Application Study Of Empowerment-Based Education Programme

Objectives1 To develop the Chinese Mainland version of 28-item DES aiming providing effective assessment tools for introducing Empowerment Education and to assess the reliability and validity of the Chinese Mainland Version。2 To determine if an empowerment-based education programme (EBE) is more effective than tranditional compliance-based education (TBE) in blood glucose, diabetes-related quality of life and self-efficacy.3 To explore 15 patients'experiences of participating in an empowerment group education.Methods1 Firstly, we translated the 28-DES into Chinese according to the principal of forward translation, back translation and review and culture adaptation. The test-retest reliability and constrcut validity of CM-DES was assessed by means of correlation anlysis and factor analysis. Internal consistency was tested by use of the Cronbach's a coefficient. Factors that could influence CM-DES were discussed using Pearson or Spearman correlations,t-tests and ANOVA.2 135 patients with type 2 diabetes were randomized to the EBE group or TBE group. All patients received routinely diabetes education classes. Besides, patients in EBE group received five times one-to-one empowerment education in which educator used the empowerment approach to help patients indentify self-management problems, consider options, set goals and make adjustments. Glycemic control, CM-DES, self-efficacy, the quality of life scores and rate of behavior change were followed up and analyzed.3 In-depth interviews were used to explore 15 patients's experiences of participating in an empowerment group education. All interviews were audio-taped and the transcripts were analysed by editing and immersion.Results1 CM-DES ascertained included 20 items and three subscales (self-understanding, self-determination and self-regulation). The Cronbach's a coefficient for CM-DES was 0.90, and for the three subscales:(self-understanding, a=0.96), (Self-determination, a= 0.88) and (self-regulation, a=0.96). Pearson's correlation coefficients of subscales for test-retest reliability ranged from 0.82 to 0.96. Almost all items were strongly correlated with hypothesized scale. The factor analysis resulted in three factors with eigenvalues> 1.0, explaining of the 79.65% variance. Patients with good metabolic control scored significantly highly on all CM-DES subscales (r=-0.51, P=0.00). People with more positive coping attitude(r=-0.68, P=0.00) and higher education level (r=0.28, P=0.03) scored higher in CM-DES. Associations were not found among the CM-DES and diabetes duration(r=0.18, P=0.17), age(r=0.28, P=0.09), family income(F=1.09, P=0.36),family care(F=0.23, P=0.80). 2 59 patients in EBE group and 60 patients in TBE group completed the six months follow-up. Using empowerment-based strategies can improve CM-DES scores (F=24.47,P=0.00), self-efficacy scores(F=13.85,P=0.00) and rate of self-monitor blood glucose (F=48.64, P=0.00), and decrease level of FPG(F=15.20, P=0.00) and 2hPG (F=37.77, P=0.00)obviously compared with that in TBE group. No significant differences (F=0.01, P=0.94) were found in life quality between EBE group and TBE group.3 (1)15 patients were interviewed. Three main categories crystallized form the interviews:two resistances for behaviour change:people are not completely aware of the diabetes severity and always blame failure of behaviour change on others or environment. (2) Horizontal relationships was built in empowerment course. (3) The Key to success of empowerment education is to make patients active and empowered.Conclusions CM-DES has good validity and reliability and, thus, could be a suitable tool in evaluating empowerment-based education programmes. Patient empowerment is an effective approach to helping blood glucose management, behavioral outcomes and impoving CM-DES and self-efficacy.