Document Type : Original Article

Authors

1 Department of Nursing, School of Medicine, Tarbiat Modarres University

2 Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran

Abstract

Type 2 diabetes is one of the most serious health concerns and policy agendas around the
world. Epidemiological evidence suggests that it will likely continue to increase globally.
Diabetes is strongly associated with the patients’ unhealthy lifestyle and behavioral patterns
and socio-economic changes. New model of thinking is required to recognize whether the
patients are in control of and responsible for the daily self-management of diabetes. Such a
new approach should be based on ‘empowerment and involvement’ to be more applicable
to daily activities in diabetic patients. Rapid changes toward patient empowerment and
increasing involvement of patients in their care plan indicate more emphasis on disease
prevention and health promotion and education than on mere disease and its treatment.
Such changes make a step toward pervasive sense of responsibility among patients
about their illness for their daily activities. Using the empowerment approach, healthcare
professionals would help patients make informed decisions in accordance with their particular
circumstances. Patient empowerment implies a patient-centered, collaborative approach
that helps patients determine and develop the inherent capacity to be responsible for their
own life. Empowerment is something more than certain health behaviors. Empowerment
is more than an intervention, technique or strategy. It is rather a vision that helps people
change their behavior and make decisions about their health care. It has the potential to
improve the overall health and well-being of individuals and communities, and to change
the socio-environmental factors that cause poor health conditions. The main concept of this
change is the tendency to change.

Keywords

1. World Health Organization. Prevalence of diabetes [Online].
2008. Available from: http://www.who.int/diabetes/facts/en/.
[Last cited on 2008 Dec 11].
2. Recommendations for healthcare system and self-management
education interventions to reduce morbidity and mortality from
diabetes. Am J Prev Med 2002;22 (4 Suppl):10-4.
3. Azizi F, Hatamei H, Jangorbanei M. Epidemiology and control of
common diseases. Tehran: Eshtiag Publication; 2000. p. 40-52.
4. Azizi F, Hatemei H, Janghorbanei M. Epidemiology and
communicable disease control in Iran. Tehran: Eshtiagh Publication;
2000. p. 34-95. Deputy of health deputy for research and technology. National
health situation states. Tehran: Tabalwor Publishing Group; 2003.
p. 59.
6. Roglic G, Unwin N. Mortality attributable to diabetes: Estimates for
the year 2010. Diabetes Res Clin Pract 2010;87:15-9.
7. Roper NA, Bilous RW, Kelly WF, Unwin NC, Connolly VM.
Excess mortality in a population with diabetes and the impact of
material deprivation: Longitudinal, population based study. BMJ
2001;322:1389-93.
8. Olshansky SJ, Passaro DJ, Hershow RC, Layden J, Carnes BA,
Brody J, et al. A potential decline in life expectancy in the United
States in the 21st century. N Engl J Med 2005;352:1138-45.
9. Falahatei Marvast M. Assessment of function of diabetes center in
diabetes control, [MSc Thesis]. Yazd: Yazd University of Medical
Sciences; 2000.
10. Roglic G, Unwin N, Bennett PH, Mathers C, Tuomilehto J, Nag S,
et al. The burden of mortality attributable to diabetes: Realistic
estimates for the year 2000. Diabetes Care 2005;28:2130-5.
11. Dale AC, Vatten LJ, Nilsen TI, Midthjell K, Wiseth R. Secular decline
in mortality from coronary heart disease in adults with diabetes
mellitus: Cohort study. BMJ 2008;337:a236.
12. Lee WL, Cheung AM, Cape D, Zinman B. Impact of diabetes on
coronary artery disease in women and men: A meta-analysis of
prospective studies. Diabetes Care 2000;23:962-8.
13. Bharati DR, Pal R, Rekhac R, Yamuna TV. Evaluation of the burden
of type 2 diabetes mellitus in population of Puducherry, south India.
Diabetes Metab Syndr 2011;5:12-6.
14. Abolhasanei F, Mohajerani Tehranei MR, Tabatabaei Molazei A,
Larijanei MB. Burden of diabetes and its complications in Iran
in year 2000. Journal of Diabetes and metabolic Disorders
2005;5:35-48.
15. Harrison TR, Kasper DL. Harrison’s principles of internal medicine.
16th ed. New York: McGraw-Hill; 2005. p. 2152-80.
16. Coons SJ, McGhan WF, Bootman JL, Larson LN. The effect of
self-care information on health-related attitudes and beliefs of
college students. J Am Coll Health 1989;38:121-4.
17. Marks R, Allegrante JP. Falls-prevention programs for older
ambulatory community dwellers: From public health research to
health promotion policy. Soz Praventivmed 2004;49:171-8.
18. Lin CC, Anderson RM, Chang CS, Hagerty BM, Loveland-Cherry
CJ. Development and testing of the diabetes self-management
instrument: A confirmatory analysis. Res Nurs Health
2008;31:370-80.
19. Issa BA, Baiyewu O. Quality of life of patients with diabetes mellitus
in a Nigerian teaching hospital. Hong Kong Journal Psychiatry
2006;16:27-33.
20. Lau DC. The cost of diabetes: A game changer. Canadian diabetes
Journal 2010:16-9. [Online]. Available from: URL: http:\\www.
diabetes.ca/publications/cjd/2010/03/.
21. Funnell MM. Quality of life and insulin therapy in type 2 diabetes
mellitus. Insulin 2008;3:31-6.
22. Mosaku K, Kolawole B, Mume C, Ikem R. Depression, anxiety and
quality of life among diabetic patients: A comparative study. J Natl
Med Assoc 2008;100:73-8.
23. Corabian P, Harstall C. Patient diabetes education in the management
of adult type 2 diabetes. Alberta Heritage Foundation for Medical
Research. Health Technology Assessment [Online]. Available from:
http://www.ihe.ca/documents/FINAL_WEB.pdf/. [Last cited on
2001 Feb].
24. Eigenmann C, Colagiuri R. National diabetes services scheme
(Australia) diabetes Australia. Outcomes and indicators
for diabetes education: A national consensus position.
Melbourne: NDSS, National Diabetes Services Scheme, Diabetes
Australia; 2007.
25. Funnell MM, Anderson RM, Arnold MS, Barr PA, Donnelly M,
Johnson PD, et al. Empowerment: An idea whose time has come
in diabetes education. Diabetes Educ 1991;17:37-41.
26. Henderson DJ. Consciousness- rising as a feminist nursing action.
Promise and practice, present and future. In: Thorne SE, Hayes VE,
editors. Nursing praxis: Knowledge and action. London: Sage
Publications; 1997. p. 157-79.
27. Laverack G. Public health: Power, empowerment and professional
practice. Basingstoke: Palgrave Macmillan; 2005.
28. Jones PS, Meleis AI. Health is empowerment. ANS Adv Nurs Sci
1993;15:1-14.
29. Gibson CH. The process of empowerment in mothers of chronically
ill children. J Adv Nurs 1995;21:1201-10.
30. Dashiff C, Bartolucci A. Autonomy development in adolescents
with insulin dependent diabetes mellitus. J Pediatr Nurs
2002;17:96-106.
31. Naidoo J, Wills J. Health promotion: Foundations for practice. 2nd
ed. London: Elsevier Health Sciences; 2000.
32. Craig PM, Lindsay GM. Nursing for public health: Population-based
care. New York: Elsevier Health Sciences; 2000. p. 143-4.
33. Anderson R, Funnell M. Compliance and adherence are dysfunctional
concepts in diabetes care. Diabetes Educ 2000; 26: 597-604.
34. Tobacco control Research Report. Youth Empowerment and
Health Promotion [Online]. Available from: http://www.ftcc.fsu.
edu/resreports/july99/index.html/. [Last cited on 1999 Jul 01].
35. Stanhope M, Lancaster J. Community and public health nursing.
Philadelphia: Mosby; 2004.
36. Anderson RM, Funnel MM. Using the empowerment approach to
help patients change behavior. In: Anderson BJ, Rubin RR, American
Diabetes Association, editors. Practical Psychology for Diabetes
Clinicians. 2nd ed. Texas: American Diabetes Association; 2003. p.
3-12.
37. Bandura A. Health promotion from the perspective of social
cognitive theory. Psychology and Health 1998;13:623-49.
38. Alhani F. Designing and evaluation of family based empowerment
model in anemia prevention [PhD Thesis]. Tehran: Tarbiat Modares
University; 2003.
39. Nouri K, Shojaei Zadeh D. Health education and behavior change.
Tehran: Resaneh Press; 2004.
40. Emler N. Health education and behavior change. New York:
YPS; 2001.
41. Deakin T, McShane CE, Cade JE, Williams RD. Group based training
for self-management strategies in people with type 2 diabetes
mellitus. Cochrane Database Syst Rev 2005;(2):CD003417.
42. Norris SL, Nichols PJ, Caspersen CJ, Glasgow RE, Engelgau MM,
Jack L, et al. Increasing diabetes self-management education in
community settings. A systematic review. Am J Prev Med 2002;22
(4 Suppl):39-66.
43. Brown SA. Interventions to promote diabetes self-management:
State of the science. Diabetes Educ 1999;25 (6 Suppl):52-61.
44. Norris SL, Lau J, Smith SJ, Schmid CH, Engelgau MM.
Self-management education for adults with type 2 diabetes: A
meta-analysis of the effect on glycemic control. Diabetes Care
2002;25:1159-71.
45. Norris SL. Self-management education in type 2 diabetes. Practical
Diabetology 2003;22:7-13.
46. Gary TL, Genkinger JM, Guallar E, Peyrot M, Brancati FL.
Meta-analysis of randomized educational and behavioral
interventions in type 2 diabetes. Diabetes Educ 2003;29:488-501.
47. Renders CM, Valk GD, Griffin SJ, Wagner EH, Eijk VJ, Assendelft WJ.
Interventions to improve the management of diabetes in primary
care, outpatient, and community settings: A systematic review.
Diabetes Care 2001;24:1821-33.
48. Funnell MM, Anderson RM. Patient empowerment: A look back, a
look ahead. Diabetes Educ 2003;29:454-8, 460, 462.
49. Roter DL, Hall JA, Merisca R, Nordstrom B, Cretin D, Svarstad B.
Effectiveness of interventions to improve patient compliance: A
meta-analysis. Med Care 1998;36:1138-61.
50. Barlow J, Wright C, Sheasby J, Turner A, Hainsworth J.
Self-management approaches for people with chronic conditions:
A review. Patient Educ Couns 2002;48:177-87.
51. Skinner TC, Cradock S, Arundel F, Graham W. Four theories and
a philosophy: Self-management education for individuals newly
diagnosed with type 2 diabetes. Diabetes Spectr2003;16:75-80.52. Polonsky WH, Earles J, Smith S, Pease DJ, Macmillan M,
Christensen R, et al. Integrating medical management with diabetes
self-management training: A randomized control trial of the
diabetes outpatient intensive treatment program. Diabetes Care
2003;26:3048-53.
53. Anderson RM, Funnell MM, Nwankwo R, Gillard ML, Oh M,
Fitzgerald JT. Evaluating a problem-based empowerment program
for African Americans with diabetes: Results of a randomized
controlled trial. Ethn Dis 2005;15:671-8.
54. Bodenheimer T, MacGregor K, Sharifi C. Helping patients manage their
chronic conditions. California: California HealthcareFoundation; 2005.