Kaohsiung Medical University, Taiwan
Chiu-Chu Lin had completed his PhD degree from University of Michigan, Ann Arbor, USA. Dr. Lin is a professor of school of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan. Her major is adult health nursing and the specialty focus on the nephrology nursing; her research interests include self-management of chronic illness, instrument development and testing, and intervention study. In recent years, she have been conducting theory-based intervention study. In the teaching area,she is responsible for the courses of adult health nursing and intervention study in the graduate institution and the course of medical-surgical nursing in the undergraduate program.
Introduction: Diabetes is the most common cause of chronic kidney disease (CKD) in Taiwan and also an increasing same cause worldwide. Studies show one third of patients with type 2 diabetes mellitus (DM) have concomitant early stage CKD. Self-management for patients with both of these chronic conditions is conflicting, complex and often inadequate. With proactive interventions, CKD-related self-management behavior may be improved and the progression of the CKD may be delayed. Objectives: The purpose of this study was to evaluate the effectiveness of an empowerment-based self-management program (EBSM) on CKD self-efficacy, CKD self-management behavior and biomedical measures in T2DM patients with early stage CKD. Methodology: The study adopts a quasi-experimental design, 71 patients (52% men, mean age 54.97 years) were assigned to the group-based EBSM program or usual care group based on their availability to attend the intervention. The EBSM group which used the empowerment approach to help patients aware self-management problems, set goals and make evaluation to their CKD self-management plans. All of the patients underwent testing at baseline (T0), 3 (T1) and 6 (T2) months after a six weeks intervention. A generalized estimating equation (GEE) models was conducted to determine the effectiveness of the intervention. Results: After adjusting for baseline and covariate, the EBSM intervention resulted in improvements in CKD self-efficacy scores (p<.001 at 3 months; p<.001 at 6 months), CKD self-management behavior scores (p<.01 at 3 months; p<.01 at 6 months); body weight (p<.05 at 3 months); BMI (p<.05 at 3 months), waist (p<.001 at 3 months; p<.001 at 6 months); systolic blood pressure (p<.001 at 3 months; p<.01 at 6 months), diastolic blood pressure (p<.01 at 3 months; p<.05 at 6 months), Haemoglobin A1c levels (, p<.01 at 3 months; p<.01 at 6 months); blood lipid levels (p<.01 at 3 months) as compared to the usual group. No group differences but maintain in GFR and UCAR were observed. Conclusion: A EBSM program for T2DM patients with early stage CKD resulted in greater improvements in self-efficacy, self-management behavior and positive effect in biomedical measures but no difference in GFR and UACR levels up to 6 months after intervenntion. Future studies testing empowerment-based interventions in larger samples with longer follow-up, and randomized controlled trial design were warranted.