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Record of Grantee Meetings



Individual Assessment


Behavior Worksheet (PDF)

The two-page assessment instrument is designed to be completed by patients. It assesses patient readiness to make specific self management behavior changes related to healthy eating, being active, monitoring blood sugar, taking medication, problem solving, healthy coping, and reducing risks. It is based on the Transtheoretical Model (TTM) for behavior change.

Author site: Galveston County Health District I 2004

Related Links

  • For other tools on multiple self management behaviors: Click here
  • For more assessment tools: Go back

The Diabetes Initiative was a national program of the Robert Wood Johnson Foundation from 2002 to 2009.
Archived in 2009, this site is a repository for information and resources gathered over the course of the Initiative.