Empowerment is a multidimensional construct applicable to individuals, organizations, and neighbourhoods (Rappaport, 1987). It is viewed as a construct rather than a concept because it is not directly observable (Jacox, 1974).The case study indicates that Patrick lacks both self control and will power in his management of his diabetes. Individuals with long-term conditions are challenged by often persistent and disruptive health problems that have cognitive, social and emotional repercussions (Larsen & Lubkin, 2009). Established methods of treating people with long-term conditions are based on the assumption that prescriptive instruction by expert health professionals will guide the user’s behaviour, thereby effectively managing their condition. However, frequent non-adherence to health care advice (Zimmerer et al, 2009) and failure to achieve behaviour change through education programmes alone (Gibson et al, 2001) indicate that this approach is often unsuccessful. Self-management programmes typically incorporate development of action plans and training in the skills required to implement such action (Lorig & Holman, 2004). Collaboration between the professional and the person with the long-term condition is required to ensure that advice is not only provided but personalised in accordance with the individual’s needs and preferences (Bodenheimer et al, 2002). In April 2009 the Department of Health released a guide on Self Management.
It detailed the “Four Pillar” approach,firstly Information, a more informed patient can make better decisions about his or her treatment, secondly skills and training, providing the patient with the skills necessary to take care of their condition better, thirdly tools and devices aiming to equip the person with the means to control their condition, and finally the all important support networks, giving the person a sense of involvement in their care and the ability to communicate any fears around their disease.
Whilst on my community placement I was introduced to an initiative that is used within a local PCT in Birmingham. It is called the Diabetes Manual (Burden & Burden, Heart of Birmingham PCT). It is a booklet/log book which is given to every newly diagnosed diabetic. It aims to educate and inform patients on their diabetes and how best to control it. It details some/most of the complications/side effects that come with having a long time condition such as diabetes. Its main aim is to educate patients through simplified terms and pictures. The integrated log book is used by patients to write down how they manage their diabetes on a day to day basis. One key area of this booklet is the action planning page. The book also incorporates target/goal setting for Patrick. On initial interview with Patrick we would aim to introduce him to the booklet and discuss with him, firstly the benefit of using this book, allowing him to self manage his condition and to better understand the implications of a long term condition such as Diabetes. It is important to ensure that Patrick is literate as this plan will not succeed if this is not so. Goal-setting for the first few weeks would be to aim to maintain blood sugars at a mutually agreed safe level.