Effectiveness of interventions using empowerment concept for patients with chronic disease: a systematic review

Chronic disease patients may undergo long periods of treatment, experience changes in their lifestyle and attitude, as well as have to maintain self-care behaviors to prevent the chronic condition from worsening or to attempt to reduce potential complications. All of the above factors could negatively impact on their quality of life. Empowerment is a patient-centered, collaborative approach tailored to match the fundamental realities of chronic disease care. Empowerment is seen as a valuable approach in promoting patients' well-being, decision-making and self-management.

The objective of this systematic review is to determine the effectiveness of interventions with empowerment concept for chronically ill patients.

The search strategy aimed to find both published and unpublished studies, in either the English or Chinese language published between 1937 to 2008. Reference lists of studies that met the inclusion criteria were searched for additional studies.

The review considered any randomized controlled trials (RCTs) and non-randomized controlled trials, quasi-experiential, and evaluation study that evaluate the effectiveness of empowerment interventions.

Patients with a chronic disease (such as chronic heart disease, chronic vascular disease, uremia, cancer and diabetes mellitus) were considered for inclusion.

Strategies that utilized the concept of empowerment were included in the review. Interventions examined in this review included education, support group, dialogue and individual consultation.

Health status outcomes as determined by physical symptoms, psychological symptoms and social aspects of the chronic disease were included. Health status was measured using disease-related laboratory data, scales of self-efficacy and psychological empowerment. Measures of disease management, such as patient knowledge and self-care were also assessed where reported. Quality of life measures were assessed when reported.

Meta-analysis was used to pool the data from included studies in order to determine the overall effectiveness of individual interventions. The Comprehensive Meta Analysis V2 was used to manage the data.

This systematic review identified twenty-five studies that examined the effects of empowerment interventions. There were three broad categories of intervention: group-directed, individual-directed, and combined. The studies utilized bio-markers and quality of life (QoL) measures as indicators of effectiveness, however, only individual-directed interventions focused on psychological and disease management. All three categories of empowering interventions showed a significant effect on haemoglobin A1C (HbA1C) in diabetic patients. The effect size for group-directed, individual-directed, and the combined interventions were: 0.326, 0.434, and 0.367, respectively. The meta-analysis also showed that group-directed interventions (effect size=0.30) had more effect than individual-directed interventions (effect size=0.278) on blood pressure in diabetic patients. The review also found that some interventions took a long time to yield results. For example - one group-directed study reported that for their intervention to significantly reduce cholesterol in diabetic patients, the intervention period should last for at least 12 months. Both group-directed and individual-directed types of empowering interventions are able to improve patients' disease knowledge and ability to manage their illness. A meta-analysis of four individual-directed studies showed statistically significant effects. When examining the effectiveness of the three categories of intervention on quality of life, group-directed and the combined type appeared to be more effective than individual-directed type interventions.

This review has shown that interventions that aim to empower patients are able to improve the health status, psychological condition and quality of life of chronically ill patients. The length of time required to observe improvements in bio-markers such as: haemoglobin A1C, blood pressure, and cholesterol varied, with some interventions taking up to 12 months to be effective. Group-directed interventions were found to improve the quality of life of chronic disease patients in the short-term, with effects lasting up to one month. All of the three categories of empowerment interventions lead to an improvement in knowledge of the disease for chronic disease patients. Individual-directed type intervention lead to an increase in the level of self-care at four weeks, one month, and three months interventions, respectively. In summary, empowerment interventions are effective in chronic disease care.