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)
21st 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