Patient empowerment: Myths and misconceptions
Introduction
Patient empowerment is a process designed to facilitate self-directed behavior change. With type 2 diabetes the empowerment approach is designed to help patients choose personally meaningful, realistic goals, especially goals related to weight loss, nutrition, and physical activity. The empowerment approach is particularly appropriate in type 2 diabetes because the recommended behavior changes involved deeply embedded aspects of the patient's daily life. To maximize the chance for success, patients must be internally motivated (e.g., “Losing weight is really important to me.”) rather than externally motivated (e.g. “My doctor wants me to lose weight.”) [1]. However, wide spread misconceptions about the empowerment approach constrain its effectiveness. The purpose of this article is to better articulate our view of empowerment and to correct misperceptions about it in hopes of enhancing its authentic and effective use in diabetes care and education.
In the 18 years since we presented the philosophy of patient empowerment as a viable approach to diabetes care and education [2], a great deal has changed [3]. While initially controversial, it has endured and become an integral part of diabetes education practice around the globe.
While empowerment has become part of the taxonomy of diabetes education, a complete and accurate understanding of this concept has not occurred as readily. For most health care professionals (HCPs), truly embracing empowerment as an overall approach to diabetes care and education means making a significant paradigm shift [4]. Making such a shift is difficult because the training and socialization of many HCPs is profoundly embedded in a traditional approach to care [4]. Rather than making a genuine philosophical shift to empowerment, many HCPs attempt to incorporate empowerment into their current beliefs and practices. As a result, there are many misconceptions about empowerment and what it means to practice in ways that are consistent with this philosophy.
Section snippets
Why empowerment?
The term empowerment was popularized by Paulo Freire. The following quote describes his view of education and provides the basis for his definition of empowerment.
There is no such thing as a neutral education process. Education either functions as an instrument which is used to facilitate the integration of generations into the logic of the present system and bring about conformity to it, or it becomes the ‘practice of freedom’, the means by which men and women deal critically with reality and
Empowerment: a process and an outcome
Freire viewed empowerment as both a process and an outcome. Empowerment is a process when the purpose of an educational intervention is to increase one's ability to think critically and act autonomously. Empowerment is an outcome when an enhanced sense of self-efficacy occurs as a result of the process. However, while empowerment is an outcome, it is not a dichotomous variable, in that one is or is not empowered. Instead, empowerment is a continuous variable, more similar to a direction than a
What's the problem with empowerment today?
Since our initial paper was published in 1991 [2], we have published many conceptual and research based articles and books. We have also given numerous presentations about the empowerment approach to diabetes care and education. In a survey of U.S. Certified Diabetes Educators asking them which of 12 approaches and theories (they could choose more than one) were most helpful to them in their practices, empowerment was the most frequently selected (98.2%) approach [9]. These findings would seem
Fundamental principles of empowerment
The foundational principles of empowerment, listed in Table 1, are based on observation and logical reasoning [13], [14]. In our judgment, HCPs are responsible for doing all that they can to ensure their patients are equipped to make decisions informed by an adequate understanding of diabetes self-management and an awareness of the aspects of their personal lives that influence their self-management decisions.
The socialization of HCPs to take responsibility for their patients’ care and outcomes
Empowerment in the real world of health care
Because HCPs and patients live and work in the real world, we have established methods and models to operationalize the empowerment approach. We articulated a 5-step approach to setting behavioral goals designed to help patients identify behavioral and psychosocial problems and concerns, identify the emotions related to those problems, and establish personally meaningful goals and strategies to solve their problems [13], [14]. We encourage patients to think of setting goals as “behavioral
Clarifying the empowerment approach to care
Below we will attempt to clarify the meaning of empowerment by correcting common misconceptions based on what HCPs have said to us or that we have found in the scientific literature.
Discussion
This article is intended to clarify some of the mistaken assumptions about empowerment. We are responsible for the denotation (the literal meaning) of our work, both written and spoken. However, the connotation (e.g., implications, subtext, unspoken assumptions) are created by and in the mind of the reader. In some instances, they reflect a misunderstanding of our approach to patient empowerment.
When we began our work in empowerment, we had no idea where it would lead. We simply believed it was
Conflict of interest
None.
Role of funding
The National Institutes of Health (NIH) had no role in the preparation and submission of this manuscript.
Acknowledgements
Pamela Wegmuller for editorial assistance. This work was supported in part by National Institutes of Health (NIH) Grant Number 1 R18 DK 062323-01 and the Michigan Diabetes Research and Training Center (MDRTC) Grant Number 2 P60 DK 020572-32.
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