Empowerment Approach to Diabetes Education: Promises and Challenges

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1 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

2 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.

3 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.

4 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

5 Diabetes research priority A cursory MEDLINE search: over 450 citations of compliance in the title (all inclusive = 8000) 21 st century as an era of researching effective models of diabetes care delivery In particular what model of care can better elicit patients cooperation

6 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

7 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

8 In the new public health era, a preventive model to patient education is regarded as Without paying attention to psychosocial and economic factors Imposing values Victim blaming

9 Victim blaming Consists 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).

10 Prevention of diabetes complications 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

11 Facilitating active engagement of patients 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

12 An empowerment paradigm 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)

13 Empowerment as the philosophy 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).

14 Empowerment as the education process Aims at facilitating patients sense of control (confidence) in Achieving goals Overcoming barriers Determining suitable methods Obtaining support Coping

15 Empowerment as the outcome 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

16 How to implement empowerment in education encounters 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

17 Scenarios and Discussions 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

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