Empowerment interventions,knowledge translation and exchange: perspectives of home care professionals,clients and caregivers

Background  

Few studies have examined empowerment interventions as they actually unfold in home care in the context of chronic health problems. This study aims to document the empowerment process as it plays out in interventions with adults receiving home care services.     

The construct validity and reliability of the Turkish version of Spreitzer's psychological empowerment scale

Background  

Today, many organizations have adopted some kind of empowerment initiative for at least part of their workforce. Over the last two decades, two complementary perspectives on empowerment at work have emerged: structural and psychological empowerment. Psychological empowerment is a motivational construct manifested in four cognitions: meaning, competence, self-determination and impact. The aim of this article is to examine the construct validity and reliability of the Turkish translation of Spreitzer's psychological empowerment scale in a culturally diverse environment.     

How technology is empowering patients? A literature review

Background

The term ‘Patient Empowerment’ (PE) is a growing concept – so in popularity as in application – covering situations where citizens are encouraged to take an active role in the management of their own health. This concept is serving as engine power for increasing the quality of health systems, but a question is still unanswered, ‘how PE will be effectively achieved?’ Beyond psychological implications, empowerment of patients in daily practice relies on technology and the way it is used. Unfortunately, the heterogeneity of approaches and technologies makes difficult to have a global vision of how PE is being performed.

Objective

To clarify how technology is being applied for enhancing patient empowerment as well as to identify current (and future) trends and milestones in this issue.

Search strategy

Searches for relevant English language articles using Medline, Scopus, ACM Digital Library, Springer Link, EBSCO host and ScienceDirect databases from the year 2000 until October 2012 were conducted. Among others, a selection criterion was to review articles including terms ‘patient’ and ‘empowerment’ in title, abstract or as keywords.

Main results and conclusions

Results state that practical approaches to empower patients vary in scope, aim and technology. Health literacy of patients, remote access to health services, and self‐care mechanisms are the most valued ways to accomplish PE. Current technology already allows establishing the first steps in the road ahead, but a change of attitude by all stakeholders (i.e. professionals, patients, policy makers, etc.) is required.     

A model for empowerment of nursing in Iran

Background  

While the Iranian nursing profession tries to reach to its full capaCity for participating in the maintenance of public health, its desire to develop is strongly influenced by cultural, economic, and religious factors. The concept of empowerment is frequently used in nursing and the health services, particularly in relation to the quality of care, since the mission of nursing is to provide safe and quality nursing care thereby enabling patients to achieve their maximum level of wellness. When considering the importance of nursing services in any health system, the 54th World Health Assembly recommended that programs be designed to strengthen and promote the nursing profession. Since empowerment is crucial to the role of nurses, a qualitative study was conducted and aimed at designing a model for empowering nurses in Iran.     

Empowerment in nursing: the role of philosophical and psychological factors

This paper examines the concept of empowerment and how it relates to nursing. It notes that empowerment is a concept used to describe most human activities. The fact that empowerment applies to almost any activity denotes its ambiguity rather than its parsimony. To clarify the concept a definition is offered together with some suggestions for its origin. Some examples of empowerment programmes are given, including the Freirian empowerment philosophy that has had a profound effect in Brazil. The paper then focuses on nursing and discusses whether or not nursing can empower patients. It is argued that nursing cannot empower patients, at least at the present time. Two specific problems are identified as the main reasons why nursing cannot empower patients. It is argued that the first problem or reason is a philosophical one explored using the philosophy of existentialism. The second problem is the nurse–patient interaction and the psychological dynamics involved within such interaction. For example, the continued use of the term ‘patient’ by nurses and other healthcare professionals is seen as militating against empowerment. This is because of the traditional conception of a patient, which invariably assumes not only the patient's sick role but also the passivity associated with being a patient. Furthermore, the hierarchical nature of the profession makes it difficult to empower others. The paper examines some research studies related to patient empowerment. The findings suggest there are problems and some of them stem from the hierarchical and authoritarian nature of nursing. The paper concludes by suggesting ways by which the ideals of patient empowerment may be turned into reality.     

The “Paradox of Empowerment” in Parent Education: A Reflexive Examination of Parents' Pedagogical Expectations

In an action research project designed to develop a new paradigm for parent education in alignment with the “strengths perspective,” a social constructionist epistemology, and the empowerment discourse, it was found that parents joining two parent groups actually valued and sought expert knowledge. Seeking to empower these parents by adopting a collaborative learning approach—facilitating a reflective discussion of their parenting experience while refraining from meeting their expectation to be taught—we were actually exercising professional power in imposing our ideology of empowerment on the parents. To resolve this “paradox of empowerment,” we came to the see that parent educators cannot avoid meeting parents' pedagogical expectation. They should, however, provide expert knowledge and advice with epistemic reflexivity. Moreover, they need to navigate the micropolitics in the interaction between themselves as “educators” and parents as “learners,” so as to negotiate a power relation that is characterized by collaboration and partnership.     

Income or living standard and health in Germany: different ways of measurement of relative poverty with regard to self-rated health

Objectives  

Current study introduces the living standard concept as an alternative approach of measuring poverty and compares its explanatory power to an income-based poverty measure with regard to subjective health status of the German population.     

Trauma-informed co-production: Collaborating and combining expertise to improve access to primary care with women with complex needs

Introduction

Health, social care, charitable and justice sectors are increasingly recognising the need for trauma-informed services that seek to recognise signs of trauma, provide appropriate paths to recovery and ensure that services enable people rather than retraumatise. Foundational to the development of trauma-informed services is collaboration with people with lived experience of trauma. Co-production principles may provide a useful framework for this collaboration, due to their emphasis on lived experience, and intent to address power imbalances and promote equity. This article aims to examine trauma-informed and co-production principles to consider the extent to which they overlap and explore how to tailor co-production approaches to support people who have experienced trauma.

Methods

Bridging Gaps is a collaboration between women who have experienced complex trauma, a charity that supports them, primary care clinicians and health researchers to improve access to trauma-informed primary care. Using co-production principles, we aimed to ensure that women who have experienced trauma were key decision-makers throughout the project. Through reflective notes (n = 19), observations of meetings (n = 3), interviews with people involved in the project (n = 9) and reflective group discussions on our experiences, we share learning, successes and failures. Data analysis followed a framework approach, using trauma-informed principles.

Results

Co-production processes can require adaptation when working with people who have experienced trauma. We emphasise the need for close partnership working, flexibility and transparency around power dynamics, paying particular attention to aspects of power that are less readily visible. Sharing experiences can retrigger trauma. People conducting co-production work need to understand trauma and how this may impact upon an individual's sense of psychological safety. Long-term funding is vital to enable projects to have enough time for the establishment of trust and delivery of tangible results.

Conclusions

Co-production principles are highly suitable when developing trauma-informed services. Greater consideration needs to be given as to whether and how people share lived experiences, the need for safe spaces, honesty and humility, difficult dynamics between empowerment and safety and whether and when blurring boundaries may be helpful. Our findings have applicability to policy-making, funding and service provision to enable co-production processes to become more trauma-informed.

Public Contribution

Bridging Gaps was started by a group of women who have experienced complex trauma, including addiction, homelessness, mental health problems, sexual exploitation, domestic and sexual violence and poverty, with a general practitioner (GP) who provides healthcare to this population, alongside a support worker from the charity One25, a charity that supports some of the most marginalised women in Bristol to heal and thrive. More GPs and healthcare researchers joined the group and they have been meeting fortnightly for a period of 4 years with the aim of improving access to trauma-informed primary care. The group uses co-production principles to work together, and we aim to ensure that women who have experienced trauma are key decision-makers throughout our work together. This article is a summary of our learning, informed by discussion, observations and interviews with members of the group.     

Gesundheitsförderung bei Menschen mit geistigen und mehrfachen Behinderungen

Background

The concept of the WHO to health promotion focuses equal opportunities, empowerment and participation. Persons with multiple disabilities are faced with considerable barriers to health provision. Still they were not recognized as a target group of health promotion and so there is no scientific discourse yet.

Objective

This work aims to point up the potential of alliance of health promotion and special needs pedagogy and to encourage a scientific discourse so that conceptions and impulses for practice can be developed. That can account to improvement of health provision for the target group.

Material and methods

Based on a literature research to the current state of knowledge the concept of health promotion of the WHO was applied to and compared with leading pedagogical guiding principles.

Results and discussion

Considerable intersections of health promotion and current pedagogical guiding principles successfully found. They suggest an increased multidisciplinarity and holistic approach to health provision for the target group.     

Program of active aging in a rural Mexican community: a qualitative approach

Background  

Education is one of the key elements in the promotion of a thorough paradigm for active aging. The aim of this study is to analyze factors that contribute the empowerment of older adults in a rural Mexican community and, thus, promote active aging.     

Prevention of exclusion: the promotion of resilience in early childhood institutions in disadvantaged areas

Aim  

The project “Avoiding exclusion by reinforcing prevention: promotion of mental health in early childhood institutions in deprived areas” aimed to empower early childhood institutions, to promote the resilience and mental health of children who are growing up in adverse conditions or disadvantaged communities.     

"We can move forward": challenging historical inequity in public health research in Solomon Islands

Background  

In resource-poor countries, such as Solomon Islands, the research agenda on health is often dominated by researchers from resource-rich countries. New strategies are needed to empower local researchers to set directions for health research. This paper presents a process which seeks to enable a local and potentially more equitable research agenda at a remote hospital in Solomon Islands.     

Adaptive coping strategies in patients with chronic pain conditions and their interpretation of disease

Background  

We examined which adaptive coping strategies, referring to the concept of 'locus of disease control', were of relevance for patients with chronic pain conditions, and how they were interconnected with patients' life satisfaction and interpretation of disease.     

Preferences for treatment of Attention-Deficit/Hyperactivity Disorder (ADHD): a discrete choice experiment

Background  

While there is an increasing emphasis on patient empowerment and shared decision-making, subjective values for attributes associated with their treatment still need to be measured and considered. This contribution seeks to define properties of an ideal drug treatment of individuals concerned with Attention-Deficit/Hyperactivity Disorder (ADHD). Because of the lack of information on patient needs in the decision-makers assessment of health services, the individuals' preferences often play a subordinate role at present. Discrete Choice Experiments offer strategies for eliciting subjective values and making them accessible for physicians and other health care professionals.     

Differences in individual empowerment outcomes of socially disadvantaged women: effects of mode of participation and structural changes in a physical activity promotion program

Objectives  

This study explored the differences in individual empowerment outcomes of a group of socially disadvantaged women participating in physical activity promotion. The outcomes observed were assessed in the context of the women’s mode of participation and the structural organizational and community level changes, which took place during the implementation of the program.     

Worry as a window into the lives of people who use injection drugs: a factor analysis approach

Background  

The concept of risk dominates the HIV/AIDS literature pertaining to People Who Use Injection Drugs (PWUID). In contrast the associated concept of worry is infrequently applied, even though it can produce important perspectives of PWUID's lives. This study asked a sample (n = 105) of PWUID enrolled in a Victoria, British Columbia needle exchange program to evaluate their degree of worry about fourteen factors they may encounter in their daily lives.     

Arabic-speaking male immigrants' perceptions of preventive initiatives: An interview study

Background

Arabic-speaking men are a sparsely investigated population in health promotion and disease prevention. This may hamper their ability to achieve the highest obtainable health due to less accessibility and acceptability of preventive measures.

Aim

We explored Arabic-speaking (Palestinian, Iraqi and Somali) male immigrants' perceptions of preventive initiatives in general and such initiatives for cardiovascular diseases (CVD) in particular to understand how to address inequalities in engagement in prevention.

Methods

This qualitative study employed content analysis of semistructured interviews with 60–66-year-old Arabic-speaking men living in Denmark. Supplementary, structured data, for example, health data, were collected. From June to August 2020, 10 men were interviewed.

Findings

Preventive initiatives were found ethically and culturally acceptable alongside personally and socially relevant; they were perceived as humanitarian and caring for the participants' health, respecting of their self-determination and enabling their empowerment. Thus, the participants entreated that their fellow countrymen be assisted in achieving the prerequisite coping capabilities to address inequality in access, perceived acceptance and relevance. This led us to define one main category ‘Preventive initiatives - Caring and humanitarian aid empower us’ with the underlying subcategories: ‘We are both hampered and strengthened by our basic assumptions’ and ‘We need help to achieve coping capabilities enabling us to engage in preventive initiatives’.

Conclusion

Prevention was perceived as acceptable and relevant. Even so, Arabic-speaking men may be a hard-to-reach group due to their basic assumptions and impaired capabilities for engaging in prevention. Addressing inequality in accessibility, acceptability and relevance in regard to prevention may be promoted through a person-centred approach embracing invitees' preferences, needs and values; and by strengthening invitees' health literacy through efforts at the structural, health professional and individual levels.

Public Contribution

This study was based on interviews. The interviewees were recruited as public representatives to assist us in building an understanding of Arabic-speaking male immigrants' perceptions of preventive initiatives in general and preventive initiatives for CVD in particular.