Workshop Location: Date: Observer: Leaders’ Names: Start time: End time: Reason for Fidelity Check: New Leader First Session Complaint Lodged General Check General Observations 1. In your opinion, was the training space comfortable Yes No for the group (e.g. room size, room temperature, Comments: lighting, noise level, etc)? 2. Were charts 2: DIABETES SELF-MANAGEMENT TOOL Yes No BOX, 3: WORKSHOP GUIDELINES, 5: BRAINSTORMING, 7: Comments: PARTS OF AN ACTION PLAN, and 8: PROBLEM SOLVING STEPS posted on the wall during the class? 3. Were the leaders on time/early and did the workshop Yes No start on time? Comments: 4. Was the session agenda posted at the beginning of Yes No the session? Comments: 5. Did the charts follow the appropriate guidelines: Yes No Used dark colored marking pens Comments: Legible handwriting Easily readable from across the room 6. Did leaders appropriatly paraphrase to deliver Yes No material presented in the leaders’ manual? Comments: Activity Feedback/Problem-Solving Session – Leader facilitating: 1. Did the leaders briefly restate their action plans and Yes No report their successes? Comments: 2. Did the leaders ask for a volunteer participant to Yes No report on their action plan in the same way? Comments: 3. Did the leaders praise participants for achieving their Yes No action plans or for modifying and being good Comments: self-managers? 4. If a participant stated that they did NOT achieve their Yes No N/A action plan, did the leaders problem solve with the Comments: group? 4a. Did the leaders utilize Chart 8: STEPS TO PROBLEM Yes No SOLVING according to the leaders’ manual guidelines? Comments: Activity Making An Action Plan – Leader facilitating:
Workshop Location: Date: Observer: Leaders’ Names: Start time: End time: Reason for Fidelity Check: New Leader First Session Complaint Lodged General Check General Observations 1. In your opinion, was the training space comfortable for the group (e.g. room size, room temperature, lighting, noise level, etc)? Yes No Comments: 2. Were charts 2: DIABETES SELF-MANAGEMENT TOOL BOX, 3: WORKSHOP GUIDELINES, 5: BRAINSTORMING, 7: PARTS OF AN ACTION PLAN, and 8: PROBLEM SOLVING STEPS posted on the wall during the class? Yes No Comments: 3. Were the leaders on time/early and did the workshop start on time? Yes No Comments: 4. Was the session agenda posted at the beginning of the session? Yes No Comments: 5. Did the charts follow the appropriate guidelines: Used dark colored marking pens Legible handwriting Easily readable from across the room Yes No Comments: 6. Did leaders appropriatly paraphrase to deliver material presented in the leaders’ manual? Yes No Comments: Activity – Feedback/Problem-Solving Session Leader facilitating: 1. Did the leaders briefly restate their action plans and report their successes? Yes No Comments: 2. Did the leaders ask for a volunteer participant to report on their action plan in the same way? Yes No Comments: 3. Did the leaders praise participants for achieving their action plans or for modifying and being good self-managers? Yes No Comments: 4. If a participant stated that they did NOT achieve their action plan, did the leaders problem solve with the group? Yes No N/A Comments: 4a. Did the leaders utilize Chart 8: STEPS TO PROBLEM SOLVING according to the leaders’ manual guidelines? Yes No Comments: Activity – Making An Action Plan Leader facilitating:
D-PATH-Fidelity-Checklist-July-2017.docx