yy): 
Issue: 
 
 
Write down the strategy that the client wants to try to overcome the issue. Make sure it’s a SMART plan 
(specific, measurable, achievable, relevant, and time-bound): 
 
 
 
Potential barrier(s) to carrying out this plan: 
 
 
 
 
 
What client will do instead, or get around 
barrier(s): 
 
 
 
Appendix Page |  223

  
26
Plan for Cholesterol Medicine – Taking Correctly, but Cholesterol Still High 
Date of plan (mm/dd/yy): 
Who is calling the doctor: 
 
 
When (day and time): 
What the client will say to the doctor: 
 
 
 
 
 
Potential barrier(s) to carrying out this plan: 
 
 
 
 
 
What client will do instead, or get around barrier(s): 
 
 
Date of plan (mm/dd/yy): Who is calling the doctor: 
 
 
When (day and time): 
What the client will say to the doctor: 
 
 
 
 
 
Potential barrier(s) to carrying out this plan: 
 
 
 
 
 
What client will do instead, or get around barrier(s): 
 
 
Date of plan (mm/dd/yy): Who is calling the doctor: 
 
 
When (day and time): 
What the client will say to the doctor: 
 
 
 
 
 
Potential barrier(s) to carrying out this plan: 
 
 
 
 
 
What client will do instead, or get around barrier(s): 
 
 
 
 
Appendix Page |  224

  
27
 
Examples of strategies to overcome each medication barrier: 
1. I just forget to take them:  
weekly pill box, take them at the same time each day (breakfast, brushing 
teeth, etc.), put a reminder on the fridge; if traveling the next day, place 
pills in a pouch or zip lock bag in your purse or your jacket the night 
before 
2. I forgot to fill my prescription in 
time:  
ask the pharmacist if they can call you when it’s time, ask for a 90-day 
supply, ask pharmacy if they have an automatic reminder program that 
can call you or send you a text, ask a family member to keep track of 
your refill date with you; ask family member to pick the medicine up for 
you if you can’t 
3. I don’t know what dose to take:  
have the client read the label to you and go over how to take it; if needed, 
call the doctor together to clarify 
4. I’m not sure exactly what each 
medicine is for:  
go over the medicine together with the client; using the list of medicines 
in the back of your manual, let them know what the medicine is for 
5. There are too many doses to 
take each day:  
go over the dosing schedule (see below box of common 
misunderstandings); if needed, call the doctor to see if there is another 
option that has fewer doses per day; if there are no other options, 
consider pill boxes that have multiple doses per day and tie the medicine 
to a routine (meals, brushing teeth, etc.) 
6. It’s too hard to keep track of 
what I am supposed to take when:  
pill box that you fill once per week; go over the list with the client and 
make sure they understand how to take each one; use color-coding to 
know which medications to take (example: put a red sticker on all 
medicines you’re supposed to take in the morning, put a blue sticker on 
all the medicines you’re supposed to take in the evening; put both red 
and blue stickers on the pill bottle if you’re supposed to take it both AM 
and PM) 
7. They are unpleasant to take:  
take with a strongly flavored drink, drink a lot of water; if having trouble 
swallowing a pill, check with doctor to see if it’s okay to crush it up in 
Jell-O or applesauce; think of a future goal right before you take the 
medicine 
8. I can’t afford them 
Ask the pharmacist for generics or what may be cheaper and then ask 
him to call the doctor, apply for free medications from the drug company 
9. My medicines make me feel bad 
or have side effects I don’t like. 
Talk to the doctor about cutting back the dose, or switching to a cheaper 
medicine 
10. I have heard about side effects 
that I am afraid I might get 
Talk to the pharmacist about how often people get the side effect you are 
afraid of, not everyone gets side effects, it’s possible the side effects you 
heard about are not true – there are a lot of rumors and misinformation 
 
-Reassured client that everyone is different and not everyone has side 
effects; always useful to provide a real world example 
 
-All medicines have side effects/ make sure client is correctly taking the 
Appendix Page |  225

  
28
medication (ex: eating food with medications) 
 
-Reassure the client. Talk through the symptoms of the side effect with 
the client. Tell the client to talk to their pharmacist and doctor if they 
experience any of the side effects 
 
11. Getting to the pharmacy to 
pick them up is difficult 
Ask for a 90 day supply, ask a friend or family member for help, plan 
ahead, use a mail-order pharmacy 
12. The pharmacy could not fill 
my prescription 
Call the pharmacy and find out why – could be they were temporarily out 
of stock, prescription expired and doctor has to renew (by law, 
prescriptions are only filled for 1 year no matter how many refills are 
ordered) 
13. My doctor or nurse forgot to 
write a new prescription 
Call the doctor and ask them to phone it in to the pharmacy 
14. I ran out of medication before I 
could call or visit my doctor or 
nurse 
Plan ahead, ask the pharmacy to set up regular calls before you run out, 
you can call the doctor the same day and they will call the pharmacy that 
day, use a calendar 
15. I don’t have enough time to 
talk with my doctor or nurse about 
problems I am having with my 
medicines. 
Tell the doctor anyway, start with this problem at your next visit (they 
always ask how you are), write things down and show the list to the 
nurse, bring a younger friend or family member who can help you to get 
your problems heard 
 
-Leave a note with the receptionist and nurse to have a doctor call you  
 
-The night before, write down your questions 
 
-prioritize items on the list / questions so that the most important ones are 
covered during visit.  
16. I sometimes forget to ask my 
doctor or nurse about problems 
that I am having with my 
medicines. 
Write it down ahead of the visit, bring the list, bring a friend or family 
member 
17. I don’t feel my medicines are 
helping me 
Learn what the medicine is and is not supposed to do (this program), 
realize that even if the medicine is not controlling your sugar it would be 
even worse off the medicine, the medicines mostly prevent long-term 
complications so it can be hard to know if they are helping without 
talking to the doctor 
 
-Talk to the doctor or nurse or pharmacy, this depends on the client 
-Get the pharmacist’s opinion 
-Talk to them and see if they feel better now than before they started, 
(may have felt bad before the doctor started on the medication and after 
they started the meds they felt better). 
18. I just don’t like taking 
Most people don’t like taking medicine so you’re not alone, years ago 
Appendix Page |  226

  
29
medicine in general. 
people didn’t have these options and complications were a lot more 
common, want to avoid complications, think positive thoughts about you 
long-term goal and that the medicine will help you get there alive and 
well 
 
-Talk about what the client wants to accomplish? Talk about why they 
want to accomplish this 
- emphasis the positive benefits – such as living as long as you can, as 
well as you can 
- provide your personal story as an example – say if you didn’t like 
taking medications and why; and what lead you to believe that 
medications were needed. 
19. Taking medicines makes my 
health worse 
Ask the doctor for a different medicine to minimize side effects, there are 
a lot of different options available nowadays, although you may have 
side effects the medicine is lowering your risks of bad things like stroke 
or dialysis 
 
-Cost-benefit comparison 
-Discussing your numbers with your doctor and relationship with 
medicines 
-Talk to your doctor about alternating medications 
-How and what way does the medicine make health worse, severity of 
the side effects 
-Finding a medicine that works for you à work with you 
-Have a notebook to keep all of your documents 
20. I sometimes find it hard to ask 
my doctor or nurse questions about 
my medications 
Write it down, practice at home, take a friend/family member with you 
 
Appendix Page |  227

Participant Material (Activity Book) 
 
 
Appendix Page |  228

1
Living Well
Diabetes
with
Participant
$FWLYLW\%RRN
Welcome to the Living Well Research Study! 
Please keep this Activity Book with your DVD player in a safe place!
My Peer Advisor’s Name Is: 
Do you have questions? Call...
    Living Well Study’s Birmingham Contact:  
 
 
 
 
 
Living Well Study’s Local Contact:
My Peer Advisor’s Phone Numbers Are:  
$SSHQGL[3DJH_

2
6HVVLRQ
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/LYLQJ:HOOZLWK'LDEHWHV3URJUDP
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 Learn about the Living Well with Diabetes Program
 Review Video 1, “Introduction to Living Well with Diabetes Program”
 Learn about diabetes basics
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3
0\5XOHV
Rules & Responsibilities
Before every call,  
Watch the Video
After every call,  
Homework & Practice
0\3HHU$GYLVRUV5XOHV
 Be on time!
 Tell me if you are not feeling well.
 Participate actively.
 Practice everyday.
 Watch the videos.
 Tell me if you have concerns.
 Be on time!
 Call you regularly during 
the program.
 Help you learn.
 Listen.

I commit to the
       Living Well with Diabetes Program!
Sign Here
Living Well
Diabetes
with
Program Schedule
Month 
1
Session 1: Introduction to Living Well with Diabetes (Today!)
Session 2: Healthy Eating Strategies
Session 3: Physical Activity and Your Health
Session 4: Diabetes Medications
Month 
2
Session 5: Blood Pressure & Cholesterol Medications
Session 6: Stress and Living Well with Diabetes
Check-in
Session 7: Planning for the Future – Part 1
Month 
3
No session this week
Check-in
No session this week
Session 8: Planning for the Future – Part 2
Month 
4
No session this week
No session this week
No session this week
Session 9: Monitoring Our Progress
Month 
5
No session this week
No session this week
No session this week
Session 10: Monitoring Our Progress
Month 
6
No session this week
No session this week
No session this week
Session 11: Final Session
$SSHQGL[3DJH_

4

This Week’s Homework
My next session is: 
I carried out my diabetes medication plan
I watched the Session 2 Video on Healthy Eating
Took My 
       Diabetes Medications?  
Day 1
(today)
    
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
     Yes           No
     Yes           No
     Yes           No
     Yes           No
     Yes           No
     Yes           No
     Yes           No
$SSHQGL[3DJH_

5
6HVVLRQ
+HDOWK\(DWLQJ
6WUDWHJLHV
,Q7RGD\¶V6HVVLRQ

/DVW6HVVLRQ5HYLHZ
 Review last week’s session
 Learn more about healthy eating strategies to live well with diabetes
 Review Video 2 “Healthy Eating Strategies”
 Review what you ate in a day 
 Make a plan to eat healthier
 Review your homework
 Work more on taking your medicines
 ,QIJM\M["JWLaKIV¼\PIVLTMJTWWL[]OIZ
 =VKWV\ZWTTMLLQIJM\M[KI][M[PQOPJTWWL[]OIZ
 =VKWV\ZWTTMLLQIJM\M[W^MZUIVaaMIZ["
 heart attack, heart failure
 stroke
 kidney problems, dialysis
 eye problems, blindness 
 nerve damage, numbness, impotence
 amputation
<ISQVOKIZMWNLQIJM\M[·TW\[_MKIVLW\WZML]KMW]ZKPIVKM[WN
OM\\QVOPMIT\PXZWJTMU[NZWULQIJM\M[¹LQIJM\M[KWUXTQKI\QWV[º
 Eat healthy
 Get enough exercise
 Take medications as prescribed
 Go to the doctor regularly for check-ups
In Most People:  
,QIJM\M[LM^MTWX[W^MZmany years.
,QIJM\M[_WV¼\OWI_Ia
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Remember the 3 Rules for Healthy Eating:
Some examples of starchy foods are...
What did I eat in the past day?
One and Done. 
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Respect the Border
-I\0MIT\Pa
8WZ\QWV[WN.WWL
Rice
Potato
Corn
Bread
Pasta
Be Sweet on Yourself 
-I\TM[[NZQMLNWWL[
IVLLZQVSNM_MZ[]OIZ
[_MM\MVLJM^MZIOM[
ME
Goal
Number of 2nd Helpings 
of Meat or Starch
    
0
Number of Fruits
3 - 4
Number of Vegetables
3 - 4
Number of  
Sugar-Sweetened Drinks
0
Number of Desserts
0 -1
Number of Servings  
of Fried Foods
0
0\*RDO,V
$SSHQGL[3DJH_

7

This Week’s Homework
My next session is: 
I carried out my diabetes medication plan
I carried out my healthy eating plan
I watched the Session 3 Video
Took My 
       Diabetes Medications?  
        Eat Healthy?
Day 1
(today)
    
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
     Yes           No
     Yes           No
     Yes           No
     Yes           No
     Yes           No
     Yes           No
     Yes           No
     Yes           No
     Yes           No
     Yes           No
     Yes           No
     Yes           No
     Yes           No
     Yes           No
$SSHQGL[3DJH_

8
Healthy Grocery Shopping at the Dollar Store

Make a plan. Think about what you need to buy so you can 
make healthy choices for breakfast, lunch, dinner, and snacks.

The stock at the Dollar Store can change often, so make a list 
of the categories of foodaW]VMMLVW\[XMKQÅKNWWL[  
(For example, list “dried fruit”, not “dried apricots”)

Don’t go shopping when you are hungry!
Before You Go Shopping!
Snack Options

Dried fruits and nuts4WWSNWZTW_[IT\WX\QWV[<Za\W_QXMWٺI[
U]KP[IT\I[XW[[QJTMQN aW]KIV¼\ÅVLTW_[IT\WX\QWV[

Baked chips, not fried (remember to eat the correct portion!)

Water is the best drink option! (If  you want soda, get the bottles 
with a cap. Drink half  a cup and save the rest for later.)
During the summer, 
check outside for 
a produce stand. 
Fresh fruits and 
vegetables are much 
tastier than canned!

Canned tuna (canned in water, not oil)

Milk (choose skim or non-fat milk)

Eggs (try scrambling, poaching, boiling) 

Cheese

Beans

Spam

Low-salt nuts

Dried fruits

Canned vegetables (look for 
TW_[IT\WX\QWV[ZQV[M[IT\Wٺ

Canned fruit (look for fruit 
canned in water, rinse with water 
fruit canned in sugary syrups)

Whole-wheat bread (even white bread is okay if  you eat 
the correct portion!)

Starchy vegetables (like potatos, corn, peas, yams)

Grits

Rice

Noodles and Pasta 

Oatmeal (Instant oatmeal is often 
sweetened with sugar, so look for regular 
oatmeal: it’s cheaper & lasts longer!)

Cereal


h 
d!
Protein
Fruits & 
Veggies
¼ 
½ 
=
=
Starch
¼ =
Fresh Fruits 
& Veggies
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DQG<RXU+HDOWK
,Q7RGD\¶V6HVVLRQ

/DVW6HVVLRQ5HYLHZ
 Review last week’s session
 Learn more about getting physical activity to live well with diabetes
 Review Video 3, “Physical Activity and Your Health”
 Develop a plan to get more exercise
 Review progress on healthy eating
 Review homework
 Work more on taking your medicines
Remember the 3 Rules for Healthy Eating:
One and Done. 
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Respect the Border
-I\0MIT\Pa
8WZ\QWV[WN.WWL
Be Sweet on Yourself 
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[_MM\MVLJM^MZIOM[
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Remember the  
3 Rules for Physical Activity
Feel Better
Think Better
Live Better
Move 2 Minutes 
Every Hour
(Brisk Walk)
Recommended:
30 minutes of brisk walking
on 5 or more days per week
Rule 1
Rule 2
Rule 3
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11

This Week’s Homework
My next session is: 
I carried out my diabetes medication plan
I carried out my healthy eating plan
I carried out my exercise plan
I watched the Session 4 Video
Took My 
       Diabetes Medications?  
        Eat Healthy?
      Exercise Minutes?
Day 1
(today)
    
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
     Yes           No
     Yes           No
minutes
minutes
minutes
minutes
minutes
minutes
minutes
     Yes           No
     Yes           No
     Yes           No
     Yes           No
     Yes           No
     Yes           No
     Yes           No
     Yes           No
     Yes           No
     Yes           No
     Yes           No
     Yes           No
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12
6HVVLRQ
'LDEHWHV0HGLFDWLRQV
,Q7RGD\¶V6HVVLRQ

/DVW6HVVLRQ5HYLHZ
 Review last week’s session
 Learn more about diabetes medicines 
and how they can help you live a full, 
active life
 Review video 4, “Diabetes Medications”
 Review homework
 Continue working on healthy eating, 
exercise, and taking your diabetes 
medicines as the doctor prescribed
 Many types of diabetes medications!  
You should be able to get on a medication that both controls 
your sugar and lets you feel well.
 ;QLMMٺMK\[KIVJMXZWJTMU, but you should discuss with 
your doctor before stopping.
 Generic drugs work as well as brand name drugs, but 
OMVMZQK[KIVJMUWZMIٺWZLIJTM
Remember the  
3 Rules for Physical Activity
'9'5HYLHZ
Recommended:
30 minutes of brisk walking
on 5 or more days per week
Medications are important, but they are not perfect.
Diabetes progresses much more quicklyWٺUMLQKI\QWV[
These complications can be prevented or delayed 
with medications, diet, and exercise.
You may need a 2nd or 3rd medication, 
even if you’re doing everything right.
Shortening 
your life
Increasing risks for conditions like
stroke
heart attack
dialysis
amputations
Diabetes 
progresses  
even on 
medicines.
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13

This Week’s Homework
Are my diabetes medicines working for me?
My Future
My next session is: 
I carried out my diabetes medication plan
I carried out my healthy eating plan
I carried out my exercise plan
I watched the Session 5 Video
     Took My Diabetes 
     Medications?   
           Eat 
           Healthy?
        Exercise  
         Minutes?
Day 1
(today)
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
minutes
minutes
minutes
minutes
minutes
minutes
minutes
We all have plans for our future,  
or occasions we’d like to be part of.
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14
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&KROHVWHURO0HGLFLQHV
,Q7RGD\¶V6HVVLRQ

/DVW6HVVLRQ5HYLHZ
 Review last week’s session
 Learn more about blood pressure and cholesterol medicines and 
how they can help you live a full, active life
 Review Video 5, “Cholesterol and Blood Pressure Medications”
 Review homework
 Continue working on healthy eating, exercise, and  
taking your diabetes medicines as the doctor prescribed
 Control your blood sugar
 Keep you from feeling bad from high sugar 
 
 
 
 
 Prevent or delay diabetes complications
Diabetes Medications
Run to the 
bathroom 
too much!
Thirsty
Tired
Medications are not perfect.
6W\-^MZaWVM/M\[;QLM-ٺMK\[	
Diabetes progresses 
much more quicklyWٺ
medications
You may need a 2nd or 3rd pill,
even if you’re doing 
everything right.
Diabetes 
progresses  
even on 
medicines.
Many types of diabetes  
medications are available.
Work with your doctor  
\WÅVLIUMLQKQVM\PI\
 controls your sugar 
 and lets you feel well
$SSHQGL[3DJH_

15
Stroke
Stroke
Dialysis
Blindness
Heart 
Attack
Heart 
Attack
'9'5HYLHZ
High blood pressure causes
High cholesterol 
causes
High blood pressure  
often has 
no symptoms.
High cholesterol has
no symptoms.
most common 
medicine for 
high cholesterol
High blood pressure is a chronic 
disease that develops over years.
High Cholesterol
 Sometimes it can  
feel like the doctor  
is experimenting on  
you because of the  
many changes in  
dose and pills!  
 One blood pressure pill may not work as well 
in you as in someone else, so it may take a 
while for you to get on the best pill for you
Many types of blood pressure  
medications are available.
Work with your doctor  
\WÅVLIUMLQKQVM\PI\
 controls your blood pressure 
 and lets you feel well
 ;QLMMٺMK\[KIVJMXZWJTMU, 
but you should discuss with your 
doctor before stopping. 
 Generic medications work as 
well as brand name drugs, but 
OMVMZQK[KIVJMUWZMIٺWZLIJTM
$SSHQGL[3DJH_

16

This Week’s Homework
How is my blood pressure?
How is my cholesterol?
My Future
My next session is: 
I carried out my diabetes medication plan
I carried out my healthy eating plan
I carried out my exercise plan
I watched the Session 6 Video
     Took My Diabetes 
     Medications?   
           Eat 
           Healthy?
        Exercise  
         Minutes?
Day 1
(today)     
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
minutes
minutes
minutes
minutes
minutes
minutes
minutes
We all have plans for 
our future, or occasions 
we’d like to be part of.
$SSHQGL[3DJH_

17
6HVVLRQ
6WUHVVDQG
<RXU+HDOWK
,Q7RGD\¶V6HVVLRQ

/DVW6HVVLRQ5HYLHZ
 Review last week’s session
 Review Video 5, “Stress and Your Health”
 Learn about stress, diabetes, and your health
 Learn how to reduce your stress
 Review homework
 Continue working on healthy eating, exercise, and  
taking your medicines as the doctor prescribed
 Normal blood pressure is 120/80 
 There are many blood pressure 
medicines available to get your 
blood pressure under control, but it 
might take a while to get there
 Most people take statins to lower 
cholesterol 
 Most people with diabetes have 
high cholesterol
Important to keep blood pressure 
and cholesterol under control. 
;QLM-ٺMK\[IZM
possible with 
blood pressure 
and cholesterol 
medicatons
 Work with your 
LWK\WZ\WÅVLIXQTT
that works for you! 
 Don’t Just Stop: 
talk to your 
doctor!
High blood pressure causes
Stroke
Dialysis
Blindness
Heart 
Attack
Stroke
Heart 
Attack
High cholesterol causes
Blood pressure goal is  
to be under 140 / 90
LDL cholesterol goal  
is to be under 100
$SSHQGL[3DJH_

18
'9'5HYLHZ
How to manage stress:
1. Recognize when you are stressed
2. Identify the  
    sources of stress
3. Do healthy  
    things to  
    reduce stress
2
Deep Breathing Technique
$SSHQGL[3DJH_

19
 Homework for the following week
Try to add more healthy eating and exercise!
My call next week is:
Call in 2 weeks:
I carried out my diabetes medication plan
I carried out my healthy eating plan
I carried out my exercise plan
     Took My Diabetes 
     Medications?   
           Eat 
           Healthy?
        Exercise  
         Minutes?
Day 1     
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
minutes
minutes
minutes
minutes
minutes
minutes
minutes

This Week’s Homework
     Took My Diabetes 
     Medications?   
           Eat 
           Healthy?
        Exercise  
         Minutes?
Day 1
(today)     
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
minutes
minutes
minutes
minutes
minutes
minutes
minutes
$SSHQGL[3DJH_

20
6HVVLRQ
3UDFWLFHDQG3ODQQLQJ
IRUWKH)XWXUH3DUW
,Q7RGD\¶V6HVVLRQ

/DVW6HVVLRQ5HYLHZ
 Review last session and homework
 Discuss what you have learned from this program and  
how activities have helped
 Think about a Health Buddy that can help you keep going when 
the program ends
 Continue working on healthy eating, exercise, and  
taking your medicines as the doctor prescribed
Important to manage  
stress in healthy ways!
1. Recognize when you are stressed
2. Identify the  
    sources of stress
3. Do healthy  
    things to  
    reduce stress
Exercise
Deep 
breathing
$SSHQGL[3DJH_

21
How is eating healthy, exercising, and taking my medications helping me?
My blood sugar is better
I can take care of my family better
I can do my job better
I can go out more
I have lost weight
I have more energy
My mood is better
It is decreasing my chances of 
experiencing complications from 
my diabetes.
It is increasing my chances of being there
for important events down the road.
$SSHQGL[3DJH_

22
How Can I Keep Going in the Future? My Health Buddy
Who 
Supports 
Me? 
Name of the person that I would 
like to be my health buddy:
When I will ask them to be my health buddy: 
$SSHQGL[3DJH_

23
 Week 2 
Try to add more healthy eating and exercise!
     Took My Diabetes 
     Medications?   
           Eat 
           Healthy?
        Exercise  
         Minutes?
Day 1     
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
minutes
minutes
minutes
minutes
minutes
minutes
minutes

Week 1
     Took My Diabetes 
     Medications?   
           Eat 
           Healthy?
        Exercise  
         Minutes?
Day 1
(today)     
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
minutes
minutes
minutes
minutes
minutes
minutes
minutes
$SSHQGL[3DJH_

24


Week 4 
Try to add more healthy eating and exercise!
Week 3 
Try to add more healthy eating and exercise!
     Took My Diabetes 
     Medications?   
           Eat 
           Healthy?
        Exercise  
         Minutes?
Day 1     
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
     Took My Diabetes 
     Medications?   
           Eat 
           Healthy?
        Exercise  
         Minutes?
Day 1     
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
minutes
minutes
minutes
minutes
minutes
minutes
minutes
minutes
minutes
minutes
minutes
minutes
minutes
minutes
Call in 2 weeks is:
Call in 4 weeks:
I carried out my diabetes medication plan
I carried out my healthy eating plan
I carried out my exercise plan
$SSHQGL[3DJH_

25
6HVVLRQ
3UDFWLFHDQG3ODQQLQJ
IRUWKH)XWXUH3DUW
,Q7RGD\¶V6HVVLRQ

/DVW6HVVLRQ5HYLHZ
 Review last session and homework
 Discuss what you have learned from this program and  
how activities have helped
 Continue working on healthy eating, exercise, and  
taking your medicines as the doctor prescribed
 Control your blood sugar,  
blood pressure, and cholesterol 
 Medications help prevent  
or delay complications
Medications aren’t perfect
 ;QLMMٺMK\[KIVJMXZWJTMU, but 
you should discuss with your doctor 
before stopping.
 Generic medications work as well 
as brand name drugs, but generics can 
JMUWZMIٺWZLIJTM
 Work with your doctor\WÅVLIXQTT
that works for you!
$SSHQGL[3DJH_

26
 Week 2 
Try to add more healthy eating and exercise!
     Took My Diabetes 
     Medications?   
           Eat 
           Healthy?
        Exercise  
         Minutes?
Day 1     
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
minutes
minutes
minutes
minutes
minutes
minutes
minutes

Week 1
     Took My Diabetes 
     Medications?   
           Eat 
           Healthy?
        Exercise  
         Minutes?
Day 1
(today)     
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
minutes
minutes
minutes
minutes
minutes
minutes
minutes
How Can I Keep Going in the Future? My Health Buddy
Homework
I want to keep going with the three-legged stool on my own!
What activities can I do with my Health Buddy to help me…
Exercise?
Eat Healthy?
Take medications?
$SSHQGL[3DJH_

27


Week 4 
Try to add more healthy eating and exercise!
Week 3 
Try to add more healthy eating and exercise!
     Took My Diabetes 
     Medications?   
           Eat 
           Healthy?
        Exercise  
         Minutes?
Day 1     
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
     Took My Diabetes 
     Medications?   
           Eat 
           Healthy?
        Exercise  
         Minutes?
Day 1     
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
minutes
minutes
minutes
minutes
minutes
minutes
minutes
minutes
minutes
minutes
minutes
minutes
minutes
minutes
Call in 4 week is:
I carried out my diabetes medication plan
I carried out my healthy eating plan
I carried out my exercise plan
$SSHQGL[3DJH_

28
6HVVLRQ
0RQLWRULQJ
0\3URJUHVV
,Q7RGD\¶V6HVVLRQ
 Review homework
 Continue working on healthy eating, exercise, and  
taking your medicines as the doctor prescribed
 Week 2 
Try to add more healthy eating and exercise!
     Took My Diabetes 
     Medications?   
           Eat 
           Healthy?
        Exercise  
         Minutes?
Day 1     
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
minutes
minutes
minutes
minutes
minutes
minutes
minutes

Week 1
     Took My Diabetes 
     Medications?   
           Eat 
           Healthy?
        Exercise  
         Minutes?
Day 1
(today)     
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
minutes
minutes
minutes
minutes
minutes
minutes
minutes
Homework

$SSHQGL[3DJH_

29


Week 4 
Try to add more healthy eating and exercise!
Week 3 
Try to add more healthy eating and exercise!
     Took My Diabetes 
     Medications?   
           Eat 
           Healthy?
        Exercise  
         Minutes?
Day 1     
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
     Took My Diabetes 
     Medications?   
           Eat 
           Healthy?
        Exercise  
         Minutes?
Day 1     
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
minutes
minutes
minutes
minutes
minutes
minutes
minutes
minutes
minutes
minutes
minutes
minutes
minutes
minutes
Call in 4 week is:
I carried out my diabetes medication plan
I carried out my healthy eating plan
I carried out my exercise plan
$SSHQGL[3DJH_

30
6HVVLRQ 0RQLWRULQJ0\3URJUHVV
,Q7RGD\¶V6HVVLRQ
 Review homework
 Continue working on healthy eating, exercise, and  
taking your medicines as the doctor prescribed
 Week 2 
Try to add more healthy eating and exercise!
     Took My Diabetes 
     Medications?   
           Eat 
           Healthy?
        Exercise  
         Minutes?
Day 1     
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
minutes
minutes
minutes
minutes
minutes
minutes
minutes

Week 1
     Took My Diabetes 
     Medications?   
           Eat 
           Healthy?
        Exercise  
         Minutes?
Day 1
(today)     
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
minutes
minutes
minutes
minutes
minutes
minutes
minutes
Homework

$SSHQGL[3DJH_

31


Week 4 
Try to add more healthy eating and exercise!
Week 3 
Try to add more healthy eating and exercise!
     Took My Diabetes 
     Medications?   
           Eat 
           Healthy?
        Exercise  
         Minutes?
Day 1     
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
     Took My Diabetes 
     Medications?   
           Eat 
           Healthy?
        Exercise  
         Minutes?
Day 1     
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
minutes
minutes
minutes
minutes
minutes
minutes
minutes
minutes
minutes
minutes
minutes
minutes
minutes
minutes
Call in 4 week is:
I carried out my diabetes medication plan
I carried out my healthy eating plan
I carried out my exercise plan
$SSHQGL[3DJH_

32
6HVVLRQ )LQDO6HVVLRQ
,Q7RGD\¶V6HVVLRQ

 Review homework
 Continue working on healthy eating, exercise, and 
taking your medicines as the doctor prescribed
     Took My Diabetes 
     Medications?   
           Eat 
           Healthy?
        Exercise  
         Minutes?
Day 1     
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
minutes
minutes
minutes
minutes
minutes
minutes
minutes
     Took My Diabetes 
     Medications?   
           Eat 
           Healthy?
        Exercise  
         Minutes?
Day 1
(today)     
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
minutes
minutes
minutes
minutes
minutes
minutes
minutes
Keep Going On Your Own!
$SSHQGL[3DJH_

33
     Took My Diabetes 
     Medications?   
           Eat 
           Healthy?
        Exercise  
         Minutes?
Day 1     
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
minutes
minutes
minutes
minutes
minutes
minutes
minutes
     Took My Diabetes 
     Medications?   
           Eat 
           Healthy?
        Exercise  
         Minutes?
Day 1
(today)     
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
minutes
minutes
minutes
minutes
minutes
minutes
minutes
     Took My Diabetes 
     Medications?   
           Eat 
           Healthy?
        Exercise  
         Minutes?
Day 1     
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
minutes
minutes
minutes
minutes
minutes
minutes
minutes
     Took My Diabetes 
     Medications?   
           Eat 
           Healthy?
        Exercise  
         Minutes?
Day 1
(today)     
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
minutes
minutes
minutes
minutes
minutes
minutes
minutes
$SSHQGL[3DJH_

34
     Took My Diabetes 
     Medications?   
           Eat 
           Healthy?
        Exercise  
         Minutes?
Day 1     
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
minutes
minutes
minutes
minutes
minutes
minutes
minutes
     Took My Diabetes 
     Medications?   
           Eat 
           Healthy?
        Exercise  
         Minutes?
Day 1
(today)     
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
minutes
minutes
minutes
minutes
minutes
minutes
minutes
     Took My Diabetes 
     Medications?   
           Eat 
           Healthy?
        Exercise  
         Minutes?
Day 1     
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
minutes
minutes
minutes
minutes
minutes
minutes
minutes
     Took My Diabetes 
     Medications?   
           Eat 
           Healthy?
        Exercise  
         Minutes?
Day 1
(today)     
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
minutes
minutes
minutes
minutes
minutes
minutes
minutes
$SSHQGL[3DJH_

35
     Took My Diabetes 
     Medications?   
           Eat 
           Healthy?
        Exercise  
         Minutes?
Day 1     
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
minutes
minutes
minutes
minutes
minutes
minutes
minutes
     Took My Diabetes 
     Medications?   
           Eat 
           Healthy?
        Exercise  
         Minutes?
Day 1
(today)     
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
minutes
minutes
minutes
minutes
minutes
minutes
minutes
     Took My Diabetes 
     Medications?   
           Eat 
           Healthy?
        Exercise  
         Minutes?
Day 1     
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
minutes
minutes
minutes
minutes
minutes
minutes
minutes
     Took My Diabetes 
     Medications?   
           Eat 
           Healthy?
        Exercise  
         Minutes?
Day 1
(today)     
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
minutes
minutes
minutes
minutes
minutes
minutes
minutes
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36
     Took My Diabetes 
     Medications?   
           Eat 
           Healthy?
        Exercise  
         Minutes?
Day 1     
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
minutes
minutes
minutes
minutes
minutes
minutes
minutes
     Took My Diabetes 
     Medications?   
           Eat 
           Healthy?
        Exercise  
         Minutes?
Day 1
(today)     
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
minutes
minutes
minutes
minutes
minutes
minutes
minutes
     Took My Diabetes 
     Medications?   
           Eat 
           Healthy?
        Exercise  
         Minutes?
Day 1     
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
minutes
minutes
minutes
minutes
minutes
minutes
minutes
     Took My Diabetes 
     Medications?   
           Eat 
           Healthy?
        Exercise  
         Minutes?
Day 1
(today)     
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
     Yes      No
minutes
minutes
minutes
minutes
minutes
minutes
minutes
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Appendix D 
 
Recruitment Flyer
 
Participant Interest Card 
 
Appendix Page |  265

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Call 205-934-7163 
                   for more information!
Living Well (X) is a research study being conducted 
in the UAB Division of Preventive Medicine. 
Dr. Andrea Cherrington, Principal Investigator
Living Well
Diabetes
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Participant Eligibility Screening Script 
 
Appendix Page |  269

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Appendix E 
 
Telephone Interview 
 
Appendix Page |  274

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$SSHQGL[3DJH_

Appendix F 
 
Biometric Protocol 
Appendix Page |  293

Anthropropomorphic and
Biometric Measurements Protocol
Protocol Version 2016-March
Living Well
Diabetes
with
$SSHQGL[3DJH_

LWD Anthropromorphic Protocol
2
Introduction ................................................................................................................................3 
Blood Pressure Measurement .....................................................................................................4
Obtaining Blood Samples ...........................................................................................................7
 
HbA1c Measurement .................................................................................................................8
LDL-Cholesterol .....................................................................................................................13
Weight ......................................................................................................................................17
Height .....................................................................................................................................19
Medication List .......................................................................................................................22
Report Card .............................................................................................................................27
Interpreting the Report Card ..................................................................................................29
Table of Contents
$SSHQGL[3DJH_

version 2016-March
3
Introduction
1. Baseline Measurements
Among the goals of the Living Well Study is to determine if the program improve HbA1c, blood pressure, weight, and  
physical function. These values will be measured at the beginning of the study and after the 12-week program. 
Measurements on each participant will be made at a community venue or in the participant’s home. Measurements will 
be made in a separate room or, at minimum, in an area properly screened from other participants. Participants should be 
wearing a loose fitting shirt that allows full access to the arm for blood pressure measurement. 
If asked, the research assistant measuring and recording the values may tell the participant their values at the time of measurement.
Remind the participant that they will receive a “report card” with the measurement values and an explanation of the values.
The Living Well with Diabetes Study is a randomized controlled trial enrolling 500 participants in rural Alabama. 
Your role of as a data collector is very important to this study. The information that you collect will help us better understand 
the day-to-day experiences of individuals living with diabetes and pain. The information will also determine what effects 
the program has on the health and well-being of study participants.
The information that you gather will help the study investigators make important decisions. The information that you gather 
will help us make important decisions. Therefore, we have to have confidence in the conclusions that we make. We get 
that confidence from knowing that the data was collected in a standard, reliable way. 
The in-person data collection will consist of 3 types of activitie:
R5 Gathering baseline measurements (blood pressure, A1c, LDL-Cholesterol, weight, height)
R5 Generating a participant medication list
R5 Providing the participant with their measurements in the form of a report card. 
30 days
Telephone Interview 1
Telephone Interview 2
In-Person Data Collection 1
In-Person Data Collection 2
30 days
6 months
2. Medication List
The investigators and Peer Advisors require an accurate list of all medications taken by the participants. The participants 
will be notified prior to the in-person data collection visit that you will making this list. You will be writing down the 
names, dosages, and frequencies of the participant’s medications. 
3. Report Card
Participants will receive a report card and an explanation of what the values mean in general terms.
This manual will provide details on how each of the activities should be completed. Since 
Living Well is a research study, we all all Biometric personnel to strictly follow these 
protocols so that we can be certain these measurements are accurate the precise.
$SSHQGL[3DJH_

LWD Anthropromorphic Protocol
4
Blood Pressure
It will take approximately 10-15 minutes to make two blood pressure measurements including the initial 5-minute rest. 
The BP measurements will be the first measurement taken during the in-person data collection visit.
1. Equipment and Supplies.
R5 LifeSource Blood Pressure Monitor (Model UA 789)
R5 Blood pressure cuffs (medium, large, extra large sizes)
R5 Tape measure
R5 Eyebrow pencil
R5 Chair with back support
R5 Table to rest arm
1.1. Maintenance of Equipment
With each use:
R5 Device is turned off at the completion of each participant’s examination.
R5 Squeeze all air from the cuff
R5 Confirm that the connection of the cuff to the tubing is secure and tubing is not kinked.
Monhtly:
R5 Inspect cuff and tubing for cracks or tears. If a leak is suspeced, place the cuff around an unopened, full, 12-ounce can, 
start the monitor, and submerge the cuff in water. If there is a leak, air bubbles will start to rise from the area of the leak. 
Replace the cuff if a leak is detected. 
R5 Wipe the exterior of the monitor with a clean cloth slightly dampened with mild detergents.
R5 Check the blood pressure cuffs to assure all sizes of cuffs are available.
R5 Inspect the measuring tape used to measure arm circumference for damage or wear.
2. Participant Preparation.
Participants should not drink any caffeine (from coffee, tea, or soda), should not eat or do any heavy physical activity, 
smoke, ingest alcohol for 30 minutes prior to recording the blood pressure.
2.1. Arm Circumference
The blood pressure is taken on the right arm. If the participant’s right arm is injured or missing, or if the participant 
reports a compelling reason to avoid measurement in this arm, such as a mastectomy on the right side, use the left arm for 
the blood pressure measurement. Measure the participant’s arm to determine the appropriate cuff size before allowing the 
participant to rest. Use the following procedures to measure the participant’s arm and determine the appropriate cuff size:
R5 Proper measurement requires that the participant’s arm is bare to the shoulder. The participant should be wearing a 
loose-fitting top.
R5 Request the participant to stand facing away from the examiner with the right elbow bent 90 degrees at the elbow with 
the hand on the stomach. The upper arm should be at a 90-degree angle to the lower arm.
R5 Measure arm length from the bony prominence of the shoulder girdle (acromion) to the tip of the elbow (olecranon 
process) using a tape measure.
R5 Mark the midpoint on the dorsal (back) surface of the arm with an eyebrow pencil.
R5 Ask the participant to relax their arm along the side of the body.
R5 Wrap the tape measure horizontally around the arm at the midpoint mark, but do not indent the skin. Make the 
measurement to the nearest 0.5 cm (round down).
R5 Use the measurement to determine the correct cuff size. Wipe pencil mark off participant’s skin
$SSHQGL[3DJH_

version 2016-March
5
Do not use the markings on the blood pressure cuff for reference. Instead, use the criteria in the chart below for 
determining the appropriate cuff size for the participant.
3. Measurement Procedures.
The blood pressure can be measured after any period where the participant has been sitting quietly (no talking or 
completing forms) for 5 or more minutes, and at least 30 minutes after ingestion of caffeine. After applying the 
appropriate sized blood pressure cuff, the participant should sit for 5 minutes with his/her feet flat on the floor and legs 
and ankles uncrossed. Two blood pressure readings will be obtained.
3.1 Application of the cuff
R5 Ensure that the participant is seated comfortably in a chair with back supported and both feet are flat on the floor.
R5 Make sure that the participant’s arm is resting on the table at a 90-degree angle with the palm facing up.
R5 Palpate the brachial artery.
R5 Mark the brachial artery with an eyebrow pencil.
R5 Attach the appropriate-sized cuff to the monitor by firmly inserting the Air Connector Plug of the blood pressure cuff 
into the Air Socket of the monitor.
R5 Place the cuff around the upper right arm, approximately at heart level, with the participant’s palm facing upward (the 
participant may rest their forearm and elbow on a table or arm of the chair). Place the lower edge of the cuff with its 
tubing connections about one inch above the natural crease across the inner aspect of the elbow.
R5 Wrap the cuff snugly about the arm, with the inflatable inner bladder centered over the area of the brachial artery. The 
brachial artery is usually found at the crease of the arm, slightly toward the body. Secure the wrapped cuff firmly by 
applying pressure to the locking fabric fastener over the area that it overlaps the cuff. You should be able to insert the 
first joint of two fingers under the cuff.
R5 If it is not feasible to measure blood pressure using the right arm, the left arm will be used. Mark which arm is used for 
the measurement on the Biometric Data Collection Form.  
 
 3.2 Performing the blood pressure measurement
R5 After the 5 minute rest, press “Start” on the monitor
R5 On the Data Form under “1st Reading” record: time, armed used (L or R), systolic value, diastolic value, pulse
R5 Allow 1 minute rest.
R5 Press “Start”
R5 On the Data Collection Form under “2nd Reading” record: time, systolic value, diastolic value, pulse
R5 Wipe pencil mark off participant’s skin
3.3 Interruptions
If the blood pressure measurement is interrupt and requires the participant to move from the seated position, the 
participant will be required to repeat the 5-minute rest and another 2 blood pressures must be performed. 4.1 Training 
requirements
Arm Circumference
Cuff Size
24 - 35.5 cm 
9.4 - 14.1 in
Medium Cuff
36 - 42 cm
14.2 - 16.5 in
Large Cuff
> 42 cm
> 16.5 in
Extra Large Cuff
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LWD Anthropromorphic Protocol
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4. Quality Assurance
Clinical experience with blood pressure measurement is required. In addition, training should include:
R5 Read and study manual and data collection packet
R5 Attend Living Well training session on techniques 
R5 Practice on other staff or volunteers
R5 Discuss problems and questions with program coordinator  
4.2 Certification requirements
R5 Complete training requirements
R5 Explain and demonstrate daily and monthly checks of blood pressure monitor
R5 Explain procedure if measurement is interrupted
R5 Performs exam according to protocol 
 
4.3 Quality assurance checklist
R5 Explains procedure
R5 Measures for cuff size
R5 Wraps cuff snugly, centering bladder over brachial artery
R5 Five minute rest period before measurement
R5 Records the systolic and diastolic readings as they appear on the digital display
R5 Deflates bladder
R5 Reviews forms for completeness
R5 Completes Data Collection Form appropriately
 
Acknowledgments:
R5 Women’s Health Initiative Operations Manual. Volume 2, Section 9.2: Blood Pressure. 8/30/95.
R5 WHAS Operations Manual. Section 3.5 Blood Pressure Measurements. 6/18/93.
R5 MOST Operations Manual Vol. IV Chapter 3E, Version 1.0.  4/3/09
R5 Mr.OS Visit 3 Operations Manual Version 1.5.  07/25/2007
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Obtaining Blood Samples
For the A1c measurement, blood samples will be collected. Instructions for the fingerstick are given here while instructions 
on use of the A1c machine and recording the data are in the following section. 
1. Equipment and Supplies.
R5 Lancet
R5 Alcohol wipes
R5 Gauze
R5 Bandaid
R5 Gloves
R5 Sharps Container 
2. Participant Preparation and Sample Collection.
R5 Put on gloves.
R5 Clean the participant’s finger, just lateral to the fingertip pad with an alcohol wipe, and allow it to dry.
R5 (Use the lancet as direct). Accu-check Safe-T-Pro Plus Lancet directions: Holding the lancet, twist off the blue 
protective lancet cap. Press the lancet lightly against the cleaned lateral side of the fingertip. Press the blue button. 
R5 Dispose of lancet in sharps container
R5 “Milk” finger by gently applying pressure from the base to the tip of the finger. 
R5 Wipe away first drop of blood with gauze and use subsequent blood drops for testing.
R5 After sample is collected, apply light pressure with gauze.  If needed, apply bandage. 
3. Quality Assurance.
3.1 Training requirements
The technician requires no special qualifications for performing this assessment. Training includes:
R5 Read and study manual and data collection packet
R5 Attend Living Well training session on techniques 
R5 Practice on other staff or volunteers
R5 Discuss problems and questions with program coordinator 
 
3.2 Certification requirements
R5 Complete training requirements
R5 Explain procedure
R5 Performs exam according to protocol
 
3.3 Quality assurance checklist
R5 Explains procedure
R5 Wears gloves
R5 Cleans finger with alcohol, correct use and disposal of lancet
R5 Obtains sample from lateral side of fingertip, wipes first drop of blood
R5 Ascertains bleeding has stopped
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LWD Anthropromorphic Protocol
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A1c Measurement
1. Equipment and Supplies.
R5 Alcohol wipe
R5 Gauze
R5 Bandaid
R5 A1cNow+ Test System (each system includes 3 items)
R5 Monitor
R5 1. Sample Dilution Kit
R5 2. Test Cartridge 
1.1. Before You Begin: Preparation of Test System
R5 Ensure all parts of the test kits are at the same temperature.
R5 All test parts are within the specified range. (Between 64 - 82 degrees F).
R5 NOTE: If the kit has recently been at high temperature (above 82 degress) or 
in the refrigerator, keep the kit at room temperature for at least one hour before 
use.
R5 NOTE: avoid running the test in direct sunlight, on hot or cold surfaces, 
or near sources of heat or cold. Quality control materials should be used to 
confirm the test kit is working properly. See Troubleshooting Section for more 
information.
R5 IMPORTANT! The Lot numbers should match the monitor, dilution kit, and 
test cartridge (DO NOT OPEN!).
2. Participant Preparation and A1c Measurement.
2.1. Collect Blood
R5 Use the lancet to draw blood.
R5 Wipe away the first drop of blood.
R5 Take blood collector and gently touch blood drop to fill.
0628216
Blood Collector
Too Little 
Add More
Too Much 
Wipe Away
Just Right
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version 2016-March
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2.2. Insert Blood Collector
R5 Fully insert Blood Collector into Sampler Body.
R5 Shake well 6-8 times to mix the blood with the solution.
R5 Stand the sampler on the table while preparing the Cartridge.
2.3. Insert Cartridge
R5 Open the Test Cartridge packet now. IMPORTANT: Must use the cartridge within 2 minutes.
R5 “Click” Test Cartridge into place.  Monitor and Test Cartridge codes must match.
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LWD Anthropromorphic Protocol
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2.4. Prepare Monitor
R5 After clicking the test cartridge into place, monitor’s display will say “WAIT”.
R5 Wait until the display says “SMPL”.
R5 When the display says “SMPL”, the monitor is ready.  
 
 
 
 
 
 
R5 Ensure that the monitor is on a level surface.
R5 Remove the base from the blood collector.
2.5. Dispense Sample into Cartridge
R5 Push down the blood collector completely on the cartridge completely to dispense diluted sample. Remove quickly.
R5 IMPORTANT! Do not handle the monitor again until the test is complete.
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version 2016-March
11
2.6. Results
R5 It will take 5 minutes to display the results.
R5 The display will count down.
R5 After the 5 minutes, 3 items will be displayed.
R5 “QCOK” - QC test result
R5 “00.0” - A1c test result
R5 “00TL” - Number of tests left
R5 This result cycle remains displayed for 60 minutes or until the next Test Cartridge is 
inserted.
R5 If “QCOK” is not displayed, please see the Troubleshooting section.
R5 Record A1c value in the data collection packet.
2.7. Troubleshooting
R5 See the table below for a description of A1cNOW+ operating and error codes.
R5 OR = Out of Range / QC = Quality Control / E = Monitor Error
Message
Description and Resolution
OR 1
The blood sample may have too little hemoglobin (less than 20% hematocrit), not enough blood 
was collected, or the blood was not well mixed inside the Sampler.* You may wish to check he-
matocrit by another method.
OR 2
The blood sample may have too much hemoglobin (greater than 60% hematocrit), or excess 
blood was collected.* You may wish to check hematocrit by another method.
OR 3
The blood sample may have too little A1C, or insufficient blood was collected.*
OR 4
The blood sample may have too much A1C, or excess blood was collected.*
OR 5
The Monitor temperature is below 180C (640F). Repeat the test at room temperature.
OR 6
The Monitor temperature is above 280C (820F). Repeat the test at room temperature.
<4.0
The %A1C is less than 4%.
>13.0
The %A1C is greater than 13%.
QC 2
Occurs when you insert a Test Cartridge that already has sample added to it. Do not remove and 
reinsert Test Cartridge after adding sample.*
QC 6
Sample was added to Test Cartridge before “SMPL” display. This counts down one test on the 
Monitor. Remove and discard Test Cartridge. To avoid this error, do not add sample until the 
“WAIT” prompt clears and “SMPL” appears.
QC 7
The Test Cartridge remained in the Monitor without sample addition for 2 minutes after 
“SMPL” prompt. This counts down one test on the Monitor. Discard the Test Cartridge and 
insert a fresh one when you are ready to dispense the Sampler.
QC 30-33
The Monitor was unable to obtain a valid initial reading. Be sure to remove the Sampler within 
one second after dispensing it into the sample port, and do not disturb the Monitor while the 
test is running. *
QC 50-51 
QC 55-56
Insufficient sample was delivered to the Test Cartridge. To avoid this error be sure to fully insert 
the Blood Collector into the Sampler and shake immediately.*
All other 
QC codes
The quality control checks did not pass. Call Bayer Technical Support toll-free at 877-212-4968 
x 1. The test will have to be repeated with another Test Cartridge and Sample Dilution Kit.
E1-E99
The Monitor has a Fatal Error. Call Bayer Technical Support toll-free at 877-212-4968 x 1.
*Carefully repeat the test using a new Test Cartridge and a new Sample Dilution Kit.
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LWD Anthropromorphic Protocol
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3. Quality Assurance.
3.1 Training requirements
The technician requires no special qualifications for performing this assessment. Training includes:
R5 Read and study manual and data collection packet
R5 Attend Living Well training session on techniques 
R5 Practice on other staff or volunteers
R5 Discuss problems and questions with program coordinator 
 
3.2 Certification requirements
R5 Complete training requirements
R5 Explain procedure and measure A1c on 2 volunteers according to protocol.
 
3.3 Quality assurance checklist
R5 Obtains sample per “obtaining blood sample” section of manual.
R5 Properly measures and records A1c measurementt.
3.4 Control
R5 Use liquid control solution to calibrate machine. 
R5 Each A1CNow+ Monitor performs over 50 internal chemical and electronic quality control checks, including 
potential hardware and software errors (e.g. cartridge alignment, programming), and potential reagent strip errors (e.g. 
insufficient sample volume, invalid calculations). The Monitor has been programmed to report an error code if these 
quality checks are not passed.
R5 Quality control testing should be performed at the following times:
R5 With each new shipment.
R5 With each new lot.
R5 With each new operator.
R5 Whenever problems (storage, operator, instrument, or other) are identified.
R5 To ensure that storage conditions have not affected the product, run a control sample before running a patient 
sample if the test kit has been stored for more than a month and it has been at least a month since the last control 
testing.
R5 The measured value should be within the acceptable limits stated for the control material. If the results obtained 
are outside the acceptable limit, please review the procedure and re-test the control material. If the measured value 
continues to fall outside the acceptable limit, please refrain from analyzing additional patient samples and contact Bayer 
Technical Support (877-212-4968).
R5 Good laboratory practices include a complete quality control program. This entails proper sample collection and 
handling practices, ongoing training of testing personnel, ongoing evaluation of control results, proper storage of test 
kits, etc. A permanent record of control results should be retained.
2.7. Reuse Monitor
R5 The Monitor is reusable (either 20 or 10 tests per test system).
R5 To run another test, use a new sampler and test cartridge from the same kit.
R5 Discard the test cartridge.
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version 2016-March
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 Consent Form 
Appendix Page |  325

Page	  1	  of	  6	  
Version   Date:   4/18/16  
CONSENT	  FORM	  
	  
TITLE	  OF	  RESEARCH:	  
Living	  Well	  (Improving	  Medication	  Adherence	  in	  the	  Alabama	  
Black	  Belt)-­‐AIM	  2	  
	  
IRB	  PROTOCOL	  NO.:	  
X160301010	  
	  
INVESTIGATOR:	  
Andrea	  Cherrington,	  MD	  MPH	  
	  
SPONSOR:	  
Patient	  Centered	  Outcomes	  Research	  Institute	  (PCORI)	  
	  
SPONSOR	  PROTOCOL	  NO.:	  
AD-­‐1306-­‐03565	  
	  
Purpose	  of	  the	  Research	  
We	  are	  asking	  you	  to	  take	  part	  in	  a	  research	  study.	  This	  research	  study	  will	  test	  if	  Peer	  Advisors	  
can	  help	  patients	  with	  diabetes	  better	  care	  for	  his	  or	  her	  diabetes	  to	  improve	  blood	  sugar	  
levels,	  blood	  pressure,	  and	  quality	  of	  life.	  	  Peer	  advisors	  come	  from	  the	  same	  community	  as	  
participants	  and	  have	  been	  trained	  to	  help	  people	  with	  diabetes.	  This	  study	  will	  enroll	  500	  
participants.	  250	  participants	  will	  work	  with	  a	  peer	  advisor	  for	  6	  months	  and	  250	  participants	  in	  
the	  general	  education	  group	  will	  receive	  health	  education	  videos.	  Which	  program	  you	  receive	  
will	  depend	  on	  a	  random	  assignment	  process.	  	  
	  
Explanation	  of	  Procedures	  
If	  you	  agree	  to	  participate	  in	  this	  study,	  you	  will	  be	  asked	  to	  take	  part	  in	  a	  telephone	  interview	  
with	  a	  UAB	  study	  research	  assistants	  that	  will	  last	  approximately	  45-­‐60	  minutes.	  During	  this	  call,	  
you	  will	  be	  asked	  questions	  about	  you,	  your	  diabetes,	  your	  overall	  health,	  and	  topics	  related	  to	  
your	  health	  such	  as	  your	  doctor,	  health	  care	  access,	  health	  knowledge,	  and	  current	  health	  
behaviors.	  	  You	  do	  not	  have	  to	  answer	  any	  questions	  that	  you	  don’t	  want	  to	  or	  that	  make	  your	  
feel	  uncomfortable.	  
	  
After	  the	  telephone	  interview,	  you	  will	  be	  asked	  to	  complete	  an	  in-­‐person	  data	  collection	  visit	  
that	  will	  last	  approximately	  45-­‐60	  minutes.	  The	  data	  collection	  will	  be	  scheduled	  within	  30	  days	  
of	  completing	  the	  telephone	  interview.	  The	  data	  collection	  visit	  will	  be	  conducted	  at	  a	  location	  
in	  your	  community	  or	  in	  you	  home,	  depending	  of	  your	  preference.	  During	  the	  in	  person	  data	  
collection	  visit,	  trained	  UAB	  study	  research	  assistants	  will	  conduct	  the	  following	  activities:	  
1. Test	  your	  blood	  sugar	  levels	  and	  your	  cholesterol	  levels	  by	  drawing	  blood	  from	  your	  
finger	  
2. Measure	  your	  blood	  pressure	  2	  times	  
3. Measure	  your	  weight	  and	  height.	  	  
4. Make	  a	  list	  of	  all	  of	  your	  medications,	  including	  the	  doses	  and	  the	  frequency	  that	  you	  
take	  the	  medicines.	  	  
5. Give	  you	  a	  health	  report	  card	  that	  provides	  you	  with	  the	  results	  of	  your	  blood	  sugar	  
levels,	  cholesterol	  levels,	  blood	  pressure,	  and	  your	  weight.	  	  
Appendix Page |  326

Page	  2	  of	  6	  
Version   Date:   4/18/16  
	  
Wearing	  a	  loose	  fitting	  shirt	  is	  recommended	  to	  the	  in-­‐person	  data	  collection	  visit	  so	  that	  we	  
are	  able	  to	  measure	  your	  blood	  pressure.	  We	  ask	  that	  you	  do	  not	  to	  not	  drink	  any	  caffeine	  
(from	  coffee,	  tea,	  or	  soda),	  do	  not	  eat	  or	  do	  any	  heavy	  physical	  activity,	  smoke,	  ingest	  alcohol	  
for	  30	  minutes	  prior	  to	  the	  in	  person	  data	  collection	  visit.	  
	  
After	  the	  in-­‐person	  data	  collection	  visit,	  you	  will	  start	  your	  6-­‐month	  program.	  You	  will	  receive	  
one	  of	  two	  programs.	  Which	  program	  you	  receive	  will	  be	  determined	  by	  chance.	  	  
	  
The	  first	  program	  is	  called	  the	  General	  Health	  Program.	  If	  you	  receive	  this	  program,	  you	  will	  
receive	  health	  education	  videos.	  The	  videos	  cover	  the	  following	  topics:	  Dementia	  and	  
Alzheimer’s,	  Breast	  Cancer,	  Colorectal	  Cancer,	  Osteoporosis	  and	  Fall	  Prevention,	  Eye	  Health,	  
Oral	  Health,	  Foot	  Care,	  and	  Driving	  Safety.	  The	  videos	  last	  between	  15	  to	  30	  minutes.	  If	  you	  are	  
in	  this	  program,	  UAB	  study	  staff	  will	  call	  you	  on	  the	  phone	  3	  times	  during	  months	  1,	  3,	  and	  5	  to	  
make	  sure	  the	  program	  is	  going	  well	  and	  to	  answer	  any	  questions	  you	  may	  have.	  These	  calls	  will	  
last	  around	  5	  minutes.	  You	  will	  also	  receive	  post	  cards	  from	  UAB	  staff	  during	  months	  2,	  4,	  6,	  
and	  for	  holidays.	  	  
	  
The	  second	  program	  is	  called	  the	  Living	  Well	  Program.	  In	  this	  program,	  you	  will	  be	  matched	  
with	  a	  peer	  advisor.	  The	  peer	  advisor	  you	  are	  matched	  to	  depends	  on	  yours	  and	  peer	  advisor’s	  
availability.	  Your	  peer	  advisor	  will	  contact	  you	  on	  the	  phone	  within	  2	  weeks.	  	  You	  will	  watch	  
videos	  that	  cover	  the	  following	  topics:	  diabetes	  basics,	  healthy	  eating,	  physical	  activity,	  stress	  
reduction,	  and	  diabetes,	  cholesterol,	  blood	  pressure	  medications.	  The	  videos	  last	  between	  20	  
to	  40	  minutes.	  You	  will	  then	  talk	  with	  your	  peer	  advisor	  on	  the	  phone	  using	  your	  study	  activity	  
goal.	  During	  the	  phone	  calls	  with	  your	  peer	  advisor,	  you	  will	  set	  health	  goals	  and	  talk	  about	  the	  
content	  covered	  in	  the	  videos.	  You	  will	  speak	  weekly	  for	  the	  first	  8	  weeks,	  bi-­‐weekly	  for	  1	  
month,	  and	  1-­‐3	  times	  for	  month	  for	  the	  final	  3	  months.	  For	  the	  first	  3	  months,	  the	  calls	  with	  
your	  peer	  advisor	  will	  last	  between	  30-­‐45	  minutes.	  For	  the	  months	  3-­‐6,	  the	  calls	  with	  your	  peer	  
advisor	  will	  last	  between	  10-­‐15	  minutes.	  The	  total	  number	  of	  times	  and	  your	  peer	  advisor	  speak	  
will	  be	  determined	  by	  you	  and	  your	  peer	  advisor	  but	  you	  will	  talk	  with	  your	  peer	  advisor	  around	  
13-­‐16	  times.	  If	  you	  are	  in	  this	  program,	  UAB	  study	  staff	  will	  call	  you	  on	  the	  phone	  2	  times	  during	  
months	  2	  and	  5	  to	  make	  sure	  the	  program	  is	  going	  well	  and	  to	  answer	  any	  questions	  you	  may	  
have.	  These	  calls	  will	  last	  around	  5	  minutes.	  You	  may	  also	  receive	  postcards	  from	  UAB	  staff	  for	  
holidays.	  Finally,	  if	  you	  are	  in	  this	  program,	  you	  have	  the	  choice	  to	  use	  a	  study	  telephone.	  This	  
phone	  will	  be	  yours	  to	  use	  for	  the	  6	  months	  when	  you	  are	  talking	  with	  your	  peer	  advisor.	  We	  
ask	  that	  you	  only	  use	  the	  phone	  to	  talk	  with	  your	  peer	  advisor.	  You	  will	  need	  to	  return	  the	  
phone	  to	  UAB	  after	  you	  finish	  the	  study.	  If	  you	  would	  like	  to	  use	  a	  study	  phone,	  the	  phone	  will	  
be	  provided	  to	  you	  during	  the	  in	  person	  data	  collection	  visit.	  You	  will	  return	  the	  phone	  to	  UAB	  
at	  the	  second	  in	  person	  data	  collection	  visit.	  	  
	  
After	  6	  months,	  all	  participants	  in	  both	  programs	  will	  be	  asked	  to	  participate	  in	  a	  second	  in	  
person	  data	  collection	  visit	  and	  a	  telephone	  interview.	  During	  month	  6,	  UAB	  study	  staff	  will	  call	  
you	  by	  telephone	  to	  schedule	  the	  in	  person	  visit	  and	  the	  telephone	  interview.	  The	  same	  
information	  and	  tests	  will	  be	  collected	  during	  the	  second	  in	  person	  data	  collection	  visit	  as	  we	  
Appendix Page |  327

Page	  3	  of	  6	  
Version   Date:   4/18/16  
collected	  in	  the	  first	  in	  person	  visit.	  We	  will	  measure	  your	  blood	  sugar	  levels,	  cholesterol	  levels,	  
two	  blood	  pressure	  measurements,	  and	  your	  weight	  and	  height.	  We	  will	  make	  another	  list	  of	  
your	  medications,	  doses,	  and	  frequency.	  You	  will	  also	  receive	  a	  health	  report	  card	  with	  your	  
measurements.	  	  At	  the	  second	  telephone	  interview,	  we	  will	  ask	  you	  many	  of	  the	  same	  
questions	  that	  we	  asked	  at	  the	  first	  interview.	  The	  in-­‐person	  data	  collection	  visit	  and	  phone	  
interview	  will	  each	  take	  45-­‐60	  minutes.	  	  
	  
Risks	  and	  Discomforts	  
The	  risks	  in	  this	  study	  are	  minimal.	  There	  is	  a	  potential	  for	  loss	  of	  confidentiality.	  You	  may	  
experience	  discomfort	  or	  pain	  during	  the	  blood	  test	  and	  may	  experience	  temporary	  redness	  
and	  soreness	  on	  your	  finger.	  It	  is	  possible	  that	  your	  numbers	  may	  be	  high	  or	  low	  when	  we	  test	  
them.	  A	  doctor	  or	  nurse	  will	  be	  available	  by	  phone	  to	  help	  you	  address	  any	  concerns	  you	  may	  
have.	  	  
	  
If	  you	  are	  working	  with	  a	  peer	  advisor,	  it	  is	  possible	  that	  the	  peer	  advisor	  may	  not	  always	  know	  
the	  right	  answer.	  The	  study	  investigators	  will	  be	  helping	  the	  peer	  advisors	  and	  meeting	  with	  
them	  weekly.	  Peer	  advisors	  are	  trained	  by	  study	  investigators.	  So	  the	  chance	  of	  the	  peer	  
advisor	  giving	  you	  the	  wrong	  information	  is	  very	  small.	  If	  any	  time	  you	  have	  concerns,	  you	  can	  
contact	  Dr.	  Cherrington.	  	  	  
	  
You	  will	  be	  assigned	  to	  a	  program	  by	  chance,	  which	  may	  prove	  to	  be	  less	  effective	  than	  the	  
other	  study	  group	  or	  available	  information.	  	  
	  
	  
Benefits	  
You	  may	  not	  benefit	  directly	  from	  taking	  part	  in	  this	  study.	  However,	  this	  study	  may	  help	  us	  
better	  understand	  how	  to	  treat	  diabetes	  better	  in	  the	  future.	  You	  will	  receive	  a	  “health	  report	  
card”	  at	  the	  data	  collection	  visits	  that	  tells	  your	  blood	  sugar	  number,	  cholesterol	  number,	  blood	  
pressure,	  and	  weight.	  	  
	  
	  
Alternatives	  
The	  alternative	  to	  this	  study	  is	  not	  to	  participate	  and	  continue	  your	  routine	  diabetes	  treatment.	  
	  
	  
Confidentiality	  
Information	  obtained	  about	  you	  for	  this	  study	  will	  be	  kept	  confidential	  to	  the	  extent	  allowed	  by	  
law.	  However,	  research	  information	  that	  identifies	  you	  may	  be	  shared	  with	  the	  UAB	  
Institutional	  Review	  Board	  (IRB)	  and	  others	  who	  are	  responsible	  for	  ensuring	  compliance	  with	  
laws	  and	  regulations	  related	  to	  research,	  including	  people	  on	  behalf	  of	  PCORI	  and	  the	  Office	  for	  
Human	  Research	  Protections	  (OHRP).	  The	  information	  from	  the	  research	  may	  be	  published	  for	  
scientific	  purposes;	  however,	  your	  identity	  will	  not	  be	  given	  out.	  
	  
Appendix Page |  328

Page	  4	  of	  6	  
Version   Date:   4/18/16  
Some	  of	  your	  sessions	  with	  your	  peer	  advisors	  may	  be	  audio	  recorded.	  A	  study	  investigator	  will	  
listen	  to	  these	  recordings	  to	  make	  sure	  that	  the	  peer	  advisor	  is	  conducting	  the	  sessions	  
correctly.	  The	  recordings	  will	  be	  kept	  in	  a	  secure	  place,	  a	  locked	  cabinet	  in	  a	  locked	  office	  suite	  
at	  UAB	  until	  they	  are	  listened	  to.	  The	  recordings	  will	  be	  erased	  after	  they	  are	  listened	  to.	  
	  
A	  description	  of	  this	  clinical	  trial	  will	  be	  available	  on	  http://www.ClinicalTrials.gov,	  as	  required	  
by	  U.S.	  Law.	  This	  Web	  site	  will	  not	  include	  information	  that	  can	  identify	  you.	  At	  most,	  the	  Web	  
site	  will	  include	  a	  summary	  of	  the	  results.	  You	  can	  search	  this	  Web	  site	  at	  any	  time.	  
	  
	  
Voluntary	  Participation	  and	  Withdrawal	  
Whether	  or	  not	  you	  take	  part	  in	  this	  study	  is	  your	  choice.	  There	  will	  be	  no	  penalty	  if	  you	  decide	  
not	  to	  be	  in	  the	  study.	  If	  you	  decide	  not	  to	  be	  in	  the	  study,	  you	  will	  not	  lose	  any	  benefits	  you	  
are	  otherwise	  owed.	  You	  are	  free	  to	  withdraw	  from	  this	  research	  study	  at	  any	  time.	  Your	  choice	  
to	  leave	  the	  study	  will	  not	  affect	  your	  relationship	  with	  UAB.	  
	  
	  
Cost	  of	  Participation	  
There	  will	  be	  no	  cost	  to	  you	  for	  taking	  part	  in	  this	  study.	  	  
	  
	  
Payment	  for	  Participation	  in	  Research	  
You	  receive	  a	  portable	  DVD	  player	  and	  $20	  for	  participating	  in	  this	  study.	  You	  will	  receive	  the	  
DVD	  player	  at	  the	  first	  in	  person	  data	  collection	  visit.	  You	  will	  receive	  a	  $20	  VISA	  card	  at	  the	  
second	  in	  person	  data	  collection	  visit.	  	  
	  
	  
Significant	  New	  Findings	  
You	  will	  be	  told	  by	  your	  doctor	  or	  the	  study	  staff	  if	  new	  information	  becomes	  available	  that	  
might	  affect	  your	  choice	  to	  stay	  in	  the	  study.	  
	  
	  
Questions	  
If	  you	  have	  any	  questions,	  concerns,	  or	  complaints	  about	  the	  research,	  you	  may	  contact	  one	  of	  
the	  studies	  investigators.	  For	  UAB,	  contact	  Dr.	  Andrea	  Cherrington.	  She	  will	  be	  glad	  to	  answer	  
any	  of	  your	  questions.	  Dr.	  Cherrington’s	  number	  is	  205-­‐996-­‐2885.	  	  	  
	  
If	  you	  have	  questions	  about	  your	  rights	  as	  a	  research	  participant,	  or	  concerns	  or	  complaints	  
about	  the	  research,	  you	  may	  contact	  the	  UAB	  Office	  of	  the	  IRB	  (OIRB)	  at	  (205)	  934-­‐3789	  or	  toll	  
free	  at	  1-­‐855-­‐860-­‐3789.	  Regular	  hours	  for	  the	  OIRB	  are	  8:00	  a.m.	  to	  5:00	  p.m.	  CT,	  Monday	  
through	  Friday.	  You	  may	  also	  call	  this	  number	  in	  the	  event	  the	  research	  staff	  cannot	  be	  reached	  
or	  you	  wish	  to	  talk	  to	  someone	  else.	  
Appendix Page |  329

Page	  5	  of	  6	  
Version   Date:   4/18/16  
Legal	  Rights	  
You	  are	  not	  waiving	  any	  of	  your	  legal	  rights	  by	  signing	  this	  informed	  consent	  document.	  
	  
	  
Signatures	  
Your	  signature	  below	  indicates	  that	  you	  have	  read	  (or	  been	  read)	  the	  information	  provided	  
above	  and	  agree	  to	  participate	  in	  this	  study.	  You	  will	  receive	  a	  copy	  of	  this	  signed	  consent	  form.	  
	  
	  
	  
	  
	  
	  
	  
	  
	  
	  
	  
	  
	  
	  
	  
	  
Signature	  of	  Participant	  
	  
	  
	  
	  
	  
	  
	  
Date	  
	  
	  
	  
	  
	  
	  
	  
	  
	  
	  
	  
	  
	  
	  
	  
	  
Signature	  of	  Person	  Obtaining	  Informed	  Consent	  
	  
	  
	  
	  
Date	  
	  
	  
	  
	  
	  
	  
	  
	  
	  
	  
	  
	  
	  
	  
	  
	  
Signature	  of	  Witness	   	  
	  
	  
	  
	  
	  
	  
	  
Date	  
	  
	  
	  
	  
	  
Reviewed	  by:	  
	  
	  
	  
	  
	  
	  
	  
	  
	  
	  
	  
	  
	  
	  
	  
Signature	  of	  Principal	  Investigator	  Reviewing	  Consent	  Document	   	  
	  
Date	  
	  
Appendix Page |  330

Page   6   of   6  
University	  of	  Alabama	  at	  Birmingham	  
AUTHORIZATION	  FOR	  USE/DISCLOSURE	  OF	  	  
PROTECTED	  HEALTH	  INFORMATION	  (PHI)	  FOR	  RESEARCH	  
	  
Participant	  Name:	  	  	  
	  
	  
	  
UAB	  IRB	  Protocol	  Number:	  X160301010	  
Research	  Protocol:	  	  Living	  Well	  (Improving	  Medication	  
Adherence	  in	  the	  Alabama	  Black	  Belt)-­‐AIM	  2	  
Principal	  Investigator:	  	  Andrea	  Cherrington,	  MD	  MPH	  
Sponsor:	  	  PCORI	  
	  
What	  is	  the	  purpose	  of	  this	  form?	  	  You	  are	  being	  asked	  to	  sign	  this	  form	  so	  that	  UAB	  may	  use	  and	  release	  your	  
protected	  health	  information	  for	  research.	  	  Participation	  in	  research	  is	  voluntary.	  	  If	  you	  choose	  to	  participate	  in	  
the	  research,	  you	  must	  sign	  this	  form	  so	  that	  your	  protected	  health	  information	  may	  be	  used	  for	  the	  research.	  
	  
Why	  do	  the	  researchers	  want	  my	  protected	  health	  information?	  	  The	  researchers	  want	  to	  use	  your	  protected	  
health	  information	  as	  part	  of	  the	  research	  protocol	  listed	  above	  and	  as	  described	  to	  you	  in	  the	  informed	  consent.	  
	  
What	  protected	  health	  information	  do	  the	  researchers	  want	  to	  use?	  	  All	  medical	  information,	  including	  but	  not	  
limited	  to	  information	  and/or	  records	  of	  any	  diagnosis	  or	  treatment	  of	  disease	  or	  condition,	  which	  may	  include	  
sexually	   transmitted	   diseases	   (e.g.,	   HIV,	   etc.)	   or	   communicable	   diseases,	   drug/alcohol	   dependency,	   etc.;	   all	  
personal	  identifiers,	  including	  but	  not	  limited	  to	  your	  name,	  social	  security	  number,	  medical	  record	  number,	  date	  
of	   birth,	   dates	   of	   service,	   etc.;	   any	   past,	   present,	   and	   future	   history,	   examinations,	   laboratory	   results,	   imaging	  
studies	   and	   reports	   and	   treatments	   of	   whatever	   kind,	   including	   but	   not	   limited	   to	   drug/alcohol	   treatment,	  
psychiatric/psychological	   treatment;	   financial/billing	   information,	   including	   but	   not	   limited	   to	   copies	   of	   your	  
medical	  bills,	  	  and	  any	  other	  information	  related	  to	  or	  collected	  for	  use	  in	  the	  research	  protocol,	  regardless	  of	  
whether	  the	  information	  was	  collected	  for	  research	  or	  non-­‐research	  (e.g.,	  treatment)	  purposes.	  
	  
Who	   will	   disclose,	   use	   and/or	   receive	   my	   protected	   health	   information?	   	   All	   Individuals/entities	   listed	   in	   the	  
informed	  consent	  documents,	  including	  but	  not	  limited	  to,	  the	  physicians,	  nurses	  and	  staff	  and	  others	  performing	  
services	  related	  to	  the	  research	  (whether	  at	  UAB	  or	  elsewhere);	  other	  operating	  units	  of	  UAB,	  HSF,	  UAB	  Highlands,	  
Children’s	  of	  Alabama,	  Eye	  Foundation	  Hospital,	  and	  the	  Jefferson	  County	  Department	  of	  Health,	  as	  necessary	  for	  
their	  operations;	  the	  IRB	  and	  its	  staff;	  the	  sponsor	  of	  the	  research	  and	  its	  employees	  and	  agents,	  including	  any	  
CRO;	   and	   any	   outside	   regulatory	   agencies,	   such	   as	   the	   Food	   and	   Drug	   Administration,	   providing	   oversight	   or	  
performing	  other	  legal	  and/or	  regulatory	  functions	  for	  which	  access	  to	  participant	  information	  is	  required.	  
	  
How	   will	   my	   protected	   health	   information	   be	   protected	   once	   it	   is	   given	   to	   others?	   	   Your	   protected	   health	  
information	  that	  is	  given	  to	  the	  study	  sponsor	  will	  remain	  private	  to	  the	  extent	  possible,	  even	  though	  the	  study	  
sponsor	   is	   not	   required	   to	   follow	   the	   federal	   privacy	   laws.	   However,	   once	   your	   information	   is	   given	   to	   other	  
organizations	   that	   are	   not	   required	   to	   follow	   federal	   privacy	   laws,	   we	   cannot	   assure	   that	   the	   information	   will	  
remain	  protected.	  
	  
How	   long	   will	   this	   Authorization	   last?	   	   Your	   authorization	   for	   the	   uses	   and	   disclosures	   described	   in	   this	  
Authorization	  does	  not	  have	  an	  expiration	  date.	  
	  
Can	   I	   cancel	   this	   Authorization?	   	   You	   may	   cancel	   this	   Authorization	   at	   any	   time	   by	   notifying	   the	   Principal	  
Investigator,	   in	   writing,	   referencing	   the	   research	   protocol	   and	   IRB	   Protocol	   Number.	   If	   you	   cancel	   this	  
Authorization,	   the	   study	   doctor	   and	   staff	   will	   not	   use	   any	   new	   health	   information	   for	   research.	   However,	  
researchers	  may	  continue	  to	  use	  the	  protected	  health	  information	  that	  was	  provided	  before	  you	  cancelled	  your	  
authorization.	  
	  
Can	  I	  see	  my	  protected	  health	  information?	  	  You	  have	  a	  right	  to	  request	  to	  see	  your	  protected	  health	  information.	  
However,	  to	  ensure	  the	  scientific	  integrity	  of	  the	  research,	  you	  will	  not	  be	  able	  to	  review	  the	  research	  information	  
until	  after	  the	  research	  protocol	  has	  been	  completed.	  
	  
Signature	  of	  participant:	  	   	  
	  
	  
	  
	  
	  
	  
	  
Date:	  	  
	  
	  
	  
or	  participant's	  legally	  authorized	  representative:	  	  
	  
	  
	  
	  
	  
Date:	  	  
	  
	  
	  
Printed	  Name	  of	  participant’s	  representative:	  	  
	  
	  
	  
	  
	  
	  
Relationship	  to	  the	  participant:	  	  
	  
	  
	  
	  
	  
	  
	  
Appendix Page |  331

In-person Data Collection Form 
Appendix Page |  332

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Health Report Card 
 
 
Appendix Page |  345

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Appendix G 
 
Participant Retention Postcards  
Appendix Page |  347

*HQHUDO+HDOWK0RQWK3RVWFDUG
$SSHQGL[3DJH_

Keep in touch!
*RWTXHVWLRQV"&DOOXVDW
Remember! Your 6 month visit is coming up soon!
Just a reminder, your 6 month visit is coming up!
We will be in contact to schedule this meeting soon.
*HQHUDO+HDOWK0RQWK3RVWFDUG
$SSHQGL[3DJH_

Reminder!
<RXUWHOHSKRQHDSSRLQWPHQWKDVEHHQVFKHGXOHGIRU
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We look forward to speaking with you!
If you have questions, please call us at: 205.934.7163
*HQHUDO+HDOWK0RQWK3RVWFDUG
$SSHQGL[3DJH_

*RWTXHVWLRQV"&DOOXVDW
from the UAB Living Well Study Team
Season’s Greetings!
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Happy Thanksgiving
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from the UAB Living Well Study Team
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Wishing you a very
Happy Birthday
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from the UAB Living Well Study Team
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$SSHQGL[3DJH_

Retention Scripts 
Appendix Page |  354

General Health Program Participant Phone Call Script – Month 1 
 
Voicemail leave message 1 time only:   
Hello, my name is __________, I am calling from the University of Alabama at Birmingham about the Living Well 
program. At your convenience, please call us at 205.934.7163. Thank you and have a nice day. 
 
Hello ___________, my name is __________________ calling from the University of Alabama at Birmingham 
about the Living Well research program. How are you today? 
 
May I please speak with __________________________? 
• 
[If not speaking] Is _____________ available? 
• 
[If no] When may I call back to speak with _____________? Thank you for your time. 
 
 
 
[Document Date/Time to call back]  
 
 
 
 
 
 
 
• 
[If yes continue when they come on the line] Hello _____________, my name is __________________ 
calling from the University of Alabama at Birmingham about the Living Well study. How are you today? 
I am calling today to welcome you to the Living Well General health research study and go over any 
questions you have about the study. 
- 
Have you watched any videos from the General Health DVD? Do you have any questions about any of the 
materials?  
- 
May I answer any questions that you may have about the study?  
 
I would like to verify your contact information. Is this your correct mailing address and telephone number?  
 
Yes – great thank you! (move to next question) 
 
No – obtain correct information and update spreadsheet. 
 
We also have ___________(name) as a friend or family member who would know your whereabouts in case 
we have trouble contacting you. Is this still the correct phone number for _________________(name)? 
 
Yes – go to close out 
 
No – Can you give me another person who would know your whereabouts in case we have trouble 
 
contacting you? Please think of someone who would not mind if we called them for this information. 
Close out:  
• 
Thank you again for your time today. A member of our team will be contacting you each month by mail or 
phone. If you would like to reach us before we talk again you can call us at the number listed on your 
DVD. If your phone number or address changes, or if you have any questions about the Living Well with 
Diabetes study, please call us at the same number. Thank you and have a wonderful day! 
 
Appendix Page |  355

General Health Program Participant Phone Call Script – Month 3 
 
Voicemail leave message 1 time only:   
Hello, my name is __________, I am calling from the University of Alabama at Birmingham about the Living Well 
program. At your convenience, please call us at 205.934.7163. Thank you and have a nice day. 
 
Hello ___________, my name is __________________ calling from the University of Alabama at Birmingham 
about the Living Well research program. How are you today? 
 
May I please speak with __________________________? 
• 
[If not speaking] Is _____________ available? 
• 
[If no] When may I call back to speak with _____________? Thank you for your time. 
 
 
 
[Document Date/Time to call back]  
 
 
 
 
 
 
 
• 
[If yes continue when they come on the line] Hello _____________, my name is __________________ 
calling from the University of Alabama at Birmingham about the Living Well study. How are you today? 
I am calling today to check in with you and answer go over any questions you have about the study. 
- 
Have you watched any videos from the General Health DVD? Do you have any questions about any of the 
materials?  
- 
May I answer any questions that you may have about the study?  
 
I would like to verify your contact information. Is this your correct mailing address and telephone number?  
 
Yes – great thank you! (move to next question) 
 
No – obtain correct information and update spreadsheet. 
 
We also have ___________(name) as a friend or family member who would know your whereabouts in case 
we have trouble contacting you. Is this still the correct phone number for _________________(name)? 
 
Yes – go to close out 
 
No – Can you give me another person who would know your whereabouts in case we have trouble 
 
contacting you? Please think of someone who would not mind if we called them for this information. 
Close out:  
• 
Thank you again for your time today. A member of our team will be contacting you each month by mail or 
phone. If you would like to reach us before we talk again you can call us at the number listed on your 
DVD. If your phone number or address changes, or if you have any questions about the Living Well with 
Diabetes study, please call us at the same number. Thank you and have a wonderful day! 
 
Appendix Page |  356

General Health Program Participant Phone Call Script – Month 5 
 
Voicemail leave message 1 time only:   
Hello, my name is __________, I am calling from the University of Alabama at Birmingham about the Living Well 
program. At your convenience, please call us at 205.934.7163. Thank you and have a nice day. 
 
Hello ___________, my name is __________________ calling from the University of Alabama at Birmingham 
about the Living Well research program. How are you today? 
 
May I please speak with __________________________? 
• 
[If not speaking] Is _____________ available? 
• 
[If no] When may I call back to speak with _____________? Thank you for your time. 
 
 
 
[Document Date/Time to call back]  
 
 
 
 
 
 
 
• 
[If yes continue when they come on the line] Hello _____________, my name is __________________ 
calling from the University of Alabama at Birmingham about the Living Well study. How are you today? 
I am calling today to check in with you and remind you that your 2nd study visit and telephone interview are 
coming up in 1 month.  
Your 2nd telephone interview and your study visit are coming up in 1 month. Let me tell you a little about these 
visits. During the telephone interview, we will ask you some questions about you and your diabetes. At the in-person 
data collection visit, UAB staff will do a finger stick test to check your A1c number, which is your average blood 
sugar level, and your blood cholesterol. They will also measure your height, weight, blood pressure, and make a list 
of your medications.  
- 
Remember, you will receive a $20 VISA gift card for completing the inperson study visit.  
- 
Would you like to schedule this visit and telephone interview today?  
o 
if no: Okay, I will give you a in 2-3 weeks. 
o 
If yes, schedule date and times: Great! We see you on ________________(date/time)! 
 
- 
May I answer any questions that you may have about the study?  
 
Close out:  
• 
Thank you again for your time today. We will talk to you on [date/time] to complete your telephone 
interview and on [date/time] to complete your 2nd in person study visit.  
• 
For your in person study visit, We ask that you do not to not drink any caffeine (from coffee, tea, or soda), 
should not eat or do any heavy physical activity, smoke, ingest alcohol for 30 minutes prior to the in person 
data collection visit. Please wear a loose fitting shirt to the study visit. 
• 
Thank you and have a wonderful day! 
 
 
 
Appendix Page |  357

 
Living Well Program Participant Phone Call Script – Month 2 
 
Voicemail leave message 1 time only:   
Hello, my name is __________, I am calling from the University of Alabama at Birmingham about the Living Well 
program. At your convenience, please call us at 205.934.7163. Thank you and have a nice day. 
 
Hello ___________, my name is __________________ calling from the University of Alabama at Birmingham 
about the Living Well research program. How are you today? 
 
May I please speak with __________________________? 
• 
[If not speaking] Is _____________ available? 
• 
[If no] When may I call back to speak with _____________? Thank you for your time. 
 
 
 
[Document Date/Time to call back]  
 
 
 
 
 
 
 
• 
[If yes continue when they come on the line] Hello _____________, my name is __________________ 
calling from the University of Alabama at Birmingham about the Living Well study. How are you today? 
I am calling today to check in with you and answer go over any questions you have about the study. 
- 
Have you spoken to your peer advisor? How many times since the beginning of the program have you 
spoken to your peer (NAME HERE).  
- 
May I answer any questions that you may have about the study?  
 
I would like to verify your contact information. Is this your correct mailing address and telephone number?  
 
Yes – great thank you! (move to next question) 
 
No – obtain correct information and update spreadsheet. 
 
We also have ___________(name) as a friend or family member who would know your whereabouts in case 
we have trouble contacting you. Is this still the correct phone number for _________________(name)? 
 
Yes – go to close out 
 
No – Can you give me another person who would know your whereabouts in case we have trouble 
 
contacting you? Please think of someone who would not mind if we called them for this information. 
Close out:  
• 
Thank you again for your time today. A member of our team will be contacting you each month by mail or 
phone. If you would like to reach us before we talk again you can call us at the number listed on your 
activity book. If your phone number or address changes, or if you have any questions about the Living Well 
with Diabetes study, please call us at the same number. Thank you and have a wonderful day! 
 
Appendix Page |  358

Living Well Program Participant Phone Call Script – Month 5 
 
Voicemail leave message 1 time only:   
Hello, my name is __________, I am calling from the University of Alabama at Birmingham about the Living Well 
program. At your convenience, please call us at 205.934.7163. Thank you and have a nice day. 
 
Hello ___________, my name is __________________ calling from the University of Alabama at Birmingham 
about the Living Well research program. How are you today? 
 
May I please speak with __________________________? 
• 
[If not speaking] Is _____________ available? 
• 
[If no] When may I call back to speak with _____________? Thank you for your time. 
 
 
 
[Document Date/Time to call back]  
 
 
 
 
 
 
 
• 
[If yes continue when they come on the line] Hello _____________, my name is __________________ 
calling from the University of Alabama at Birmingham about the Living Well study. How are you today? 
I am calling today to check in with you and remind you that your 2nd study visit and telephone interview are 
coming up in 1 month.  
- 
Have you spoken to your peer advisor? How many times in the past 4 weeks have you spoken to your peer 
(NAME HERE) 
- 
Your 2nd telephone interview and your study visit are coming up in 1 month. Let me tell you a little about 
these visits. During the telephone interview, we will ask you some questions about you and your diabetes. 
At the in-person data collection visit, UAB staff will do a finger stick test to check your A1c number, 
which is your average blood sugar level, and your blood cholesterol. They will also measure your height, 
weight, blood pressure, and make a list of your medications.  
- 
Remember, you will receive a $20 VISA gift card for completing the inperson study visit.  
- 
Would you like to schedule this visit and telephone interview today?  
o 
if no: Okay, I will give you a in 2-3 weeks. 
o 
If yes, schedule date and times: Great! We will call you on the phone and send you a reminder in 
your mail before the visits as a reminder. 
- 
May I answer any questions that you may have about the study?  
 
I would like to verify your contact information. Is this your correct mailing address and telephone number?  
 
Yes – great thank you! (move to next question) 
 
No – obtain correct information and update spreadsheet. 
 
We also have ___________(name) as a friend or family member who would know your whereabouts in case 
we have trouble contacting you. Is this still the correct phone number for _________________(name)? 
 
Yes – go to close out 
 
No – Can you give me another person who would know your whereabouts in case we have trouble 
 
contacting you? Please think of someone who would not mind if we called them for this information. 
Close out:  
• 
Thank you again for your time today. We will talk to you on [date/time] to complete your telephone 
interview and on [date/time] to complete your 2nd in person study visit. Thank you and have a wonderful 
day! 
 
Appendix Page |  359