以系統性文獻回顧檢視賦權介入在糖尿病個案的應用及成效

The Application and Effectiveness of an Empowerment Intervention among Diabetes Patients: A Systematic Review

10.6288/TJPH2011-30-02-01

陳美芳(Mei-Fang Chen)；王瑞霞(Ruey-Hsia Wang)；唐善美(Shan-Mei Tang)

系統性文獻回顧 ； 賦權 ； 糖尿病 ； systematic review ； empowerment ； diabetes

台灣公共衛生雜誌

30卷2期（2011 / 04 / 15）

93 - 109

繁體中文

世界衛生組織指出賦權對糖尿病個案是很重要的衛教策略。本文採系統性文獻回顧法，分析賦權介入措施於糖尿病個案之應用及其結果。方法為搜尋PubMed等6個中、英文資料庫，經收案與排除條件審核後，共19篇文章符合篩選標準。結果顯示，文章研究品質佔最多為A級的設計良好，具隨機化控制之研究與B級的控制好的回溯性研究或有良好的控制組研究，各佔8篇(42.1%)。 在賦權方式方面，18篇文章以團體方式進行賦權。內容無論是以個案問題或研究者自定糖尿病相關主題為主，皆強調激發個案覺醒、開放性的溝通、共同參與與提供必要的訊息。在賦權結果方面，19篇文章中，僅2篇文獻以質性分析呈現結果，其餘皆是量性結果分析。在介入成效中，以探討糖化血色素最多，共15篇，其中13篇(86.7%)對糖化血色素是有顯著改善。無論在介入策略之運用或介入後的成效，皆能呼應賦權之理論。本文可作為臨床實務與未來賦權研究方向之參考。

The World Health Organization has postulated that education in empowerment strategies is essential for patients living with diabetes. This study reviewed the literature on empowerment interventions for these patients. The literature search included six medical databases in either Chinese or English, including PubMed. Nineteen studies that met the inclusion criteria for this study were reviewed. The authors evaluated all studies in terms of quality of the research. Of the nineteen articles rated, eight (42%) received an A rating (a well-conducted and adequately randomized and controlled study), and eight (42%) received a B rating (a well-conducted cohort study or a well-conducted case-control study). Eighteen studies delivered the empowerment programs to groups. Whether the content of the programs focused mainly on specific problems which patients had, or on pre-planned diabetes related issues, the strategies included raising awareness, open communication, mutual participation and the provision of necessary information. With regard to outcome analysis, only two studies used qualitative methods whereas the others used quantitative methods. The results of all reviewed studies were consistent with the theory regarding change in self, change in behavior and change in relationships. Of the fifteen studies indicating that the HbA1C level was an important indicator of empowerment in this patient group, thirteen reported that empowerment interventions significantly improved HbA1C levels in their participants. The content and outcome of empowerment interventions were consistent with the theory about patient empowerment. The findings of this study may provide a reference for clinical practice and empowerment research.

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