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Type 2 diabetic patients' experiences of two different educational approaches: A qualitative study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Clinical Research, County of Västmanland. (vårdforskning medicin)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. (vårdforskning medicin)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. (vårdforskning medicin)
2008 (English)In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 7, no 45, 986-994 p.Article in journal (Refereed) Published
Abstract [en]

Objective: The aim of the current study was to explore patients' experiences of participating in an empowerment group education programme or receiving individual counselling. Method: In total, 28 patients from seven primary care centres were interviewed. Of these, 14 had received individual counselling and the remaining 14 had also participated in 4-5 empowerment group sessions. The semi-structured interviews were tape-recorded, transcribed verbatim and analysed using qualitative content analysis. Findings: Three main categories crystallized from the interviews: (I) relationships, (II) learning and (III) controlling the disease. The relationships in the individual counselling seemed vertical, characterized by one-way communication with care providers acting as superiors and patients as subordinates. The relationships in the empowerment group appeared to be horizontal, characterized by trust and mutual communication. Those who had received individual counselling talked about learning by compliance-care providers acted as superiors, giving advice they expected the patients to follow. In the empowerment groups the patients talked more about participatory learning, whereby the facilitators and patients shared their knowledge and experiences. Controlling the disease could be labelled external in individual counselling, which made it difficult for patients to take responsibility for and control of their diabetes self-care. On the contrary, the patients in the empowerment group achieved the insight that diabetes is a serious disease but can be influenced, which contributed to their experience of self-control. Conclusions: The current study indicates that vertical relationships, learning by compliance and external control seem to limit patients' ability to take responsibility for their disease, while horizontal relationships, participatory learning and self-control may contribute to strengthening patients' ability to influence and be actively involved in their own care.

Place, publisher, year, edition, pages
2008. Vol. 7, no 45, 986-994 p.
Keyword [en]
empowerment group, individual counselling, type 2 diabetes
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-97423DOI: 10.1016/j.ijnurstu.2007.07.007ISI: 000257918000003PubMedID: 17822705OAI: oai:DiVA.org:uu-97423DiVA: diva2:172371
Available from: 2008-09-01 Created: 2008-09-01 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Patient Education for People with Type 2 Diabetes in Primary Health Care
Open this publication in new window or tab >>Patient Education for People with Type 2 Diabetes in Primary Health Care
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The general aim of this thesis was to evaluate different aspects of patient education for people with type 2 diabetes in Swedish primary health care.

The evaluation was conducted in a primary health care setting in central Sweden and in Swedish primary health care in its entirety. Seven centres in central Sweden had implemented the empowerment programme for patients with type 2 diabetes. Data on 16 care providers’ views on implementing the programme were collected in focus-group interviews. The effect and the patients’ experiences of the programme were evaluated in a randomized controlled trial (RCT) (n=101) and in individual interviews (n=28). In the RCT, 50 patients were assigned to the programme and 51 patients to routine diabetes care. The patients answered a 27-item questionnaire and BMI and HbA1c were measured, before the intervention and at one-year follow-up. Further, data from 485 primary health care centres with 91,637 diabetic patients were collected to evaluate patient education in Swedish primary health care in its entirety.

The care providers experienced conflicting roles in changing from expert to facilitator in the empowerment programme. The programme improved patients’ confidence in diabetes knowledge and contributed to their experience of self-control, while patients in the routine diabetes care experienced external control. Of the 485 centres, 50% reported having checklist-driven individual counselling and 8% that they individualized the counselling based upon patients’ needs. Most centres (>90%) set individual goals, but only one-third involved patients in the final decisions regarding their goals. Setting individual goals was found to have an impact on patients’ possibilities to reach national treatment targets.

In conclusion, the implementation of empowerment in patient education demands support to care providers in order to influence patients’ self-care. Furthermore, patients need to reflect upon necessary self-care changes and also set individual goals to facilitate the reaching of national treatment targets.

Place, publisher, year, edition, pages
Uppsala: Universitetsbiblioteket, 2008. 68 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 367
Keyword
Diabetes mellitus, empowerment, patient education, primary health care
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-9200 (URN)978-91-554-7254-2 (ISBN)
Public defence
2008-09-26, Samlingssalen, Psykiatricentrum, Centrallasarettet, Ing 29, Västerås, 13:15
Opponent
Supervisors
Available from: 2008-09-01 Created: 2008-09-01 Last updated: 2010-10-06Bibliographically approved

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