Grand Rapids African American Health Institute · Diabetes Prevention

One moment please...

Diabetes Prevention

Program Details:
Location: GRAAHI Office

Dates: Wednesdays - 5/15, 5/22, 5/29, 6/5

Times: 6pm-7:30pm

Program Description:
Laying the groundwork: This is a 4 week curriculum aimed at providing a foundational set of tools to Identify, manage, and treat the different types of diabetes.

GRAAHI Program Coordinator:

Kalon Shackleford | Community Health Navigator
500 Lafayette Avenue, NE Grand Rapids, MI
616-331-5830

Name

First Name

Last Name

Verify Email

Zip Code

Phone

What is Your Age?

What is your Gender?

Male

Female

Non-binary

Transgender Man

Transgender Woman

I prefer not to disclose

Other:

What is your race? (Please select ALL that apply)

American Indian or Native Alaskan

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

Multiracial

Prefer not to say

Ethnicity

Hispanic

Non-Hispanic

Are you predisposed or have you been diagnosed with any of the following chronic diseases?

HTN

Diabetes

Kidney/Heart Disease

High Cholesterol

Other

Are you taking prescribed medications?

Yes

Choose not to answer

On average, how many minutes a week do you exercise weekly?

30 Minutes or Less

30 - 60 Minutes

60 - 90 Minutes

90 - 120 Minutes

120 - 150 Minutes

150 + minutes

How often do you track your caloric intake?

Not at all

Daily

Weekly

Monthly

On average, how many days do you meal prep weekly?

1-3

3-4

On a scale from 1-5, how confident are you in preparing a balanced meal?

1 (Not confident)

2 (Somewhat confident)

3 (Neutral)

4 (Confident)

5 (Very Confident)

On average, how many hours do you sleep each night?

5 hrs or less

6 - 7 hrs

8 or more

On a scale from 1 -5, how comfortable are you navigating a smart device?

1 (Not confident)

2 (Somewhat confident)

3 (Neutral)

4 (Confident)

5 (Very Confident)

Do you currently have a primary care medical provider?

Yes

I need one.

Is there anything else you would like to share with us in preparation for the courses?