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Introduction: Diabetes is a highly prevalent chronic disease that frequently coexists with other medical conditions and implies a high burden for patients and the healthcare system. Clinicians currently are challenged to provide effective interventions that are both multidisciplinary and empower patient self-care. The Diabetes Empowerment Group Program (DEGP) was developed with the aims of fostering patient engagement in diabetes self-care through the lens of empowerment and to support the empowerment of patients with diabetes by providing multidisciplinary group-based care. This research's objectives were to: (1) develop a comprehensive description of the DEGP for potential adopters, and (2) explore the factors influencing the feasibility and acceptability of implementing it in other healthcare settings in Montreal.Methods: A qualitative descriptive study was conducted, following a participatory approach. Data were obtained from: (1) semi-structured interviews with 14 patients who participated in the pilot program; (2) from semi-structured group interviews with patient partners, healthcare professionals, and other stakeholders from 4 Montreal family medicine groups, and (3) discussions among the participatory research team during various knowledge translation activities. Inductive content analysis of the data was performed.Results: The DEGP identified seven key elements: medical visit, continuity of care, group-based dynamics, multi-disciplinarity, clinician facilitation, patient-centered agenda, and a theoretical framework of empowerment. The content and organization of the group visits were conceived to address each of these four domains. The empowerment framework comprises four domains of self-care: emotional (attitude), cognitive (knowledge), behavioral (skills), and relational (relatedness). Factors impacting the feasibility and acceptability of implementing the DEGP in other primary care settings were identified.Discussion: The DEGP fits within the discourse around the need for more patient-centered programs for people living with diabetes, following a more comprehensive empowerment model. This research could facilitate the development or adaptation of similar programs in other settings.

BACKGROUND Diabetes is a prevalent chronic condition that poses a major burden for patients and the health care system. Evidence suggests that patient engagement in self-care improves diabetes control and reduces the risk of complications. To provide effective interventions that aim to improve empowerment processes relating to diabetes, a comprehensive and valid measure of empowerment is needed. This article details the development and validation of the McGill Empowerment Assessment–Diabetes (MEA-D). METHODS The development and validation of the MEA-D questionnaire comprised three steps: item generation, qualitative face validation, and factorial content validation. An initial version was created by combining existing items and inductively generated items. Items were mapped to an empowerment framework with four domains: attitude, knowledge, behavior, and relatedness. Semi-structured interviews were conducted with 21 adults living with diabetes to assess face validity. The questionnaire was revised by a team of clinicians, researchers, and patient-partners. Factorial content validation was then performed using responses from 300 adult Canadians living with type 1 or type 2 diabetes. RESULTS The final version of the MEA-D contained 28 items. A moderately good item-domain correlation was found between the individual items within the four domains. Cronbach’s α was 0.81 (95% CI 0.78–0.85) for attitude, 0.73 (95% CI 0.67–0.79) for knowledge, 0.84 (95% CI 0.81–0.87) for behavior, and 0.81 (95% CI 0.77–0.84) for relatedness. CONCLUSION The evaluation of diabetes programs demands a validated measure of empowerment. We developed the MEA-D to address this need. The MEA-D may be adapted to measure patients’ empowerment regarding other chronic health conditions.

Background: Advance Care Planning has benefits for patients and is often optimal when done in the primary care setting. Unfortunately, it does not occur frequently or routinely. The goal of this project was to understand the challenges and barriers that residents at a Family Medicine training site face in initiating and discussing Advance Care Directives.   Methods: An online survey was conducted among 50 Family Medicine residents at the Herzl clinic. Participants were asked about their experience, their comfort level, and their challenges with Advance Care Planning discussions.   A focus group with 12 Family Medicine residents further probed, through open-ended questions, the specific challenges they have faced during Advance Care Planning and ideas to address them.   Results: The online survey and focus group identified that most residents perceived a lack of time, inadequate training, and poor uptake of available tools as barriers to have Advance Care Planning discussions in a community setting. Residents also felt that patients were inadequately prepared for these discussions. For improvement, most residents suggested to increase the variety of teaching modalities, to dedicate time for these discussions and to prioritize in-person discussions.   Conclusion: The residents in Family Medicine face many challenges and barriers to having Advance Care Directives discussions with their patients but were able to provide avenues for improvement.