Empowerment Approach to Diabetes Education: Promises and Challenges

1
Empowerment Approach to Diabetes Education
Promises and Challenges

• 25 March 2006 (12-1300)
• Society of Nursing Education
• Kan, Eva
• Shiu, Ann TY
• and
• 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.

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

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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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• 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

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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 individuals 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

• 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

• 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 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

• 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 patients health and quality of
  life (Anderson et al., 1995).

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Empowerment as the education process

• 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

• 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

• 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

• 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