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
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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.
Acceptance Date19/08/2019
All Author(s) ListCheng L, Sit JWH, Choi KC, Chair SY, Li XM, Wu YN, Long JH, Yang H
Journal nameInternational Journal of Nursing Studies
Volume Number116
Article number103407
LanguagesEnglish-United States

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