Learning to Empower Patients: Results of Professional Education Program for Diabetes Educators

Anderson, Robert M.; Funnell, Martha M.; Barr, Patricia A.; Dedrick, Robert F.; Davis, Wayne K.

doi:10.2337/diacare.14.7.584

Cited by 171 publications

(82 citation statements)

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“…For example, providing health care practitioners with training in methods to increase patient empowerment has positive effects on attitudes toward patients with diabetes, but it remains unclear whether these attitudinal changes lead to improvements in clinical practice or medical outcome (R. M. Anderson et al, 1991;G. C. Williams et al, 1998).…”

Section: Health Care Professionals and Health Care Systemsmentioning

confidence: 99%

Diabetes and behavioral medicine: The second decade.

Gönder-Frederick¹,

Cox²,

Ritterband³

2002

Journal of Consulting and Clinical Psychology

166

144

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Diabetes management depends almost entirely on behavioral self-regulation. Behavioral scientists have continued a collaboration with other health systems researchers to develop a holistic approach to this disease. The authors summarized the literature in 4 major areas: self-management of diabetes, psychosocial adjustment and quality of life, neuropsychological impact, and psychobehavioral intervention development. Progress made in each of these areas over the past decade is highlighted, as are important issues that have not yet received sufficient scientific attention. Emerging areas likely to become central in behavioral research, such as diabetes prevention, are introduced. The future of behavioral medicine in diabetes is also discussed, including topics such as the changing role of psychologists in diabetes care, the urgent need for more and better intervention research, the growing importance of incorporating a health system-public health perspective, and obstacles to the integration of psychobehavioral approaches into routine health care delivery.A profound event in diabetes management during the past decade was the release of the 1993 report of the National Institutes of Health (NIH) funded Diabetes Control and Complications Trial (DCCT; DCCT Research Group, 1993), which radically altered both the goals and the philosophy of treatment of this disease. The DCCT was a controlled, prospective trial following more than 1,400 adults and adolescents with Type 1 diabetes (T1DM) over an average of 6.5 years. The results provided strong evidence that the use of intensive treatment regimens to maintain tighter glucose control can delay or prevent the development of at least some of the devastating long-term complications of diabetes, including retinopathy and nephropathy. Subsequent studies replicated these findings and demonstrated the benefits of maintaining tighter metabolic control for patients with Type 2 diabetes (T2DM; Ohkubo et al., 1995;Reichard, Nilsson, & Rosenqvist, 1993;Turner, Cull, & Holman, 1996).It is almost impossible to overestimate the impact of the DCCT on diabetes treatment and research. Seemingly overnight, large numbers of patients were expected to follow a demanding, intensive treatment regimen that previously had been recommended only for those who were most highly motivated and diligent in their diabetes self-management. Health care practitioners were also expected to know how to help patients achieve these lofty treatment goals. In addition to problems in implementing intensive treatment, questions arose concerning the effects of these regimens on quality of life (QOL) for patients. Intensive regimens also posed new dilemmas for health care practitioners and patients, not the least of which was the dramatic increase in risk for episodes of severe hypoglycemia when patients attempted to lower blood glucose (BG) levels. It quickly became clear that the greatest challenge to contemporary diabetes treatment was overcoming the many psychobehavioral and social-environmental barriers to optimal ...

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Section: Health Care Professionals and Health Care Systemsmentioning

confidence: 99%

Diabetes and behavioral medicine: The second decade.

Gönder-Frederick¹,

Cox²,

Ritterband³

2002

Journal of Consulting and Clinical Psychology

166

144

View full text Add to dashboard Cite

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Section: Instrument Developmentmentioning

confidence: 99%

“…The structure of the DES and the patient empowerment program were based on our earlier work in patient empowerment (25)(26)(27). In an earlier study (25), we defined the purpose of the empowerment approach to diabetes education as helping patients make informed choices about their diabetes selfmanagement. In that study, we offered a 4-step behavior change model: 1) patient identification of problem areas, 2) exploration of the emotions associated with those problems, 3) development of a set of goals and strategies to overcome the barriers to achieving those goals, and 4) determining patients' motivation to make a commitment to the behavior change plan.…”

Section: Instrument Developmentmentioning

confidence: 99%

The Diabetes Empowerment Scale: a measure of psychosocial self-efficacy.

et al. 2000

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739 Patients with diabetes must make a series of daily decisions involving nutrition, physical activity, medication, blood glucose monitoring, and stress management. Patients must also interact effectively with the health care system, their family members, friends, and employers to obtain the support necessary to manage their diabetes (1). Thus, enhancing the perceived self-efficacy of patients to self-manage their diabetes is an important goal of diabetes care and education.Perceived self-efficacy has become an important and useful construct in psychology (2-4) because it is related to the willingness and the ability of people to engage in various behavioral challenges including preventive and disease management behaviors (5-15). Studies in diabetes have demonstrated the effect of perceived self-efficacy on the adherence behavior of adolescents (16,17), African-American women with diabetes (18), adults with complex insulin regimens (18,19), and adults with type 1 or type 2 diabetes (20-22). However, in these studies, self-efficacy has been defined primarily as the perceived ability to engage in various situation-specific self-management tasks such as blood glucose monitoring and ordering meals in a restaurant, or the studies have focused on the needs of particular group of patients (e.g., adolescents).In 1991, we conducted a randomized controlled trial to evaluate the effectiveness of a patient empowerment program for adults that focused entirely on psychosocial issues such as managing stress, obtaining family support, negotiating with health care professionals and employers, and dealing with uncomfortable emotions (23). Because we were unable to identify a measure of diabetes-related self-efficacy for adults that focused on these important psychosocial areas, we developed the Diabetes Empowerment Scale (DES), which is a 37-item Likert-type questionnaire (24), and we used it in that study. The study showed that the program resulted in both psychosocial and blood glucose level improvements. RESEARCH DESIGN AND METHODS Instrument developmentThe pilot version of the DES had 8 subscales that were keyed to the major content areas of the patient empowerment and education program (23,24). The structure of the DES and the patient empowerment program were based on our earlier work in patient empowerment (25)(26)(27). In an earlier study (25), we defined the purpose of the empowerment approach to diabetes education as helping patients make informed choices about their diabetes selfmanagement. In that study, we offered a 4-step behavior change model: 1) patient identification of problem areas, 2) exploration of the emotions associated with those problems, 3) development of a set of goals and strategies to overcome the barriers to achieving those goals, and 4) determining patients' motivation to make a commitment to the behavior change plan. That approach to facilitating behavior change in diabetic patients was adapted from earlier work in counseling psychology (28-31). Most of the patient empowerment program and DES subsc...

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“…O caráter moral da ação de cuidado Anderson et al (1991) tratam de como o educador deve ajudar os pacientes a se empenharem em projetos específicos para alcançarem seus objetivos. Como "conselheiro" o educador não deve direcionar ou controlar esse processo, mas, sim, agir como um "facilitador", procurando ser perspicaz e sensível para inferir -a partir de sua própria experiência, e a partir do tom de voz, postura, e expressões faciais do paciente -a melhor forma de explorar e resolver os problemas apresentados pelo tratamento.…”

Section: Empoderamento Versus Obediência E Aderênciaunclassified

Cuidado e Empoderamento: a construção do sujeito responsável por sua saúde na experiência do diabetes

Lopes

2015

Saude soc.

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ResumoA partir da análise da literatura sobre a abordagem do empoderamento do paciente no campo da diabetologia, discute-se o impacto dessa perspectiva sobre os significados das transformações nas relações de cuidado, explorando as implicações para a posição ocupada por profissionais da saúde e pacientes. Consideram-se as dificuldades e os incômodos apontados pelos profissionais da saúde frente às mudanças requeridas pelo empoderamento do paciente. Esses dados são problematizados por meio de um enfoque antropológico, apoiando-se nas elaborações sobre o contraste entre a lógica da escolha e a lógica do cuidado, e considerando a diferença entre as representações dos agentes da biomedicina e dos pacientes a partir da oposição entre os modelos indivíduo/pessoa. O percurso analítico é concluído com a constatação da necessidade de relativizar a ideia de que o empoderamento do paciente representa o incremento do individualismo nas relações de assistência à saúde, o que contribui para matizar as reflexões que os cientistas sociais têm desenvolvido acerca da tendência atual de atribuir ao indivíduo a responsabilidade pela própria saúde.

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Learning to Empower Patients: Results of Professional Education Program for Diabetes Educators

Cited by 171 publications

References 0 publications

Diabetes and behavioral medicine: The second decade.

Diabetes and behavioral medicine: The second decade.

The Diabetes Empowerment Scale: a measure of psychosocial self-efficacy.

Cuidado e Empoderamento: a construção do sujeito responsável por sua saúde na experiência do diabetes

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