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The effects of an empowerment-based self-management intervention on empowerment level, psychological distress, and quality of life in patients with poorly controlled type 2 diabetes: A randomized controlled trial.

Authors
  • Cheng, Li1
  • Sit, Janet W H2
  • Choi, Kai-Chow3
  • Chair, Sek-Ying4
  • Li, Xiaomei5
  • Wu, Yuning6
  • Long, Junhong7
  • Yang, Hui8
  • 1 School of Nursing, Sun Yat-Sen University, Guangzhou, China. Electronic address: [email protected] , (China)
  • 2 The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong. Electronic address: [email protected] , (Hong Kong SAR China)
  • 3 The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong. Electronic address: [email protected] , (Hong Kong SAR China)
  • 4 The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong. Electronic address: [email protected] , (Hong Kong SAR China)
  • 5 School of Nursing, Health Science Center, Xi'an Jiaotong University, Xi'an, China. Electronic address: [email protected] , (China)
  • 6 The Department of Endocrinology, The Ninth Affiliated Hospital of Xi'an Jiaotong University, China. Electronic address: [email protected] , (China)
  • 7 The Department of Endocrinology, The Second Affiliated Hospital of Xi'an Jiaotong University, China. Electronic address: [email protected] , (China)
  • 8 The Department of Endocrinology, The Second Affiliated Hospital of Xi'an Jiaotong University, China. Electronic address: [email protected] , (China)
Type
Published Article
Journal
International journal of nursing studies
Publication Date
Apr 01, 2021
Volume
116
Pages
103407–103407
Identifiers
DOI: 10.1016/j.ijnurstu.2019.103407
PMID: 31679744
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

There is considerable interest in advocating empowerment in diabetes care. Health professionals, however, often fail to realize empowerment in clinical practice, especially in patients with poorly controlled type 2 diabetes. To evaluate the effectiveness of an empowerment-based intervention on empowerment level, psychological distress, and quality of life among patients with poorly controlled type 2 diabetes. An analysis of secondary outcomes of a prospective multi-center, randomized, parallel, investigator-blinded controlled trial. A total of 242 adult patients with poorly controlled type 2 diabetes [Hemoglobin A1c (HbA1c)≥ 58 mmol/mol in the recent six months] were randomly allocated to either intervention (n = 121) or attentional control (n = 121) groups. The design of the intervention was based on the Empowerment Process Model. The intervention group received a 6-week empowerment-based transitional care program, with significant emphasis on establishing personally meaningful goals, facilitating collaborative partnership and shared decision-making, resolving life-disease conflicts via situational reflection. Participants in the attentional control group received two general health education classes and post-discharge social calls on top of routine care. Outcomes of interest include empowerment level, diabetes distress, and quality of life. Participants were invited to complete a set of questionnaires before randomization, one-week, and three-month post-intervention. Statistical analyses were performed using the generalized estimating equations based on the intention-to-treat principle. Comparing with the attention control group, participants in the intervention group showed significant improvements on empowerment level [(β= 0.163; 95% confidence interval (CI): 0.011 to 0.316, p = 0.036) at one-week post-intervention and (β= 0.176; 95% CI: 0.020 to 0.331, p = 0.027) at three-month post-intervention, respectively]. This group of patients also displayed significant reduction in terms of emotional-distress (β= -0.424, 95% CI: -0.798 to -0.049, p = 0.027) and regimen-distress (β= -0.397, 95% CI: -0.702 to -0.091, p = 0.011) at three-month post-intervention and physician-related distress (β= -0.236, 95% CI: -0.466 to -0.006, p = 0.044) at one-week post-intervention. Significant improvement in quality of life (β= 4.151, 95% CI: 1.291, 7.012, p = 0.004) at three-month post-intervention was also observed in the intervention group. Findings provide empirical evidence for the values of an empowerment-based intervention program for patients with poorly controlled type 2 diabetes in increasing the empowerment level and perceived quality of life and reducing diabetes distress. Long-term effects of the intervention and its underlying mechanisms need further investigation. Copyright © 2019. Published by Elsevier Ltd.

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