Assessment needs

Module 6 Learning Activity Worksheet

Assessment of Needs

1. Self-assess and evaluate yourself in these four health promotion domains. Click the links below to view and write a brief summary for each finding once completed.

· Physical Assessment

· Complete a SIMPAQ questionnaire

· Refer to this video for guidance on how to complete it and its scoring

· If you prefer written instructions, refer to this accompanying document

Impression of findings (2-4 sentences):

· Nutrition

· Complete a 24-hr diet recall on yourself

· This intervention should be approached with care and caution in most patients (and yourself), considering the prevalence of eating disorders, and personal and cultural sensitivities. You may “opt out” if this would be an unhealthy activity for you. Please indicate if this is the case.

· Reflect on the day’s calorie load, meal composition and quality (proportion of protein, carbs, fiber, fat), meal frequency, satiety levels, drinks, supplements, etc.

Impression of findings (2-4 sentences):

· Stress

· Use the Stress Warning Signal Checklist to identify any warning signs (or see Murdaugh et al., p. 102)

Impression of findings (2-4 sentences):

· Social

· Complete an Emotional Support Diagram (see Murdaugh et al., p. 104)

Impression of findings (2-4 sentences):

Planning

2. Based on your self-assessment, complete the Health Planning Process template (copied below) to synthesize your findings.

· See a filled-in example (Figure 5-1) in Murdaugh et al., pp. 119-120.

Implementation

3. Next, based on your own assessment and plan for yourself, read the chapter that corresponds most to your first identified priority behavior change goal. Highlight the read chapter.

· Murdaugh et al., Ch. 6 – Physical Activity

· Murdaugh et al., Ch. 7 – Nutrition

· Murdaugh et al., Ch. 8 – Stress management

· Murdaugh et al., Ch. 9 – Social support

4. Based on your first priority health goal from the Health Planning Process template, complete the SMART Goal worksheet based on this goal (also copied below).

· Refer to this video for guidance in creating your SMART goal.

Evaluation

5. Read Chapter 10 in Murdaugh et al.

· Afterwards, describe how you will evaluate yourself based on your created SMART goal. List what metrics or actions you will monitor to ensure you’re progressing.

· Presume you are explicitly ready for change (in the "contemplation" stage or further).

Evaluation (2-4 sentences):

Rev. 8/24

Health Planning Process Template

Your strengths (list 3-5):
Cultural preferences:
Desired behavioral and health outcomes (list 2-3):
Personal Health Goals (1=highest priority)	Selected Behaviors to Accomplish Goals	Stage of Change	Strategies/Interventions for Change
1.
2.
3.

Modified Individual Health Promotion-Prevention Plan

SMART Goal Worksheet

Crafting a SMART Goal is designed to help you identify if what you want to achieve is realistic and determine a deadline. When writing a SMART Goal, use concise language, but include relevant information.

INITIAL GOAL	Write the goal you have in mind.
S	What do you want to accomplish? Who needs to be included? When do you want to do this? Why is this a goal?
SPECIFIC
M	How can you measure progress and know if you’ve successfully met your goal?
MEASURABLE
A	Do you have the skills required to achieve the goal? If not, can you obtain them? What is the motivation for this goal? Is the amount of effort required on par with what the goal will achieve?
ACHIEVABLE
R	Why am I setting this goal now? Is it aligned with overall objectives?
RELEVANT
T	What’s the deadline and is it realistic?
TIME-BOUND
SMART GOAL	Review what you have written, and craft a new goal statement based on what the answers to the questions above have revealed.