Appendix - Grade 9

Appendix A

Population Health Promotion Model (Diagram 1)

Population Health Promotion Model

Source: Hamilton & Tariq, 1996, Health Promotion Development Division, Health Canada.

Appendix B

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Sample Checklist for Evaluating Health-related Sources of Information (Grade 9)

Author: _______________________ Publisher: ___________________________________

Title: _________________________ Copyright Date: ______________________________

Criteria
The author	Yes	No	Not sure/ Don't know	Comments
The author's credentials are visible for the consumer to see.
The author's educational background is in the discipline in which the author is writing. (Note: Be cautious of titles which sound impressive but do not really indicate professional qualifications.)
The author is a recognized expert in the discipline in which the he or she is writing.
The author is a recognized member of a professional health organization in the area in which he or she is writing.
The author considers other authorities and all of the relevant evidence and arguments, not just the evidence that supports his or her position.
The source
The source (publisher, producer) is recognized in the health field.
The source is interested in sharing information, not in presenting a bias or making a profit.

'Yes' answers are positive indicators.

Appendix C

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Sample Checklist for Evaluating Health-related Information (Grade 9)

Author: _______________________ Publisher: ___________________________________

Title: _________________________ Copyright Date: ______________________________

Criteria
The information	Yes	No	Not sure/ Don't know	Comments
The information is based solely on personal observations or experiences and not on sound scientific data.
The author uses broad or vague generalities.
The author uses testimonials of what others have said or done with little or no supporting evidence.
Sensationalism and/or scare tactics are used to emphasize points.
The information includes ambiguous statements or unsubstantiated claims.
The information includes loaded words.
The information includes few or no references to substantiate a point or claim.
The information is inconsistent with other reliable information on the same topic.
Significant information has been omitted.
The information defies common sense and seems unbelievable.
The information provides the perspective of a particular interest group. (It is important to access other authorities that present a different viewpoint.)

'No' answers are positive indicators.

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Assessing My Leadership Skills for Promoting Health

Student Name: ____________________________

Date of Assessment: ________________________

Leadership Skills

Likert Rating Scale

I do not possess this skill
I possess this skill but do not use it well
I use this skill moderately well
I use this skill well

Comments:

Occasions when I used this skill to promote health

Include dates where possible

Appendix E

Population Health Promotion Model
(Diagram 2)

Population Health Promotion Model

Appendix F

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Sample 5WH Checklist for Planning

Elements of an Effective Action Plan	Comments
Who Who might be involved? Who else could help? Who needs to be contacted for approval? Who needs to be told about the project? Who is the project targeted at?
Where Where might this project take place? Where might we find the resources (e.g., resource people)? Where might we advertise (if applicable)? Where might we get funding? Where might we get help?
What What needs to be done? What needs to be done first? What might be done by others? What resources are needed? What is our goal?
When When might we plan to start? When might we plan to finish? When might we know that we have been successful? When might we tell others about the plan? When might we have time to work on the details?
Why Why is this a good idea? Why is this project needed? Why have we never tried this idea? Why will this idea work?
How How might we tell others about our plan? How might we involve others? How might we fund the project? How might we judge the success of our action? How might we reward ourselves when we complete the plan?

Appendix G

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Selecting a Support Person to Monitor Leadership Skills

Traits of an Effective Support Person

Leadership Skills that I use Moderately Well or Very Well

While we plan, carry out, and evaluate our action plan, a good support person for me is _______________________________________
Why?

Appendix H

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Sample Rubric for Evaluating the Elements of
an Action Plan to Promote Health

Element of Action Plan	Less Effective Rating of 1	Somewhat Effective Rating of 2	More Effective Rating of 3
Who	Plan includes name of one support person.	Plan includes name of an adult or a teacher as well as the name of a peer support person.	Plan includes name of an adult or teacher as well as the name of a peer support person and the name(s) of others from the community who will be involved in the action plan.
What	Plan includes a statement of what is to be done.	Plan includes a goal statement that is clear, specific, measurable, and attainable.	Plan includes a goal statement that is clear, specific, measurable, and attainable. Also included is a statement of purpose that features promoting health and the leadership skills required to promote health.
How	Plan includes a vague outline of what is to be done.	Plan includes some detail of what is to be done.	Plan includes a step-by-step outline of what is to be done, and includes a description of the leadership skills and health promotion strategies needed to work toward the goal and achieve it.
Why	Plan includes a vague explanation about why particular steps are in place.	Plan includes some detail about why some steps are in place.	Plan includes justification of why specific steps are planned to meet the goal. Possible barriers or obstacles are listed, along with ways they might be overcome.
When	Plan includes start date and end date.	Plan includes start date, end date, and at least the first check-in date.	Plan includes start and end dates as well as check-in dates and celebration dates. Details are included about dates and times for each step of the action plan.
Where	Plan includes no indication of where the action plan is to occur.	Plan includes scant details about where the action is to occur.	Plan includes specific indication of exactly where each step of the action plan will occur.

Appendix I

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Sample Rubric for Evaluating the Implementation of
an Action Plan to Promote Health

	0	1	2	3
Who What evidence is there that a support person was involved throughout the implementation of this action plan?	Support person is not mentioned in the log. No signatures. Support persons were not used.	Support person is mentioned occasionally in the log. No signatures to provide supporting evidence. Support persons may have been used.	The support person is mentioned throughout the log but there is no signature as evidence. Or, the signature is included but there is little or no evidence in the log of involvement.	Support person(s) is included throughout the log. Student log includes signature of support person(s) at start date, check-in dates, celebration date(s), and end date. Support persons were used.
What What evidence is there that the goal was attained?	Goal statement is not mentioned in the log. The goal was not met.	Student log includes a goal statement but does not include a self-evaluation of student's implementation to determine the degree to which the goal was attained.	Student log includes a goal statement and a partial evaluation of the student's implementation. The goal was partially met.	Student log includes a goal statement. The log also includes the student's evaluation of his/her implementation as well as an evaluation by the community and school support persons. The goal was achieved.
How What evidence is there that the step-by-step plan was followed?	Student log includes no evidence of implementation. The action plan was not implemented.	Student log includes scant details of actions taken to promote health. The action plan may have been partially implemented.	Student log includes details of step-by-step action to promote health but does not include how others responded to her or his leadership skills throughout the implementation. The action plan was carried out.	Student log or journal includes: details of step-by-step progress action of health promotion details of how others responded to strategies of health promotion and to demonstration of leadership skills. The action plan was carried out.
Why What evidence is there that the steps within the plan progressed toward the goal?	No indication of obstacles or of how they were overcome.	Student log mentions obstacles but they were not resolved.	Student log identifies obstacles that were partially overcome.	Student log or journal identifies possible barriers or obstacles and explains how they were overcome.
When What evidence indicates that the proposed timelines were followed?	Student log includes start dates and end dates.	Log includes start and end dates as well as at least one check-in date.	Log includes start, end, check-in, and celebration dates. Also includes signatures.	Student log includes: dates and times of each step within the action plan check-in dates celebration dates signature of support person at dates and times of check-ins and celebrations.
Where (if applicable) What evidence is there that the action plan was implemented in the arranged location(s)?	Student log does not indicate location of implementation.	Student log includes some details about where the action plan was implemented.	Student log includes complete details about where each step of the action plan was implemented.	Student log includes: complete details about where each step of the action plan occurred signature of support persons from the facility/agency/community/ school.

Appendix J

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Tobacco Industry Action Plan Outline (Grade 9: Promote Health)

Element of Action Plan	Action	My Action Plan
What	Set a specific goal to counter tobacco promotions in the community	A goal that will counter tobacco promotions in the community is ______________________________ ________________________________________ ________________________________________.
When	Set a start date, an end date, and check-in dates	I/We plan to start the action plan on (start date)____ ________________________________________ and to finish the action plan on (end date)_________ ________________________________________. I/We will check-in with my/our support person on __________, _____________, and ____________.
Why	List benefits of achieving goal to counter tobacco promotions Identify obstacles	My/Our goal will benefit the community by _______ ________________________________________ ________________________________________. I/We plan to overcome obstacles by ____________ ________________________________________ ________________________________________ ________________________________________.
Who	Identify support person(s)	A person who will support my/our plan to counter tobacco promotions in our community is ________________ Signature: _______________________________
How	List step-by-step plan of how to achieve goal	To achieve the goal, I/we will: The health promotion strategy I/we will use is ________________________________________ and the leadership skills I/we will use are ________________________________________ ________________________________________.
Where	Identify location(s)	Based upon what I/we want to achieve (the goal) and how I/we plan to achieve it (step-by-step plan), I/we will carry out the action plan at ___________________________ and possibly at ________________________________.

Appendix K

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Suggested Survey Questions
Our Community's Response to People with HIV/AIDS
and their Caregivers (Grade 9)

Where are the physical needs of people with HIV/AIDS and their caregivers attended to in our community?

Where are the emotional needs of people with HIV/AIDS and their caregivers attended to in our community?

Where are the social needs of people with HIV/AIDS and their caregivers attended to in our community?

Where are the closest acute and long-term health facilities to care for people in our community with AIDS?

What procedures are employed in hospitals to ensure the respectful and compassionate care of persons living with HIV/AIDS?

Where is the closest hospice to address the unique needs of persons in our community dying from AIDS?

Which of our local media develop programs to help reduce prejudice and discrimination toward persons with HIV/AIDS and their caregivers?

Appendix L

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Judging Alternatives based upon Specific Criteria (Grade 9)
Criteria -------------- Alternatives	response	time	effort	cost	reliability
face-to-face
telephone
mail