Table 2 Summary of individual studies

Admiraal, et al. (2017) [37] Netherlands

To examine the effectiveness of a web-based tailored psychoeducational program (ENCOURAGE) for breast cancer patients, to empower patients to take control over prevailing problems

Randomized Controlled Trial (RCT)

Theory: The theory of problem solving (Dunker, 1935)

N = 138 adult female breast cancer patients who recently completed neo-adjuvant chemotherapy. Study group (n = 70)

Control Group (n = 69)

Setting: Web based intervention

Mode: Group

Study gr: 12-week access to the ENCOURAGE program with fully automated information

Control gr = Usual care

1: Increased optimism and control over the future (subscale of the constructs empowering outcomes questionnaire)

2: Distress was measured using the Dutch DT/PL, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (QLQ-C30) and the breast cancer specific Quality of Life Questionnaire

(QLQ-BR23)

Self-report questionnaire: six and 12 weeks

No differences between the control and intervention group for primary and secondary outcomes. In clinically distressed patients (N = 57), the ENCOURAGE program increased optimism and control over the future at 12 weeks more than in the control group (Cohen’s d = 0.65)

Akturan et al. (2017) [38] Turkey

To investigate the effect of the BATHE therapeutic interview technique on the empowerment of type 2 diabetes mellitus (DM) patients

Cluster RCT Theory: not identified

N = 112 adult type 2 DM patients. Study Group:

(n = 57)

Control Group: (n = 55)

Setting: Outpatient primary care

Mode: Individual

Study gr: DM patients of primary care physicians who had taken training in the BATHE therapeutic short interview technique. Control gr: patients of physicians without this training

1: A 21-item Turkish version of the diabetes empowerment process scale (DES) was used to assess the participants’ perceptions of empowerment provided by healthcare providers

Self-report questionnaires: Baseline + in the 6th month

Increase in the DES total score for the intervention group was higher than for the control group (Δ = 10.56 ± 8.97; Δ = 5.64 ± 7.36; p < 0.001). The BATHE intervention showed a significant predictor of the DES difference (B: 8.861; CI: 6.092–11.629; p < 0.001)

Almeida et al. (2019) [39] Iran

To assess the effectiveness of the Living Harmoniously with Diabetes program in self-efficacy perceptions in patients with type 2 DM

Quasi randomized Theory: Health Belief Model (Becker, 1974) [40]

N = 42 adult Type 2 DM patients diagnosed for more than a year, and possess skills to manage their disease autonomously Study Group:

(n = 19). Control Group:

(n = 23)

Setting: Outpatient public health center

Mode: Group

Study gr: Mode: six two-hour group sessions held once a week. Interactive and practical approach, on decision-making and daily problem-solving skills. The educational program was grouped into 4 modules. Control gr: Follow the regular surveillance program

1: The Diabetes Empowerment Scale—Short Form (DES-SF)

Self-report questionnaires: Baseline + 6 weeks

The DES subscale score for “Assessing Dissatisfaction and Readiness to Change” did not change during the study period (p = 0.382), whereas “Managing Psychosocial Aspects of Diabetes” and "Setting and Achieving Goals” subscale scores increased significantly

Aslani et al. (2019) [41] Iran

To determine the effect of empowerment on the self-efficacy of Ischemic Heart Disease (IHD) patients admitted to a healthcare center

RCT

Theory: A Person Centered Model for the Promotion of his/her empowerment (Anderson & Funnell, 2004) [42]

N = 56 adult patients with IHD. Study Gr:

(n = 28),

Control Gr: (n = 28)

Setting: Outpatient at hospital

Mode: Group (3–5 pers)

Study gr: The empowerment program was presented in three 45-min sessions. Control gr: Usual care

1: The standard chronic disease self-efficacy scale (CDSES)

Self-report questionnaire: baseline, after training, 4 weeks, 8 weeks

No significant difference in the mean scores of self-efficacy before the intervention. After the intervention and at the first and second phases of control, the mean score of self-efficacy was higher in the experimental group than in the control group

Chen et al. (2018) [43] China

To examine the effectiveness of patient-centered self-management empowerment intervention (PCSMEI) on self-efficacy, activities of daily living, and rehospitalization of first-time stroke survivors

Two armed single blind Randomized Controlled prospective trial Theory: The Health Empowerment Theory (Shearer, 2009) [44]

N = 144 adult stroke patients. Study Group:

(n = 72)

Control Group: (n = 72)

Setting: Hospitalized in-patient and continued post-discharge out-patient

Mode: Mixed (Group + Ind)

Study gr: Patient-centered self-management empowerment intervention:

5 daily sessions (day 3–7), one small group setting, discharge instruction + 4 weeks telephone follow up

Control gr: Conventional nursing (unstructured health education), same number of telephone calls of general social chatting

1: The Stroke Self-Efficacy Questionnaire (SSEQ). 2: The Barthel index (BI) was used to measure performance in ADL

Self-report questionnaire: baseline, on discharge (T1), 1-month postdischarge(T2) and 3 months postdischarge(T3)

There were significant differences found in the change of self-efficacy between the study group and the control group

T1 (β = 3.644; 95% CI [0.728, 6.560]), T2 (β = 4.968; 95% CI [1.322, 8.613]), and T3 (β = 4.252; 95% CI [0.576, 7.928]), reaching statistical levels at T1 (p = .014), T2 (p = .008) and T3 (p = .023)

Cheng et al. (2018) [45] China

To evaluate the effectiveness of a patient-centered, empowerment-based programmed on glycemic control and self-management behavior

Prospective multi-center, single blind, RCT. Theory: The Health Empowerment Theory (Shearer, 2009) [44]

N = 242 adult patients with poorly controlled Type 2 DM. Study Group:

(n = 121) Control Group: (n = 121)

Setting two tertiary hospitals (in-patients)

Mode: Mixed (Group + Individual)

Study gr: Two group sessions (1/ week) + 4 phone based individual sessions on diabetes related empowerment-based self-management Control gr: Health education classes and post discharge follow-up

1: Glycemic control (measured by HbA1c) and self-management behaviors

Biometric and survey assessment:

Baseline + 8th- and 20th-week follow-ups

The intervention group exhibited significant improvements in general diet management at the 8th-week (β = 0.740; p = 0.013), specific diet management at 8th-week (β = 0.646; p = 0.022) and 20th-week (β = 0.517; p = 0.043), and blood glucose self-monitoring at both the 8th- (β = 0.793; p = 0.009) and 20th-week (β = 0.739; p = 0.017) follow-ups

Cheng et al. (2021) [46] China

To report the intervention effects on levels of empowerment, diabetes-specific distress, and quality of life, which are secondary outcomes in the overall study

Randomized, parallel, investigator-blind, controlled trial. Theory: The Empowerment Process Model Cattaneo and Champman (2010) [47]

N = 242 adult patients with poorly controlled Type 2 DM

Study Group:

(n = 121)

Control Group: (n = 121)

Setting in-patient at 2 hospitals and post discharge telephone follow-up

Mode: Group

Study group: 6 week empowerment based transitional care program (establishing goals, diabetes self-management regimen (dietary management and blood glucose self-monitoring)

Control group:

Two general health education classes and biweekly post-discharge social calls on top of routine care

1: Diabetes Empowerment Scale-Short Form (DES-SF), 2: Diabetes Distress Scale (DDS), and the Audit Diabetes Dependent Quality of Life (ADDQoL)

Self-report questionnaire

baseline, one-week post-intervention, and three-month post-intervention

Participants in the intervention group showed significant improvements on empowerment level [(β = 0.163; 95% confidence interval (CI): 0.011 to 0.316, p = 0.036) at one-week post-intervention and (β = 0.176; 95% CI: 0.020 to 0.331, p = 0.027) at three-month post-intervention respectively

Cinar et al. (2018) [48] Denmark and TurkeY

To assess the effectiveness of Health Coaching (HC) compared with a health education (HE) intervention on the management of glycemic control and periodontal health

(RCT) (partially randomised patient preference trial (PRPP) design

Theory: The coaching framework (by the International Coaching Community)

N = 302 adults with Type 2 diabetes. Groups: First phase: Turkey: N = 136 HE: N = 101 and HC: N = 74 (2010–2012). Second phase: Denmark: N = 116 HE: N = 78 and HC: N = 96

Setting: Out-patient medical /dental clinic

Mode: Individual Study group (HC): 3–4 face-to-face sessions and 2–3 telephone calls. The sessions (20–60 min), with a professional health coach in both countries, focused on maintenance and improvement of lifestyles with the aim of at least a 0.4–0.8% reduction in HbA1c (P < 0.05)

Control group (HE): Received standard lifestyle advice after baseline examination and were invited for two more face-to-face and 1–2 telephone sessions

HbA1c, periodontal treatment need index (CPI), health behaviors and anthropometric measures

Self-report questionnaire

Not incuded

The study duration was 12 months (6 months initiation-maintenance, 6 months follow-up)

HbA1c and CPI, were significantly improved in the HC group compared with the HE group (P < 0.05) in both countries. No significant change was observed in the other clinical parameters (BMI, LM and BFP) in both groups (P ≥ 0.05). In Turkey: The HC group compared with the HE group reported a significantly higher rate of ‘positive change in at least one behaviour’ (85% vs. 60%, P = 0.001)

No difference in Denmark

Cortez et al. (2017) [49] Brazil

To evaluate the effectiveness of an empowerment program for metabolic control aimed at Brazilian patients in the public health system with type 2 diabetes

Cluster RCT

Theory: Freirean theories (2007) [50]

N = 238 Adults aged 30–80 with type 2 diabetes

Study Group:

(n = 127)

Control Group:

(n = 111) Setting: Ten primary care settings (health units)

Mode: Mixed (Group + monthly telephone follow-up between cycles of meetings)

Study gr: 10 meetings over 12 months. (2 h each). Discussions about diabetes identifying needs and building the foundation for empowerment. Control gr: did not attend the educational meetings, but received the same routine care from the health teams

1: A questionnaire that evaluates diabetic knowledge (DKN), user attitudes (ATT) and the self-care questionnaire (ESM). The short form empowerment scale (DES)

Self-report questionnaire At the beginning of the study, before any educational activity, and at the end of the study

Blood was collected twice: HbA1c (%), triglycerides (TGL) (mg/dl), total cholesterol (TC) (mg/dl), light density lipoprotein (LDL) (mg/dl), and high density lipoprotein (HDL) (mg/dl)

Participants in SG exhibited a greater reduction in the percentage of HbA1c and DBP, and a greater percentage increase in the scores for selfcare, knowledge and attitudes in comparison to individuals in CG (p < 0.05)

Dehghan et al. (2017) [51] Iran

To compare the effect of educating self-empowerment program through the training package and workshop on the life quality of diabetic patients

Pre/post design. Theory: Not identified

N = 40 adults with type 2 diabetes

Study group:

(n = 20)

Control group: (n = 20)

Setting: An out-patient diabetes clinic

Mode: Group

Study gr: = training workshop, 5 sessions of 1:30 h training in small 5-people groups with methods of improving the daily activities of life, ability to overcome obstacles of the disease and principles of weight control, nutrition, exercise and increase motivation and power of decision- making and management of stress

Control gr: = training package, a multimedia CD with same content

1: The questionnaire of life quality of diabetic patients

Self-report questionnaire

Baseline + two months after the end of sessions

The research findings showed no significant difference in the scores of life quality between two intended groups before and after intervention (P: 0.570), but a significant difference was found before and after intervention (inter-group) in the scores of life quality in each group (P < 0.0001)

Dehghan, et al. (2018) [52] Iran

To investigate the effect of empowerment model-based education on self-efficacy and self-esteem in type 2 diabetic patients

Randomized Control Trial. Theory: Discussed theories related to defining self-efficacy (Bandura) etc. but no theory that drove the study

N = 90 Adults with type 2 diabetes

Study Group:

N = not reported. Control Group: N = not reported. Setting: Out-patient diabetes clinic

Mode: Group

Study gr: 6 sessions of 90-min attendance Empowerment based on the three steps of threat perception, problem- solving and evaluation

Control gr: Usual care

1: Cooper Smith's adult self-esteem questionnaire and 2: diabetes' self-efficacy. DMSES self-efficacy questionnaire

Self-report questionnaire

Verbal questioning before sessions and six weeks after intervention using self-efficacy and self-esteem questionnaires

There is a significant difference between the two groups in level of self-esteem after the intervention, where the level of self-esteem has increased in the st. group. There was no significant difference between the two groups regarding the level of self-efficacy after the intervention

Doupis et al. (2019) [53] Greece

To investigate the effects of a systematic education program and telephone support on self-reported adherence to oral glucose treatment in patients with type 2 Diabetes

Cluster RCT Theory: Not presented

N = 457 Adults with type 2 diabetes. Study Group:

(n = 230)

Control Group:

(n = 227)

Setting: Conducted in 45 primary and secondary outpatient diabetes care centers

Mode: Mixed (Group + telephone)

Study gr: standard-of-care with a systematic patient education program (empowerment group) included information on disease knowledge, diet and exercise, use of medications and adherence to treatment and stress + biweekly telephone follow up from doctors

Control gr: usual care

1: HbA1c, blood glucose, LDL-c; and systolic blood pressure, diastolic blood pressure, proteinuria. 2: Morisky Medication Adherence Scale (MMAS). Health-related quality: the five-level EQ-5D (EQ-5D-5L). The visual analogue scale (EQVAS). Treatment satisfaction: Diabetes Treatment Satisfaction Questionnaire (DTSQ/ DTSQc versions)

Self-report questionnaire

baseline visit and at 4- and at 8-month (± 1 week)

MMAS-4 scores showed that the mean score for the empowerment group was significantly higher compared to control group at 4 months (p = 0.023) and 8 months (p = 0.043). For the empowerment group, the mean HbA1c was reduced to 7.1% at 4 months (- 0.9% from baseline) and to 7.0% at 8 months (- 1.0% from baseline); for the control group, the respective mean HbA1c levels and reductions from baseline were 7.0% (- 0.7%) and 6.9 (- 0.8%). No sign. between-group differences were observed in other clinical characteristics

Ebrahimi et al. (2016) [54] Iran

To evaluate the effect of empowerment model on indicators of metabolic control in patients with type 2 diabetes

Randomized Control Trial. Theory: Cognitive theories by Azobel (1997) [55]

N = 113 Adults with Type 2 diabetes Study Group:

(n = 53)

Control Group:

(n = 53) Setting: an out-patient clinic

Mode: Group (five groups of 10)

Study gr The intervention of empowerment approach training: 5–7 weekly meetings (60–90 min) with two experienced nurses + endocrinologist and a nutritionist, and according to the model’s stages (perception of threat, problem solving, and evaluation)

Control Gr: Conventional training

HbA1C and laboratory indicators consist of fasting and non-fasting blood sugar, triglyceride, cholesterol, and high- and low-density lipoproteins

Measured baseline + 3 months

Self-report questionnaire

Not included

After intervention, there was a significant mean difference in HbA1C (p = 0.003), FBS (p = 0.004), BS (p = 0.003), Cholesterol (p = 0.033), Triglyceride (p = 0.001) and HDL (p = 0.000) in two groups in favour of study gr. LDL (p = 0.081) was the only metabolic indicator that showed no significant change after intervention

Fardazar et al. (2018) [56] Iran

To empower patients with type 2 diabetes in order to prevent diabetic foot

Quasi randomized. Theory: not presented

N = 104 Adult patients with Type 2 diabetes. Study Gr:

(n = 52)

Control Gr:

(n = 52)

Setting: in two diabetes clinics

Mode: Mixed (Group + ind)

Study gr: Foot Care Principles program 4 weekly groups × 40–50 min with empowerment strategies; lectures, practically doing feet examination and special feet exercises, films, practicing, group discussion, question and answer, pamphlets and CDs. + individual counseling about foot care and psychological counseling with a mental health professional and suitable socks for diabetic foot

Control gr: usual care

An empowerment assessment questionnaire, and foot care behavior checklist

Self-report questionnaire

Baseline, one and 3 months after intervention

The mean score of empowerment and foot care behavior of the experiment group was significantly higher than that of the control group in 1 and 3 months after the intervention (P < 0.001)

Hourzad et al., (2018) [57] Iran

to evaluate the effectiveness of an empowering self-management model on the self-efficacy and Sense of Coherence (SOC) in the retired elderly with chronic diseases

Randomized Control Trial. Theory: Antonovsky’s theoretical model of salutogenesis (1993)

N = 60 with at least one officially diagnosed chronic disease. Study Gr: N = 30

Control Gr: N = 30. Setting: Out-patient, individual interviews, virtual visits and or telephone

Mode: Individual Study gr: A five-stage plan (2 weeks of interviews and in-person trainings followed by 6 weeks implementation 1) self-awareness of changes and expectations; 2) optimal goal setting; 3) planning; 4) adjusting physical, psycho-logical, and social structures; and 5) evaluation. first three stages were performed in two 45-min sessions

Control gr: routine care = screening tests for common diseases, annual visits by a GP, referral to specialist in case of compli-cations, and a group training on general healthy lifestyle

The Sherer’s self-efficacy and Antonovsky’s SOC questionnaires

Self-report questionnaire

Before and after intervention (after 8 weeks)

The mean self-efficacy scores increased by 9.5±5.32 and 1.7±6.04 in the intervention and control groups, respectively, after the intervention (t=5.20, P < 0.001. The mean score of SOC increased by 24.2 ±12.05 and 0.1±13.42 in the intervention and control groups, respectively (t=7.18, P < 0.001

Hsiao et al. (2016) [58] Taiwan

To evaluate the impact of participation in empowerment groups on the empowerment and self-care of post-renal-transplant recipients

Randomized Control Trial. Theory: discussed theories related to defining concepts but no theory that drove the study? (Orem’s self-care theory)

N = 122 patients who had undergone a renal transplant within the past 20 years. Study Gr:

(n = 56) Control Gr:

(n = 66) Setting: Out-patient setting

Mode: Group

Study gr: One 2-h meeting every 2 weeks for a total of six meetings. The topics included goal setting, problem solving, coping with daily stress, seeking social support, and staying motivated., Control gr: usual care

Empowerment Scale, and Self-Care Scale

Self-report questionnaire: baseline + 4 weeks after the intervention

The empowerment group reported significant increases both in terms of level of empowerment (F = 5.29, p = .023) based on age and time interaction (F = 9.86, p G .001) and in terms of self-care behaviors (F = 7.15, p = .009)

Kordshooli et al. (2018) [59] Iran

To investigate the effect of family-centered empowerment model on illness perception in heart failure patients (cognitive and emotional representation)

Randomized Control Trial. Theory: Family centered empowerment model by Alhani in 2002

N = 70 Patients with heart failure. Study Gr:

(n = 35)

Control Gr:

(n = 35) Setting: Heart clinic in hospital

Mode: Group

Study gr: Received the family-centered empowerment modeling done in 5 sessions. Control gr: usual care

The brief illness perception Questionnaire (BIPQ)

Self-report questionnaire: baseline + 8 weeks

After the intervention, a significant difference was observed in all of the dimensions of illness perception in favour of the study group, except for time line

Lavesen et al. (2016) [60] Denmark

To explore whether telephone follow-up after discharge may reduce readmission rates, lower mortality, and improve disease management in patients with chronic obstructive pulmonary disease (COPD)

Randomized Control Trial. Theory: not identified

N = 224 Adult patients with COPD. Study Gr:

(n = 122)

Control Gr:

(n = 122) Setting: Out-patient nurse led telephone empowerment strategy

Mode: Individual Study gr: The nurse-initiated telephone follow- up consisted of two telephone follow-up calls on day 2 and day 30 after discharge. Calls centered on admission, awareness of signs of exacerbations and disease management. Control gr: usual care

Quality of Life measured by Rand 36 item short form. 1) The primary outcome was readmission rate. 2) Mortality and disease management were secondary outcomes

Self-report questionnaire: Questionnaire on day 30 after discharge, Re- admissions and deaths were recorded on day 30 and day 84 after discharge

There was no significant difference in readmission rates or mortality, but significant differences in patients’ assessment of own perception of managing dyspnoea, lung symptoms, ability to react to signs of exacerbation and communicate with health professionals

Lenjawi et al. (2017) [61] QATAR

To assess whether a structured nurse led diabetes educational program is effective in improving glycemic and metabolic parameters among South Asians with type 2 diabetes compared to regular outpatient care

Randomized Control Trial. Theory: the theories of the health belief model, change in locus of control, and patient empowerment

N = 460 Adults with type 2 diabetes.. The Study Gr:

(n = 230) Control Gr

(n = 230)

Setting: Community setting

Mode: Group

Study gr: A theory based nurse-led, diabetes educational program that is 8 h long, divided into four sessions each lasting 2 h, and held once weekly

Control gr: Usual care

The primary outcome was the improvement in HbA1c and other metabolic parameters, including lipid profile, albumin/creatinine ratio, blood pressure, and body mass index

Self-report questionnaire: Not included

The intervention group had statistically significant improvements in HbA1c (-0.55%, p = 0.012),

fasting blood sugar (-16.6 mg/dl, p = 0.022), albumin/ creatinine ratio (-3.09, p \ 0.001), and HDL cholesterol (?6.08 mg/dl, p < 0.0001), compared to the controls. There was no sta- tistically significant difference between the groups in systolic blood pressure or diastolic blood pressure, nor BMI

Li et al. (2020) [19] China

To assess the effects of a motivational interviewing (MI) based patient empowerment program (PEP) on Type 2 Diabetes patient self-management compared to traditional diabetes health education

Randomized Control Trial. Theory: Motivational Interviewing by Miller/Rollnick: strongly rooted in the person-centered approach of Carl Rogers (1951, 1959, 1980)

N = 225

Adult Type 2 DM The Study Gr

(n = 117) The Control Gr:

(n = 108) Setting: Out- patient setting

Mode: Group

Study gr: received a four-session PEP in small groups over 1 month by trained nurses and doctors. Control gr: received the traditional lecture style health education on diabetes

Problem Areas in Diabetes (PAID), patient enablement index (PEI), mental health,

patient satisfaction

Self-report questionnaire:

baseline, post-activity and 3 months

The PEP has a significant effect on improving diabetes-related distress, but MI was not significantly different from the traditional health education programs when it comes to the readiness to change

Macedo et al. (2017) [62] Brazil

The objective of the present study was to evaluate the adherence and empowerment shown by people that engaged in these group activities

Randomized Control Trial. Theory: A person-centered model for the promotion of his/her empowerment (Anderson & Funnell, 2005) [42]

N = 183 Adult patients with Type 2 diabetes. The Study Gr:

N = 72

The Control Gr:

N = 111. Setting: Out- patient clinic

Mode: Group

Study gr: seven group meetings, of two hours with five steps to encourage to think about their condition (based on the Behavior Change Protocol.) topics: 1) problem definition; 2) identification and handling of feelings; 3) definition of goals; 4) elaboration of a care plan; 5) evaluation

Control gr: Usual care

The validated instruments of adherence to self-care practices for diabetes mellitus (ESM) and empowerment for self-care in diabetes mellitus, short version (Diabetes Empowerment Scale-Short Form – DES-SF), and assessment of HbA1c

Self-report questionnaire:

Baseline + at three-month

A statistically significant decrease (< 0.001) in the value of glycated hemoglobin and an increase in the scores of adherence to self-care and empowerment scales were found for participants in the intervention group (< 0.001)

Maryam et al. (2017) [63] Iran

To evaluate the effect of empowerment program based on telenursing in caregivers of patients on functional capacity and dyspnea in elderly patients with heart failure (HF)

Randomized Control Trial and prospective study

Theory: A person-centered model for the promotion of empowerment (Anderson & Funnell, 2005) [42]

N = 75 Patients with HF. Study Gr. #1:

N = 25;

Study Gr.#2:

N = 25

Control Gr:

N = 25

Setting: In-person training sessions, 3-months telephone follow-up call

Mode: Individual

Study gr: 1 and group 2. The Patients with caregivers received education by a nurse. During three months, only caregivers of patients in group 2 were followed via telephone and received advice on physical activity, diet, medication, and vital signs monitoring of the patients. Control gr: Usual care

Six Minute Walking Test and dyspnea was measured via Burg Scale

Baseline + 3 months

Self-report questionnaire: Not included

After the 3-months intervention there were no significant differences between the three groups (p = 0.14)

Moein et al. (2017) [64] Iran

To investigate the effect of a self- empowerment program on self-efficacy in patients with type 2 diabetes

Randomized Control Trial

Theory: A person-centered model for the promotion of his/her empowerment (Anderson & Funnell, 2005) [42]

N = 50 Adult Type 2 diabetics. Study Gr:

(n = 25) Control Gr:

(n = 25) Setting: a diabetes center

Mode: Group

Study gr: five steps program conducted in eight 45-min sessions two days a week for four consecutive weeks

Control gr: usual care

Diabetes self-efficacy questionnaires

Self-report questionnaire:

Baseline + two months after the intervention

At the end of the study, a significant difference was observed between the mean self-efficacy scores in the two groups (55.71 ± 13.25 in the intervention group vs. 40.24 ± 17.55 in the control group, P = 0.001)

Musavinasab et al. (2016) [65] Iran

To determine the effect of a self-management empowerment model on the Sense of Coherence (SOC) among elderly patients with cardiovascular disease

Quasi randomized controlled trial. Theory: Antosovsky’s theoretical model of salutogenesis

N = 96, patients with cardio-vascular disease. Study Gr

(n = 48)

Control Gr

(n = 48) (received educational booklet). Setting: In-patient

Mode: Group

Study gr: 4 steps: 1) instill self-awareness of changes in physical psychological and social capacities, 2) optimum goal setting. 3) planning, using the goals based on solutions proposed by the elderly and the areas of self-management in the empowerment model. The first three stages were performed in two 45-min sessions. Control gr: usual care

Antonovsky’s standard SOC Scale, which were completed by face- to-face interviews with the elderly

Self-report questionnaire: Baseline + after intervention

A significant difference between the mean total score and the dimensions of SOC in the experimental group and the control group (p = .0001): the SOC scores of the experimental group were increased after the intervention

Naik et al. (2019) [21] United States

To evaluate the effectiveness of Healthy Outcomes Through Patient Empowerment (HOPE) (proactive population screening plus telephone delivery of a collaborative goal setting intervention) compared with enhanced usual care (EUC)

Randomized Control Trial. Theory: not identified

N = 225 US veterans with depression and diabetes. Study Gr:

(n = 136). Control Gr:

(n = 89) Setting: in both in-patient and 6 affiliated community-based outpatient clinics

Mode: Individual

Study gr: Intervention Healthy Outcomes Through Patient Empowerment (HOPE) included 9 telephone sessions with 24 trained health care professionals using collaborative goal-setting and behavioral activation methods

Control gr: EUC and notification of high-risk status. + related educational materials

The Patient Health Questionnaire–9 (PHQ-9) telephone screening for depression and HbA1c,

Self-report questionnaire baseline, 6 months, and 12 months

Mixed results; a significantly higher proportion of intervention participants achieved and maintained clinically significant responses of depression symptoms at 12 months, but did not find such improvements for glycemic levels at 12 months

Ramli et al. (2016) [66] Malaysia

To evaluate the effectiveness of the EMPOWER-PAR intervention (multifaceted chronic disease management strategies designed based on the Chronic Care Model (CCM0) in improving clinical outcomes for patients with TYPE 2 diabetes using existing health care resources in the Malaysian public primary care setting

Randomized Control Trial. Theory: EMPOWER-PAR intervention (based on The Chronic Care Model) Wagner, E., 1998 [67]

N = 888 Patients with Type 2 diabetes. Study Gr:

(n = 471)

Control Gr:

(n = 417) Setting: 10 public primary care clinics

Mode: Individual

Study gr: During the 1-year intervention period, all patients in the intervention arm were required to be seen at least twice by the Chronic Disease Management (CDM) team from each clinic. The EMPOWER-PAR intervention was designed based on the six interrelated elements of the CCM

Control gr: Five clinics continued with usual care

Primary outcome: change in the proportion of patients achieving glycemic target of HbA1c < 6.5% (48 mmol/mol). Secondary outcomes were measured by changes in the proportions of patients achieving the following targets: BP ≤ 130/80 mmHg; BMI < 23 kg/m2; Waist Circumference (WC) < 90 cm for men, < 80 cm for women; Total cholesterol (TC) ≤ 4.5 mmol/L; Triglycerides (TG) ≤ 1.7 mmol/L; Low density lipoprotein cholesterol (LDL-c) ≤ 

2.6 mmol/L; and High density lipoprotein cholesterol (HDL-c) ≥ 1.1 mmol/L

Measures: baseline and at 1-year follow-up. Self-report questionnaire: Not included

The intervention group showed significant reduction in the mean HbA1c compared to control, which showed an increase in the mean HbA1c (intervention: − 0.1%, SE ± 0.06 vs. control: 0.2% SE ± 0.09, P = 0.003). For diastolic BP, although both groups showed an increment at 1-year follow-up, the intervention group had a significantly lower mean change in diastolic BP compared to the control group (intervention: 0.4 mmHg, SE ± 0.43 vs. control: 1.9 mmHg SE ± 0.47, P = 0.02)

dos Santos et al. (2017) [68] Brazil

To compare the adherence and empowerment of patients with type 2 diabetes mellitus for self-care practices and glycemic control in group education strategies and home visits

Cluster Randomized Controlled Trial. Theory: not identified

N = 238 Patients with type 2 diabetes Study Gr:

N = 93

Control Gr:

N = 111

Setting: A clinical setting and home visits

Mode: Mixed (group education and home visits)

Study gr: Empowerment intervention with 10 meetings (120 min) and 8 home meetings (90 min). Educational strategies focused on adherence and empowerment for self-care using the behavior change protocol

Control gr: usual education, 2 telephone calls and 2 semiannual meetings

HbA1c and Brazilian version of the Diabetes Empowerment Scale-Short Form (DES-SF); Self-Care Questionnaire in Diabetes Mellitus (ESM); and HbA1c

Self-report questionnaire + blood test: baseline + 1 year follow up

Both educational strategies contributed to the improvement of adherence and empowerment for self-care. However, group education when compared individually with the control group and the home visit was the strategy that presented the best result in glycated hemoglobin

Shin et al. (2016) [69] Korea

To examine the effects of the Empowerment Program for Self-management (EPSM) on stroke patients’ self- efficacy, self-management behavior, and functional recovery

Randomized Control Trial. Theory: Freire Theories (The Educational Theory): Freire, 2007 [50]

N = 77 Stroke patients Study Gr:

N = 41 Control Gr:

N = 36. Setting: An ambulatory rehabilitation center of a subacute hospital

Mode: Mixed (Group + individual)

Study gr: The final 12-month EPSM consisted of three parts: (i) 12-week lifestyle modification group sessions (60–90 min) (i.e. exercise, education on low-sodium recipes, smoking cessation and drinking), and discussions about goal setting and problem solving; (ii) individual phone calls by research nurses (iii) monthly maintenance follow-up meetings

Control gr: conventional including aerobics or yoga and counselling about medication adherence

Self-efficacy, social support and self-care behaviors. BP control and renal function were measured as clinical outcomes

Self-report questionnaire + clinical tests baseline, 6 months and 12 months

Significant interactions of group by time for self-efficacy (P < 0.001) and self-care behaviour (P = 0.019). Blood pressure control at 12 months showed a significant improvement in the empowered group compared with the control group (82.8% versus 56.8%, P < 0.014). systolic blood pressure (P = 0.006) and renal function (P < 0.001), showed significant interactions of group by time

Souza et al. (2017) [70] Brazil

To evaluate the effect of home visits on the adherence and empowerment of users with type 2 diabetes for self-care practices

Randomized Control Trial. Theory: Discussed theories related to defining concepts etc. but no theory that drove the study

N = 145 Patients with Type 2 diabetes. Study Gr:

(n = 34)

Control Gr:

(n = 111) Setting: out-patient home visits

Mode: Individual (Home visits + monthly telephone) Study gr: home visits (each 2 h = 14 h totally in 3 cycles, 3 month intervals between) based on the Behavior Change Protocol in diabetes. = 31 questions in five steps: (1) problem identification; (2) identification and approach of feelings; (3) goal setting; (4) the care plan; and (5) assessment and experience about the care plan

Control gr: conventional follow-up + three telephone calls from the research nurses and pamphlets about diabetes

The Diabetes Empowerment Scale-Short Form (DES-SF) and self-care measurements with diabetes (ESM)

Self-report questionnaire: baseline: baseline, and intragroup between before and after the study period

In the comparison between intervention and control groups, the effect on the diabetes self-care (ΔESM) in the intervention group was considered statistically different from the control group (p < 0.001). Regarding empowerment (DES-SF), there was a statistically significant in- crease of the median score in both groups (p < 0.05). However, this increase was not considered statistically different between the two groups (p = 0.607)

Sit et al. (2016) [71] Hong Kong

To examine the effects of the empowerment intervention (HEISS)on stroke patients’ self- efficacy, self-management behavior, and functional recovery

Randomized Control Trial. Theory: Health Empowerment Theory by Shearer, (2009) [44]

N = 210 patients with stroke. Study Gr:

(n = 105) Control Gr:

(n = 105) Setting: an ambulatory rehabilitation center of a subacute hospital

Mode: Mixed: (group + telephone follow up)

Study gr: 13-week empowerment intervention part 1 had 6-weekly small group sessions from week 3 to week 8; groups worked with nurse facilitator for stroke self-management to begin personal goal setting and action planning. Part 2: home-based during weeks 9–13 with biweekly telephone follow-up calls

Control gr: receiving usual ambulatory rehabilitation care

Self-efficacy and self-management behavior were assessed using the Chinese Self-Management Behavior Questionnaire

Self-report questionnaire: baseline: baseline (T0), 1 week (T1), 3 months (T2), and 6 months (T3) postintervention

SG reported better self-efficacy in illness management 3-month (P = 0.011) and 6-month (P = 0.012) post -intervention, better self-management behaviors at all follow-up time points (all P,0.05), apart from medication adherence (P.0.05). SG had significantly better functional recovery (Barthel, all P,0.05; Lawton, all P,0.001), compared to CG

Tabari et al. (2018) [72] Iran

To examine the effect of education based on family-centered empowerment model on the quality of life of elderlies with chronic obstructive pulmonary disease (COPD)

Non-randomized clinical trial. Theory: Family centered empowerment model by Alhani in 2002

N = 80 Older adults with COPD. Study Gr:

(n = 40)

Control Gr:

(n = 40) Setting: in a pulmonary clinic

Mode: Group

Study gr: 4 stages of education based on family-centered empowerment (threat perception, knowledge translation and improvement, problem solving, Control gr: usual care

Quality of Life Questionnaire (SF-36)

Self-report questionnaire:

Baseline + 3 months

After the intervention, the difference between the mean score of quality of life in the two groups was statistically significant (P < 0.001)

Theeranut et al. 2018 [73] Thailand

To evaluate the short-term effects of the empowerment program on the short-term effects of the empowerment program on HbA1c and lipid profiles in an inpatient setting

Quasi-experimental intervention study

Theory: Not identified

N = 57 Patients with type 2 diabetes. Study Gr:

(n = 27) Control Gr:

(n = 30) Setting: An in-patient setting

Mode: Individual Study gr: received the empowerment course three times prior to discharge. Consisting of 4 steps 1. building patient self-awareness, 2. implementing nursing interventions to empower patients, 3. evaluating outcomes and 4. monitoring and supporting pat empowerment Control gr: standard care

Body weight (BMI), HbA1c, HDL-c, and LDL-c

Baseline, three and six months

Self-report questionnaire: Not included

The mean HbA1c and LDL-c levels of the intervention group were significantly lower than those of the control group at three and six months (p < 0.05), The mean HDL-c level of the intervention group was significantly higher than the control group six months (1.54 vs 1.29 mmol/L; p value < 0.001). The average BMI of the intervention group was significantly lower at six months (22.74 vs 25.54 kg/m2; p-value = 0.016)

Üzar-Özetin et al. (2019) [74] Turkey

To assess the feasibility of an integrated empowerment program for cancer survivors, to examine the effect of the program on the resilience and Post Traumatic Growth (PTG) levels of cancer survivors, and relationships between resilience and PTG at the end of the program and in the follow-up

Randomized Control Trial. Theory: Post traumatic Growth (PTG) Theory (Tedeschi RG, Calhoun LG)

N = 89 Cancer patients.. The Study Group: (n = 45). Control Gr: (n = 44) Setting: an outpatient oncology unit

Mode: Group Study gr: Received a structured 10-session empowerment program with different content (cancer experience; communication and self-expression; assertiveness skills; self-perception and roles; coping skills)

Control gr: Usual care

Post traumatic Growth Inventory (PTGI) and the Resilience Scale for Adults (RSA)

Self-report questionnaire: baseline, end of intervention + one month after the intervention

Posttraumatic growth and resilience levels significantly improved in the intervention group compared with the control group both at the end of and a month after the program

Vahedian-Azimi et al. (2016) [75] Iran

To determine if a hybrid cardiac rehabilitation (CR) program using the Family-rehabilitation (CR) program Centered Empowerment Model (FCEM) with standard CR will improve patient quality of life, perceived stress and state anxiety of patients with myocardial infarction (MI)

Randomized Control Trial. Theory: Family centered empowerment model by Alhani in 2002

N = 70 Patients status post myocardial infarction. Study Gr:

(n = 359)

Control Gr:

(n = 35) Setting: a coronary care unit

Mode: Mixed (telephone with nurse + 21 support group webinars)

Study gr: intervention of a hybrid cardiac rehabilitation program using the Family- Centered Empowerment Model (FCEM) in four stages: (1) determining perceived threat; (2) self-efficacy; (3) improving self-esteem and (4) process and outcome evaluations

Control gr: standard cardiac rehabilitation

Family-Centered Empowerment Model (FCEM), the 36-Item Short Form Health Survey (SF-36), the perceived stress, and State and Trait Anxiety questionnaires

Self-report questionnaire: baseline: The HRQoL dimensions, perceived stress and anxiety were assessed at baseline and at 3 months postintervention. Empowerment was measured at baseline and at 10 days postintervention

The quality of life results in the FCEM group showed significant improvement compared with control ( p < 0.0001). Similarly, the perceived stress and state anxiety results showed significant improvement compared with control (p < 0.0001). No significant difference was found either within or between groups for trait anxiety

van Puffelen et al. (2019) [76] Netherlands

To improve type 2 diabetes patient self-management and quality of life in the first years of living with the disease

Randomized Control Trial. Theory: not identified

N = 168 Patients with type 2 diabetes Study gr:

(n = 82) Control Gr:

(n = 86) Setting: in an out-patient setting

Mode: Group

Study gr: self- management support program, consisting of three monthly 2-h interactive sessions and one booster session three months after the last session

Control gr: received (a single educational lecture) with their partners

Self-care was assessed with the revised Summary of Diabetes Self-Care Activities measure (SDSCA)

Self-report questionnaire: baseline, 2 + 8 months from baseline

The intervention group showed a significantly higher increase in physical activity and fruit and vegetable intake immediately after the program, whereas the low baseline levels of diabetes distress remained unaffected

Visser et al. (2018) [77] Netherlands

To test the effect of a blended care intervention Group-Medical Consultations MY-GMC (and online app and online SGS) to an individual BC follow-up visit (care as usual)

Randomized Control Trial (. Theory: not identified

N = 109 Breast cancer patients. Study Gr:

(n = 59 = 

Control Gr:

(n = 50) Setting: one academic and two general hospitals in the Netherlands

Mode: Mixed (Group + online follow up)

Study gr: participated in a face-to-face GMC combined with a tablet-based online app, consisting of three online support group sessions (SGS) and additional information). Control gr: One individual outpatient follow-up visit

1: The Symptom checklist -90 (SCL-90), The Dutch Diabetes Empowerment Scale (Dutch DES-20)

2: The 8-item Cancer Worry Scale (CWS), Quality of life was measured by the EORTC-QLQ- C30 and the EORTC-BR23

Self-report questionnaire: baseline, 1 week, 3 and 6 months after the visit

No between-group differences were found for the primary outcomes distress and empower- ment. More themes were discussed in GMCs compared to individual visits. Significantly more patients experienced peer-support in GMCs

Young et al. (2020) [78] United States

To evaluate the effectiveness of a nurse coaching program using motivational interviewing (MI) paired with mobile health (mHealth) technology on diabetes self-efficacy and self-management for persons with type 2 diabetes

Randomized Control Trial. Theory: They discussed theories related to defining self-effect etc. but no theory that drove the study

N = 287 Persons with type 2 diabetes

Study Gr:

(n = 132). Control Gr:

(n = 155) Setting: in-person orientation with the nurse coach, followed by telephone sessions

Mode: Individual + telephone follow up

Study gr: 6 individual sessions using a counseling style based on the concepts of MI. Sessions promoted mutual goal setting, enhanced self-efficacy in health behavior change, and assist to derive meaning from data to reinforce choices and behaviors. In-person orientation with the nurse coach, then telephone sessions every 2 weeks for 3 months (6 contacts total)

Control gr: usual care

1. Diabetes Empowerment Scale (DES-SF)

2. Depression severity (Patient Health Questionnaire-9 (PHQ-9)

Self-report questionnaire: Web-based surveys at baseline, 3 months (coinciding with the end of the intervention or 3 months from baseline), and 9 months

The participants in the intervention group had significant improvements in diabetes self-efficacy (DES -SF), 0.34; 95% CI –0.15,0.53; P < .01) and a decrease in depressive symptoms compared with usual care at 3 months PHQ-9; 0.89; 95% CI 0.01–1.77; P = .05), with no differences in the other outcomes. The differences in self-efficacy and depression scores between the 2 arms at 9 months were not sustained

Zamanzadeh et al. (2017) [79] Iran

To investigate the effect of distance education by telephone and short message service on empowering patients with type 2 diabetes who were referred to the Urmia Diabetes Association

Randomized Control Trial. Theory: not identified

N = 66 Patients with type 2 diabetes.. Study Gr:

(n = 33) Control Gr:

(n = 33)

Setting: at the Urmia diabetes association in Iran

Mode: Individual

Study gr: received an educational text message daily and instructive phone calls three days a week for three months along with usual care. Control gr: usual care

Diabetes Empowerment Scale (DES)

Self-report questionnaire:

Baseline + after intervention

The empowerment of the intervention group compared with the control group significantly improved after three months of distance education (p < 0.00, EF = 1. 16)

Zoun et al. (2019) [80] Netherlands

To study the effectiveness of the SemCAD or Self- Management for Chronic Anxiety and Depression) ZemCAD on quality of life, symptom severity and empowerment compared to usual care

Multicenter RCT

Theory: not identified

N = 141. Study Gr: zemCAD:

(n = 70)

Control Gr: CAU:

(n = 71) Setting: 12 specialized outpatient mental health care services in the Netherlands

Mode: Individual

Study gr: ZemCAD consists of three parts.; 13 sessions over 26 weeks. First, educationd about the nature of their chronic disorder, (coping). 1: 3 weeks/ weekly sessions, individual treatment plan, identify symptoms…

2: coaching and treatment phase of 14 weeks with sessions every second week. (social skills/ problem solving)

3. 9 weeks with sessions every three weeks (action plan, deal with crisis). Control gr: Usual care (outpatient mental health care)

Quality of life was measured with the World Health Organization Quality of Life instrument, Brief version (WHOQOL-BREF); the Beck Anxiety Inventory (BAI); the Patient Health Questionnaire-9 (PHQ-9); Empowerment is assessed using the Netherlands Empowerment List (NEL)

Self-report questionnaire Baseline, 6, 12, and 18 months after baseline

Results at 18-month follow-up regarding to quality of life and symptom severity, showed no significant differences between the ZemCAD group and the CAU group, except on the ‘social relationships’-domain (d = 0.37). With regard to empowerment a significant difference between both groups was observed in the total empowerment score and one empowerment dimension (d = 0.45 and d = 0.39, respectively)