The Road to Health Toolkit 

TRAINING GUIDE

How to Prevent or Delay 

Type 2 Diabetes in Your Community 

A Training Guide for Community Health Workers 

2010 

Suggested Citation 

Centers for Disease Control and Prevention. Road to Health Training Guide. Atlanta, GA: U.S. 


Department of Health and Human Services, Centers for Disease Control and
 

Prevention; 2010.
 

The Road to Health Training Guide 1 
Continuing Education Credit 

The Road to Health Training Guide 

Goal 

The goal of The Road to Health Training Guide is to: 

1) help readers learn how to use the Road to Health Toolkit and 

2) increase knowledge and skills regarding type 2 diabetes prevention among 

community health workers (CHWs) in Hispanic/Latino and African American/ 

African Ancestry communities, so they are able to clearly relay the following 

message: Type 2 diabetes does not have to be our destiny because it can be prevented 

or delayed in people at high risk for the disease. 

Objectives 

The following are the learning objectives for these materials. 

After this activity, the participant will have the knowledge, skills, and competency to: 

•	Define types, symptoms, and complications of diabetes. 

•	List at least three major findings of the Diabetes Prevention Program (DPP) 

study. 

•	Explain how type 2 diabetes can be prevented or delayed. 

•	Identify at least five risk factors for type 2 diabetes. 

•	Explain the importance of making small lifestyle changes to prevent or delay 

the onset of type 2 diabetes. 

•	Define serving and portion size for common foods. 

•	Demonstrate how to use the Road to Health Toolkit. 

•	Conduct a role play activity by using the Road to Health Toolkit Flipchart. 

•	Identify serving size, total calories, and saturated fat on Nutrition Facts labels. 

•	Use the National Diabetes Education Program (NDEP) Food and Activity 

Tracker to record food and drink intake and physical activity. 

•	Use the NDEP Fat and Calorie Counter to demonstrate how to determine the 

grams of fat and calories eaten. 

•	Use the poster Step by Step—The Road to Health to introduce, summarize, and 

end the training workshop. 

2 The Road to Health Training Guide 
 

 

•	Communicate the three key prevention messages to help prevent or delay the 

onset of type 2 diabetes— 

o 5 percent to 7 percent weight loss, if overweight by: 

o	 Making healthy food choices and following a low fat, low calorie meal 

plan. 

o	 Increasing physical activity for a minimum of 30 minutes at least five 

days a week. 

•	State the role of CHWs in helping people learn how to prevent or delay type 2 

diabetes by: 

o Explaining the roles CHWs have in the community. 

o Learning tips from CHWs. 

•	Develop and strengthen a partnership with the NDEP. 

Target Audiences 

The target audiences that may most benefit from these materials include people who 

develop or offer train-the-trainer workshops for CHWs/promotores de la salud who 

work with Hispanic/Latino or African American/African Ancestry people. Other 

health care professionals, diabetes educators, health educators, nurses, dietitians, and 

community educators may also use this Road to Health Training Guide. 

Authors 

The Road to Health Training Guide was written by 

Martha Londoño, PhD, Scimetrika, Independent Consultant 

Betsy Rodriguez, MSN, CDE, Centers for Disease Control and Prevention 

Leticia R. Dávila, MPH, Centers for Disease Control and Prevention 

Editors 

Jane Kelly, MD 

Michelle D. Owens, PhD 

Maralis B. Mercado, MPH 

Ashley Heath, MPH 

Ana Toro, MA 

Technical Reviewers 

Carol Brownson, MSPH – Robert Wood Johnson Foundation Diabetes Initiative 

James M. Galloway, MD – University Medical Center cardiologist, Indian Health 

Service 

The Road to Health Training Guide 3 
Credits Available 

CNEU 

The Centers for Disease Control and Prevention (CDC) is accredited as a provider 

of Continuing Nursing Education by the American Nurses Credentialing Center’s 

Commission on Accreditation. This activity provides 2.0 contact hours. 

CECH 

The Centers for Disease Control and Prevention is a designated provider of 

continuing education contact hours (CECH) in health education by the National 

Commission for Health Education Credentialing, Inc. This program is a designated 

event for the CHES to receive 2.0 Category I contact hours in health education, 

CDC provider number GA0082. 

CEU 

CDC has been reviewed and approved as an Authorized Provider by the 

International Association for Continuing Education and Training (IACET), 1760 

Old Meadow Road, Suite 500, McLean, VA 22102. CDC is authorized 

by IACET to offer 0.2 CEU for this program. 

Note to Nurses: CDC is accredited as a provider of continuing education in nursing 

by the American Nurses Credentialing Center’s (ANCC) Commission on Accreditation. 

ANCC credit is accepted by most State Boards of Nursing. 

California: The California Board of Nursing will accept CDC’s ANCC credit for 

self-study courses. However, they will not accept ANCC credit for courses offered 

within the state of California. When applying for re-licensure using ANCC credit, 

write-in “ANCC self-study.” A provider number is not needed. 

Iowa: Courses that are presented via “live” distance learning technologies, such as 

teleconferences or satellite programs, must be covered by an approved Iowa provider 

if they are attended at a site within Iowa. There are no exceptions to this requirement. 

However, courses taken as self-study over the Internet are acceptable if they are 

either covered by an approved Iowa provider, granted special approval, approved by 

the ANA (or ANCC), approved by the NLN, the NFLPN, NAPNES, or if they are 

approved by a board of nursing in another mandatory continuing education state. 

Reference: IAC 655, Chapter 5 - 5.2(2)f(i) 

4 The Road to Health Training Guide 
Instructions for Obtaining Continuing Education Credit 

•	Go to the CDC/ATSDR Training and Continuing Education Online at 

http://www.cdc.gov/TCEOnline. If you have not registered as a participant, 

click on New Participant to create a user ID and password; otherwise click 

on Participant Login and log on. 

•	Once logged on to the CDC/ATSDR Training and Continuing Education 

Online Web site, you will be on the Participant Services page. Click on Search 

and Register. Enter the course number (SS/DV1306) or a keyword under 

Keyword Search. Click View. 

•	Click on the course title: The Road to Health Training Guide. Select the type 

of CE credit you would like to receive and then click Submit. Three 

demographic questions will come up. Complete the questions and then Submit. 

A message will come up thanking you for registering for the course. If you have 

already completed the course, you can choose to go right to the evaluation and 

posttest. Complete the evaluation and Submit. Complete the posttest and 

Submit. A record of your course completion will be located in the Transcript 

and Certificate section. 

•	When asked for a verification code, please use HWRTH10. 

•	Continuing education credits for additional professions may be offered in the 

future. Visit http://www.cdc.gov/TCEOnline for updates. 

If you have any questions or problems, please contact: 

CDC/ATSDR Training and Continuing Education Online 

1-800-41TRAIN or 404-639-1292, or e-mail ce@cdc.gov. 

The materials and continuing education credits are free. Requirements for obtaining 

continuing education include reading The Road to Health Training Guide and 

Video, registering on CDC’s continuing education Web site 

(http://www.cdc.gov/TCEOnline), and completing an evaluation form and posttest. 

Release and Expiration Dates 

Release Date: 12/1/2008

Expiration Date: 12/1/2011

The Road to Health Training Guide 5 
Disclosure Statement 

CDC, our planners, and our content experts wish to disclose that they have no 

financial interests or other relationships with the manufacturers of commercial 

products, suppliers of commercial services, or commercial supporters. Content will 

not include any discussion of the unlabeled use of a product or a product under 

investigational use. 

Acknowledgments 

We acknowledge the contributions made to this toolkit from members of the following: 

National Diabetes Education Program (NDEP) Hispanic/Latino and the African 

American/African Ancestry Work Groups 

CDC 

Jane Kelly, MD 

Michelle Owens, PhD 

CDC thanks the following persons who pilot tested the materials: 

CDC 

Kristina Ernst, BSN, RN, CDE 

Susan McCarthy, MPH, CHES 

Susan Butler, EdD, CHES 

Irene Heaston, MSN 

External 

Mary Ellen Sagatys, MSN 

Deborah McGill, MSN, CHES 

Katharine Fitzgerald, MPH, MID, CHES 

Ashley Heath, MPH, CHES 

Heather Speer, MPH, CHES, COE 

Aisha Hasan, MSN 

The following persons were part of the review process of these materials: 

Rita Diaz- Kenney, MPH, RD, LD 

Luby Garza, MS, RD, LD 

Joanne Gavillan, MS, RD 

6 The Road to Health Training Guide 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Table of Contents
 

Introduction . . . . . . . . . . . . . . . . . . . 11
 

The Road to Health Toolkit 14 

Who is this Training Guide for? . . . . . . . . . . . . . 14
 

Goals of the Training Guide . . . . . . . . . . . . . . 15
 

Objectives . . . . . . . . . . . . . . . . . 15
 

Guide Format. . . . . . . . . . . . . . . . . . . 17
 

Methodology . . . . . . . . . . . . . . . . 17
 

Guide Organization . . . . . . . . . . . . . . 17
 

Areas: General Description . . . . . . . . . . . . 17
 

Colors . . . . . . . . . . . . . . . . . . 20
 

Activities . . . . . . . . . . . . . . . . . . 20
 

Icons . . . . . . . . . . . . . . . . . . . 21
 

Appendices . . . . . . . . . . . . . . . . . 22
 

Educational Session Development . . . . . . . . . . . . 23
 

Room Set-Up . . . . . . . . . . . . . . . . 23
 

Activity Planning. . . . . . . . . . . . . . . . . . 24
 

Key Questions . . . . . . . . . . . . . . . . 24
 

Training Preparation . . . . . . . . . . . . . . 24
 

Materials and Equipment. . . . . . . . . . . . . 26
 

Lessons Learned from Previous Train-the-Trainer Workshops . . . . 27
 

The Road to Health Training Guide 7 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Activity 1: What Do I Know and What Do I Want To Learn? . . . . 29
 

Activity 2: Introduction to the National Diabetes
 

Education Program (NDEP). . . . . . . . . . . 33
 

Activity 3: The Road to Health Toolkit 34
 

Area 1: Type 2 Diabetes and Its Prevention . . . . . . . . . 38
 

Activity 4: Introduction to Type 2 Diabetes Prevention . . . . . . 39
 

Activity 5: Williams’ Family Story: A Role Play . . . . . . . . 41
 

Activity 6: The Basic Concepts of Diabetes . . . . . . . . . . 43
 

Activity 7: A future without type 2 diabetes—can you see it? . . . . 46
 

Area 2: Making Healthy Food Choices . . . . . . . . . . 50
 

Activity 8: Where Do Calories Come From? . . . . . . . . . 51
 

Activity 9: Fat Detectives . . . . . . . . . . . . . . . 54
 

Activity 10: Portions. . . . . . . . . . . . . . . . . 57
 

Activity 11: The Traffic Light Method . . . . . . . . . . . 60
 

Area 3: Physical Activity and Movement . . . . . . . . . . 66
 

Activity 12: Moving Is the Key . . . . . . . . . . . . . 67
 

Activity 13: Move for Your Life . . . . . . . . . . . . . 70
 

Activity 14: Walking Down the Road to Health,
 

a Change Toward Good Health.
 

Type 2 Diabetes Does Not Have To Be Our Destiny . . . 74
 

Activity 15: Lifestyle Changes: Big Rewards . . . . . . . . . 76
 

Activity 16: The Road to Health Training Video . . . . . . . . 78
 

Activity 17: Community Health Workers (CHWs) Help People
 

to Follow The Road to Health . . . . . . . . . . 79
 

8 The Road to Health Training Guide 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Appendix A: PowerPoint Presentations . . . . . . . . . . . 81
 

Appendix B: . . . . . . . . . . . . . . . . . . . 82
 

Sign-in Sheet . . . . . . . . . . . . . . . . 83
 

Training Checklist . . . . . . . . . . . . . . . 84
 

Sample Agenda . . . . . . . . . . . . . . . . 87
 

Participant Profile . . . . . . . . . . . . . . . 91
 

Pretest and Posttest. . . . . . . . . . . . . . . 92
 

My Risk Factors For Type 2 Diabetes . . . . . . . . . 97
 

Training Evaluation . . . . . . . . . . . . . . 98
 

Appendix C: Posters Used During Training . . . . . . . . . . 100
 

Appendix D: Flipchart Sheets . . . . . . . . . . . . . . 100
 

Flipchart Sheet: What Do I Know and
 

Flipchart Sheet: Expectations and
 

Flipchart Sheet: Risk Factors: A future without
 

Flipchart Sheet: Training Ground Rules . . . . . . . . 101
 

What Do I Want To Learn? . . . . . . . . . . . . 102
 

Three Areas of Interest. . . . . . . . . . . . . . 103
 

Flipchart Sheet: The Williams’ Family Story . . . . . . . 103
 

Flipchart Sheet: The Basic Concepts of Diabetes . . . . . . 103
 

type 2 diabetes—can you see it? . . . . . . . . . . . 104
 

Flipchart Sheet: Where Do Calories Come From? . . . . . 104
 

Flipchart Sheet: Fat Detectives . . . . . . . . . . . 105
 

Flipchart Sheet: Portions . . . . . . . . . . . . . 105
 

The Road to Health Training Guide 9 
 

 

 

 

 

 

 

 

 

 

 

Flipchart Sheet: The Traffic Light Method. . . . . . . . 105
 

Flipchart Sheet: Walking Down the Road to Health,
 

a Change Towards Good Health. Type 2 Diabetes Does
 

Flipchart Sheet: CHWs Help People to Follow
 

Flipchart Sheet: Moving Is the Key . . . . . . . . . . 106
 

Flipchart Sheet: Move for Your Life. . . . . . . . . . 106
 

Not Have To Be Our Destiny. . . . . . . . . . . . 106
 

Flipchart Sheet: Lifestyle Changes: Big Rewards . . . . . . 106
 

Flipchart Sheet: The Road to Health Training Video . . . . 107
 

the Road to Health. . . . . . . . . . . . . . . 107
 

Appendix E: Attendance Certificate . . . . . . . . . . . . 108
 

Appendix F: DPP Study Prompt Questions. . . . . . . . . . 109
 

References . . . . . . . . . . . . . . . . . . . . 110
 

10 The Road to Health Training Guide 
Introduction 

Almost everyone knows someone who is affected by diabetes. Diabetes affects all 

of us regardless of age, ethnic group, or beliefs. It can cause disability, increased 

health care costs, loss of quality of life, and even early death. Almost 23.6 million 

people, or 7.8% of Americans, have diabetes, and an estimated 5.7 million are 

undiagnosed (Centers for Disease Control and Prevention [CDC]). 

Source: National Diabetes Fact Sheet: General Information and National Estimates on Diabetes in the 

United States, 2007. Atlanta, GA: U.S. Department of Health and Human Services, Centers for 

Disease Control and Prevention, 2008. 

Type 2 diabetes is the most common form of the disease (CDC 2008). Additionally, 

2007 data from the CDC estimate that another 57 million American adults had 

prediabetes, a condition that increases the risk of developing type 2 diabetes. 

In the United States, minority populations as a whole are at greater risk of developing 

diabetes than non-Hispanic whites. The risk is even greater among Hispanic/Latino 

and African American communities. Sufficient data are not available to derive 

prevalence estimates of both diagnosed and undiagnosed diabetes for all minority 

populations. Because most minority populations are younger and tend to develop 

diabetes at earlier ages than the non-Hispanic white population, population age 

differences must be controlled for when making race and ethnic comparisons. After 

adjusting for population age differences, 2004–2006 national survey data for people 

aged 20 years or older indicate that 10.4% of Hispanics and 11.8% of non-Hispanic 

blacks had diagnosed diabetes. Among Hispanics, rates were as follows: 

•	8.2% for Cubans 

•	11.9% for Mexican Americans 

•	12.6% for Puerto Ricans (CDC 2008) 

The Road to Health Training Guide 11 
Diabetes can affect many parts of the body and can lead to serious health 

problems such as: 

•	Heart attack and stroke 

•	Eye problems that can lead to trouble seeing or going blind 

•	Nerve damage that can cause your hands and feet to hurt, tingle, or feel numb 

•	Possible loss of foot or leg if feet are not checked on regular basis 

•	Kidney problems that can cause your kidneys to stop working, requiring kidney 

transplantation or life-long dialysis 

•	Gum disease and loss of teeth (Adapted from the National Diabetes Education 

Program [NDEP] 2006a) 

Despite diabetes being so common, many people have incorrect information about 

this disease and its complications. If left untreated, diabetes can lead to serious 

problems and early death. People should understand what diabetes is, and if they 

have the disease, receive the appropriate treatment to avoid its complications. Equally 

important is for people who do not have the disease to know what steps they can take 

to prevent or delay type 2 diabetes. 

About 5.7 million people are undiagnosed, and 57 million American adults had 

prediabetes in 2007 (CDC 2008). Many people do not find out they have diabetes 

until they are faced with problems, such as blurry vision or heart trouble. For this 

reason, people need to know if they are at risk for diabetes (NDEP 2006b). 

According to the Diabetes Prevention Program (DPP) study, diabetes is both 

a preventable and controllable chronic disease. The DPP study suggests a person can 

potentially prevent or delay the onset of type 2 diabetes if they: 

•	Lose 5 to 7 percent of their weight, if they are overweight—that’s 10 to 14 

pounds (4.5 to 6.3 kg) for a 200 pound (90.6 kg) person. 

•	Lose and maintain the weight loss by making healthy food choices by eating 

a variety of foods that are low in fat and reducing the number of calories they 

eat per day. 

•	Get at least 30 minutes of moderate-intensity physical activity at least five 

days a week. This could be brisk walking, yard work, and actively playing with 

children, for, example riding bicycles or playing soccer. (DDP, 2002 NDEP 

2006b). 

12 The Road to Health Training Guide 
NDEP works to ensure that people with diabetes learn how to control their condition 

and prevent future complications. It also promotes the understanding of methods 

to prevent or delay the onset of type 2 diabetes. NDEP uses the latest science, such 

as the DPP study results, to develop effective public education initiatives and bring 

them to life. 

NDEP has developed tools and products for minority populations to be used by 

health care professionals including CHWs. NDEP values CHWs, or, as they are 

known in Spanish, promotores de salud, as agents of change in the community. 

CHWs also known as community health advocates, lay health educators, community 

health representatives, peer health promoters, community health outreach workers, 

and promotores de salud are community members who work almost exclusively in 

community settings. They serve as connectors between health care consumers and 

health care professionals to promote health among groups that have traditionally 

lacked access to adequate health care (CDC, Division of Diabetes Translation, 2005). 

“When developing tools for the community, NDEP recognizes that type 2 

diabetes is a serious, common, costly, and controllable disease that can 

be prevented or delayed in people at high risk.” 

Source: Community Health Worker/Promotores de Salud: Critical Connection in Communities. 

http://www.cdc.gov/diabetes/projects/comm/htm. 

The Road to Health Training Guide 13 
 

The Road to Health Toolkit 

The Road to Health Toolkit is designed specifically for CHWs who provide outreach 

education to Hispanic/Latino and African American/African Ancestry communities, 

two groups at higher risk for type 2 diabetes. The Road to Health Toolkit provides 

real-life examples, hands-on activities, and interactive ideas, which focus on healthy 

food choices and increasing physical activity. 

The components of The Road to Health Toolkit are as follows: 

•	Flipchart 

•	User’s Guide 

•	Activities Guide 

•	Resource Guide 

•	Photo Journal 

•	CD/DVD Step-by-Step: Moving towards prevention of Type 2 Diabetes 

•	CD/DVD Movimiento Por Su Vida 

•	VHS copy of the music videos from Movimiento and Step-by-Step 

•	NDEP Food and Activity Tracker 

•	NDEP Fat and Calorie Counter 

•	The Road to Health Supplemental CD-ROM 

•	The Road to Health Training Guide 

•	The Road to Health Training Video 

NDEP identified the need for a product that addresses the use of the toolkit and 

as a result, this Training Guide was developed. 

Who is this Training Guide for? 

This guide is designed for people who develop or offer train-the-trainer workshops 

and for CHWs who work with Hispanic/Latino or African American/African 

Ancestry people. Other health care professionals, diabetes educators, health educators, 

nurses, dietitians, and community educators can also be trained in using the Road 

to Health Toolkit The Road to Health Toolkit was designed for Hispanic/Latino and 

African American/African Ancestry communities, but it can appeal to anyone. 

14 The Road to Health Training Guide 
Goals of the Training Guide 

1. To increase knowledge and skills about type 2 diabetes prevention among CHWs 

in Hispanic/Latino and African American/African Ancestry communities so they 

are able to clearly relay the following message: Type 2 diabetes does not have to 

be our destiny because it can be prevented or delayed. 

2. To help participants learn how to use the Road to Health Toolkit 

3. To develop and/or strengthen partnerships with NDEP 

Objectives 

At the end of the training, participants will have: 

The knowledge to 

•	Define types, symptoms, and complications of diabetes. 

•	List at least three major findings of the DPP study. 

•	Explain how type 2 diabetes can be prevented or delayed. 

•	Identify at least five risk factors for type 2 diabetes. 

•	Explain the importance of making small lifestyle changes to prevent or delay 

the onset of type 2 diabetes. 

•	Define serving and portion size. 

The skills to 

•	Demonstrate how to use the Road to Health Toolkit. 

•	Conduct a role play activity by using the Road to Health Toolkit Flipchart. 

•	Identify serving size, total calories, and saturated fat on Nutrition Facts Labels. 

•	Use the NDEP Food and Activity Tracker to record food and drink intake and 

physical activity. 

•	Use the NDEP Fat and Calorie Counter to demonstrate how to determine the 

grams of fat and calories eaten. 

•	Use the poster Step by Step—The Road to Health to introduce, summarize, and 

end the training workshop. 

The Road to Health Training Guide 15 
The competency to 

•	Communicate the three key prevention messages to help prevent or delay the 

onset of type 2 diabetes: 

o By teaching how to make healthy food choices 

o Increasing physical activity for 30 minutes at least 5 days a week 

o 5 to 7 percent weight loss, if overweight 

•	State the role of CHWs in helping people learn how to prevent or delay type 2 

diabetes by: 

o Explaining the roles CHWs have in the community.
 

o Learning tips from CHWs.
 

•	Develop and/or strengthen a partnership with NDEP. 

16 The Road to Health Training Guide 
Guide Format 

Methodology 

The Training Guide uses an active learning (participatory) method that focuses 

on “learning by doing.” The activities developed in this Training Guide include 

questions that actively involve participants. By the completion of this training, 

participants’ skills and knowledge of primary prevention of type 2 diabetes is 

expected to increase. Participants are then expected to have the knowledge and skills 

necessary to relay to others a clear and precise presentation of the various health 

messages and tools of the Road to Health Toolkit. 

This guide was written in an easy-to-read format. It contains activities that are based 

on different educational strategies and reference tools such as the Flipchart, Resource 

Guide, Activities Guide, and Photo Journal, which are part of the Road to Health 

Toolkit. 

Guide Organization 

The guide is divided into three areas, and each area contains several topics. The areas 

are: 

1. Type 2 Diabetes and Its Prevention 

2. Making healthy food choices 

3. Physical Activity and Movement 

Areas: General Description 

Area 1: Type 2 Diabetes and Its Prevention – Red 

Topics 

1. A future without type 2 diabetes—can you see it? 

2. Understanding Diabetes—Who is at Risk? 

3. How to Prevent or Delay Type 2 Diabetes 

Objectives 

•	Define diabetes and its types, symptoms, and complications. 

•	Explain the difference between controlling diabetes and preventing
 

type 2 diabetes.
 

The Road to Health Training Guide 17 
•	Discuss at least three findings of the Diabetes Prevention Program (DPP). 

•	Identify three key strategies for preventing type 2 diabetes. 

Activities 

•	Introduction to the prevention of type 2 diabetes. 

•	Williams’ family story (a role play). 

•	The basic concepts of diabetes. 

•	Risk factors: A future without type 2 diabetes—can you see it? 

Area 2: Making Healthy Food Choices – Yellow 

Topics 

1. Food Labels—Where are the Calories? 

2. Fat Hidden in Food—Fat Detectives 

3. Fast Food—Less for More 

4. Portion Size—More for Your Money 

Objectives 

•	Explain the “traffic light method” as a strategy to select healthier foods, reduce 

portion size, and increase fruit and vegetable intake. 

•	Discuss the difference between a portion and a serving. 

•	Compare foods to common objects (for example, deck of cards, baseball) and 

tell the difference between a portion and a serving size. 

•	Analyze the concept of “more for your money.” 

•	Identify serving size and fat, sugar, and calorie content per serving on Nutrition 

Facts labels. 

Activities 

•	Fat detectives 

•	Where do calories come from? 

•	Portions 

•	The Traffic Light Method 

18 The Road to Health Training Guide 
Area 3: Physical Activity and Movement – Blue 

Topics 

1. Physical Activity—How Much, How Often, and What Type? 

2. Barriers and Excuses—Welcome to the City of Excuses 

3. Rewards for a Healthy Lifestyle 

Objectives 

•	Analyze barriers for not being physically active. 

•	Explain the importance of making small lifestyle changes to prevent or delay 

type 2 diabetes. 

•	Use the Movimiento Por Su Vida music CD/DVD/VHS and Step by Step: 

Moving towards prevention of Type 2 Diabetes music CD/DVD/VHS 

as strategies to promote physical activity. 

Activities 

•	Moving is the key. 

•	Move for your life. 

•	Walking down the road to health, a change towards good health.
 

Type 2 Diabetes does not have to be our destiny.
 

•	Lifestyle changes: big rewards. 

•	The Road to Health Training Video 

•	CHWs help people to follow the road to health. 

The Road to Health Training Guide 19 
Colors 

Each area has been assigned a color to make it easy to remember. 

Note that color was not available for this publication. 

Red For Type 2 Diabetes and Its Prevention, red symbolizes that 

you must be alert. 

Yellow For Making Healthy Food Choices, yellow symbolizes being careful; 

we can’t eat everything we want in any amount we want. 

Blue	 For Physical Activity and Movement, blue symbolizes that 

you need to walk and move your body towards prevention 

of type 2 diabetes. 

Activities 

A variety of activities have been developed to encourage participant learning using 

the Road to Health Toolkit. 

In these activities, participants’ senses are used to ensure that 90% of what is learned 

is remembered. We remember 20% of what we hear, 30% of what we see, 50% 

of what we see and hear, 70% of what we say to others, and 90% of what we do 

(Pike, 1989). 

The purpose, duration, materials, and procedures are specified for each activity. 

In some activities, you will see definitions or concepts and notes for the trainer. 

20 The Road to Health Training Guide 
Icons 

The guide uses several icons to assist the trainer. 

If you come across 

this icon It means And the trainer should: 

Required Materials Pay special attention and be sure 

to organize all necessary materials. 

? Questions 

Ask participants the provided 

questions to facilitate group 

participation. 

Activity Duration 

Note the average time suggested 

for an activity. Activities on 

average require 15–30 minutes 

to complete; but modifying 

factors, such as number of people, 

group format, and previous 

knowledge of basic diabetes 

concepts, among others, must 

be taken into account. 

Trainer Notes 

Keep these suggestions 

or comments in mind while 

developing the activity. 

Definitions 

and Concepts 

Highlight key concepts and 

definitions. 

The Road to Health Training Guide 21 
Appendices 

In the appendices you will find: 

Appendix A: PowerPoint Presentations 

•	Training Guide’s goals and objectives 

•	Introduction to the National Diabetes Education Program (NDEP) 

•	The Road to Health Toolkit 

•	Introduction to Prevention of Type 2 Diabetes Prevention Study (DPP) 

•	The Basic Concepts of Diabetes 

Appendix B: Forms 

•	Sign-in Sheet 

•	Training Checklist 

•	A sample Agenda 

•	Participant Profile 

•	Pretest and Posttest 

•	My Risk Factors for Type 2 Diabetes 

•	Training Evaluation 

Appendix C: Posters Used During Training 

•	A future without type 2 diabetes—can you see it? 

•	Step by Step—The Road to Health 

•	Welcome to the City of Excuses 

•	Nutrition Facts Labels 

•	The Traffic Light Method 

Appendix D: Flipchart Sheets 

Appendix E: Attendance Certificates 

Appendix F: DPP Study Prompt Questions 

References 

22 The Road to Health Training Guide 
Educational Session Development 

Room Set-Up 

1. Have a registration table at the room entrance with the following items: 

Clearly label the registration table as “Registration Table” — a handwritten sign 

will do if you do not have a printed one. 

•	Sign-in sheet 

•	Participant profile form 

•	Pretest 

•	Red, yellow, and blue cards 

•	Training agenda 

•	Name tents and tags 

•	Pens and/or pencils 

2. Place all necessary materials for each activity on a table located beside the place 

where you will be conducting the presentation. Also have the following items 

available: 

•	Training Evaluation 

•	Posttest 

•	Music CD/DVD/VHS: Movimiento Por Su Vida and/or Step-by-Step: Moving 

towards prevention of Type 2 Diabetes CD/DVD/VHS 

3. Try to arrange participants’ chairs in a U-shape so that the trainer and
 

participants can see each other to increase interaction.
 

The Road to Health Training Guide 23 
 

 

 

4. Place the posters listed below in visible locations so that everyone can see them. 

•	Step-by-Step—The Road to Health 

•	Welcome to the City of Excuses 

•	Nutrition Facts Labels 

•	A future without type 2 diabetes—can you see it? 

•	The Traffic Light Method 

Activity Planning 

When preparing for the training workshop, ask yourself the following questions: 

Key Questions 

1.	 Why do you want to do this training? - General objectives 

2.	 What do you want to achieve with this training? - Goals 

3.	 Who is the training for? - Number of participants and participants’ profiles 

4.	 How do you want to do the training? All activities or specific areas?
 

What content and activities do you want to use?
 

5.	 Where will the training be held? - Physical location of the training 

6.	 When? - Date and time 

7.	 How long will the training session last? - Duration 

8.	 Who will conduct the training? - Trainer profile 

9.	 What is the budget for the training? - Amount paid to the trainers by the hour 

and total amount (detailed by areas) 

10. What additional resources do you need? - This guide indicates the physical 


resources required for each activity.
 

Training Preparation 

1. Choose and reserve a well located, easily accessible, and proper sized room 

equipped with a computer, LDC projector and screen, or an overhead projector. 

2. Make sure that the training location is distraction free, well lit, and
 

at a comfortable temperature. The environment should be spacious to allow 


movement while working with small and large groups.
 

3. Determine how you will notify participants about the place and time for the 

training. 

24 The Road to Health Training Guide 
 

4. Make sure all of the equipment is working before the training. 

5. Print a copy of the trainer notes. 

6. Practice your training—preferably in the same room and with the same 

equipment you are planning to use during the training. 

7. Gather all necessary materials. (See the materials checklist for the entire training 

on page 84 and for each activity.) 

8. Make sure you have enough copies of the materials for all participants. 

9. Keep in mind that groups work better when you define group rules at the 

beginning of the activity. The following are suggestions to keep in mind when 

defining group rules: 

o	 We encourage each trainer to define his or her own rules with each group 

to avoid the belief that “one size fits all.” 

o	 The following example can help guide the trainer in leading the group 

in rule-setting. 

Respect:

•	Each person has the opportunity to ask questions and share information. 

•	All ideas and thoughts are good. We have the right to disagree. Please do not 

criticize or degrade others. 

•	When a person speaks, everyone will listen actively. 

•	Questions and comments will be limited to allow time for everybody
 

to participate.
 

•	We will stick to the agenda and begin and finish each session on time. 

Feedback to participants must be: 

•	Focused on the behavior, not on the person 

•	Constructive 

•	Sensitive 

•	Relevant 

Confidential:

•	Personal opinions and experiences shared with the group will stay in the group. 

The Road to Health Training Guide 25 
Materials and Equipment 

The following are materials and equipment you will need to lead the entire training 

session. 

•	Training Checklist in Appendix B 

•	A flipchart on its tripod and/or wall space to exhibit flipchart sheets. Before the 

training, write out the text on the flipchart sheets using the flipchart examples. 

See Appendix D for the flipchart sheets. 

•	Different colored markers 

•	Different colored pieces of paper 

•	Colored paper foot cutouts 

•	Masking tape 

•	Blank paper or notebooks 

•	Pens/pencils 

•	Copies of different food group labels 

•	Training agenda 

•	Attendance sign-in sheet: to be made according to the organization’s needs. 

You may include, name, telephone number, address, e-mail address, and other 

information of interest. 

•	Name tents and tags: for participants to display their names. 

•	Participant Profile form: this form gathers basic information that collects the 

characteristics of participants. You may want to develop your profile form for 

your specific needs. 

•	Pretest: this test is used to determine areas of strength and weakness among 

participants, so that the trainer can help reinforce the weaker areas. 

•	Posttest: this test is used at the end of the training session to determine if 

knowledge was increased. 

•	Color cards for each area: red for type 2 diabetes and its prevention, yellow 

for making healthy food choices and blue for physical activity and movement 

(the number of cards for each area will equal the number of participants. See 

description of activity 1.) 

•	DPP study prompt questions: see description in Activity 4. 

•	Training evaluation form: the form is organized according to the objectives, 

areas, and topics developed in the guide; it can be used to analyze achievements 

and improve future training sessions. 

26 The Road to Health Training Guide 
•	Depending on equipment availability a computer loaded with PowerPoint 

software and an LCD projector for the computer (or a simple overhead 

projector and slides). While a screen is desirable, if necessary, a bare wall will 

suffice. The five presentations you need are listed in the appendices. Consider 

having printed copies of the presentations for each participant. You can also 

have them enlarged to present them on a flipchart. 

•	The Road to Health Toolkit 

•	Posters listed in the Appendix page are available in full color in the
 

Road to Health Supplemental CD-ROM.
 

o A future without type 2 diabetes—can you see it? 

o Step-by-Step—The Road to Health 

o Welcome to the City of Excuses 

o Nutrition Facts Labels 

o The Traffic Light Method 

•	Equipment to play the music CD/DVD and video 

•	Elastic stretch bands (three different types and colors—green, red, and yellow.) 

This is optional. You can use other common objects like food cans; the idea 

is to encourage physical activity and movement. 

Lessons Learned from Previous Train-the-Trainer 

Workshops 

In this section, we describe the lessons learned from previous training workshops 

with various groups of CHWs. Lessons learned were collected by using several 

sources: conference evaluations, training evaluations, observations, shared experience 

among trainers, and video recordings of training workshops. 

Logistics Planning 

•	The training should be carried out by two trainers. If this is not possible, the 

trainer must have an assistant to help with training logistics. 

•	Plan the training as an 8-hour workshop, which allows time for discussion, 

sharing, and questions. 

•	Work with small groups, no more than 30 participants, to ensure participation, 

productivity, and interaction. 

•	Conduct the training in a large space. Some activities require participants 

to move throughout the room. 

The Road to Health Training Guide 27 
Trainers 

•	Be flexible with the agenda and keep an open mind. Participants may be very 

diverse in terms of age, gender, culture, level of education, knowledge about 

diabetes, skills, and training expectations. 

•	If any changes are made, document changes to activities for future classes and 

for evaluation. 

Training Session 

•	At the beginning of the training, emphasize the training’s purpose; be clear that 

the objective is to teach primary prevention of type 2 diabetes, which includes 

activities to help people change their behavior and modify their lifestyle. 

•	Clarify the goals of the training and participants’ expectations. Explain that the 

training is about the prevention of type 2 diabetes. 

•	All materials must be available in both English and Spanish. 

•	At the end of the training, plan to review and discuss the answers of the 

Posttest. This activity will allow the trainer to clarify questions and/or doubts. 

•	Allow time for participants to practice what they learned from the activity 

and to demonstrate how they would conduct this activity in a future training. 

You might need to adjust the times for each activity if you, as trainer, would 

like to add this “demonstration” piece. 

28 The Road to Health Training Guide 
 

Activity 1: What Do I Know and What Do I Want To Learn? 

Purpose 

•	To encourage participation. 

•	To determine previous knowledge level. 

•	To identify group expectations. 

•	To facilitate the relationship between participants
 

and trainers.
 

30 minutes for 30 participants 

•	Flipchart sheet: What Do I Know and What Do I Want To Learn?—See 

Appendix D 

•	Flipchart sheet: Expectations and Three Areas of Interest—See Appendix D 

•	Training Guide’s Goals and Objective PowerPoint 

•	Color markers 

•	Three Colored Cards for each area 

o	 Red (type 2 diabetes and its prevention), yellow (making healthy food 

choices), and blue (physical activity and movement). Prepare three cards 

for each participant with appropriate text for each. 

•	Three balls—red (type 2 diabetes and its prevention), yellow (making healthy 

food choices), blue (physical activity and movement) 

The Road to Health Training Guide 29 
The three areas and the text to be written on each card are as follows: 

Red 

Card 1 – Type 2 Diabetes and Its Prevention 

•	A future without type 2 diabetes—can you see it? 

•	Understanding Diabetes—Who is at Risk? 

•	How to Prevent or Delay Type 2 Diabetes 

Yellow 

Card 2 – Making Healthy Food Choices 

•	Food Labels—Where are the Calories? 

•	Fat Hidden in Food—Fat Detectives 

•	Fast Food—Less for More 

•	Portion Size—More for Your Money 

Blue 

Card 3 – Physical Activity and Movement 

•	Physical Activity—How Much, How Often, and What Type? 

•	Barriers and Excuses—Welcome to the City of Excuses 

•	Rewards for a Healthy Lifestyle 

30 The Road to Health Training Guide 
 

 

 

 

 

 

 

 

 

Starting the Session 

1.	 Welcome participants as they come in, ask them to sign the attendance sheet, 

and give them name tags and forms (Participant Profile, Pretest, the area cards, 

and Training Agenda). Ask participants to complete the pretest individually. 

2.	 Ask participants to take a red, blue, and yellow card and to read what each one 

says. Instruct them to choose: first the area card they know the most about and 

have the most experience in, and second a card that represents an area in which 

they have little knowledge. Have participants sit at the table with the color that 

corresponds to the colored card they picked, indicating the area they know 

most about. 

3.	 After sitting down, participants should take the card they have little knowledge 

about or experience in and place it on the table in front of them. Tell them to 

be ready to discuss their training expectations and the areas about which they 

would like to learn more. 

4.	 When all participants are seated, ask them if they have finished filling out the 

Profile and the Pretest. Pick them up. 

5.	 Welcome participants and introduce the trainers and other people who are 

helping with the training. Thank the organization that is making it possible 

to do this training. 

6.	 Have all participants introduce themselves. 

7.	 Start the presentation by telling them that the toolkit has been developed 

by NDEP. The toolkit was developed for CHWs who work with Hispanic/ 

Latino persons and African Americans/African Ancestry communities at risk 

of developing type 2 diabetes. 

8.	 Locate flipcharts to record feedback and make sure that all participants can see 

the flipchart or the projection screen. Also, make sure that each participant has 

training materials. You as the trainer will record feedback in these three areas: 

•	The area they know the most about. 

•	The area participants are the most interested in learning more about. 

•	Their training expectations. 

9.	 Ask participants if they have health education experience in the community, 

at home, or at work. Ask for two to three people to briefly share their 

experiences. Explain that health education involves participatory activities that 

allow participants to have the opportunity to share their experiences. 

10. Discuss the ground rules with the group. Now you are ready to conduct the 

first activity in this guide. 

The Road to Health Training Guide 31 
Procedure 

This activity begins as participants arrive. 

1. Before the activity, the trainer will write on the flipchart sheet the three areas 

of interest: 1) Type 2 Diabetes and Its Prevention, 2) Making Healthy Food 

Choices and 3) Physical Activity and Movement. See Appendix D page 102 for 

an example. 

2. The trainer places one color card at each table: one table with a red card, one 


with a yellow card, and one with a blue card.
 

3. Reinforce the notion that each participant should sit in the colored area
 

corresponding to the area in which they have the most knowledge.
 

4. The color cards on each table should aid the trainer in identifying the areas
 

of expertise of participants. The trainer should encourage them to use their
 

experiences throughout the training.
 

5. The trainer throws the balls to different people and instructs participants to 

introduce themselves and state the area in which they have the most knowledge 

and the area they would like to learn more about. This process will continue 

until all participants have had a chance to introduce themselves. The trainer also 

asks participants about their expectations for the training. 

6. As participants indicate the area they would like to learn more about, the trainer 

or co-trainer will write their responses on the flipchart under the proper area. 

Reminder: the three areas are Type 2 Diabetes and Its Prevention, Making 

Healthy Food Choices, and Physical Activity and Movement. 

7. On another flipchart sheet, the trainer or co-trainer writes participants’
 

expectations for this training.
 

8. At the end, everybody has become familiar with the three areas in the guide 

along with the area they would like to learn more about. The trainer will 

emphasize that the training has been planned to help participants develop these 

three areas. 

9. Emphasize the areas participants would like to learn more about. You must 

pay special attention to the expectations of the group and to areas of major and 

minor interest. We strongly suggest that the trainer take into account the 

participants’ learning needs. 

•	Review the goals and objectives on pages 15–16 of this guide and use the 

Training Guide’s Goals and Objectives PowerPoint located in the Road to Health 

Supplemental CD-ROM. Make sure to tie the goals and objectives to 

participants’ expectations for the training. 

•	Present the training agenda. 

•	Identify additional learning needs. 

•	Continue with the next activity. 

32 The Road to Health Training Guide 
Activity 2: Introduction to the National Diabetes Education 

Program (NDEP) 

Purpose 

•	Share the goals, objectives and activities of the National Diabetes Education 

Program (NDEP). 

•	Introduce the products and campaigns developed by NDEP. 

NDEP information can be replaced for the organization’s information. We encourage 

you to tell participants that they can find more information about the National 

Diabetes Education Program, by visiting www.ndep.nih.gov. A list of NDEP Web 

sites can be found in the Road to Health Resource Guide on page 3. 

10 minutes 

•	Computer, LCD projector, screen 

•	Introduction to the NDEP PowerPoint or transparencies presentation
 

(copies for each participant)
 

•	Overhead projector and screen if you use transparencies 

•	Toolkit tool to use:
 

o Road to Health Resource Guide
 

Procedure 

1. Present the PowerPoint on the National Diabetes Education Program, which 

is found in the Road to Health Supplemental CD-ROM of this guide. The trainer 

will highlight NDEP goals, objectives, and campaigns. 

2. Answer any questions, clarify concerns, and then continue with the next activity. 

The Road to Health Training Guide 33 
 

Activity 3: The Road to Health Toolkit 

Purpose 

•	Introduce The Road to Health Toolkit 

•	Show the different tools of the toolkit. 

o Flipchart 

o User’s Guide 

o Activities Guide 

o Resource Guide 

o Photo Journal 

o CD/DVD Step-by-Step: Moving towards prevention of Type 2 Diabetes 

o CD/DVD Movimiento Por Su Vida 

o VHS copy of the music videos from Movimiento and Step-by-Step 

o NDEP Food and Activity Tracker 

o NDEP Fat and Calorie Counter 

o The Road to Health Supplemental CD-ROM 

o The Road to Health Training Guide 

o The Road to Health Training Video 

•	Promote toolkit use. 

15 minutes 

•	Computer, LCD projector, screen 

•	The Road to Health Toolkit PowerPoint or transparencies presentation (copies for 

each participant) 

•	Overhead projector and screen if you use transparencies 

•	Toolkit tool to use:
 

o Road to Health Toolkit
 

34 The Road to Health Training Guide 
Procedure 

1. Present the Road to Health Toolkit goals and objectives. It is recommended that 

the trainer review the User’s Guide and the instructions on how to use the Road 

to Health Flipchart. 

2. Make sure each participant has a toolkit. 

3. Present the tools one by one, allowing time for participants to glance briefly 

at each one. 

4. Inform participants that this training is designed to learn how to use the tools 

of the toolkit. 

This area introduces basic diabetes information, the difference between diabetes 

control and prevention, the DPP study, and several type 2 diabetes prevention 

strategies. 

The Road to Health Training Guide 35 

Area 1 
Area 1: Type 2 Diabetes and Its Prevention – Red 

Note: Color was not available. 

This section introduces basic diabetes information, the difference between diabetes 

control and prevention, the DPP study, and several type 2 diabetes prevention 

strategies. 

Objectives 

1. Define diabetes, its types, symptoms, and complications. 

2. Explain the difference between controlling diabetes and preventing
 

type 2 diabetes.
 

3. Discuss at least three findings of the DPP study. 

4. Identify three key strategies for type 2 diabetes prevention. 

38 The Road to Health Training Guide 
 

Activity 4: Introduction to Type 2 Diabetes Prevention 

Purpose 

•	Communicate the three key DPP study messages to prevent or delay type 2 

diabetes: weight loss, making healthy food choices, and physical activity. 

15 minutes 

•	Computer, LCD projector, screen 

•	A future without type 2 diabetes—can you see it? poster - See Appendix C 

•	DPP study prompt questions cards - See Appendix F 

•	Introduction to prevention of type 2 diabetes and the DPP study PowerPoint 

or transparencies presentation (copies for each participant) 

•	Overhead projector and screen if you use transparencies 

•	Toolkit tools to use:
 

o Road to Health User’s Guide
 

Procedure 

1. Ask participants to think about someone close to them who has been able 

to prevent or delay type 2 diabetes. Ask if anyone would like to share his or her 

story. 

o	 Make sure you have prepared three index cards with the DPP study 

prompt questions on each card (see Appendix F for examples of the 

cards). 

2. Discuss the three important messages (see box) of the DPP study using the DPP 

study prompt questions as follows: 

o What was the goal of the DPP study? 

o Which age group had the highest reduction in the development 

of diabetes?
 

o What are the three main messages of the DPP study?
 

The Road to Health Training Guide 39 
Three main messages of the DPP study 

•	Lose 5% to 7% of your weight, if you are overweight—that’s 10 to 14 pounds 

(4.5 to 6.3 kg) for a 200-pound/90.6 kg person. 

•	Lose and maintain the weight loss by making healthy food choices by eating a 

variety of foods that are low in fat and reducing the number of calories they eat 

per day. 

•	Get at least 30 minutes of moderate-intensity physical activity (brisk walking, 

yard work, and actively playing with children) at least 5 days a week (NDEP, 

2006b). 

3. Ask for three volunteers to choose a question card, read it out loud, and share 

their response with the group. 

This activity will help you to identify participants’ knowledge of the DPP study. 

4. After all questions have been answered, continue the activity by using the 

Introduction to Prevention of Type 2 Diabetes and the DPP Study PowerPoint 

to summarize this topic of the DPP study. 

5. Conclude the activity by showing the poster A future without type 2 diabetes— 

can you see it? 

40 The Road to Health Training Guide 
Activity 5: The Williams’ Family Story (a Role Play) 

Purpose 

•	Learn to use the Road to Health Flipchart as a training tool to assist in teaching 

participants to recognize diabetes as a family problem. 

15 minutes 

•	A future without type 2 diabetes—can you see it? poster - See Appendix C 

•	Flipchart sheet: The Williams’ Family Story - See Appendix D 

•	Toolkit tools to use: 

o Road to Health Flipchart 

o Road to Health User’s Guide 

Procedure 

1. Explain how to use the Road to Health Flipchart as a training tool. You can refer 

to the first section of the Road to Health Flipchart for instructions as well as the 

Road to Health User’s Guide. 

2. Ask at least three participants to come up to the front and sit in a circle. Explain 

that they will role play using the Road to Health Flipchart. Ask one to play the 

CHW and the other actors to play a family in their home environment. The 

CHW will read the Williams’ Family story using the Road to Health Flipchart. 

3. Have the participant who is playing the CHW read the Background section 

of the Road to Health Flipchart where it says, “Angela and Ray are sister and 

brother.” The person who is role playing Angela should say, “I see our future...a 

future without type 2 diabetes...” Ray should say “With better choices, we can 

prevent or delay type 2 diabetes...” 

4. Use the flipchart sheet “The Williams’ Family Story”. The CHW will ask the 

following questions, first, to the actors and then to the other participants in the 

room: 

The Road to Health Training Guide 41 
?

•	Does anyone in your family have diabetes? Open the discussion and allow 


everybody to participate.
 

•	How has diabetes affected your family? Open the discussion and allow
 

everybody to participate.
 

•	Do you think you are at risk of developing diabetes? This topic is not
 

thoroughly discussed because it will be presented in Activity 7.
 

5. Emphasize the fact that persons at increased risk can prevent or delay type 2 

diabetes by losing a small amount of weight and getting at least 30 minutes 

of moderate-intensity physical activity at least 5 days a week. This could be brisk 

walking, yard work, or actively playing with children, for example, riding 

bicycles or playing soccer. (Use A future without type 2 diabetes—can you see it? 

poster - See Appendix C). 

6. Ask participants to repeat this at least twice: “Type 2 diabetes does not have 

to be our destiny.” 

7. Thank role play participants and then ask them to return to their seats and 

continue with the next activity. 

42 The Road to Health Training Guide 
Activity 6: The Basic Concepts of Diabetes 

Purpose 

•	Define pancreas, the function of insulin, and in general, the human body and 

diabetes. 

•	Define diabetes. 

•	Talk about the types of diabetes. 

•	Discuss the symptoms and complications. 

15 minutes 

•	The human body included in the Road to Health Flipchart 

•	Flipchart sheet: The Basic Concepts of Diabetes - See Appendix D 

•	Markers 

•	The Basic Concepts of Diabetes PowerPoint 

•	Link for Life: Interactive Program on Diabetes and Cardiovascular Diseases 

(http://web.diabetes.org/link/chooser.htm) 

•	Toolkit tools to use:
 

o Road to Health Flipchart
 

o Road to Health Resource Guide
 

The Road to Health Training Guide 43 
 

 

Procedure 

Be sure to review and study the basic concepts of diabetes and understand them 

clearly before this activity. Use the Road to Health Resource Guide or the resources 

that follow. 

1. Start the activity by introducing diabetes basics using either A, B, or C: 

A. The Link for Life: Interactive Program on Diabetes and Cardiovascular 

Diseases tool found on the American Diabetes Association Web site 

at http://web.diabetes.org/link/chooser.htm. 

B. The Basic Concepts of Diabetes PowerPoint 

C. Interactive diabetes tutorial at: 

http://www.nlm.nih.gov/medlineplus/tutorials/diabetesintroduction/htm/index.htm 

(Internet access is needed to use this tool). This tutorial can be used 

to develop your own explanation of this chronic illness. 

2. Ask participants the questions that follow. Wait for answers and write them
 

on the flipchart.
 

?

•	What is diabetes? 

•	What are the symptoms of diabetes? 

•	What are the complications of diabetes? 

•	What does the pancreas do? 

•	What is insulin? 

•	What are the types of diabetes? 

The trainer must previously review and study the basic concepts of diabetes and 

understand them clearly. For this, it is suggested that you use the Road to Health 

Resource Guide. In the Training Guide, you will find Web sites which, upon 

consultation will provide information which, upon consultation, will provide 

information about diabetes. 

3. Review the responses given by participants. Continue with the human body 

figure in the Road to Health Flipchart. 

4. Highlight the examples included in the Road to Health Flipchart (glass with 

lemonade). Next, review the most important aspects of normal human body 

function and how diabetes alters that functioning. 

44 The Road to Health Training Guide 
5. Ask participants the following questions: 

?

•	When the Williams’ family talks about diabetes, how do they refer to it? 

•	Do you know what the complications of diabetes are? 

•	Do you consider diabetes to be a disease that can bring serious complications? 

•	Do you know how to delay or prevent these complications?
 

Do you know what the complications of diabetes are?
 

•	When your family talks about diabetes, what do they talk about? 

•	Did you know that type 2 diabetes can be prevented or delayed? 

•	What do you think when you hear type 2 diabetes can be prevented
 

or delayed by small changes in your lifestyle?
 

6. Finally, clarify and respond to questions participants may have before you 

continue. 

The Road to Health Training Guide 45 
Activity 7: Risk Factors: A future without type 2 diabetes— 

can you see it? 

Purpose 

•	Identify risk factors and the importance of knowing if you are at risk. 

15 minutes 

•	A future without type 2 diabetes—can you see it? poster - See Appendix C 

•	Step-by-Step—The Road to Health poster - See Appendix C 

•	My Risk Factors for Type 2 Diabetes - See Appendix B 

•	Flipchart sheet: Risk Factors: A Future Without Type 2 Diabetes—Can You See 

It? - See Appendix D 

•	Colored sheets of paper and flipchart 

•	Toolkit tools to use:
 

o Road to Health Flipchart
 

o Road to Health Resource Guide
 

o Road to Health User’s Guide
 

Procedure 

A survey conducted by NDEP found that only 25% of people at high risk for diabetes 

reported that they thought they were at increased risk for diabetes. Of those who 

thought they were at high risk, 60% identified family history of diabetes as the reason 

they felt they were at risk. For this reason, we hope that people will relate their story 

with the story of the Williams’ family. 

Other risk factors were noted much less frequently in the NDEP survey. Fewer than 

1 in 5 people at risk for diabetes mentioned modifiable risk factors. For example, 

only 22% reported being overweight as a risk factor, and only 13% mentioned poor 

eating habits. 

46 The Road to Health Training Guide 
Furthermore, when asked “Do you feel at risk for diabetes?” more than half of the 

people who had been told by a doctor or other health care professional that they have 

prediabetes said that they feel at risk for diabetes. We need to help people recognize 

when they are at increased risk for diabetes and what risk factors they can do 

something about (NDEP Program Update Newsletter, 2007). 

1. To begin this activity, instruct participants to open the Road to Health Flipchart 

to page 1, The Williams’ Family Story. 

2. Ask for a volunteer to read page 3 of the Road to Health Flipchart: “Diabetes 

runs in our family, but I don’t claim it. I’m making small changes to what I eat 

and what I do. I am losing a few pounds and I’m in control.” Continue reading: 

“Even those of us at high risk can prevent or delay type 2 diabetes.” 

3. Using the flipchart sheet Risk Factors: A future without type 2 diabetes—can 

you see it? You may want to raise the following questions with participants. Wait 

for responses and write them down. 

?

•	What is a risk factor? 

•	What are some of the risk factors for type 2 diabetes? 

•	What do you think when they tell you that you may be at high risk?
 

Do you worry?
 

•	List modifiable risk factors 

•	List non-modifiable risk factors 

•	What are the risk factors for type 2 diabetes that you can control. 

•	What are the risk factors for type 2 diabetes that you can’t control. 

4. Pass out the form My Risk Factors for Type 2 Diabetes (see Appendix B). Ask 

participants to evaluate each risk factor and to perform a self-analysis of risk. 

5. Refer participants to the Road to Health User’s Guide, Cultural Issues Around 


Weight (page 29), to check to see if their weight places them at risk for
 

developing type 2 diabetes.
 

The Road to Health Training Guide 47 
6. Place colored pieces of paper on a table. Ask each participant to take a piece 

of paper for each risk factor that they have identified for themselves. Explain that 

this represents how many risk factors you have and it shows which ones you can 

work towards reducing. 

7. Say: “Of the modifiable risk factors, select one that you will work on and 

commit to changing.” 

? •	What do you think are the small changes we can talk about today 

(e.g., nutrition, physical activity, and gradual weight loss)? 

8. Distribute the Road to Health Resource Guide. 

9. Check the Road to Health Resource Guide to find other materials or information 

that may help you teach about risk factors for developing type 2 diabetes. 

10. Finish the activity using the Step-by-Step—The Road to Health poster to review 

the modifiable and non-modifiable risk factors for type 2 diabetes. 

48 The Road to Health Training Guide 
Area 2 
Area 2: Making Healthy Food Choices – Yellow 

Note: Color was not available. 

This area introduces nutrition as a one of the type 2 diabetes prevention strategies 

recommended by the DPP study. 

Objectives 

1. Explain the “traffic light method” as a strategy to select healthier foods, reduce 

portion size, and increase fruit and vegetable intake. 

2. Discuss the difference between a portion and a serving. 

3. Compare foods to common objects (deck of cards, baseball, etc.). 

4. Analyze the concept of “more for your money.” 

5. Identify the serving size and fat, sugar, and calories per serving on Nutrition 

Facts labels. 

50 The Road to Health Training Guide 
Activity 8: Where Do Calories Come From? 

Purpose 

•	Learn to identify the origin of calories. 

•	Learn to select foods that have a healthy amount of calories. 

30 minutes 

•	Nutrition Facts Labels Poster - See Appendix C 

•	Copies of different food group labels 

•	Flipchart sheet: Where Do Calories Come From? - See Appendix D 

•	Toolkit tools to use:
 

o NDEP Fat and Calorie Counter
 

o Road to Health Supplemental CD-ROM
 

o Road to Health Activities Guide
 

o Road to Health Flipchart
 

Procedure 

The NDEP Fat and Calorie Counter is a booklet that lists more than 1,500 foods with 

their fat content and calorie count. Review and select the foods that you are going to 

discuss for this activity. Be sure you have one booklet per participant. To obtain copies 

of the NDEP Fat and Calorie Counter booklet, visit the NDEP Web site at 

www.ndep.nih.gov. Copies are also available in the Road to Health Supplemental CD-ROM. 

1. Hand out the NDEP Fat and Calorie Counter booklet and let participants know 

they’ll be using it for this activity. 

2. Begin the activity by saying, “Many Americans are overweight. Almost two-thirds 

of us are. You may be at a ‘healthy weight’, but not eating the right foods that 

give your body all the good nutrients you need to be healthy. For example, you 

may be at a healthy weight, but you may also not be eating enough fruits, 

vegetables, or whole grains. We’ve been talking a lot about calories. Why? Because 

the number of calories you eat and drink, and use up through daily activities, 

is closely associated with your weight. Does it matter what types of foods the 

The Road to Health Training Guide 51 
 

calories come from. Yes and no. When it comes to calories and managing 

your weight, the answer is no. A calorie is a calorie. Choosing healthy food is 

important, and we’ll address this. That is one of the reasons why we are here today: 

to share practical information that we can use to improve our decisions.” 

(A Healthier You: Based on the Dietary Guidelines for Americans. 2005). 

We do not expect participants to become experts at estimating how many grams 

of fat or how many calories there are in each food. But looking up favorite fast-food 

restaurant choices, which are often high-fat, high-calorie choices, can be an 

eye-opener. The most important thing is that we become aware of the need to reduce 

the amount of food that we eat daily and increase our physical activity to reduce the 

risk of developing diabetes. 

3. Use the flipchart sheet Where Do Calories Come From? (see Appendix D). 

Ask participants the following questions: 

? •	Where do calories come from? 

•	What food groups have more calories? 

4. Summarize the answers participants provide and add, “Let’s discover interesting 

things.” Write the following information on the Where Do Calories Come 

From? flipchart sheet: 

•	 1 g of sugar = 4 calories

•	 1 g of alcohol = 7 calories

•	 1 g of protein = 4 calories 

•	 1 g of fat = 9 calories 

•	 1 teaspoonful of sugar is equivalent to 4 grams of sugar = 20 calories 

•	 Example: 1⁄2 Apple juice, which has 15 g of carbohydrates, is 15 ÷ 4 = 33⁄4
 

teaspoonfuls of sugar = 60 calories
 

•	 1 teaspoonful of lard is equivalent to 5 grams of fat = 45 calories 

5. Continue the activity by saying, “If you are thinking about losing weight, you 

must reduce calories and increase physical activity. Let’s go on with the activity— 

this is very interesting—let’s see what you eat.” 

52 The Road to Health Training Guide 
6. Ask participants to look in their NDEP Fat and Calorie Counter to find at least 

two of their favorite foods and identify the calories per serving size. 

7. Refer participants to the Road to Health Flipchart section on value meals. Say: 

“Value meals are a bargain for your wallet but not a bargain for your health. Take 

a look at the amount of fat and calories each item contains.” Have a participant 

read out loud the amount of calories for the hamburger, fries, and a soft drink. 

8. Use the Where Do Calories Come From? flipchart sheet, located in Appendix D. 

Ask participants the following questions: 

•	What did you find? 

•	What do you want to change now that you have this information? 

9. Conclude by saying, “We have already learned some eating secrets. The decision 

is ours: keep the secret or tell it to others.” 

Review the Road to Health Activities Guide for more activity ideas on healthy 

nutrition or you can use the Food Comparison Sheet located in the Appendix section 

of the Road to Health Activities Guide. 

If participants ask questions about carbohydrate counting say that we are only 

looking at being fat detectives and preventing type 2 diabetes. 

Say that carbohydrate counting is a method used for people with diabetes. 

?

The Road to Health Training Guide 53 
Activity 9: Fat Detectives 

Purpose 

•	Learn to read and use nutrition facts labels to make a better food selection. 

30 minutes 

•	Step-by-Step—The Road to Health poster - See Appendix C 

•	A future without type 2 diabetes—can you see it? poster - See Appendix C 

•	Flipchart sheet: Fat Detectives - See Appendix D 

•	Nutrition Facts Labels poster - See Appendix C 

•	Copies of reduced fat milk (2%) and nonfat milk labels - See Appendix C 

•	Toolkit tools to use:
 

o Road to Health Flipchart
 

o Road to Health Activities Guide
 

Procedure 

Before you begin the activity, make copies of the Nutrition Facts Labels poster. 

1. Begin this activity saying, “To prevent or delay type 2 diabetes, lose 5% to 7% of 

weight, if overweight—that’s 10 to 14 pounds (4.5 to 6.3 kg) for a 200-pound 

person (90.6kg); get at least 30 minutes of moderate-intensity physical activity 

at least 5 days a week; eat a variety of foods that are low in fat; and reduce the 

number of calories you eat per day.” Show A future without type 2 diabetes—can 

you see it? poster. 

2. Say, “Let’s begin with nutrition. Let’s review the nutrition facts label.” 

3. Use the flipchart sheet Fat Detectives (see Appendix D). Ask participants the
 

following question:
 

54 The Road to Health Training Guide 
•	How many of you look at food labels to select healthy foods? 

4. Say, “The first thing that Ray, the brother in our story, wants to learn is about 

the nutritional value of the foods he eats and how to choose better foods. We are 

going to look at the nutrition facts labels of very common foods.” 

5. Distribute the Nutrition Facts Labels poster that has the reduced fat milk (2%) 

and nonfat milk food labels. On the labels, identify the portion and the serving 

size. Say to participants, “Let’s find the calories, the fat content, and the sugar 

content in each product.” 

Trainers, be sure to explain that information on the Nutrition Facts Label is based on 

ONE serving, but many packages contain more than one serving. Look at the serving 

size and how many servings you are actually consuming. If you double the servings 

you eat, you double the calories and nutrients. When comparing calories and 

nutrients between brands, check to see if the serving size is the same. 

?

6. On a flipchart sheet, draw the chart below: 

Food Serving size Calories Total fat Sugar 

Reduced fat 

(2%) milk 

Nonfat milk 

7. Ask participants to help you fill out the chart. 

8. After presenting the milk labels, show other nutrition facts labels and ask 

participants to identify serving sizes and fat and calories content, etc. Refer 

to page 4 of the Road to Health Flipchart, which has a section on nutrition facts 

labels and also the Road to Health Activities Guide under the section Background 

Information: Reading Nutrition Labels for Fats and Sugars (page 14). 

9. Ask participants to refer to the section Activity 3: Food Detective II in the Road 

to Health Activities Guide page 13. This activity teaches participants to read labels 

and shop for healthier choices for themselves and their families. Have one 

volunteer read Activity 3. 

The Road to Health Training Guide 55 
10. Ask participants to refer to the section on high-fat foods in the Road to Health 

Flipchart. Say, “There are a lot of hidden fats in your food. These fats can 

be called oil, partially hydrogenated oil, butter, margarine, lard, or shortening. 

Small amounts of high-fat foods are high in calories. Take a look at some 

of these examples in the flipchart (potato chips, two chicken drumsticks, and 

a donut) (page 5).” 

11. Ask participants these questions: 

? •	What kinds of food do you eat that are high in fat? 

•	What are easy ways to reduce fat in what you eat? 

12. Ask participants what they have learned about reading the Nutrition Facts 


Label as a tool to choose healthier foods.
 

13. Ask participants the following questions, and write their answers on the
 

flipchart sheet.
 

?

•	What do you think about when you hear the expression “making healthy 

food choices?” 

•	What do you look for when you read nutrition labels? 

•	Can you mention some foods that you could substitute for healthier options? 

Ask for several examples. 

14. Review what has been written and emphasize the need to change eating habits. 

15. Conclude by saying, “To start, we need to know how to choose healthier foods. 

As we have just seen, learning to read and use nutrition facts labels can help 

us make better food decisions.” Clarify doubts and go on to the next activity. 

You can also use other products for this example, such as the difference between 

pre-sweetened cereals and whole grain, no-sugar-added cereals, or cooked oatmeal 

(not instant); the content of an orange and orange juice versus orange-flavored 

drinks; etc. 

56 The Road to Health Training Guide 
Activity 10: Portions 

Purpose 

•	Learn how to determine food portions. 

30 minutes 

•	A light bulb, a deck of cards, and an ice cream scoop (as shown on the Road to 

Health Flipchart page 8) 

•	Flipchart sheet: Portions - See Appendix D 

•	Toolkit tools to use: 

o	 Road to Health User’s Guide 

o	 Road to Health Activities Guide 

o	 Road to Health Flipchart - “Learning how to control portion
 

size is easy”
 

Procedure 

Review and study pages 18–20 of the Road to Health User’s Guide to learn how to 

use the Road to Health Activities Guide and the Road to Health Resource Guide, where 

you will find information about Web sites that provide additional information on 

the concepts of serving and portion sizes. In addition, review the Road to Health 

Flipchart—“Learning how to control portion size is easy”—to be able to teach the 

concept of proper portion size. 

The concept of “portions” versus “servings” can be challenging. We recommend you 

discuss portion control using these terms, but if participants seem confused, consider 

using the term “helping” to indicate the amount of food one might take at a meal. 

For example: 

•	 “How big of a helping do you usually take of this food?” 

•	 “Do you usually take second helpings?” 

•	 “How big would a second helping of this food be for you?” 

The Road to Health Training Guide 57 
1. Begin by reading the Road to Health Flipchart Background section, where it 

explains that Angela and Ray have learned about the foods they eat. They have 

also learned the importance of eating adequate food portions. 

Reinforce the concept that the key to losing weight is to control the portion size of 

the food we eat. 

2. Use the Portions flipchart sheet in Appendix D to write down the questions that 

guide the discussion on portion size. Ask participants the following questions: 

?

•	How do you measure ingredient portions when you cook? 

•	Do you measure the portions or do you approximate the amounts?
 

Do you estimate?
 

3. Say, “Yes, we can estimate, but it is better to have images of objects that we know 

and use in everyday life to approximate eating healthier portion sizes. For this, 

we’re going to do an exercise.” 

4. Ask participants to look Activity 1: Portion Distortion on page 10 of the Road 

to Health Activities Guide. This activity helps to teach how portions have become 

larger over time and how these larger portions add up to eating too many 

calories per day. You can also use the Portion Distortion Quiz in the Supplemental 

CD-Rom of the Road to Health Toolkit. 

5. You can find examples of common objects to illustrate portion size in the 

Appendix of the Road to Health Activities Guide titled “Size Up Your Servings.” 

You can also find information on portions versus serving size and tips for portion 

control in the Appendix of the Road to Health Activities Guide titled “Portions 

versus Servings.” 

Remember! You can create your own version of a common object example box for 

your group containing things like an ice cream scoop (1⁄2 cup of cooked rice or pasta), 

4 dice (11⁄2 ounces of low-fat cheese), a deck of cards or a cassette tape (3 ounces 

of lean meat or fish), and a ping pong ball (2 tablespoons low-fat peanut butter) 

(NDEP, 2006b). 

58 The Road to Health Training Guide 
6. Ask participants to pair up and discuss the common objects used to illustrate 

portion size. 

7. Refer participants to the Road to Health Flipchart section on portions. Say, “Take 

a look at the common objects being used in this example. This easy system will 

help you bring your portion size of food closer to the recommended serving 

size.” 

8. Ask participants the following questions: 

?

•	What is your favorite food? 

•	How much do you usually eat of your favorite food? 

•	What is the recommended portion of your favorite food? 

•	How big is your portion (or helping) of your favorite food? 

•	What is your commitment to health? 

9. Summarize what has been written on the flipchart sheet. Clarify doubts and 

continue with the next activity. 

The Road to Health Training Guide 59 
Activity 11: The Traffic Light Method 

Purpose 

•	Use the traffic light method as a way to choose healthy foods. 

•	Recognize foods that put you at high risk for gaining weight. 

30 minutes 

•	Step-by-Step—The Road to Health poster - See Appendix C 

•	The Traffic Light Method poster - see Appendix C 

•	Flipchart sheet: The Traffic Light Method - See Appendix D 

•	Toolkit tools to use:
 

o Road to Health Flipchart
 

o NDEP Fat and Calorie Counter
 

o NDEP Food and Activity Tracker
 

o Road to Health Activities Guide
 

Procedure 

1. Say to participants: “We have already reviewed several concepts, such as nutrition 

facts labels, fat, calories, and portions, which help us to making healthy food 

choices. Now we are going to use the traffic light as a method for grouping and 

selecting the best foods.” 

2. Show The Traffic Light Method poster and then ask the following question. 

Use the flipchart sheet The Traffic Light Method in Appendix D to guide the 

discussion. 

? •	What does each traffic light color mean?

60 The Road to Health Training Guide 
3. State the following: “Yes, the colors indicate when it’s safe to cross the street. 

In making healthy food choices, the traffic light can also be used to classify foods 

according to their tendency to increase weight and bring about obesity, thus 

resulting in diseases, such as diabetes and heart disease.” Then ask participants the 

following question: 

? •	What does red mean? 

4. Wait for answers and add, “Red means we cannot cross the street because there 

is a high risk of accident and death. In the same way, red foods put us at risk of 

excess weight, obesity, and chronic diseases, such as type 2 diabetes.” Continue 

with the following question: 

? •	What foods would you classify as red? 

5. Wait for answers, then say, “Red foods means to “have these foods only once in 

a while and in very small portions.” You must always remember this when you 

select what to eat.” Then ask participants the following question: 

? •	What does yellow mean? 

6. Wait for answers and add, “Yellow represents foods that we can eat, but if we 

eat them daily or in portions that are too large, they will put us at risk for excess 

weight and obesity and diseases, such as type 2 diabetes.” Continue with the 

following question: 

The Road to Health Training Guide 61 
? •	What foods would you classify as yellow? 

7. State that: “Foods classified as yellow can be considered acceptable, but we must 

be careful to avoid eating too many of these foods.” Then ask participants the 

following question: 

? •	What does green mean? 

8. Wait for answers and add, “It’s the color we associate with foods that are healthy 

as long as we take portion size into account.” Ask participants the following 

question: 

? •	What foods would you classify as green? 

9. Tell participants to keep the traffic light concepts in mind when they plan their 

meals and go grocery shopping. Ask participants the following questions: 

•	How can you eat healthier foods and still satisfy your hunger? 

•	How can you use the traffic light method for daily eating? 

?

62 The Road to Health Training Guide 
 

Reinforce concepts 

•	Remind participants to use the NDEP Fat and Calorie Counter to help identify 

the fat and calorie content of different foods and to use this information to 

make better food choices. 

•	Instruct participants to locate the traffic light illustration in the Road to Health 

Flipchart. Also, find examples of foods for each color of the traffic light. The 

poster can be found in The Road to Health Supplemental CD-ROM 

•	Instruct participants to use the NDEP Food and Activity Tracker to write down 

how much of what they eat and drink and the amount of physical activity they 

do. To obtain copies of the NDEP Food and Activity Tracker, in English and 

in Spanish, visit the NDEP Website at www.ndep.nih.gov. Copies are also 

available on the Road to Health Supplemental CD-ROM. 

•	Remind participants that another method for making healthy food choices 

can be found in the Road to Health Activities Guide, “Tips for Getting More 

Vegetables in Your Diet: The Plate Method” for another method of making 

healthy food choices. 

10. Conclude by saying, “And all of this is to continue on the road to health.”
 

Use the Poster Step-by-Step—The Road to Health.
 

The Road to Health Training Guide 63 
64 The Road to Health Training Guide 
Area 3 

The Road to Health Training Guide 65
Area 3: Physical Activity and Movement – Blue

This area addresses prevention strategies from the DPP study to increase physical 

activity. 

Note: Color was not available. 

Objectives 

1. Analyze barriers to physical activity. 

2. Explain the importance of making small lifestyle changes to prevent or delay 


type 2 diabetes.
 

3. Use the Movimiento Por Su Vida music CD/DVD/VHS and Step-by-Step: 

Moving Towards Prevention of Type 2 Diabetes music CD/DVD/VHS as strategies 

to promote physical activity. 

66 The Road to Health Training Guide 
Activity 12: Moving is the Key 

Purpose 

•	Promote physical activity to prevent or delay type 2 diabetes. 

•	Identify common barriers to physical activity. 

•	Identify strategies to eliminate the barriers. 

10 minutes 

•	Step-by-Step—The Road to Health poster - See Appendix C 

•	Welcome to the City of Excuses poster - See appendix C 

•	Flipchart sheet: Moving is the Key - See Appendix D 

•	Paper 

•	Pens and pencils 

•	Toolkit tools to use:
 

o Road to Health Flipchart
 

o Road to Health Activities Guide
 

Procedure 

1. Begin by reading what Angela says in the Road to Health Flipchart (page 9): 

“Preventing type 2 diabetes is not just about food choices. I also had to move 

more! I make simple, small moves that add up to at least 30 minutes a day.” 

2. Continue by reading from the Road to Health Flipchart (page 10) in the 

Background section: “Ray talks about excuses to avoid physical activity—he 

didn’t have time, he was too tired, and lots of others. So he tackled them one 

at a time. He broke up 30 minutes into three 10 minute segments.” 

The Road to Health Training Guide 67 
Be sure to emphasize the following message to your training participants: “The excuse 

often given for not being physically active is lack of time. Setting aside at least 30 

consecutive minutes each day for planned physical activity is one option, but it is not 

the only way. Physical activity can include short periods (e.g., 10-minute sessions) 

of moderate-intensity activity. The accumulated total is what is important—both for 

health and for burning calories. Physical activity can be accumulated through three 

to six 10-minute bouts over the course of a day” (Adapted from U.S. Department 

of Health and Human Services, 2005). 

3. Say to participants “Now let’s talk about common barriers to physical activity. 

We all have them.” 

4. Use the flipchart sheet Moving is the Key (see Appendix D), and show the 

Welcome to the City of Excuses poster. Indicate that this poster is in the Road 

to Health Activities Guide. You can also find a copy of the Welcome to the City 

of Excuses in the Road to Health Supplemental CD-ROM. 

5. Another resource you can use to explain excuses or barriers participants may face 

is the Barriers to Being Active quiz, a PDF file in the Road to Health Supplemental 

CD-ROM. It can help you identify the types of barriers that keep participants 

from making regular physical activity an important part of their lives. Once 

participants have taken the quiz and have been scored on all seven parts, they 

will understand which barriers affect them the most, and you can look together 

at the table on the next page for suggestions on how to overcome them. Use 

the Welcome to the City of Excuses poster to show examples of barriers. Help 

participants identify ways to make these barriers less overwhelming by focusing 

on small changes one day at a time. 

6. Ask the following question: 

? •	What is the main reason you and your family may not do physical activity? 

68 The Road to Health Training Guide 
7. Wait for answers and write them down on the flipchart sheet. Continue with the 

following questions, writing answers on the flipchart sheet. 

? •	What are the barriers in your life that keep you from making healthy changes? 

•	How can you reduce or eliminate the barriers? 

8. Use the Moving is the Key flipchart sheet (see Appendix D). Ask participants the 

following questions: 

•	What healthy habits can you acquire this month? Wait and congratulate the 

efforts and commitments to change. 

?

9. Give participants one sheet of paper each and ask them to write their personal 

goals. Then ask, “How can we measure success and the progress of goals?” 

10. Use the Step-by-Step—The Road to Health poster to summarize what participants 

have learned thus far. You should also highlight where you are now on the 

Step by Step—The Road to Health poster. 

11. Conclude by asking participants to repeat the following: “There are no excuses; 

only my decisions. Every day, I decide to make small changes to take care 

of myself and to take control of my life.” 

The Road to Health Training Guide 69 
 

Activity 13: Move for Your Life 

Purpose 

•	Practice a physical activity to prevent or delay type 2 diabetes. 

•	Identify different options for physical activity. 

•	Encourage participants to make important contributions to their health, sense 

of well-being, and maintenance of a healthy body weight by participating 

in physical activity. 

30 minutes 

•	Flipchart sheet: Move for Your Life - See Appendix D 

•	CD/DVD/VHS player 

•	Toolkit tools to use: 

o Movimiento Por Su Vida CD/DVD/VHS 

o Step-by-Step: Moving Towards Prevention of Type 2 Diabetes CD/DVD/VHS 

o Road to Health Activities Guide 

•	Optional: Red, yellow, and green elastic bands (each with a different degree of 

elasticity) or other common objects like food cans to use in practicing physical 

activity and movement. 

To order copies of the CD/DVD/VHS, visit the NDEP Web site at 

www.ndep.nih.gov/diabetes/pubs/catalog.htm. 

70 The Road to Health Training Guide 
Procedure 

1. Say, “Now we are going to practice something we have learned.
 

Let the movement begin!”
 

2. Explain to participants that they are going to do a simple physical activity
 

as a demonstration and that to move we only need to want to move.
 

3. Say, “Always consult your health care professional team before beginning any 


nutrition or physical activity program.”
 

4. Have the audience listen to the CD or watch the videos. Use Movimiento
 

Por Su Vida (CD/DVD/VHS) or Step-by-Step: Moving Towards Prevention
 

of Type 2 Diabetes (CD/DVD/VHS).
 

Keep in mind that the music video Step-by-Step: Moving Towards Prevention of Type 

2 Diabetes lasts 3:28 minutes and that the Movimiento Por Su Vida music video lasts 

3:44 minutes. Plan the training time considering the need to repeat the video several 

times. 

5. Say “Now we are ready! Let’s move! Follow the movements you see in the video 

step by step!” Repeat if time permits and if the group is interested. 

If you only have a CD player, you can play the music and ask that participants start 

with simple movements using the elastic bands to stretch. Do this with lots of energy. 

Repeat if time permits and if the group is interested. 

6. Say, “Just like the colors of the traffic light method, we have three bands—red, 

yellow, green—each with a different elasticity to allow more or less stretching.” 

7. Say to participants, “We will be using the stretch bands for this activity. Take the 

red band and stretch it with your hands 10 times (See image A). Next, stretch 

the band behind your back while extending your arms, 10 times (See image 

B). Use the stretch band now with your feet. Do this 10 times (See image C). 

Finally, use the stretch band by crossing your hands and stretching up to your 

chest (See image D). Once you have finished doing all four types of activities, 10 

times each, switch to the yellow and then to the green stretch band. You can also 

do other stretch band activities to work out your leg muscles.” 

The Road to Health Training Guide 71 
Stretch Band Activities
 

Image A Image B 

Image C Image D 

72 The Road to Health Training Guide 
8. Use flipchart sheet Move for Your Life (see Appendix D). Ask the following 


questions:
 

?

•	What band could you stretch more? 

•	What band could you stretch less? 

•	How can we use the colors of the band to do the exercise? 

9. At the end of 10 minutes, stop the music, ask them to sit down and breathe 


deeply three times. Continue the activity by asking participants the following 


questions:
 

?

•	What has taken place during the past 10 minutes? 

•	How do we start a physical activity with people whose willingness to do
 

physical activity we don’t know?
 

•	How can we overcome group participant resistance to do this type of activity? 

Conclude by saying, “The most important thing is the decision to start moving. Ask 

your doctor if you are OK to begin a physical activity program. Make it part of your 

routine with a goal of working up to at least 30 minutes a day moderate-intensity 

physical activity (like brisk walking) at least 5 days a week. Start moving, and you will 

see and feel the results.” 

In the Road to Health Activities Guide (pages 32 to 43), you will find a series of 

exercises to promote physical activity. For example, Walk to Timbuktu is an 

activity that is easy to plan and carry out in the classroom, if you have the space. 

Keep in mind participants’ needs, available space, and other conditions while 

planning activities. Remember to be enthusiastic and enjoy yourself during this 

activity. This will motivate participants to continue doing physical activity. 

The Road to Health Training Guide 73 
Activity 14: Walking Down the Road to Health, a Change 

Toward Good Health. Type 2 Diabetes Does Not Have 

to Be Our Destiny. 

Purpose 

•	Reinforce decision-making to encourage lifestyle modifications. 

30 minutes 

•	Step-by-Step—The Road to Health poster - See Appendix C 

•	Colored paper foot cutouts 

•	Flipchart sheet: Walking Down the Road to Health, A Change Toward Good 

Health. Type 2 Diabetes Does Not Have To Be Our Destiny - See Appendix D 

Procedure 

1. Invite one participant to read the text inside each foot on the Step-by-Step—The 

Road to Health poster. 

2. Have the participant read each footstep with a Road to Health Toolkit component. 

You can also ask the following question: Which step is the most meaningful for 

you? 

3. Give participants a paper foot cutout. Ask them to make one commitment 

to prevent or delay type 2 diabetes by making changes in their life—for example, 

losing weight, making healthy food choices, or doing physical activity. Allow 

several participants to share their commitments. 

4. Use the flipchart sheet Walking Down the Road to Health, a Change Toward 

Good Health. Type 2 Diabetes Does Not Have To Be Our Destiny. Ask 

participants the following question: 

74 The Road to Health Training Guide 
? •	Where are you going to place the commitments that you made with yourself? 

(On the refrigerator door, your bathroom mirror, your closet door?) 

5. Say, “It doesn’t matter where you place your commitments; the most important 

thing is that you see them so that you remember and you practice them.”

 6. Conclude by saying, “Remember that to prevent or delay type 2 diabetes, we 

must make small changes step-by-step.” Reinforce the messages from the DPP 

study: 

•	Lose 5% to 7% of your weight, if you are overweight—that’s 10 to 14 pounds 

for a 200-pound person. 

•	Lose and maintain the weight loss by making healthy food choices that are low 

in fat and reducing the number of calories they eat per day. 

•	Get at least 30 minutes of moderate-intensity physical activity at least 5 days 

a week. This could be brisk walking, yard work, and actively playing with 

children, for example, riding bicycles, or playing soccer. 

Say: “New habits take time; we must go slowly and safely.” Continue with the next 

activity. 

The Road to Health Training Guide 75 
Activity 15: Lifestyle Changes: Big Rewards 

Purpose 

•	Promote small but measurable changes to prevent or delay type 2 diabetes. 

15 minutes 

•	Step-by-Step—The Road to Health poster - See Appendix C 

•	Flipchart sheet: Lifestyle Changes: Big Rewards - See Appendix D 

•	Toolkit tools to use:
 

o Road to Health Flipchart
 

Procedure 

1. To begin the activity, ask participants to think about how they are going 

to reward themselves when they make and maintain changes on their road 

to health. Use the Lifestyle Changes: Big Rewards flipchart sheet and continue 

by asking participants the following questions: 

•	What changes are you going to make, starting today? 

•	How are you going to reward your achievements? 

?

2. Review what has been discussed and reinforce the need to reward the 

achievements. Remember that the most important rewards are the results at the 

end of the road: to prevent or delay type 2 diabetes! 

76 The Road to Health Training Guide 
3. Say, “Remember, everything must be Step-by-Step. All changes must be done 

little by little and we should not expect to do it all at once, rather only one 

change at a time. Refer to the Step-by-Step–The Road to Health poster. 

4. Refer participants to page 11 in the the Road to Health Flipchart and review 

the message at the bottom: “My rewards come from the small changes, one 

at a time.” 

5. Conclude by asking participants to say together: 

“Type 2 diabetes does not have to be our destiny.” 

The Road to Health Training Guide 77 
Activity 16: Road to Health Training Video 

Purpose 

•	Become familiar with using the Road to Health Training Guide and the Road to 

Health Training Video together. 

30 minutes 

•	DVD player 

•	Flipchart sheet: Road to Health Training Video - See Appendix D 

•	Toolkit tools to use:
 

o Road to Health Training Video
 

How to use the Road to Health Training Video 

•	The Road to Health Training Video walks you through selected activities from 

previous trainings to help you visualize and get ideas about how to conduct 

successful trainings. The video is a great companion to the Road to Health 

Training Guide. 

•	The benefit of this video is that it is a real-world recording that takes you 

through all the steps, so you can later follow along and try them out yourself. 

View the video as many times as needed. 

•	The video is available in English and in Spanish and contains additional 

information on diabetes. 

•	The complete video includes 10 activities and last 30 minutes. 

•	Be sure to watch the video before presenting it to participants and have the 

Road to Health Training Guide on hand. 

•	Once the video is presented, discuss the following questions with participants 

using the flipchart sheet Road to Health Training Video. 

? •	In the video, what caught your attention the most? 

•	How are you going to implement what you learned from the video? 

78 The Road to Health Training Guide 
Activity 17: CHWs Help People to Follow the Road to Health 

Purpose 

•	Recognize the work of CHWs. 

•	Share success stories. 

15 minutes 

•	 Flipchart sheet: CHWs Help People to Follow the Road to Health 

- See Appendix D 

•	Toolkit tools to use:
 

o Road to Health Photo Journal
 

o Road to Health Resource Guide
 

Procedure 

1. Distribute the Road to Health Photo Journal. 

2. Ask participants to read a story about Thomas, Nidia, Herlinda, Pat, or Sonia 

in the Road to Health Toolkit Photo Journal. 

3. Use the flipchart sheet: CHWs Help People to Follow the Road to Health and 

ask the following questions: 

•	What characteristic stands out in these CHWs?

•	What do they do?

•	Why are they effective in their community? 

?

The Road to Health Training Guide 79 
This activity must be done when training community health workers or health 

educators. 

Trainer: For more information about CHWs networks, go to 

http://www.chwnetwork.org/page5.html (Accessed January 2010). 

Encourage participants to make their own photo journal like the Road to Health 

Photo Journal to show what CHWs are doing in their own communities. 

4. Conclude by saying, “You are the CHWs: men and women from different 

communities who are making a difference in the prevention and control 

of diseases, in this case diabetes. Thank you for spreading the word about type 2 

diabetes prevention.” 

“Remember, Type 2 diabetes does not have to be our destiny.” 

Finish/End 

•	At the end of the training: 

•	Thank each participant. 

•	Distribute the Posttest and discuss it; clarify doubts, if necessary. 

•	Distribute the Training Evaluation included in the Appendix B of this guide. 

•	Distribute the attendance certificates - See Appendix E 

80 The Road to Health Training Guide 
 

Appendix A: PowerPoint Presentations 

•	Training Guide’s Goals and Objectives for the Road to Health Toolkit 

•	Introduction to the National Diabetes Education Program (NDEP) 

•	Road to Health Toolkit 

•	Introduction to Prevention of Type 2 Diabetes and the DPP Study 

•	The Basic Concepts of Diabetes 

Note: These presentations are available in the Road to Health Supplemental CD-ROM 

included in the Road to Health Toolkit 

The Road to Health Training Guide 81 
Appendix B: Forms 

•	Sign-in Sheet 

•	Training Checklist 

•	Sample Agenda 

•	Participant Profile 

•	Pretest and Posttest 

•	My Risk Factors for Type 2 Diabetes 

•	Training Evaluation 

82 The Road to Health Training Guide 
Road to Health Sign-in Sheet 

Name of Training _________________________________________________________ 

Date ___________________________________________________________________ 

Location _______________________________________________________________ 

Name Organization Position Address Phone/E-mail 

The Road to Health Training Guide 83 
Road to Health Training Checklist 

Following are materials, equipment, and room preparation instructions for the development 

of all educational activities. This checklist serves as a reminder to gather the materials 

necessary for the training. 

Review each item and check off the appropriate box. 

Materials Yes No Pending 

Flipchart on a tripod 

Colored markers 

Different colored pieces of paper 

Colored paper foot cutouts 

Adhesive tape 

Blank paper or notepads 

Pens/pencils 

Training agenda 

Sign-in sheet 

Name tags and tents 

Participant profile form 

Pretest 

Posttest 

Colored cards for each area (red, blue, yellow) 

Elastic stretch bands (three types and colors—red, green, 

and yellow) 

DPP Study Prompt Questions Cards 

Training Evaluation Form 

Certificate of Attendance 

Road to Health Toolkit Tools 

3 

3 

3 

3 

3 

3 

3 

3 

3 

3 

Flipchart 

User’s Guide 

Activities Guide 

Resource Guide 

Photo Journal 

Training Guide 

Training Video 

CD/DVD Step-by-Step: Moving towards prevention 

of Type 2 Diabetes 

CD/DVD Movimiento Por Su Vida 

VHS copy of the music videos Movimiento and 

Step-by-Step 

84 The Road to Health Training Guide 
3

3

3

3

3

NDEP Fat and Calorie Counter 

NDEP Food and Activity Tracker 

Road to Health Training Guide 

Road to Health Training Video 

Road to Health Supplemental CD-ROM 

Five PowerPoint presentations 











Training Guide’s Goals and Objectives for the 

Toolkit 

Introduction to the National Diabetes Education 

Program (NDEP) 

Road to Health Toolkit 

Introduction to Prevention of Type 2 Diabetes 

and the DPP Study 

The Basic Concepts of Diabetes 

Posters 











A future without type 2 diabetes— 

can you see it? 

Step-by-Step—The Road to Health 

Welcome to the City of Excuses 

Nutrition Facts Labels 

The Traffic Light Method 

Depending on availability, you should use the following equipment. 

	Laptop computer and LCD projector 

	White screen 

	Overhead projector 

	Television and a VCR to play a VHS 

	CD/DVD Player 

Note: The Road to Health Supplemental CD-Rom also contains tools, promotional materials 

and lesson plans. 

The Road to Health Training Guide 85 
o 

o 

o 

o 

o 

o 

o 

o 

o 

o 

o 

o 

Choosing and Setting up the Room 

•	Choose and reserve a well-located, easily accessed, and proper-sized room equipped 

with a computer, LCD projector, and screen or an overhead projector. 

•	Make sure the training location is free of distractions, well lit, and at a comfortable 

temperature. The room should have enough open space to allow for easy movement. 

•	Have a registration table at the room entrance with the following forms: 

Sign-in sheet 

Training checklist 

A sample agenda 

Participant profile 

Pretest and Posttest 

My Risk Factors for Type 2 Diabetes 

Training Evaluation 

Try to arrange the participants’ chairs in a U-shape so that the facilitator and the participants 

can see each other to increase interaction. 

Place the posters in visible locations so that everybody can see them. 

Step-by-Step—The Road to Health 

Welcome to the City of Excuses 

Nutrition Facts Labels 

A future without type 2 diabetes—can you see it? 

The Traffic Light Method 

86 The Road to Health Training Guide 
Sample Agenda 

8:00–8:30 AM Sign-in 

 Pretest - What Do I Know and What Do I Want to Learn? 

8:30–8:35 AM Welcome 

8:35–8:45 AM Trainer Introduction 

8:45–8:50 AM Training Ground Rules (starting session) 

8:50–9:30 AM What Do I Know and What Do I Want to Learn? 

•	

•	

•	

Activity 1 

Training Guide’s Goals and Objectives for the 

Toolkit PowerPoint 

Road to Health User’s Guide 

9:30–9:35 AM Present the Training Agenda 

•	 Activity 1, #7 

9:35–9:50 AM BREAK 

9:50–10:10 AM Introduction to the National Diabetes Education Program 

•	

•	

•	

Activity 2 

Introduction to the National Diabetes Education Program 

(NDEP) PowerPoint 

Road to Health Resource Guide 

10:10–10:30 AM Road to Health Toolkit 

•	

•	

•	

Activity 3 

Road to Health Toolkit PowerPoint 

Road to Health Toolkit 

The Road to Health Training Guide 87 
 

 

 

 

 

10:30–11:40 AM 


11:40 AM–12:40 PM 

12:40–2:40 PM 

Type 2 Diabetes and Its Prevention (Area 1) 

1. Introduction to Type 2 Diabetes Prevention 

•	 Activity 4 

•	 Introduction to Prevention of Type 2 Diabetes and the 

DPP Study PowerPoint 

•	 Road to Health User’s Guide 

2. The Story of the Williams’ Family (a Role Play) 

•	 Activity 5 

•	 Road to Health Flipchart 

•	 Road to Health User’s Guide 

3. The Basic Concepts of Diabetes 

•	 Activity 6 

•	 The Basic Concepts of Diabetes PowerPoint 

•	 Link for Life: Interactive Program on Diabetes and 

Cardiovascular Diseases 

•	 Road the Health Flipchart 

•	 Road the Health Resource Guide 

4. Risk Factors: A future without type 2 diabetes—can you see it? 

•	 Activity 7 

•	 Road to Health Flipchart 

•	 Road to Health Resource Guide 

LUNCH 

Making Healthy Food Choices (Area 2) 

1. Where Do Calories Come From? 

•	 Activity 8 

•	 NDEP Fat and Calorie Counter 

•	 Road to Health Activities Guide 

88 The Road to Health Training Guide 
 

 

 

 

 

2. Fat Detectives 

•	 Activity 9 

•	 Road to Health Flipchart 

•	 Road to Health Activities Guide 

3. Portions 

•	 Activity 10 

•	 Road to Health User’s Guide 

•	 Road to Health Activities Guide 

•	 Road to Health Flipchart 

4. The Traffic Light Method 

•	 Activity 11 

•	 Road to Health Flipchart 

•	 NDEP Fat and Calorie Counter 

•	 NDEP Food and Activity Tracker 

•	 Road to Health Activities Guide 

2:40–3:30 PM Movement and Physical Activity 

1. Moving is the Key 

•	 Activity 12 

•	 Road to Health Flipchart 

•	 Road to Health Activities Guide 

2. Move for Your Life 

•	 Activity 13 

•	 Movimiento Por Su Vida CD/DVD/VHS 

•	 Step-by-Step: Moving Towards Prevention 

of Type 2 Diabetes CD/DVD/VHS 

•	 Road to Health Activities Guide 

3:30–3:45 PM BREAK 

The Road to Health Training Guide 89 
 

 

 

3:45–4:15 PM Walking Down the Road to Health, a Change Towards Good Health 

Type 2 Diabetes Does Not Have to be Our Destiny 

•	 Activity 14 

4:15–4:30 PM Lifestyle Changes: big rewards 

•	 Activity 15 

4:30–4:45 PM Road to Health Training Video 

•	 Activity 16 

•	 Road to Health Training Video 

4:45–5:00 PM CHWs Help People to Follow the Road to Health 

•	 Activity 17 

•	 Road to Health Photo Journal 

•	 Road to Health Resource Guide 

5:00–5:30 PM Posttest, Training Evaluation, Attendance Certificates 

90 The Road to Health Training Guide 
Road to Health Participant Profile 

Name __________________________________________________ Date ___________
 

Name of the organization ___________________________________________________
 

Position _________________________________________________________________
 

Work Phone Number ___________ Fax ________ E-mail _________________________
 

Work Address ____________________________________________________________
 

City _______________________________________ State _______ Zip Code ________
 

Gender ____ Date of Birth _______________ Country of Origin ___________________
 

Years of school completed _______
 

Do your responsibilities include community health education? Yes______ No______
 

Which target population(s) do you provide education services to?
 

Children _____ Teens _______ Adults ______ Elderly ______Women ______
 

What are the three major problems in the community you serve?
 

1. ______________________________________________________________________
 

2. ______________________________________________________________________
 

3. ______________________________________________________________________
 

How much do you know about type 2 diabetes and its complications?
 

Nothing ____ A little____ A lot____
 

Have you received diabetes training? Yes ______ No _______
 

Why did you come to this training? ____________________________________________
 

________________________________________________________________________ 

What do you expect from this training? _________________________________________ 

The Road to Health Training Guide 91 
Road to Health Pretest and Posttest 

Instructions: Choose either true or false for each statement. 

Pretest ___________ Posttest ____________ True False 

1. People with type 2 diabetes produce insulin but not enough or their 

body cannot use it correctly. 

2. Symptoms of type 2 diabetes include being very thirsty and hungry, 

frequent urination, and cuts that do not heal. 

3. People with type 1 diabetes do not produce any insulin and need 

insulin to stay alive. 

4. The Diabetes Prevention Program (DPP) is a study that examined 

3,234 people at high risk for diabetes. 

5. A1C is the test that provides a “big picture” of your overall blood 

glucose (sugar) level over the last 2 to 3 months. 

6. A portion the size of an ice cream scoop equals one serving of rice, 

cereal, or potato. 

7. According to the DPP study, if people want to prevent or delay type 

2 diabetes, they should participate in a minimum of 30 minutes 

of moderate-intensity physical activity for at least 5 days a week. 

8. In the traffic light method, green represents foods that are healthy 

to eat. 

9. Modifiable risk factors for type 2 diabetes are diet, age, genetics, and 

family history of diabetes. 

10. Risk is the possibility that a person can develop a disease over 

a period of time. 

11. A light bulb size portion equals three servings of vegetables. 

12. Fats are hidden in all kind of foods. 

13. If you have diabetes in your family, you are at a high risk of 

developing diabetes, but type 2 diabetes can be prevented or 

delayed. 

14. Type 2 diabetes can occur at any age, but the risk is higher in older 

adults. 

15. Nutrition facts labels have the total number of calories per serving, 

total number of servings, and the number of calories from fat. 

16. To prevent or delay type 2 diabetes, the Road to Health Toolkit 

recommends using nutrition facts labels to choose foods with less 

than half of the calories coming from fat. 

17. The Road to Health Toolkit recommends using common objects as a 

method for teaching portion control. 

18. One of the goals of the DPP study was to achieve and maintain 

a weight loss of 15% with healthy eating and increased physical 

activity. 

To obtain free information from NDEP, call 1-888-693-NDEP or go to www.ndep.nih.gov. 

92 The Road to Health Training Guide 
 

Road to Health Pretest and Posttest 

Pretest ___________ Posttest _____________ 

Circle the letter to indicate how strongly you agree or disagree with each of the following 

statements. 

1. Most people in my community will probably get diabetes at some point in their lives. 

a. Strongly agree 

b. Somewhat agree 

c. Undecided 

d. Somewhat disagree 

e. Strongly disagree 

2. Nothing can be done to prevent diabetes. 

a. Strongly agree 

b. Somewhat agree 

c. Undecided 

d. Somewhat disagree 

e. Strongly disagree 

3. Once someone develops diabetes, there is nothing that can be done to prevent it from 

getting worse. 

a. Strongly agree 

b. Somewhat agree 

c. Undecided 

d. Somewhat disagree 

e. Strongly disagree 

4. There are so many recommendations about healthy ways to eat; it’s hard to know what 

to believe. 

a. Strongly agree 

b. Somewhat agree 

c. Undecided 

d. Somewhat disagree 

e. Strongly disagree 

The Road to Health Training Guide 93 
 

 

 

 

 

 

 

5. What a person eats can make a big difference in his or her chance of getting a disease, such 

as heart disease, cancer, or diabetes. 

a. Strongly agree 

b. Somewhat agree 

c. Undecided 

d. Somewhat disagree 

e. Strongly disagree 

6. It’s hard for most of the people I work with to get fruits and vegetables. 

a. Strongly agree 

b. Somewhat agree 

c. Undecided 

d. Somewhat disagree 

e. Strongly disagree 

7. Exercise or physical activity doesn’t affect whether a person develops diabetes. 

a. Strongly agree 

b. Somewhat agree 

c. Undecided 

d. Somewhat disagree 

e. Strongly disagree 

8. Indicate which of the following foods you think are high in fat: 

___ 

___ 

___ 

___ 

___ 

___ 

White bread 

Donuts 

Bananas 

Margarine 

Macaroni and cheese 

Creamed corn 

___ 

___ 

___ 

___ 

___ 

___ 

Tortillas 

French fries 

Hamburger 

Bologna 

Frozen pizza 

Fried fish 

___ 

___ 

___ 

___ 

___ 

Crackers 

Butter 

Cheese 

Mayonnaise 

Hot dog 

Please select the best answer to complete the following statements: 

9. If diabetes runs in a person’s family 

a. It is only a matter of time before that person develops it too 

b. The person can catch it from others 

c. The person is at increased risk of developing diabetes 

d. There is nothing the person can do to prevent diabetes 

e. All of the above 

f. None of the above 

g. Don’t know 

94 The Road to Health Training Guide 
 

 

 

 

 

 

 

10. Risk factors for developing diabetes include: 

a. Having had gestational diabetes (diabetes when pregnant) 

b. Being overweight 

c. Sedentary lifestyle (lack of physical activity) 

d. Being over the age of 45 

e. All of the above 

f. None of the above 

g. Don’t know 

11. Type 2 diabetes 

a. Can occur at any age 

b. Is more common in older adults 

c. Can cause problems with the eyes, feet, and kidneys 

d. Can lead to heart attack and stroke 

e. All of the above 

f. None of the above 

g. Don’t know 

Please select the single best answer to the following: 

12. Overweight participants in the Diabetes Prevention Program (DPP) study were able 

to prevent diabetes by losing at least what percent of their starting weight? 

a. 5% 

b. 10% 

c. 15% 

d. 20% 

e. None of the above 

f. Don’t know 

13. In the DPP study, how many minutes of physical activity (for example, brisk walking) 

did people have to do to prevent or delay type 2 diabetes? At least 

a. 30 minutes every day 

b. 30 minutes 5 days a week 

c. 60 minutes every day 

d. 60 minutes 5 days a week 

e. None of the above 

f. Don’t know 

The Road to Health Training Guide 95 
 

14. The nutrition facts label includes information on: 

a. Total number of calories in a serving of that food 

b. The number of servings in the container 

c. Number of calories from fat in that food 

d. All of the above 

e. None of the above 

f. Don’t know 

15. What does the Road to Health Toolkit recommend for people to measure portion size? 

a. Use a cupped hand to estimate the number of servings in a portion 

b. Always use a food scale to be precise 

c. Use everyday objects to estimate (for example, a deck of cards equals 1 serving 

of meat) 

d. All of the above 

e. None of the above 

f. Don’t know 

16. You can obtain free NDEP materials by: 

a. Calling 1-888-693-NDEP 

b. Downloading from the NDEP Website www.ndep.nih.gov 

c. Ordering from directly from the NDEP Website www.ndep.nih.gov 

d. All of the above 

e. None of the above 

f. Don’t know 

96 The Road to Health Training Guide 
Road to Health: My Risk Factors for Type 2 Diabetes 

Name Age 

Weight Ethnic group (race) 

Relative with diabetes Had diabetes while pregnant 

(This is gestational diabetes) 

My goals: 

___________________________________________________________ 

___________________________________________________________ 

Personal commitments: 

___________________________________________________________ 

___________________________________________________________ 

___________________________________________________________ 

The Road to Health Training Guide 97 
Road to Health Training Evaluation Sheet 

As training organizers, it’s very important to know what you think about the training. 

Your feedback is used to improve future trainings. We thank you in advance. 

Instructions: Please circle the face that best represents your opinion about each of the themes 

or activities presented today. 

 All of my expectations were met 

 Some of my expectations were met 

 Very few or none of my expectations were met 

1. What do I know and what do I want to learn?	   

2. Introduction to the National Diabetes Education Program 	

(NDEP) 

  

3. The Road to Health Toolkit and Training Guide’s goals and 

objectives for the toolkit 

  

4. Introduction to type 2 diabetes prevention	   

5. The Williams’ Family story	   

6. The basic concepts of diabetes	   

7. Risk factors: A future without type 2 diabetes—can you see it?   

8. Where do calories come from?	   

9. Fat detectives   

10 Portions   

11. The Traffic Light Method	   

12. Moving is the key	   

13. Move for your life	   

14. Walking down the Road to Health, a change towards good 	

health. Type 2 diabetes does not have to be our destiny. 

  

15. Lifestyle changes: big rewards   

16 Road to Health Training Video   

17. CHWs help people to follow the Road to Health	   

Please fill out the next page. 

98 The Road to Health Training Guide 
_______________________________________________________________________ 

_______________________________________________________________________ 

_______________________________________________________________________ 

_______________________________________________________________________ 

_______________________________________________________________________ 

_______________________________________________________________________ 

_______________________________________________________________________ 

_______________________________________________________________________ 

_______________________________________________________________________ 

_______________________________________________________________________ 

_______________________________________________________________________ 

_______________________________________________________________________ 

_______________________________________________________________________ 

_______________________________________________________________________ 

_______________________________________________________________________ 

What have you learned today for your life? 

How do you feel about what you learned today? 

What will you do with what you have learned today? 

What did you like the most about the training? 

Any additional comments? 

The Road to Health Training Guide 99 
Appendix C: Posters Used During Training 

•	A future without type 2 diabetes—can you see it? 

•	Step-by-Step—The Road to Health 

•	Welcome to the City of Excuses 

•	Nutrition Facts Labels 

•	To reduce fat milk (2%) and nonfat milk labels 

•	The Traffic Light Method 

Note: Posters are also available in full color in the Road to Health Supplemental CD-ROM 

of the Road to Health Toolkit. 

Appendix D: Flipchart Sheets 

•	Training Ground Rules 

•	What Do I Know and What Do I Want to Learn? 

•	Expectations and Three Areas of Interest 

•	The Williams’ Family Story 

•	The Basic Concepts of Diabetes 

•	Risk Factors: A future without type 2 diabetes—can you see it? 

•	Where Do Calories Come From? 

•	Fat Detectives 

•	Portions 

•	The Traffic Light Method 

•	Moving is the Key 

•	Move for Your Life 

•	Walking Down the Road to Health, a Change Towards Good Health. Type 2 Diabetes 

Does Not Have to be Our Destiny. 

•	Lifestyle Changes: big rewards 

•	Road to Health Training Video 

•	CHWs Help People to Follow the Road to Health 

100 The Road to Health Training Guide 
Flipchart Sheet: Training Ground Rules 

Respect one another 

•	Each person has the opportunity to ask questions and share information. 

•	All ideas and thoughts are good. We have the right to disagree. Please, do not criticize 

or degrade others. 

•	When a person speaks, everyone will listen actively. 

•	Questions and comments will be limited to have time for everyone to participate. 

•	We will stick to the agenda and begin and finish each session on time. 

Provide feedback to participants that is 

•	Focused on the behavior, not on the person 

•	Constructive 

•	Sensitive 

•	Relevant 

Maintain confidentiality 

•	Personal opinions and experiences shared with the group will stay in the group. 

Additional rules 

•	Ask the group if they want to identify any additional rules of conduct for the session. 

The Road to Health Training Guide 101 
Flipchart Sheet: What Do I Know and What Do I Want to Learn? 

(Activity 1) 

What Do We Want to Learn? 

Area 1: Type 2 Diabetes 

and Its Prevention 

Area 2: Making Healthy 

Food Choices 

Area 3: Physical Activity 

and Movement 

102 The Road to Health Training Guide 
Flipchart Sheet: Expectations and Three Areas of Interest 

1. 

2. 

3. 

4. 

5. 

Flipchart Sheet: The Williams’ Family Story (Activity 5) 

•	Does anyone in your family have diabetes? 

•	How has diabetes affected your family? 

•	Do you think you are at risk of developing diabetes? 

Flipchart Sheet: The Basic Concepts of Diabetes (Activity 6) 

•	What is diabetes? 

•	What are the symptoms of diabetes? 

•	What are the complications of diabetes? 

•	What does the pancreas do? 

•	What is insulin? 

•	What are the types of diabetes? 

•	When the family talks about diabetes, how do they refer to it? 

•	Do you consider diabetes to be a disease that can bring serious complications? 

•	Do you know what the complications of diabetes are? Do you know how to delay 

or prevent these complications? 

•	When your family talks about diabetes, what do they talk about? 

•	Did you know that type 2 diabetes can be prevented or delayed by small changes 

in your lifestyle? 

•	What do you think when you hear that type 2 diabetes can be prevented or delayed 

by small changes in lifestyle? 

The Road to Health Training Guide 103 
 

 

 

 

 

Flipchart Sheet: Risk Factors: A future without type 2 diabetes— 

can you see it? (Activity 7) 

•	What is a risk factor? 

•	What are some of the risk factors for type 2 diabetes? 

•	What do you think when they tell you that you may be at high risk?
 

Do you worry?
 

•	List modifiable risk factors 

•	List non-modifiable risk factors 

•	What are the risk factors for type 2 diabetes that you can control. 

•	What are the risk factors for type 2 diabetes that you can’t control. 

•	What do you think are the small changes we can talk about today
 

(e.g., nutrition, physical activity, and gradual weight loss)?
 

Flipchart Sheet: Where Do Calories Come From? (Activity 8) 

•	Where do calories come from? 

•	What food groups have more calories? 

Examples: 

1 g of sugar = 4 calories
 

1 g of alcohol = 7 calories
 

1 g of protein = 4 calories
 

1 g of fat = 9 calories
 

•	1 teaspoonful of sugar is equivalent to 4 grams of sugar. 

o	 Example: Apple juice, which has 34 g of carbohydrates, is 34 ÷ 4 = 8.5 

teaspoonfuls of sugar 

•	1 teaspoonful of lard is equivalent to 5 grams of fat. 

•	What did you find? 

•	What do you want to change now that you have this information? 

104 The Road to Health Training Guide 
Flipchart Sheet: Fat Detectives (Activity 9) 

•	How many of you look at nutrition facts labels to choose healthy foods? 

•	What kinds of food do you eat that are high in fat? 

•	What are easy ways to reduce fat in what you eat? 

•	What do you think about when you hear the expression “making healthy food choices?” 

•	What do you look for when you read nutrition labels? 

•	Can you mention some foods that you could substitute for healthier options? 

Flipchart Sheet: Portions (Activity 10) 

•	How do you measure ingredient portions when you cook? 

•	Do you measure portions or do you approximate the amounts? Do you estimate? 

•	What is your favorite food? 

•	How much do you usually eat of your favorite food? 

•	What is the recommended portion of your favorite food? 

•	What is your commitment to health? 

Flipchart Sheet: The Traffic Light Method (Activity 11) 

•	What does each traffic light color mean? 

•	What does red mean? 

•	What foods would you classify as red? 

•	What does yellow mean? 

•	What foods would you classify as yellow? 

•	What does green mean? 

•	What foods would you classify as green? 

•	How can you eat healthier foods and still satisfy your hunger? 

•	How can you use the traffic light method for daily eating? 

The Road to Health Training Guide 105 
Flipchart Sheet: Moving is the Key (Activity 12) 

•	What is the main reason you and your family may not do physical activity? 

•	What are the barriers in your life that keep you from making healthy changes? 

•	How can you reduce or eliminate the barriers? 

•	What healthy habits can you acquire this month? 

Flipchart Sheet: Move for Your Life (Activity 13) 

•	What band could you stretch more? 

•	What band could you stretch less? 

•	How can we use the colors of the band to do the physical activity? 

•	What has taken place during the past 10 minutes? 

•	How do we start a physical activity with people whose willingness to do physical 

activity we don’t know? 

•	How can we overcome group participant resistance to do this type of activity? 

Flipchart Sheet: Walking Down the Road to Health, a Change 

Towards Good Health. Type 2 Diabetes Does Not Have to Be Our 

Destiny. (Activity 14) 

•	Where are you going to place the commitments that you made with yourself? 

Flipchart Sheet: Lifestyle Changes: Big Rewards (Activity 15) 

•	What changes are you going to make, starting today? 

•	How are you going to reward your achievements? 

106 The Road to Health Training Guide 
Flipchart Sheet: Road to Health Training Video (Activity 16) 

•	In the video, what caught your attention the most? 

•	How are you going to implement what you learned from the video? 

Flipchart Sheet: CHWs Help People to Follow the Road to Health 

(Activity 17) 

•	What characteristic stands out in these CHWs? 

•	What do they do? 

•	Why are they effective in their community? 

The Road to Health Training Guide 107 
Appendix E: Attendance Certificates
	

Note: Please refer to page 112 for a printable version of this certificate.
	

108 The Road to Health Training Guide 
Appendix F: DPP Study Prompt Questions
 

Card 1 – DPP 

Study Prompt Questions
 

What was the goal of the DPP study?
 

Card 2 – DPP 

Study Prompt Questions
 

Which age group had the highest reduction


 in the development of diabetes?
 

Card 3 – DPP 

Study Prompt Questions
 

What were the three main messages
 

of the DPP study?
 

The Road to Health Training Guide 109 
 

References 

•	American Diabetes Association. Link for Life: A Make the Link! Interactive Program 

on Diabetes and Cardiovascular Disease. Retrived August 21, 2007, from 

at http://web.diabetes.org/link/chooser.htm. 

•	Centers for Disease Control and Prevention. Community Health Workers/Promotores 

de Salud: Critical Connections in Communities. 2005. Available at 

http://www.cdc.gov/diabetes/projects/comm.htm. 

•	National Diabetes Fact Sheet: General Information and National Estimates on 

Diabetes in the United States, 2007. Atlanta, GA: U.S. Department of Health and 

Human Services, Centers for Disease Control and Prevention, 2008. 

•	National Diabetes Education Program. 4 Steps to Control Your Diabetes For Life. 

Bethesda: National Institute of Health; 2006. 

•	National Diabetes Education Program. NDEP’s Survey of Public Attitudes
 

indicates long road ahead. NDEP Update 2007;8(2):3,5. Available at
 

http://www.ndep.nih.gov/new/nltr/2007/ProgramUpdateSummer2007.pdf.
 

•	National Diabetes Education Program. Small Steps. Big Rewards. Your GAME PLAN 

to Prevent Type 2 Diabetes: Information for Patients. Bethesda: National Institute 

of Health; 2006. 

•	Pike, RW. Creative Training Techniques Handbook. Minneapolis, MN: Lakewood Books; 

1989. 

•	U.S. Department of Health and Human Services. A Healthier You: Based on the Dietary 

Guidelines for Americans. Washington, DC: U.S. Government Printing Office; 2005. 

110 The Road to Health Training Guide 
The Road to Health Training Guide 111 


The U.S. Department of Health and Human Services’ National Diabetes Education Program (NDEP) 

is jointly sponsored by the National Institutes of Health (NIH) and the Centers for Disease Control 

and Prevention (CDC) with the support of more than 200 partner organizations. 

National Diabetes Education Program 

1-888-693-6337 www.ndep.nih.gov 

2010 CS201104