NAME SECTIONTIME OF CLASS PREWELLNESS ASSESSMENT AND BEHAVIOR CHANGE

NAME SECTIONTIME OF CLASS PREWELLNESS ASSESSMENT AND BEHAVIOR CHANGE




Post Testwell Analysis Instructions

Name

Section/Time of Class



Pre-Wellness Assessment and Behavior Change Plan

Instructions

GHTH 100: Personal Wellness



This assignment is due September 11


Locate and complete the Interactive Assess Yourself inventory, which can be found online in the following manner:


Complete the inventory online, and print out a copy of your results upon completion. Keep a copy of your Pre-Assessment results for comparison with the Post-Assessment. Use the results from your Pre-Assessment to answer the following questions. On the due date, submit your responses to the questions below, as well as the Behavior Change Contract which is attached. The assignment will not be accepted early.


  1. Type your Pre-Wellness Assessment scores in the chart.


Category

Ideal Score

Your Score

Physical Fitness

40


Social Health

40


Emotional Health

40


Environmental Health

40


Spiritual Health

40


Intellectual Health

40


Personal Health Promotion and Disease Prevention

40


Pre-Wellness Assessment Total Score

280



Answer questions 2-7 based on the Pre-Wellness Assessment results. Highlight your responses on this page.


  1. The category for my Pre-Assessment overall score is:


  1. 245-280 points – Excellent or High Level Wellness

  2. 210-244 points – Good or Many Positives/Need Some Improvement

  3. 140-209 points – Your Health Risks are Beginning to Show

  4. Less than 140 points – Needs Improvement or Choices Adverse to Health


  1. My Pre-Asessment overall score is:


  1. A complete surprise to me

  2. Somewhat expected

  3. Exactly what I expect



4. Which of the following responses best reflects your feelings/thoughts about your score:


  1. I am aware of areas I do well and areas I need to change and the score accurately reflects my health behaviors.

  2. I am aware of areas I do well and areas I need to change, however the score does not accurately reflect my health behaviors.

  3. There is more to health than I realized and the score accurately reflects my health behaviors.

  4. There is more to health than I realized and the score still seems off in relation to how I feel about my health.


5. List 5 positive health behaviors or practices that you currently engage in and plan to

maintain.











6. List 5 negative health behaviors or practices that you currently engage in.










7. List 3 health behaviors that you will make attempts to engage in this semester. You may add positive behaviors that you are not practicing and/or stop negative behaviors that you are practicing.
























Complete the Assess Yourself questionnaire and read the Skills for Behavior Change box describing the stages of change. After reviewing your results and considering the various factors that influence your decisions, choose a health behavior that you would like to change, starting this semester. Sign the contract at the bottom to affirm your commitment to making a healthy change and ask a friend to witness it.



My behavior change will be: _____________________________________________________________________________



My long-term goal for this behavior change is: _______________________________________________________________



These are three obstacles to change (things that I am currently doing or situations that contribute to this behavior or make it harder to change):


  1. ___________________________________________________________

  2. ___________________________________________________________

  3. ___________________________________________________________



The strategies I will use to overcome these obstacles are:

  1. ___________________________________________________________

  2. ___________________________________________________________

  3. ___________________________________________________________



Resources I will use to help me change this behavior include:


A friend/partner/relative: _____________________________________

A school-based resource: _____________________________________

A community-based resource: _____________________________________

A book or reputable website: _____________________________________



In order to make my goal more attainable, I have devised these short-term goals


__________________________________ ____________ _________________

Short-term goal Target date Reward


__________________________________ ____________ _________________

Short-term goal Target date Reward


__________________________________ ____________ _________________

Short-term goal Target date Reward



When I make the long-term behavior change described above, my reward will be:


_______________________________________________ Target date: _________


I intend to make the behavior change described above. I will use the strategies and rewards to achieve the goals that will contribute to a healthy behavior change.


__________________________________ _________________________________________

Signature Witness





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