The effects of an empowerment-based self-management intervention on empowerment level, psychological distress, and quality of life in patients with poorly controlled type 2 diabetes: A randomized controlled trial

Background: There is considerable interest in advocating empowerment in diabetes care. Health professionals, however, often fail to realize empowerment in clinical practice, especially in patients with poorly controlled type 2 diabetes. Objectives: To evaluate the effectiveness of an empowerment-based intervention on empowerment level, psychological distress, and quality of life among patients with poorly controlled type 2 diabetes. Design: An analysis of secondary outcomes of a prospective multi-center, randomized, parallel, investigator-blinded controlled trial. Methods: A total of 242 adult patients with poorly controlled type 2 diabetes [Hemoglobin A1c (HbA1c)>= 58 mmol/mol in the recent six months] were randomly allocated to either intervention (n = 121) or attentional control (n = 121) groups. The design of the intervention was based on the Empowerment Process Model. The intervention group received a 6-week empowerment-based transitional care program, with significant emphasis on establishing personally meaningful goals, facilitating collaborative partnership and shared decision-making, resolving life-disease conflicts via situational reflection. Participants in the attentional control group received two general health education classes and post-discharge social calls on top of routine care. Outcomes of interest include empowerment level, diabetes distress, and quality of life. Participants were invited to complete a set of questionnaires before randomization, one-week, and three-month post-intervention. Statistical analyses were performed using the generalized estimating equations based on the intention-to-treat principle. Results: Comparing with the attention control group, participants in the intervention group showed significant improvements on empowerment level [(beta = 0.163; 95% confidence interval (CI): 0.011 to 0.316, p = 0.036) at one-week post-intervention and (beta = 0.176; 95% CI: 0.020 to 0.331, p = 0.027) at three-month post-intervention, respectively]. This group of patients also displayed significant reduction in terms of emotional-distress (beta= -0.424, 95% CI: -0.798 to -0.049, p = 0.027) and regimen-distress (beta= -0.397, 95% CI: -0.702 to -0.091, p = 0.011) at three-month post-intervention and physician-related distress (beta= -0.236, 95% CI: -0.466 to -0.006, p = 0.044) at one-week post-intervention. Significant improvement in quality of life (beta= 4.151, 95% CI: 1.291, 7.012, p = 0.004) at three-month post-intervention was also observed in the intervention group. Conclusions: Findings provide empirical evidence for the values of an empowerment-based intervention program for patients with poorly controlled type 2 diabetes in increasing the empowerment level and perceived quality of life and reducing diabetes distress. Long-term effects of the intervention and its underlying mechanisms need further investigation. (C) 2019 Elsevier Ltd. All rights reserved.

Automated summary

The study demonstrates the significant benefits of an empowerment-based intervention program for patients with poorly controlled type 2 diabetes, including improvements in empowerment levels, quality of life, and reduction in diabetes distress. Further investigation is needed to explore the long-term effects and underlying mechanisms of the intervention.