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Empowerment Approach to Diabetes Education: Promises and Challenges. 25 March 2006 (12-13:00) Society of Nursing Education Kan, Eva Shiu, Ann TY and Wong, Rebecca. Empowerment: Meaning. A common terminology New public health and health promotion: Specific meaning

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Empowerment approach to diabetes education promises and challenges l.jpg

Empowerment Approach to Diabetes Education: Promises and Challenges

25 March 2006 (12-13:00)

Society of Nursing Education

Kan, Eva

Shiu, Ann TY


Wong, Rebecca

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Empowerment: Meaning

  • A common terminology

  • New public health and health promotion: Specific meaning

  • The WHO definition (1998)

    • Empowerment is a process through which people gain greater control over decisions and actions affecting their health.

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Relevance to nursing practice

Tones (1998)

  • Self-empowerment model of health education (patient education) is suitable for nursing practice in the context of individual or small group education encounters.

  • This is the area where nursing practice can operationalise the concept of ‘health promotion at the micro level’.

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The literature shows a paradigm shift

  • Diabetes

    • A chronic illness

    • Over 95% of decision-making

    • Self-managed illness

    • Active engagement of patients

    • Education as the corner-stone

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  • Diabetes research priority

    • A cursory MEDLINE search: over 450 citations of compliance in the title (all inclusive = 8000)

    • 21st century as an era of researching effective models of diabetes care delivery

    • In particular what model of care can better elicit patients’ cooperation

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  • Diabetes education research

    • A gradual shift since 1990s: from a traditional/didactic/preventive model to an empowerment approach

    • The limitation of the preventive approach: knowledge does not always lead to change in behaviour, e.g., a systematic review 2004

    • As exemplar pioneering the shift in the patient education arena

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  • A general agreement at the end of 1990s

    • Patients as active and informed participants

    • A preventive (compliance/adherence) model is an acute illness model

    • Empowering patients to take control of both physiological and psychological outcomes

      – to be the major underpinning philosophy of care provision

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Victim blaming educationConsists of

  • “Ignoring the broader social, material, economic and cultural factors determining individual behaviour and

  • placing the entire burden of responsibility for action on individuals (victims) themselves while,

  • at the same time, not recognising the limits to the individual’s power to act and,

  • on occasions, denying the individual the opportunity to take responsibility when he or she actually has some scope for making choices”(Tones and Tilford, 2001).

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Prevention of diabetes complications education

  • Extremely important: A goal of diabetes education

  • But may become victim blaming

    • when the environmental factors are ignored or

    • when patients’ opportunity to take responsibility and make choices are denied

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Facilitating active engagement of patients education

  • The approach to diabetes care should change from compliance to empowerment

    • does not abandon educating for knowledge

    • but goes beyond it

  • The shift is likely to

    • enhance knowledge and cooperation

    • foster appropriate self-management abilities

    • enable patients to overcome some of the personal, social and environmental barriers

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An empowerment paradigm education

  • Education strategies derived from the empowerment model may be more effective in achieving prevention of diabetes complications

  • For example, A randomised control trial study shows that patient empowerment can improve patient outcomes such as HbA1c and QoL (Anderson et al., 1995)

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Empowerment as the philosophy education

  • The Anderson team at Michigan started advocating patient empowerment in the 1990s

  • ‘This philosophy is based on the assumption that to be healthy, people need to have the psychosocial skills to bring about changes in

    • their personal behaviour,

    • their social situations, and

    • the institutions that influence their lives.

      These skills probably play an important role in the development and implementation of a successful diabetes self-care plan, i.e., a plan that enhances the patient’s health and quality of life’(Anderson et al., 1995).

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Empowerment as the education process education

  • Aims at facilitating patients’ sense of control (confidence) in

    • Achieving goals

    • Overcoming barriers

    • Determining suitable methods

    • Obtaining support

    • Coping

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Empowerment as the outcome education

  • Include self-efficacy beliefs, sense of coherence, self esteem

  • To assess the outcome of programmes guided by patient empowerment, a measure of meaning to the philosophy should be used

  • Anderson et al. (1995) developed and psychometrically tested the Diabetes Empowerment Scale – measures diabetes psychosocial self-efficacy

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How to implement empowerment in education encounters education

  • Clarify and internalise the philosophy

    • Beliefs about diabetes self-management

    • Values and associated beliefs about diabetes education

    • A deep reflection on the roles and responsibilities

  • Develop awareness of the basic assumptions of the use of this and other theoretical models

  • Use education strategies of meaning to the self-empowerment model

    • Two-way communication

    • Mutual respect: two experts

    • Experiential learning activities

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Scenarios and Discussions education

  • Some scenarios from our clinical experience

    Aim to stimulate discussion on

  • (1) promises and

  • (2) challenges of implementing empowerment in diabetes education, which may include the constraints arising from

    • the patient,

    • the nurse, and

    • the context