title: Effectiveness of empowerment-based self-management interventions on patients with chronic metabolic diseases: a systematic review and meta-analysis.
abstract: BACKGROUND
  Management of chronic metabolic diseases has recently become an important global health issue. Extensive research on empowerment-based self-management interventions (EBSMIs) for patients with chronic metabolic diseases has been conducted, but no systematic review has evaluated their effects.
  
  
  OBJECTIVE
  To evaluate the effects of EBSMIs on patients with chronic metabolic diseases.
  
  
  METHODS
  A systematic review and meta-analysis was conducted. Five electronic databases (Airiti Library, CINAHL, Cochrane Library, PubMed/ MEDLINE, and Index of Taiwan Periodical Literature System) were searched from the earliest year available to October 2012. Controlled trials about the effectiveness of interventions on patients with chronic metabolic diseases were included. Each study was appraised by three reviewers and assigned a level of evidence based on the modified Jadad scale. Extracted data were entered and analyzed using Review Manager 5.2.
  
  
  RESULTS
  Nineteen studies were reviewed. Most studies showed that EBSMIs improved patients' hemoglobin A1c test (HbA1c) (p < .00001), waist circumference (p = .02), and empowerment level (p = .004). Four studies compared the effect on body weight and body mass index, but the overall effect was not significant (p = .33 and .73, respectively). Five studies compared the effect on self-efficacy, four of which indicated significant increase. However, the overall effect on self-efficacy was not compared because studies used different scales.
  
  
  CONCLUSIONS
  EBSMIs improved HbA1c test results, waist circumference, self-efficacy, and empowerment level in patients with chronic metabolic diseases. When implementing the EBSMIs, healthcare institutions need to provide training programs related to empowerment from which health professionals can acquire competence in patient empowerment. Moreover, healthcare leaders should assess and overcome barriers (e.g., time, manpower, cost, etc.) to implementing EBSMIs in clinical settings.
authors.affiliation: Advanced Practice Nurse, Emergency Department, Chi-Mei Medical Center, and doctoral candidate, School of Nursing, Kaohsiung Medical University, and Assistant Professor, Department of Nursing, Chang Jung Christian University, Tainan, Taiwan.
authors.forename: Chia-Chi
authors.initials: CC
authors.lastname: Kuo
authors.forename: Chiu-Chu
authors.initials: CC
authors.lastname: Lin
authors.forename: Fu-Mian
authors.initials: FM
authors.lastname: Tsai
mesh_terms: D000328:Adult; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008659:Metabolic Diseases / Q000523:psychology* / Q000628:therapy*; D008875:Middle Aged; D011209:Power, Psychological; D012648:Self Care / Q000523:psychology*; D020377:Self Efficacy; D013624:Taiwan
keywords: chronic metabolic disease; empowerment; literature review; metabolic syndrome; self-management; systematic review and meta-analysis