Paper Interpretation | Effect of empowerment-based interventions on self-efficacy and self care capacity among patients with sickle cell disease: A randomized controlled trial

Sickle Cell Disease (SCD), an inherited hemoglobinopathy, has become an important public health challenge globally, especially in sub-Saharan Africa and the Middle East, due to its susceptibility to vascular occlusion, painful crises, and multi-organ complications. In the Kingdom of Bahrain, this disease cannot be ignored. Despite the promotion of specialized treatment and medication through national programs, the lack of patient self-care remains a key bottleneck to treatment outcomes. In this context, empowerment interventions are gaining attention as a chronic disease management model that focuses on improving individual capabilities, but there is a lack of empirical studies in Bahrain on whether a practice framework based on the 5A model can effectively improve self-efficacy and self-care capabilities of SCD patients.

In this regard, Zohour Ibrahim Rashwan et al. from the University of Bahrain, Zarak Bahrain, Kingdom of Bahrain, published an article entitled "Effect of empowerment-based interventions on self-efficacy" in the International Journal of Nursing Sciences. interventions on self-efficacy and self care capacity among patients with sickle cell disease: a randomized controlled trial" in the International Journal of Nursing Sciences. A randomized controlled trial was conducted to systematically investigate the effectiveness of empowerment-based interventions in this population and to provide new ideas and rationale for nursing practice for patients with SCD.

The study was conducted in two health centers in the Kingdom of Bahrain and 76 adult SCD patients were recruited through whole cluster sampling and finally 68 completed the study, 36 in the intervention group and 32 in the control group. Inclusion criteria were patients treated in primary health care facilities, literate and willing to participate in educational programs, excluding those with a history of mental illness and advanced comorbidities. The intervention group received an empowerment-based intervention including structured group discussions, individualized counseling based on the 5A model (assess, advise, agree, assist, arrange), and follow-up visits, while the control group received routine health education.

The development of the intervention protocol was optimized through literature review, focus group research, expert validation, and pretesting, covering the basics of SCD (definition, complications, etc.) and self-management strategies (diet, exercise, pain management, etc.), and using a variety of instructional methods such as lectures, video learning, and case studies. The effect assessment tools were the Sickle Cell Self-Efficacy Scale (SCSES) and the Revised Assessment of Self-Care Ability Scale (ASA-R), which were measured at baseline and 1 month after the intervention, respectively. The results showed that the SCSES scores were significantly higher in the intervention group than in the control group after the intervention, as well as the ASA-R scores, and that there was a significant improvement in all dimensions of self-care competence in the intervention group, with no significant change in the control group.

The study noted that SCD is a hereditary hemoglobinopathy and is an important public health problem in Bahrain, and the empowerment intervention improves health by enhancing patients' abilities. The discussion section mentions that the results are consistent with previous studies such as Ahmadi et al. who found that the 5A model enhances self-efficacy in patients with SCD and that follow-up through social media helps to maintain the effect. Limitations include small sample size, non-inclusion of patients in secondary care and presence of dropout. The study concluded that 5A model-based empowerment interventions are effective and recommended to be promoted as a cost-effective strategy for chronic disease care.