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Table 2 Summary of selected articles

From: Defining an enabling environment for those with chronic disease: an integrative review

Author Year Type Purpose of the article Main results concerning the enabling environment
Angwenyi 2019
Mixed-method study: interviews, focus group, observations
(n = 140)
To show that support for Self-management in disadvantaged settings contributes to Empowerment *Professional/patient interaction: time, supportive environment
*Explain prevention approaches, encourage
*Home visits appreciated
*Learning achieved: 50% through network (religious leader, community and civil society organization, volunteer), radio and television
*Peer support
*Group problem-solving approaches and a supportive
Collective problem-solving approaches and a supportive environment to cope with the stress of the disease
Brady 2017
Qualitative study: semi-structured interviews
(n = 21)
Showing the use of the internet as a form of Empowerment *Access to online health information:
Confidence, routine questions related to illness, no questions related to acute side of symptoms.
*Allows interaction with health professionals to make decisions
*Communicate with others with same disease
*Interactions with peers provide support
*Supportive reciprocal relationship versus patient
passive with specialized care
*Online community
Bravo 2015
Mixed: Scoping review and semi-structured interviews
(n = 19)
Develop a conceptual map of empowerment including relationships with health literacy, self-management and shared decision making *Empowerment level is modifiable by care interventions implemented by professionals and the care system
*Health education is necessary but not sufficient for empowerment
*Self-management: realistic and personally meaningful goals
*Partnership between professionals and patients: informed decision making
Chang 2015
Descriptive study via questionnaire
(n = 306)
Identify factors of self-care behavior in elderly patients with hypertension 4 predictors of self-care:
*social support
*perceived severity of illness
where to evaluate these variables to support people
Randomized controlled trial (n = 312) To examine the effects of a nurse case management program for older adults with comorbidities at hospital discharge For effective care interventions must incorporate:
*a comprehensive discharge needs assessment
*support for patient-centered processes
*shared decision making
Empowerment interventions increase self-efficacy and decrease hospitalizations
Home visits allow interventions in the person’s environment
*It is the relationship between the nurse and the patient and not the platform that allows for improvements
*Importance of setting up an RPN rather than a generalist because of the different approach
Cojocaru 2014
Congress To show the importance of developing Self-Management in people with chronic diseases *Professionals consider self-management around structured education
*For the patient: complex, multifaceted and non-linear process
Patient engagement in self-management depends on: disease type, time, gender, age, socioeconomic status, self-efficacy and social support network
*Self-management: major issue for positive health outcomes and costs
*Importance of the physician-patient relationship configuration
Cooper 2019
Expert opinion Show how Self-Management and education can support Empowerment 5 points for self-management:
*collaborative care
*focus on individual situations
*structured support
*liaison with community agencies
Importance of time between professional and patient
Cortez 2017
Randomized controlled trial (n = 238) Evaluating the effectiveness of an Empowerment program for metabolic control in patients with diabetes *Positive metabolic results after implementation of the empowerment program
*program based on individualized objectives: psychosocial, behavioural and clinical aspects
Delaney 2019
Qualitative phenomenological study
(n = 15)
Explore and describe the lived experience of chronically ill adults receiving nurse coaching *Being listened to and heard increases the patient’s power and sense of empowerment
*environment of safety, trust, empowerment
*examine the patient experience
*interaction between professional and patient
*need for guidance in the care system
Elissen 2013
Qualitative study in 13 European countries To show whether Self-Management support is integrated into care approaches Self-management: key behaviour in chronic disease for effective management,
*similarity between countries: nursing, care setting
*difference: mode and format of support
*Support activities: medical and behavioural management of patients, less emotional management and consequences of illness
*support for self-management focused on individual needs: provider time and resources
*nature of patient-physician communication and interprofessional work
Fisher 2017
Expert opinion Provide a practical framework for organizing and structuring empowerment programs to improve their use *building the relationship with the professional
* productive interview focused on patients’ needs: competence, autonomy, relationship - patients’ motivations and preferences
* respect for patients’ needs
Fotokian 2017
Qualitative grounded theory study with interviews and field notes
(n = 24)
Illuminating the Empowerment experiences of patients, their families and caregivers *importance of families in the management of the disease
*cooperation with professionals
*various sources of information: internet, radio, peers, discussion with professionals
Hellings 2017
Expert opinion Respond to various commissions on prevention and self-management in the context of respiratory diseases *Mobile application for Education and Self-management
*implementation of prevention strategy
Hernandez 2012
Quantitative study via questionnaires
(n = 378)
Evaluating the effect of Empowerment on adherence and self-care behavior in Diabetes *Knowledge is not enough to produce self care
* patient adherence
*psychosocial support
*giving the patient an active and central role in care
Hoffman 2013
Expert opinion Describe through examples how nurses apply symptom self-management theory to patients’ perceived self-efficacy *5 skills for self-management:
problem solving, decision making, resource utilization, professional and patient partnership, actions to manage health status
* Idea of control, empowerment and confidence
Isaksson. 2015
Quantitative study via questionnaires
(n = 159)
Describe the perceptions and associations between Empowerment, Self-Management and support needs in a rural community *Need for professional support at the beginning of the disease and 15 years after
*need for emotional support and family support
* cultural influence
*notion of visibility of the disease, if invisible difficult to ask for help
*purpose of self-management: quality of life and well-being
Johnsen 2017
Qualitative study via interview
(n = 16)
Determine how the concept of Empowerment manifests itself in the cancer patient *Mastery of treatment and care (ability to say no)
*knowledge and skills
*care system responsive to people’s concerns and needs
no clear link between empowerment and self-care (some patients do not want self-care)
Kärner Köhler 2018
Cross-sectional quantitative study
(n = 157)
Exploring the relationship between empowerment, self-efficacy and well-being *Importance of individualized follow-up by focusing on patients’ beliefs, needs and goals
*Collaboration between patients and professionals by helping to raise awareness of patient needs, goals and
patient’s needs, goals and beliefs
*communication between professionals and patients
*use of resources to solve problems
Korpershoek 2016
Qualitative study with semi-structured interviews
(n = 15)
Identify and explain the underlying process of self-management behavior during disease aggravation *Interventions corresponding to patients’ perceptions, abilities, needs and requests for care
* 2 skills for self-management (recognition of worsening and taking action)
Kristjansdottir 2018
Qualitative study via interview
(n = 39)
Explore patients’ talk about their strengths for their health and well-being *relation and support of professionals
*supporting the forces for self-management and wellbeing.
*self-management: priorities, stress reduction, goal setting, knowledge and support
*environment for a healthy lifestyle
Magnezi 2014
Quantitative study via questionnaires
(n = 296)
Evaluating the effects of participation in an online social health network *greater impact on younger people (20–29 years)
*information role
*notion of immediate results, information without waiting for a medical consultation
*personal questions are easier to ask on the
personal questions are easier to ask on the network than to peers
Musacchio 2011
Quantitative study using medical record data
(n = 1004)
Document the impact of an empowerment program on clinical outcomes, including reducing visits to a diabetologist *the importance of a multi-professional team in the
in the care, role in the follow-up
*telemedicine (internet and telephone) generates
interaction between patient and doctor, immediate response
*social network, email, text message: immediate feedback without waiting for the consultation
Nie 2016
Expert opinion Examine the characteristics and types of health information in diabetes mobile apps in the context of self-management *applications are related to education (75%) in diabetes and then blood glucose monitoring, diet and exercise
*few applications on psychosocial support
*research on applications must take into account cultural aspects
Prigge 2015
Cross-sectional quantitative study (n = 1622) Document the benefits and best practices that should guide Empowerment *need for competence versus need for autonomy vary according to the situation, in severe conditions competence is more effective for empowerment
* patient-centered medicine, focused on the patient’s needs and fears
*strategies for interaction between doctor and patient
*reliable and formal knowledge platform
Ramsay 2012
Qualitative study via interview
(n = 29)
To study the understanding, acceptance and use of the concept of Empowerment in a low-income clinic *empowerment perceived as responsibility
*passive role of the patient because professional gives instruction for self-management and patient is responsible for implementation
*empowerment refers to “doing what the patient is supposed to do
*professionals need to elicit questions, explain choices rather than recommend therapy
*need to listen, to have patients’ concerns addressed
Santos 2017
Quantitative randomized controlled trial
(n = 238)
Compare adherence and Empowerment for self-care and glycemic control practices in group education and home visit strategies *Group education and home visits promote change for adherence and empowerment
by providing an important environment (notion of time), more effective with the group
*allows for the development of caregiving skills such as decision making, autonomy and the experience of living with the disease
*Role of peers, exchange of experience
Schildmeuer 2018
Expert opinion Conduct a review of the development of an online health tool to empower patients *social support from the moment of diagnosis
*peers patients forum for experiences, (autonomy, skills and relationship)
*ehealth: provide functionalities for self-management.
*connecting with peers, relatives
Stoilkava Hartmann 2018
Theory Present a care model: KALMOD *holistic approach to optimize self-management
*importance of communication
*education practice adapted to each patient
Storni 2013
Case study via observations and interviews
(n = 14)
Question the design of a self-care technology that supports a large number of patients *understanding the home environment for the realization of assistive technology
*understanding the place and role of each
*Glycemic device refers to medical monitoring but does not address the complexity and uncertainty of patients
*appropriate the technology by adapting it to patients’ conditions
Suarez Vazquez 2016
Quantitative study via questionnaires
(n = 181)
Analyze the Empowerment experience of patients *Importance of involvement in empowerment - trust in health care professionals
*the more serious the illness, the less involved the patient is
*climate of trust generates a positive self-perception of empowerment
Sürücü 2018
Quantitative descriptive cross-sectional study
(n = 220)
Studying Empowerment, social support as a factor in self-care behaviour * Perception of social support has an impact on self-care behaviour
*feeling empowered allows for self-management of the disease
*training related to behavioural approaches and culture
Tang 2010
Quantitative study of a cohort
(n = 77)
Measure the impact of an intervention in diabetes management *Importance of a continuous intervention, centered on the patient, evolving in relation to the environment and in real life conditions
*patient choice of behaviour change leads to greater motivation
*clinical feedback
*newsletter for self-care behaviour
Vadiee 2012
Expert opinion Acquire skills with a patient program *Patient expertise is a central element
*Self-care: an element of chronic disease management for the maintenance of optimum health
*Self-care: essential basis for preventive and effective measures
Varekamp 2009
Qualitative exploratory study with interview (n = 64) Exploring Empowerment in Employees with Chronic Illness *empowerment training: working on work-related issues and seeking solutions in management
*importance of communication here to ask for accommodations
*different focus: not on their limitations but on their skills as professionals
*develop knowledge and skills
* focus on needs
Varekamp 2011
Randomized controlled quantitative study
(n = 64)
Evaluate the effect of a program on employee stress and fatigue * self-efficacy increases if empowerment
*interventions focused on employees’ needs
Vosbergen 2013
Qualitative study via interviews and focus group
(n = 23)
Examining the patient experience with Self-Management at different stages of coronary artery disease *Healthcare professionals remain the preferred source of information
*notion of time with the health care professional
*online self-management service: tailored to needs
* need for psychological support to reduce anxiety and stress
Wong 2012
Quantitative cohort study
(n = 1141)
Evaluating the effectiveness of an Empowerment program *importance of time spent on education
*chronic disease management: medical, social and emotional needs
Wong 2016
Quantitative cohort study
(n = 24,250)
Evaluating the effectiveness of an Empowerment program on the use of hospital services and care *Program influence: behaviour change, healthy living
*program structures education, decreases frequency of care and hospitalization
Randomized controlled quantitative study
(n = 66)
Studying the effect of telephone-based distance learning on Empowerment *Telehealth program provides structured care: improves relationship, removes barriers of location and time
*importance of time spent on education
*distance education has a positive effect
Zhang 2019
Prospective quantitative study (n = 60) Evaluating the effect of health education on patients’ quality of life using empowerment theory *better understanding of the disease allows the patient to develop self-management and quality of life
*health education allows the patient to feel in control of his life and his disease
*health education is necessary if there is no empowerment in relation to the disease