만성질환 노인에서 임파워먼트 이론에 근거한 다학제적 자기관리 프로그램의 효과 = Effects of a Multi-disciplinary Approached, Empowerment Theory Based Self-management Intervention in Older Adults with Chronic Illness

다국어 초록 (Multilingual Abstract)

Purpose: The purpose of this study was to develop a multi-disciplinary self-management intervention based on empowerment theory andto evaluate the effectiveness of the intervention for older adults with chronic illness. Methods: A randomized controlled trial design wasused with 43 Korean older adults with chronic illness (Experimental group=22, Control group=21). The intervention consisted of twophases: (1) 8-week multi-disciplinary, team guided, group-based health education, exercise session, and individual empowerment counseling,(2) 16-week self-help group activities including weekly exercise and group discussion to maintain acquired self-management skillsand problem-solving skills. Baseline, 8-week, and 24-week assessments measured health empowerment, exercise self-efficacy, physicalactivity, and physical function. Results: Health empowerment, physical activity, and physical function in the experimental group increasedsignificantly compared to the control group over time. Exercise self-efficacy significantly increased in experimental group over time butthere was no significant difference between the two groups. Conclusion: The self-management program based on empowerment theoryimproved health empowerment, physical activity, and physical function in older adults. The study finding suggests that a health empowermentstrategy may be an effective approach for older adults with multiple chronic illnesses in terms of achieving a sense of control overtheir chronic illness and actively engaging self-management.

참고문헌 (Reference)

1 Chorong Park, "Validity and Reliability of Korean Version of Health Empowerment Scale (K-HES) for Older Adults" 한국간호과학회 7 (7): 142-148, 2013

2 전민영, "Validity and Reliability of Korean Version of International Physical Activity Questionnaire Short Form in the Elderly" 대한가정의학회 33 (33): 144-151, 2012

3 Royani Z, "The effect of empowerment program on empowerment level and self-care self-efficacy of patients on hemodialysis treatment" 18 (18): 84-87, 2013

4 Marzieh Moattari, "The effect of empowerment on the self-efficacy, quality of life and clinical and laboratory indicators of patients treated with hemodialysis: a randomized controlled trial" Springer Nature 10 (10): 115-, 2012

5 Anderson RM, "The diabetes empowerment scale-short form(DES-SF)" 26 (26): 1641-1642, 2003

6 Tricia S. Tang, "Self-management support in “real-world” settings: An empowerment-based intervention" Elsevier BV 79 (79): 178-184, 2010

7 Gortner SR, "Self-efficacy and activity level following cardiac surgery" 15 (15): 1132-1138, 1990

8 Bandura A, "Self-efficacy : Toward a unifying theory of behavioral change" 84 (84): 191-215, 1977

9 Bernard M., "Promoting health in old age: Critical issues in self health care" Open University Press 2000

10 T M Manini, "Physical activity and maintaining physical function in older adults" BMJ 43 (43): 28-31, 2008

11 Robert M. Anderson, "Patient empowerment: reflections on the challenge of fostering the adoption of a new paradigm" Elsevier BV 57 (57): 153-157, 2005

12 Ae Kyung Chang, "Nurse-led empowerment strategies for hypertensive patients with metabolic syndrome" Informa UK Limited 42 (42): 118-128, 2014

13 Pellino T, "Increasing self-efficacy through empowerment : Preoperative education for orthopaedic patients" 17 (17): 48-51, 1998

14 Bodenheimer T, "Improving primary care for patients with chronic illness : The chronic care model, Part 2" 288 (288): 1909-1914, 2002

15 Centers for Disease Control and Prevention, "How much physical activity do older adults need?: Physical activity is essential to healthy aging"

16 MELINDA HUFFMAN, "Health coaching: A new and exciting technique to enhance patient self-management and improve outcomes. Home Healthcare Nurse" Ovid Technologies (Wolters Kluwer Health) 25 (25): 271-274, 2007

17 Nelma B. Crawford Shearer, "Health Empowerment Theory as a Guide for Practice" Elsevier BV 30 (30): 4-10, 2009

18 Susan L. Norris, "Health Care for Older Americans with Multiple Chronic Conditions: A Research Agenda" Wiley-Blackwell 56 (56): 149-159, 2008

19 Anderson RM, "Evaluating the efficacy of an empowerment-based self-management consultant intervention: Results of a two-year randomized controlled trial" 1 (1): 3-11, 2009

20 Jordan JE, "Enhancing patient engagement in chronic disease self-management support initiatives in Australia: The need for an integrated approach" 189 (189): S9-S13, 2008

21 N.M. de Vries, "Effects of physical exercise therapy on mobility, physical functioning, physical activity and quality of life in community-dwelling older adults with impaired mobility, physical disability and/or multi-morbidity: A meta-analysis" Elsevier BV 11 (11): 136-149, 2012

22 Centers for Disease Control and Prevention, "Deaths and mortality"

23 Brown SA, "Culturally competent diabetes self-management education for Mexican Americans : The starr county border health initiative" 25 (25): 259-268, 2002

24 Newman SP, "Chronic disease self-management approaches within the complex organisational structure of a health care system" 189 (189): S7-S8, 2008

25 Centers for Medicare & Medicaid Services, "Chronic conditions data warehouse: Condition categories"

26 Chung K, "Analysis of the survey of living conditions and welfare needs of Korean older persons" Institute for Health and Social Affairs 2012

27 Gu MO, "A structural model for self care behavior and metabolic control in diabetic patient" Seoul National University 1992

28 Guralnik JM, "A short physical performance battery assessing lower extremity function: Association with self-reported disability and prediction of mortality and nursing home admission" 49 (49): M85-M94, 1994

29 Rogers ES, "A consumer-constructed scale to measure empowerment among users of mental health services" 48 (48): 1042-1047, 1997