Walk With Ease (WWE) + National Diabetes Prevention Program (National DPP) Coupling Evaluation Form

Walk With Ease (WWE) + National Diabetes Prevention Program (National DPP) Coupling Evaluation Form

Thank you for your interest in the WWE+DPP Coupling Guide! Ensuring this guide is useful and effective in your coupling efforts is extremely important to us. We ask that those interested in using the guide complete this form and provide their contact information to respond to periodic check-ins with NACDD so that we may better understand how your experience has been.

You will receive a link to download a copy of the guide after completing this form.

Organization Name*

Your Name*

Email*

Role in Organization*

City/State*

Please include city and state

HALT User

Are you currently using Health and Lifestyle Training Platform (HALT)?

Select or enter value

National DPP DPRP ID

National DPP DPRP Status*

Select or enter value

Number of years delivering National DPP*

Number of years delivering WWE*

Has your organization coupled the National DPP?*

Yes

If yes. for how many years?

Which coupling formats are you interested in?*

Select or enter value

What coupling timings will you use?*

Select or enter value

Which method will you use?*

Will you refer National DPP participants out to a WWE program or integrate it with your National DPP LCP cohort?

Select or enter value

Additional information

Please provide any additional information on how you might coupling the two programs - even if you're just in the idea phase!

(e.g., implementing WWE Self-Directed Enhanced with a weekly group walk after the National DPP and email reminders)

How many cohorts do you plan to start with?

What do you hope to achieve through coupling?

Do you have any questions for NACDD?

Do you have any questions about the guide or about coupling?

Send me a copy of my responses

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