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

• Published in: International journal of nursing studies Vol. 116; p. 103407
• Main Authors: Cheng, Li, Sit, Janet W.H., Choi, Kai-chow, Chair, Sek-ying, Li, Xiaomei, Wu, Yuning, Long, Junhong, Yang, Hui
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.04.2021; Elsevier Limited
• Subjects: Attentional processes; Clinical medicine; Clinical outcomes; Clinical trial; Clinical trials; Diabetes; Diabetes distress; Empowerment; Group decision making; Health education; Health promotion; Hemoglobin; Intervention; Long term; Medical personnel; Nursing; Poorly controlled type 2 diabetes; Psychological distress; Psychological empowerment; Quality of life; Self-management; Selfmanagement; Transitional care; Type 2 diabetes mellitus; Transitional care; Poorly controlled type 2 diabetes; Self-management; Clinical trial; Diabetes distress; Empowerment; Quality of life
• ISSN: 0020-7489; 1873-491X
• DOI: 10.1016/j.ijnurstu.2019.103407

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.