When was the last time you were measured by a health care professional? | Within 12 | 1 | ||
blood pressure is when? | month | 2 | ||
H2a | 1-5 years | 3 | ||
No measurement in 5 | ||||
year | ||||
H2b | Have you ever been told by a doctor or medical professional Does your doctor say you have high blood pressure? | Have Are not | 1 2 | |
Have you ever heard a doctor/health worker say that | Have | 1 | ||
H3 | Do you have heart disease (eg angina, | Are not | 2 | |
myocardial infarction) | ||||
(for women only) | Have | 1 | ||
H4a | Have you ever been pregnant? | Are not | 2 | |
Are not? | ||||
In such pregnancies, how many | Have | 1 | ||
H4b | Now you have been diagnosed with diabetes by your doctor. | Are not | 2 | |
or blood sugar disorders? | Don't know | |||
Have you ever given birth to a baby weighing more than 4 kg? | Have | 1 | ||
H4c | Are not? | Are not | 2 | |
Don't know | 3 | |||
Does anyone in your family (parents, siblings) have the disease? | Have | 1 | ||
H5 | diabetes? | Are not | 2 | |
Don't know | 3 | |||
Height and weight | Code | |||
BMI | < 18.5 | 1 | ||
M1 | 18.5 -<23 | 2 | ||
≥ 23 | 3 | |||
Waist | ||||
M2 | Waist | (in centimeters)……………….cm | ||
M3 | Hips | (in centimeters)……………….cm | ||
M4 | WHR | |||
Blood pressure | Code column | |||
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1st measurement Systolic BP | Systolic mmHg | …………… | |||
M4b | diastolic blood pressure | Diastolic mmHg | ………….. | ||
M5a | Second measurement of systolic blood pressure | Systolic mmHg | …………… | ||
M5b | diastolic blood pressure | Diastolic mmHg | …………… | ||
M6 | In the past 2 weeks, have you been using | Have | 1 | ||
medicine to treat high blood pressure? | Are not | 2 | |||
Testing | Encoded column | ||||
M7 | In the past 12 hours, besides drinking water, have you eat or drink anything else? | Have Are not | 1 2 | ||
M8 | Time of day to take sample (24 hour clock) | …..hour….. minute… | |||
Diabetes | 1 | ||||
M9 | Blood sugar | Labor Law | 2 | ||
Normal | 3 | ||||
Measure Blood Sugar 2nd Time (Do the test) | Diabetes | 1 | |||
M10 | glucose tolerance if 1st time RLĐHLĐ) | RLDNG Normal | 2 3 | ||
HbA1c (When tested 1st and 2nd time is | Good < 5.7 | 1 | |||
M11 | Labor and Employment Laws and Labor Relations | Fair 5.7 – 6.5 Poor ≥ 6.5 | 2 3 | ||
High Low B. Normal | Male | Female | |||
≥ 20% | ≥ 30% | ||||
M12 | Body opening ratio | < 10 | < 20 | ||
10- < 20 | 20- < 30 | ||||
Organ opening rate | Height >9 | 1 | |||
M13 | Normal (1 – 9) | 2 | |||
Risk of progression to type 2 diabetes in | Short | 1 | |||
10 years | Low light | 2 | |||
M14 | Medium | 3 | |||
High | 4 | ||||
Very high | 5 | ||||
quit | Encoded column | ||||
T1 | Eat sweet | Eat more Eat less | 1 2 | ||
T2 | Eat fat | Eat a lot Eat less | 1 2 | ||
M4a
Eat fat | Eat a lot Eat less | 1 2 | |
T4 | Have dinner | Eat before 8pm Eat after 8pm | 1 2 |
T5 | Eat fruit | Eat a lot Eat less | 1 2 |
Knowledge (Rating by illustration card) | Encoded column | ||
K1 | Diabetes prevention knowledge | Good Fair Poor | 1 2 3 |
K2 | Attitude to prevent diabetes | Good Fair Poor | 1 2 3 |
K3 | Practice on diabetes prevention | Good Pretty Poor | 1 2 3 |
K4 | Know the risk factors | Know | 1 2 |
K5 | Know how to detect diabetes | Know | 1 2 |
K6 | Know how to prevent diabetes | Know | 1 2 |
K7 | Know the consequences of diabetes | Know | 1 2 |
T3
Investigator...........................
Investigator...........................
APPENDIX 2
HAU GIANG DEPARTMENT OF HEALTH
DIABETES RISK MONITORING BOOK
File number:………………
Full name:…………………………………………………
Date of birth: ……/……/…………
Gender: Male Female
Occupation:…………………………………………………………………………………………………………... Address:……………………………………..Commune……………………….District………………………………..
Contact phone number:……………………………………………………………………………………
Personal history
1 | Weight at heaviest………………….kg Child's birth weight over 3.5kg: ………times Child's birth weight under 2.6kg: ………times Smoking: Yes No |
2 | |
3 | |
4 |
5
Drink alcohol: Yes No | |||
Already diagnosed | Place of diagnosis | ||
6 | Hypertension | Yes No | |
7 | Myocardial ischemia | Yes No | |
8 | Stroke | Yes No | |
9 | Gestational diabetes | Yes No | |
Family history (father, mother, siblings)
1
Obesity | Yes No | 4 | Cardiovascular disease | Yes No | |||
2 | Diabetes | Yes No | 5 | Hypertension | Yes No | ||
3 | Lipid disorders | Yes No | 6 | Mobile money | Yes No | ||
7 | Other diseases: (specify)………………………………....... | ||||||
EXAMINATION AND TEST RESULTS | |||||||
The… Day…… | The… Day…… | The… Day…… | The… Day…… | The… Day…… | The… Day…… | The… Day…… | |
Weight (kg) | |||||||
Waist circumference (cm) | |||||||
Height (cm) | |||||||
BMI (kg/m2) | |||||||
Blood pressure when resting | |||||||
(mmHg)
Fasting blood glucose (mmol/l) | ||||||||||||||
HbA1c | ||||||||||||||
Body fat | ||||||||||||||
Visceral fat | ||||||||||||||
Implementation results | Have | Are not | Have | Are not | Have | Are not | Have | Are not | Have | Are not | Have | Are not | Have | Are not |
Drink alcohol | ||||||||||||||
Smoke | ||||||||||||||
Eat salty | ||||||||||||||
Eat a lot of fat | ||||||||||||||
Physical exercise | ||||||||||||||
Eat sugar | ||||||||||||||
Eat vegetables and fruits | ||||||||||||||
Eat after 8pm | ||||||||||||||
SELF ASSESSMENT | ||||||||||||||
CONFIRMATION OF COLLEAGUE | ||||||||||||||
APPENDIX 3
Khmer people aged 45 and over were selected for the study.
District
Commune | Number of people Khmer ethnic group | Number of people from 45 years old | Rate (%) select | Sample selection | |
Long My | Phien Commune | 3328 | 931 | 22.9 | 213 |
Luong Nghia | 3217 | 943 | 22.9 | 216 | |
Water | Water | 2570 | 799 | 22.9 | 183 |
Vinh Trung | 2910 | 814 | 22.9 | 186 | |
Chau Thanh A | The Clog | 1820 | 642 | 22.9 | 147 |
Seven Thousand | 1928 | 676 | 22.9 | 155 | |
Total | 06 | 16,573 | 4,805 | 22.9 | 1100 |
Number of subjects selected for intervention and control samples of communes
Social proof
Sample certificate | Social intervention | Intervention form | |
Water | 183 | The Clog | 147 |
Vinh Trung | 186 | Seven Thousand | 155 |
2 | 369 | 2 | 302 |





