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Patient empowerment outcomes in chronic disease care in Lebanon with validation of a measurement scale and associated determinants
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  • Published: 02 February 2026

Patient empowerment outcomes in chronic disease care in Lebanon with validation of a measurement scale and associated determinants

  • Jihan Safwan  ORCID: orcid.org/0000-0002-8602-10421,2,3,4,
  • Mariam Dabbous  ORCID: orcid.org/0000-0002-5191-34971,2,5,
  • Faraj Saade  ORCID: orcid.org/0000-0003-2100-23581,6,7,
  • Mohamad Rahal  ORCID: orcid.org/0000-0002-9707-62171,
  • Lina Traboulsi  ORCID: orcid.org/0009-0006-3531-30172,3,4,8,
  • Iqbal Fahs  ORCID: orcid.org/0000-0001-7012-48591,9,
  • Riwa Kfoury  ORCID: orcid.org/0009-0007-5843-68851,2,7,
  • Rony M. Zeenny  ORCID: orcid.org/0000-0002-5443-77802,10,
  • Aline Hajj  ORCID: orcid.org/0000-0003-0826-60332,11,12,
  • Hala Sacre  ORCID: orcid.org/0000-0001-6547-62512,13,
  • Pascale Salameh  ORCID: orcid.org/0000-0002-4780-07722,14,15,16,
  • Marwan Akel  ORCID: orcid.org/0000-0002-1419-29342 &
  • …
  • Fouad Sakr  ORCID: orcid.org/0000-0002-6905-58141,2 

Scientific Reports , Article number:  (2026) Cite this article

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Subjects

  • Diseases
  • Health care
  • Medical research

Abstract

Chronic diseases are a major cause of morbidity and mortality in Lebanon, straining the healthcare system. Patient empowerment is recognized as a strategy to enhance self-management and outcomes. This study aimed to develop and validate a Patient Empowerment Outcomes (PEO) scale adapted to Lebanon and to examine associated factors. A cross-sectional survey was conducted with 640 adults with chronic conditions using structured face-to-face interviews. The questionnaire included sociodemographic and behavioral items, along with four validated tools: the focused Patient Assessment of Chronic Illness Care (fPACIC), General Practice Interpersonal Care (GPIC), Health Empowerment and Self-Management (HESM), and the new PEO scale. Higher PEO scores were significantly associated with older age (B = 0.102, p = 0.002), proactive behaviors (B = 5.486, p = 0.001), and higher GPIC (B = 0.319, p < 0.0001), HESM (B = 0.681, p < 0.0001), and fPACIC (B = 0.104, p = 0.037) scores. Negative associations included greater medication burden (B =  − 0.395, p = 0.029) and health fatalism (B =  − 1.406, p = 0.008). The PEO scale is a valid, culturally adapted tool to assess empowerment in Lebanese patients with chronic diseases. Findings highlight the role of communication, self-management, and informed decision-making in guiding patient-centered interventions and policies.

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Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. School of Pharmacy, Lebanese International University, Beirut, Lebanon

    Jihan Safwan, Mariam Dabbous, Faraj Saade, Mohamad Rahal, Iqbal Fahs, Riwa Kfoury & Fouad Sakr

  2. INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon

    Jihan Safwan, Mariam Dabbous, Lina Traboulsi, Riwa Kfoury, Rony M. Zeenny, Aline Hajj, Hala Sacre, Pascale Salameh, Marwan Akel & Fouad Sakr

  3. Aging Research Team, Center for Epidemiology and Research in POPulation Health (CERPOP), Université de Toulouse, Université Paul Sabatier, Inserm, 31000, Toulouse, France

    Jihan Safwan & Lina Traboulsi

  4. University Paul Sabatier Toulouse III, 31062, Toulouse, France

    Jihan Safwan & Lina Traboulsi

  5. Inserm U1094, IRD UMR270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Global Health – Michel Dumas, OmegaHealth, Limoges, France

    Mariam Dabbous

  6. Alice Ramez Chagoury School of Nursing, Lebanese American University, Byblos, Lebanon

    Faraj Saade

  7. Faculty of Medicine, Saint George University of Beirut, Beirut, Lebanon

    Faraj Saade & Riwa Kfoury

  8. Lebanese Association of the Knights of Malta (Order of Malta Lebanon), Beirut, Lebanon

    Lina Traboulsi

  9. Institut de Recherche pour Le Développement (IRD), Surveillance épidémiologique, microbiologique, moleculaire et phylogenomique des maladies infectieuses (RITMES-E4), Aix-Marseille Université, Institut Hospitalo-Universitaire Méditerranée-Infection, Marseille, France

    Iqbal Fahs

  10. Department of Pharmacy, American University of Beirut Medical Center, Beirut, Lebanon

    Rony M. Zeenny

  11. Faculté de Pharmacie, Université Laval, Québec, Canada

    Aline Hajj

  12. Oncology Division, CHU de Québec Université Laval Research Center, Québec, Canada

    Aline Hajj

  13. Drug Information Center, Order of Pharmacists of Lebanon, Beirut, Lebanon

    Hala Sacre

  14. School of Medicine, Lebanese American University, Byblos, Lebanon

    Pascale Salameh

  15. Faculty of Pharmacy, Lebanese University, Hadat, Lebanon

    Pascale Salameh

  16. Department of Primary Care and Population Health, University of Nicosia Medical School, 2417, Nicosia, Cyprus

    Pascale Salameh

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Contributions

All authors contributed to the conception and design of the study. J.S., Fa.S., M.D., and M.A. performed material preparation. J.S., L.T., Fo.S., and I.F. performed the data collection. J.S. performed data analysis under the supervision of P.S.. The first draft of the manuscript was written by J.S., M.R., A.H., M.A., R.K., and R.M.Z.. H.S. critically reviewed and edited the manuscript. All authors commented on the drafts of the manuscript and read and approved the final version.

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Correspondence to Jihan Safwan.

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The authors have no relevant financial or non-financial interests to disclose.

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This study was performed in line with the principles of the Declaration of Helsinki. The Ethics and Research Committee at the Lebanese International University approved the project (Approval number: 2023RC-013-LIUSOP).

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Informed written consent was obtained from all individual participants included in the study.

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Safwan, J., Dabbous, M., Saade, F. et al. Patient empowerment outcomes in chronic disease care in Lebanon with validation of a measurement scale and associated determinants. Sci Rep (2026). https://doi.org/10.1038/s41598-026-35380-1

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  • Received: 03 October 2025

  • Accepted: 05 January 2026

  • Published: 02 February 2026

  • DOI: https://doi.org/10.1038/s41598-026-35380-1

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Keywords

  • Chronic disease management
  • Healthcare strategies
  • Lebanon
  • Patient empowerment
  • Scale validation
  • Self-efficacy
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