For years we have known that making empowerment a reality in practice is difficult. However, the true value of empowerment will not be experienced before the idea is translated into daily care. Thus we need to develop and disseminate methods that promote the process of translating empowerment into the care of people with diabetes.

Guided Self-Determination (GSD) was developed to overcome barriers to empowerment identified by grounded theory research that investigated relationships between health care professionals (HCP) and people with persistent high HbA1c. GSD promotes shared decision making and mutual problem solving through a combination of reflection sheets and advanced professional communication skills. Awareness of the barriers to empowerment is part of the GSD-training because they can be recognized by HCPs and convinces them that changes have to be made if empowerment is going to be realized. 

Theory-driven research has demonstrated that GSD overcame the barriers to empowerment when it was used in a one-on-one approach, and six randomized controlled trials have tested the effect of GSD in group-based and individual GSD-interventions in diabetes and other chronic conditions. Self-management support takes place in four to eight one-hour sessions. In diabetes, HbA1c reduction up to in average 0.6% after 18 months has been seen besides improvements in diabetes distress, self-esteem, motivation and perceived competence in managing the condition. The GSD-providers in the trials had a professional background as nurses, physicians, or dieticians and took part in a total of 24-32 hours of supervised training which provided the theoretical background of GSD and enabled them to use reflection sheets and three communication skills: mirroring, active listening, and values-clarifying responses.

GSD’s strategies for engaging people Patients prepare the sheets at home by writing or drawing their reflections as a way of becoming active in a process of change. Hearing people read aloud what they have expressed on the sheets, HCPs learn about specific difficulties they had not considered. Thereby shared decision-making is achieved on the basis of person-specific evidence.

Implications for practice Remarkable positive outcome for the patients shown in GSD research is a good message for healthcare professionals in diabetes and other chronic care settings, who for long have asked for concrete empowering methods that they can use as an integral part of clinical care.

·         Time can be used more efficiently when patients work at home to clarify their difficulties.

·         The research shows the importance of shifting the focus from ‘numbers’ to the patient’s life with diabetes.

·         The article shows that a mess of unspoken difficulties and non-accepted diabetes had to be unpacked before a time-consuming integration process could start.

·         The article emphasizes that breaking isolation through communication is an appropriate way to achieve good diabetes control.

Implication for research High prevalence of diabetes, long distances to HCPs and busy lives among people with diabetes indicate the need for IT-based interventions. IT-based GSD is being tested in on-going research, for instance in Australia.