Patient Perceptions of Empowerment Processes, Health Outcomes and Related Factors in Patients Living with Diabetes in Taiwan: A Cross-Sectional Survey

Causal Model of Psychological Empowerment Among People With Spinal Cord Injury in Thailand

The purpose of this study was to develop and evaluate a causal model illustrating the relationships of age, education, physical impairment duration, social support, functional ability, and self-esteem with psychological empowerment in persons with spinal cord injury. Participants were 260 individuals admitted to a hospital in Thailand. Data were analyzed using path analysis (with the maximum likelihood estimation technique) in Linear Structural Relationship (LISREL). The study results revealed that age and education did not significantly influence psychological empowerment. However, self-esteem had a direct effect on psychological empowerment, whereas physical impairment duration, functional ability, and social support had indirect effects through self-esteem. These four predictors explained 64% of the total variance in this model of psychological empowerment for people with spinal cord injury. These findings can be used as a guideline for developing appropriate interventions to promote psychological empowerment among Thais with spinal cord injury.

Exploring patient empowerment

Purpose

The purpose of this paper is to develop a research framework for exploring and improving patient empowerment through the analysis of the effects produced by a satisfying physician relationship on patient involvement in the healthcare process.

Design/methodology/approach

The authors begin with a literature review of patient empowerment in healthcare, useful to highlight the importance of relational aspects. Then, the authors tested the hypotheses of the research through the analysis of 450 questionnaires. The results are analyzed through covariance-based structural equation modeling.

Findings

This paper highlights how empowerment is a more complex phenomenon, needing many dimensions to be investigated. The hypotheses were tested, and correlations computed, highlighting a medium-strong positive correlation between physician relationship and patient involvement determining satisfying patient empowerment.

Research limitations/implications

The considerations conducted in the paper are restricted to physician relationship and needs further research aimed to analyze and evaluate the changes in the patient behaviors influenced by empowerment.

Practical implications

The research points offer new insight into patient empowerment and allow the healthcare provider to create new opportunities for promoting patient empowerment through the development of quality relationship for effective patient involvement.

Originality/value

The study developed contributes new insight about patient empowerment in the healthcare management literature, proving the key role of satisfying physician relationship useful for future researches.

Empowerment of type 2 diabetic patients visiting Fuladshahr diabetes clinics for prevention of diabetic foot

AIMS

Diabetic foot is one of the most serious and costly complications of diabetes. Empowerment is an important indicator in promoting foot care behaviors that helps patients to use their maximum abilities. This study was carried out with the aim of empowering patients with type 2 diabetes to prevent diabetic foot in the city of Fuladshahr, Isfahan, Iran.

METHODS

This is a quasi-experimental study. 104 eligible patients were randomly assigned to two groups: intervention group and control group. The data were collected through a form of profile, empowerment questionnaire, and foot care behavior checklist. The questionnaires were completed by the two groups in the pre-intervention, 1 and 3 months after the end of the intervention. Data were analyzed in SPSS22 using independent t-test, paired t-test, Chi-square, ANOVA, LSD post hoc test and repeated data analysis.

RESULTS

The results showed that there was no significant difference between two groups in terms of demographic variables. Independent t-test showed that there was no significant difference between the two groups in terms of mean score of empowerment and foot care behavior before intervention. However, the mean score of empowerment and foot care behavior of the experiment group was significantly higher than that of the control group in 1 and 3 months after the intervention (P < 0.001).

CONCLUSION

The empowerment of diabetic patients is effective in promoting foot care behavior, and implementation of empowerment programs in diabetes clinics in this city is recommended.

Substantial effects of empowerment case management on physical health of type 2 diabetic patients

AIMS AND OBJECTIVES

To evaluate the effects of empowerment case management on the physical health of patients with type 2 diabetes.

BACKGROUND

Diabetes is a global health issue. Case management is often used on diabetes management at various levels. Empowerment has been used for chronic situation management, but its effects have not been widely studied in diabetic populations.

DESIGN

Purposive sampling was used to recruit 125 participants with type 2 diabetes aged 18 years or older from a regional teaching hospital in Taiwan.

METHODS

Empowerment case management was applied for 42 participants, while the other 83 received normal case management. Survey items included demographics, preprandial (AC) and postprandial (PC) blood sugar levels, glycated haemoglobin (HbA1C), systolic and diastolic blood pressure, total cholesterol, and the presence or absence of acute and chronic complications. Descriptive statistics and a generalised estimating equation were used to analyse the model's effects on the two groups.

RESULTS

The PC blood sugar levels of patients receiving empowerment case management declined at 3 months (B = -34.26, p < .01), and this decrease was maintained at 6 months (B = -83.66, p < .001). As of 6 months after starting the intervention, patients receiving empowerment case management enjoyed better physical health. These patients' AC blood sugar levels (B = -50.16, p < .001), HbA1C (B = -0.98, p < .001), systolic blood pressure (B = -8.24, p < .001), diastolic blood pressure (B = -5.73, p < .01) and total cholesterol (B = -13.74, p < .05) all experienced a continuous drop and were controlled well, and no diabetes-related acute or chronic complications were observed either. Patients with type 2 diabetes who received empowerment case management managed their physical health better. Moreover, its greatest effect was that patients were able to form exercise groups and continue to maintain their health.

CONCLUSIONS

Empowerment case management was shown to have a substantial effect on the physical health and self-care of patients with diabetes, thus making it a suitable intervention tool for managing diabetes cases.

RELEVANCE TO CLINICAL PRACTICE

The study results showed that empowerment case management is suitable for managing diabetes cases. It has a substantial effect on the maintenance of physical health, occurrence of complications and effectiveness of self-care among patients with diabetes. For better care outcomes, empowerment case management should be integrated into the guidelines of diabetes management.

Understanding Adult Participant and Parent Empowerment Prior to Evaluation in the Undiagnosed Diseases Network

The burden of living with an undiagnosed condition is high and includes physical and emotional suffering, frustrations, and uncertainty. For patients and families experiencing these stressors, higher levels of empowerment may be associated with better outcomes. Thus, it is important to understand the experiences of patients with undiagnosed conditions and their families affected by undiagnosed conditions in order to identify strategies for fostering empowerment. In this study, we used the Genetic Counseling Outcome Scale (GCOS-24) to assess levels of empowerment and support group participation in 35 adult participants and 67 parents of child participants in the Undiagnosed Diseases Network (UDN) prior to their UDN in-person evaluation. Our results revealed significantly lower empowerment scores on the GCOS-24 in adult participants compared to parents of child participants [t(100) = − 3.01, p = 0.003, average difference = − 11.12, 95% CI (− 3.78, − 18.46)] and no significant association between support group participation and empowerment scores. The majority of participants (84.3%, 86/102) are not currently participating in any support groups, and participation rates were not significantly different for adult participants and parents of child participants (11.4 vs. 19.7%, respectively, FE p = 0.40). Open-ended responses provided additional insight into support group participation, the challenges of living with undiagnosed conditions, and positive coping strategies. Future research will evaluate the extent to which empowerment scores change as participation in the UDN unfolds.

Psychosocial factors not metabolic control impact the quality of life among patients with type 2 diabetes in China

AIMS

Quality of life is a major focus of health care today. In published studies on patients with type 2 diabetes, findings on quality of life are mixed. Those with diabetes have chronic illness and must adhere to a complicated care regimen daily, which for many patients is challenging. This study analyzed psychosocial factors and metabolic control as potential predictors of quality of life among these patients.

METHODS

A cross-sectional study of 397 patients with type 2 diabetes was conducted in a hospital in Nanjing, China. Demographic information and clinical characteristics were collected from the medical record. The World Health Organization Quality of Life-BREF, General Self-Efficacy Scale, Diabetes Distress Scale, and Diabetes Empowerment Scale-Short Form were administered.

RESULTS

The mean score of quality of life was 67.80 ± 13.44 on a 100-point scale. General self-efficacy (β = 0.340, P < 0.001), diabetes distress (β = -0.266, P < 0.001), and diabetes empowerment ability (β = 0.207, P < 0.001) were predictors of quality of life. In contrast, other factors including HbA1c, diabetes complications, and the duration of diabetes were not associated with quality of life (P > 0.05).

CONCLUSIONS

Our study indicated that psychosocial factors such as self-efficacy, diabetes distress, and diabetes empowerment ability are related to quality of life. Assessment and interventions aimed at reducing psychosocial problems should be applied in diabetes care.

Investigation of the relationship between patient empowerment and glycaemic control in patients with type 2 diabetes: a cross-sectional analysis

OBJECTIVE

To determine whether there is an association between patient empowerment and diabetes management in terms of the primary outcomes of metabolic control as measured by glycaemic control (glycated haemoglobin, HbA1c), high-density lipoprotein (HDL), low-density lipoprotein (LDL), total cholesterol (TC) and triglycerides.

DESIGN

Retrospective cross-sectional analysis conducted in 2012.

SETTING

Data from Diabetes Federation of Ireland from participants enrolled in the Community Orientated Diabetes Education (CODE) Programme.

PARTICIPANTS

569 patients diagnosed with type 2 diabetes.

EXPOSURES

Patient empowerment levels, as measured by the Diabetes Empowerment Scale-Short Form. Additional information collected included patients' gender, age, body mass index (BMI), smoking status and number of years with diabetes.

OUTCOME MEASURES

HbA1c, HDL, LDL, TC and triglycerides values.

RESULTS

Partial correlation analyses failed to show any statistically significant relationship between patient empowerment and glycaemic control or other diabetes management variables (HbA1c, p=0.32; HDL, p=0.95; LDL, p=0.77; TC, p=0.49; triglycerides, p=0.77). Logistic regression analysis confirmed that patient empowerment score was not a significant predictor of level of glycaemic control. Time since diagnosis of diabetes was associated with increased HbA1c levels. Age and gender were significant predictors of HDL and LDL levels, while gender and age were associated with changes in TC and triglycerides levels, respectively.

CONCLUSIONS

No significant association was found between patient empowerment levels and other measures of diabetes control in this study. Further research into the short-term and long-term outcomes of the empowerment model, at different levels of disease management, and across different settings, is required to evaluate its value in the management of patients with diabetes.

Predicting health-promoting self-care behaviors in people with pre-diabetes by applying Bandura social learning theory

AIMS

The aim of this study was to apply Bandura social learning theory in a model for identifying personal and environmental factors that predict health-promoting self-care behaviors in people with pre-diabetes.

BACKGROUND

The theoretical basis of health-promoting self-care behaviors must be examined to obtain evidence-based knowledge that can help improve the effectiveness of pre-diabetes care. However, such behaviors are rarely studied in people with pre-diabetes.

METHODS

This quantitative, cross-sectional survey study was performed in a convenience sample of two hospitals in southern Taiwan. Two hundred people diagnosed with pre-diabetes at a single health examination center were recruited. A questionnaire survey was performed to collect data regarding personal factors (i.e., participant characteristics, pre-diabetes knowledge, and self-efficacy) and data regarding environmental factors (i.e., social support and perceptions of empowerment process) that may have associations with health-promoting self-care behaviors in people with pre-diabetes.

RESULTS

Multiple linear regression showed that the factors that had the largest influence on the practice of health-promoting self-care behaviors were self-efficacy, diabetes history, perceptions of empowerment process, and pre-diabetes knowledge. These factors explained 59.3% of the variance in health-promoting self-care behaviors.

CONCLUSIONS

To prevent the development of diabetes in people with pre-diabetes, healthcare professionals should consider both the personal and the environmental factors identified in this study when assessing health promoting self-care behaviors in patients with pre-diabetes and when selecting the appropriate interventions.