Empowerment - Expectations Vs Delivery

Michael Concannon

Initiation

MSc DissertationCPD - DiabetesNSF - Standards 2001

NSF Standards Conclusion

“Diabetic services will be:Person centred: - empowering the

individual to adopt a healthy lifestyle and to manage their own diabetes through education and support which recognises the importance of lifestyle, culture and religion, and which where necessary tackles the adverse impact of material disadvantage and social exclusion.”

Literature reviewHeavy criticismsof the medical modelof Empowerment.

“the medical modelis no more than Capitalistic marketing”Grace 91 & Skelton 94

Little evidence of success supporting the use of /need for, empowerment

Clear evidence needing the power to shift from the “so called expert” to the “actual expert” of the disease

Empowerment should be interactive, cultivating control in others through the sharing of knowledge, expertise and resources. This philosophy breaks the tradition of patients receiving a service but encourages active partnerships between practitioner and patient.

It is suggested several times in the literature that the medical model will not allow this!

Aim and objectives

Aim: • To explore the concept of empowerment from a

delivery perspective for people with diabetes (within podiatry)

Objectives: • Level of knowledge• Attitudes towards empowerment• Establish the level of training

Underlying question?

To achieve true empowerment of service users Who should be empowered? Who is teaching and who is learning?

Method

SurveySurvey in the form of QuestionnaireQuestionnaire4 sections (5 point Likert Scales used)

Demographics DAS (prevalidated and used with

permission) NSF offering validity in raising questions

from official documentation from DOH Training standards and competencies

A 7 point Likert Scale

The 5 point Likert scale used (semantic differential scale)

Q’n Stronglyagree

agree Neither agreenor disagree

disagree Strongly disagree

1 I feel confident to developand review programmes for empowering people with diabetes

Sampling Sampling Non randomised and convenient sample of 130 clinically active SRCh/podiatrists were targeted

Data collectionData collection Anonymity and informed consent assured

Data analysisData analysis Using SPSS a mixture of descriptive and parametric tests were used

Pilot studyPilot study This was carried out on colleagues in an attempt to refine and ensure reliability of the chosen method

Final studyFinal study The final study was carried out in line with ethical approval

Results 20 Pages in the dissertation illustrating 25 graphs and 8 tables

Mean, median and SD’s for DAS/NSF/TN Box and Whisker plots Graphs, Histograms and Pie Charts Inferential Stats = Parametric Tests1. Regression analysis using Pearson’s

correlation (sunflower chart showing strength of relationships)

2. Unpaired (independent t tests)*consideration to = sections of Q’re, Gender,

Grade, number of years post qualified

ResultsFrom 99 returned questionnaires:

The results indicated that podiatrists perceived themselves to have an awareness of diabetes and issues related to empowerment

DAS (18-90 possible) 70 NSF (12-60 possible) 34 Training Needs - only 17 people believed

training was sufficient at undergraduate level

Interpretation of resultsNo significant difference between

genderNo significant difference between years

qualifiedThere was a significant relationship

between the 3 main sections of the questionnaire therefore offering validity to the results! (consistency!!??)

DiscussionCrosstabulations

Pt with DM is the most important member of the MDT!82/99 agreed 50/82 strongly – 3/99 disagreed 0/99 stronglyParticipants are forward thinking in attitude! 2 statements

earlier however? Individuals with DM should have the final say in setting

blood glucose levels!35/99 agreed 5/99 strongly – 32/99 disagreed 7/99 strongly

An opinion consistent with the medical model of care and its critical influence on empowerment, as highlighted in the literature review (Glaser 1990, Grace 1991, Skelton 1994, Johnston-Roberts 1999, Coulter 1999, Feder & Griffith 2000, Taylor 2000, Patterson 2001 and Traynor 2003).

Only 41 people disagreed with thisYet! Only 17 people felt that the training was sufficient

Only 10 people disagreed with this!

11My training has allowed me to empower

individuals to adopt a healthy lifestyle and to manage their own diabetes through education and support which recognises the importance of lifestyle, culture, and religion.

Stronglyagree

agree Neither Agreenor disagree

Disagree

Strongly disagr

ee

17 46 26 7 3

12I am in a position to tackle the adverse

impact of material disadvantage and social exclusion for people with diabetes

Strongly agree

agree ?/? disagree StronGlyDisagree

4 17 37 31 10

 

ConclusionHealth Professionals, whilst good intentional are

reluctant to relinquish control to patients therefore tokenistic and paternalistic with practice of empowerment

The framework is not conducive to a true empowerment model Gibson 91, Henwood et al 2003, Christie & Cross 2003.

Health promotion based on issues perceived important by the HCP are unlikely to succeed and should address the beliefs and priorities of people with DM Boulton et al 2000

ConclusionsDid you know? The QAAHE 2001, NSF 2001, HPC 2004(in

partnership with SOCP) have benchmarks stating:

“The graduate should be able to educate motivate and alter behaviour. They should also be able to recognise opportunities to influence social policy!”

Only 17 people believed their undergraduate training in empowerment was sufficient

Conclusions (cont) Yet the majority of the results indicated a

perceived understanding of the surrounding issues of empowerment

The author proposed several flaws in the fundamental basis of the method: i.e. if a person has insufficient knowledge of empowerment then they are not in a position to offer self criticism of the same issue!

Critique of study

Larger than the results section!

Sampling methodsTraining needs invalidating the training

sectionClosed ended questionsSuitabilility of staff experience

Outcome of researchThis presentationMore researchQualitative Discursive forum of

data collection/analysis i.e.Focus groups

Need for training and policy change

ReferencesBoulton AJM., Connor H., Cavanagh PR."The foot in Diabetes" 3rd Edition 2000 John Wiley & Sons LtdChristie, A & Cross, V (2003) "Clinical specialisms: patient empowerment or professional control?" British Journal of Therapy and Rehabilitation Vol.: 10, No: 3 pp100-108Coulter A (1999) "Paternalism or partnership“ BMJ vol 319 18th Sept 1999Department of Health NSF "A practical aid to implementation in primary care“ August 2002 http://www.doh.gov.uk/nsf/diabetes.htm Feder G., Griffiths C, Eldridge S., Gantley M., "Patient empowerment and coronary heart disease" Lancet Volume 356 Issue 9237 Page 1278, 7th Oct 2000Gibson, C "A concept analysis of empowerment“ Journal of Advanced Nursing Vol.: 16 pp 354-361 1991Glaser NY., "The home as a workshop: women as amateur nurses and medical care providers" Gender and society (1990) 4 479-499Grace VM., "The marketing of empowerment and the construction of the health consumer: a critique of health promotion" International journal of health services (1991) 21: 2 329-343Health Professions Council 2004 "Standards of education and training and the approvals process - Education and training paper" www.hpc-uk.org site accessed 11/03/04Henwood F, Wyatt S, Hart A, Smith J (2003) 'Ignorance is bliss sometimes': constraints on the emergence of the 'informed patient' in the changing landscapes of health information, Sociology of Health and Illness Sep 2003,Volume 25, Issue 6, Page 589-607 Johnston-Roberts K., "Patient empowerment in the United States: a critical commentary" Health expectations Vol. 2, Issue 2, May 1999, pages 82-92 Paterson B 2001 "Myth of empowerment in chronic illness“ Journal of advanced Nursing 34 (5) 574-581The Quality Assurance Agency for higher education 2001 "Podiatry (chiropody) subject benchmark statements for health care programmes“ Frontier print and design LtdSkelton R "Nursing and empowerment: concepts and strategies" Journal of advanced nursing, (1994) 19:415-423Taylor.P., "Patients, Power and Politics. Health and empowerment: Research and Practice" Health and Social Care in the Community. Sept 2000.vol 8 issue 5 pp350Traynor M (2003) "A brief history of empowerment: response to discussion with Julianne Cheek". Primary Health Care Research and Development. 4 129-136

Any Questions?Thanks for listening!