Self-management support in "real-world" settings: An empowerment-based intervention

Department of Medical Education, University of Michigan Medical School and Michigan Diabetes Research and Training Center, University of Michigan, MI, USA.
Patient Education and Counseling (Impact Factor: 2.2). 11/2009; 79(2):178-84. DOI: 10.1016/j.pec.2009.09.029
Source: PubMed


This study examined the impact of a 6-month, empowerment-based diabetes self-management support (DSMS) intervention on clinical outcomes, self-care behaviors, and quality of life (QOL) compared to a 6-month control period.
This control-intervention cohort study recruited 77 African-American adults with type 2 diabetes. Baseline, 6-month, and 12-month assessments measured A1C, weight, body mass index (BMI), blood pressure, lipids, self-care behaviors, and QOL. During the control period, participants received weekly educational newsletters. During the intervention period, participants attended weekly DSMS groups as frequently as they needed. Sessions were guided by participants' self-management questions and concerns, and also emphasized experiential learning, coping, problem-solving, and goal-setting.
The control period found significant improvements for diastolic BP (p<0.05), serum cholesterol (p<0.001), following a healthy diet (p<0.01), and monitoring blood glucose (p<0.01). The intervention period found significant additional improvements for A1C (p<0.001), weight (p<0.05), BMI (p<0.05), and LDL (p<0.001). Compared to the control period, participation in the intervention led to a significant reduction in A1C (p<0.01).
Findings suggest that an empowerment-based, DSMS intervention is promising for improving and/or maintaining diabetes-related health, particularly A1C.
Incorporating empowerment principles in DSMS interventions may be useful for supporting patients' self-management efforts in "real-world" settings.

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Available from: Martha M Funnell, Sep 30, 2014
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    • "Patients and health professionals jointly decide about the care to be provided (collaborative care). Patients show a higher level of adherence to recommendations, thus achieving better outcomes (van Dam et al. 2003, Rachmani et al. 2005, Williams et al. 2005, Peyrot & Rubin 2007, Tang et al. 2010, Duncan et al. 2011). Internal motivations of the patient are more effective for lifestyle change than external motivation (Arnold et al.1995, Glasgow & Anderson 1999, Anderson & Funnell 2000). "
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    ABSTRACT: AimTo describe a protocol for a quantitative systematic review, to identify critique and summarize factors that influence self-management education. Background Self-management education enables patients to manage their condition successfully and it is associated with better self-care, good control over lifestyle and leading the best possible quality of life, notwithstanding the presence of a chronic disease. Type II Diabetes is a chronic disease that requires lifestyle adjustments and disease management to keep glycaemia and long-term complications under control. Education has to be customized and based on an assessment that includes factors influencing self-management, such as personal characteristics that can optimize the educational intervention. DesignThe protocol for the systematic review was conducted according to the guidelines of the Centre for Reviews and Dissemination, York (UK). Method The review question was defined in terms of population, interventions, comparators, outcomes and study designs. The protocol included decisions about the review question, inclusion criteria, search strategy, study selection, data extraction, quality assessment, data synthesis and plans for dissemination. Funding for the review was confirmed on January 2011 by the Centre of Excellence for Nursing Scholarship in Rome. DiscussionAn initial summary will be made by tabulating the data; the review will be reported in a narrative style and be developed according to the PRISMA guidelines. The protocol for the systematic review will allow us to identify, among the factors influencing self-management in people with Type II diabetes, the personal characteristics most relevant to the factors of motivation and empowerment. In addition, the systematic review will also identify an appropriate self-management model.
    Full-text · Article · Jun 2013 · Journal of Advanced Nursing
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    • "Patient education about self-care according to predetermined written patient information [29] will be provided to a group of patients consisting of 6–9 people at a meeting in PHC directly following randomisation and again after one year. "
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    ABSTRACT: Background Even though there is convincing evidence that self-care, such as regular exercise and/or stopping smoking, alters the outcomes after an event of coronary heart disease (CHD), risk factors remain. Outcomes can improve if core components of secondary prevention programmes are structurally and pedagogically applied using adult learning principles e.g. problem-based learning (PBL). Until now, most education programs for patients with CHD have not been based on such principles. The basic aim is to discover whether PBL provided in primary health care (PHC) has long-term effects on empowerment and self-care after an event of CHD. Methods/Design A randomised controlled study is planned for patients with CHD. The primary outcome is empowerment to reach self-care goals. Data collection will be performed at baseline at hospital and after one, three and five years in PHC using quantitative and qualitative methodologies involving questionnaires, medical assessments, interviews, diaries and observations. Randomisation of 165 patients will take place when they are stable in their cardiac condition and have optimised cardiac medication that has not substantially changed during the last month. All patients will receive conventional care from their general practitioner and other care providers. The intervention consists of a patient education program in PHC by trained district nurses (tutors) who will apply PBL to groups of 6–9 patients meeting on 13 occasions for two hours over one year. Patients in the control group will not attend a PBL group but will receive home-sent patient information on 11 occasions during the year. Discussion We expect that the 1-year PBL-patient education will improve patients’ beliefs, self-efficacy and empowerment to achieve self-care goals significantly more than one year of standardised home-sent patient information. The assumption is that PBL will reduce cardiovascular events in the long-term and will also be cost-effective compared to controls. Further, the knowledge obtained from this study may contribute to improving patients’ ability to handle self-care, and furthermore, may reduce the number of patients having subsequent CHD events in Sweden. Trial registration NCT01462799
    Full-text · Article · Nov 2012 · BMC Family Practice
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    • "Coping with the stress of illness involves managing the stressors (such as pain) stemming from the chronic illness [22]. The SMP also has an empowering approach aimed at enhancing participants' knowledge, attitudes, skills and behaviours and enabling them to take responsibility for their own health management and daily life [21,23-25]. The programme is described in Table 1. "
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    ABSTRACT: Background The European League Against Rheumatism (EULAR)has developed evidence-based recommendations for management of FM. The recommendations are both pharmacological and non-pharmacological. Non-pharmacological recommendations include multidisciplinary approaches, such as self-management programmes (SMP). SMPs have been developed to assist people with chronic rheumatic diseases in their efforts to cope with their disease in daily life. A review of FM studies shows that SMP with or without exercise gave sustained benefits across a range of outcomes for more than 6 months after completion of the SMP. Objectives To evaluate effects of a one week multidisciplinary inpatient self-management programme (SMP) on psychological distress, skills as a consumer of health services, self-efficacy, andfunctional and symptomatic consequences of fibromyalgia (FM). Methods A randomised controlled two-armed, assessor-blinded trial with three-week follow-up to evaluate SMP. Primary outcomes were the General Health Questionnaire (GHQ-20) and the Effective Musculoskeletal Consumer Scale (EC-17), while secondary outcomes included the Fibromyalgia Impact Questionnaire (FIQ) and Self-efficacy scales for pain, function and symptoms (ASES). Results 150 patients with FM were randomised to one week SMP (n=75) or to a waiting list control group (n=75). Of these, 58 participants in the treatment group and 60 in the control group completed the study. At three weeks’ follow up there was a significant difference in EC-17 (0-100) in favour of the treatment group (mean difference 4.26, 95% CI 0.8 to 7.7, p=0.02). There were no differences between the groups for any of the other outcomes. Conclusions This study shows that in patients with fibromyalgia the SMP has a small short-term effect on skills and behavior that are important for managing and participating in health care (EC-17). Disclosure of Interest None Declared
    Full-text · Article · Sep 2012 · BMC Musculoskeletal Disorders
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