Measuring community empowerment: a fresh look at organizational domains

In 1986, the Ottawa Charter identified community empowerment as being a central theme of health promotion discourse. Community empowerment became a topical issue in the health promotion literature soon afterwards, though its roots also come from earlier literature in community psychology, community organizing and liberation education. Subsequent international conferences to address health promotion in Sundsvall, Adelaide and Jakarta have acted to reinforce this concept. It is as relevant today as it was more than a decade ago. The literature surrounding health promotion has since moved onto other overlapping theoretical perspectives, such as community capacity and social capital. And yet the critical issue of making community empowerment operational in a programme context remains thorny and elusive. Community empowerment is still difficult to measure and implement as a part of health promotion. This article offers a fresh look at key theoretical and practical questions in regard to the measurement of community empowerment. The theoretical questions help to unpack community empowerment in an attempt to clarify how the application of this concept can be best approached. The practical questions address the basic design characteristics for methodologies to measure community empowerment within the context of international health promotion programming. The purpose of this article is to allow researchers and practitioners to address again the important issue of making community empowerment operational.     

A structure for affective education for young gifted children

Providing affective education for young gifted children is an issue that has been much debated in the literature. Controversy centers around the nature of affective education, the effectiveness of the approach used and characteristics and needs of the gifted child that may make affective education uniquely beneficial to this group. The purpose of this article is to provide a selected review of the literature related to these issues and to suggest an organizational structure for designing affective education programs in the schools.     

Locating the feminist scholar: relational empowerment and social activism

Over the past decade, the rhetoric of "empowerment" has permeated the health promotion, education, and social welfare literature. Many scholars and professionals, particularly those active in the field of social intervention and community development, have found themselves struggling for location in the emancipatory process. This struggle often is characterized by a profound self-consciousness of privilege and the fear of being perceived as imposing and manipulative. This article explores the tensions inherent in the role of the scholar/activist using illustrations from the author's experience as principal investigator of the Atlantic Regional Evaluation of the Community Action Program for Children. In so doing, it discusses the importance of a relational approach to empowerment, one characterized by mutuality. A commitment to mutuality is seen as a key factor in enhancing the emancipatory capacities of empowerment-based research projects.     

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.     

Masculinities and young men's sex education needs in Ireland: problematizing client-centred health promotion approaches

In recent decades, dominant discourses in health promotion have emphasized empowerment, client participation and the notion of people identifying and being facilitated to meet their own health needs. However, there has been little analysis of the concept of 'need' and the possibility, at least, that the fulfillment of some such self-defined needs are not in the interest of social justice and equality. In this article, we present an account of the sex education needs of secondary school pupils from their own perspectives, and problematize the concept of self-identified needs in health education. Twenty-nine focus group interviews were conducted with 226 secondary school pupils in Ireland, and data were subjected to a qualitative analysis. Findings suggested that young men tended to prioritize practical guidance that would provide them with the skills and confidence to take the lead in sexual encounters, and display competence in the act of penetrative sex. We argue that these self-defined sex education needs emanate from a culture of traditional masculinity where, for a male, one's place in the pecking order is derived from one's capacity to conquer, lead and display mastery with regard to sex. In the discussion, we attempt to unpack the notion of clients identifying their own needs and the concept of empowerment as it relates to our data, in the context of gender-based structural inequalities.     

高校附属医院城市社区授权教育对妊娠期糖尿病患者的影响研究

目的:探讨传统健康教育和高校附属医院城市社区授权教育两种方式对妊娠糖尿病患者进行干预的影响。方法:采用随机数字表法将社区的60例妊娠糖尿病患者分为干预组和对照组各30例,干预组采用高校附属医院城市社区授权教育管理,对照组采用常规的健康教育管理。分别在干预前、干预3、6个月后检测患者的空腹血糖和餐后2 h血糖,在干预12个月结束后给患者发放生存质量量表SF-36。结果:干预组的空腹血糖、餐后2 h血糖、生存质量等指标明显优于对照组,差异有统计学意义(P<0.05);孕妇及新生儿的并发症率明显低于对照组,差异有统计学意义(P<0.05)。结论:经1年的社区授权教育管理模式取得了较好的效果,值得推广。     

Health education–the case for rehabilitation

The emergence of health promotion in the 1980s was a direct response to critiques of health education which centred on its victim-blaming orientation and a growing appreciation of the need to address the wider determinants of health and health-related behaviour. This paper argues a priori that such critiques centre on a preventive model of health education and overlook its broader potential. It reviews a number of alternative models of health education and locates these within the core values of equity and empowerment which underpin the Ottawa Charter and subsequent WHO documents. It suggests that, despite the rhetoric of health promotion, practice frequently remained focused on individual behaviour change and the use of persuasive health education. The move to health promotion effectively stifled further debate about the broader role of health education in achieving individual empowerment and social change. This paper calls for a broader conceptualisation of health education–the New Health Education–and concludes that this should be the driving force behind health promotion.     

The Role of Empowerment in the Association between a Woman's Educational Status and Infant Mortality in Ethiopia: Secondary Analysis of Demographic and Health Surveys

Background

Socioeconomic status at national, sub-national, household, and individual levels explains a significant portion of variation in infant mortality. Women''s education is among the major determinants of infant mortality. The mechanism through which a woman''s own educational status, over her husband''s as well as household characteristics, influences infant mortality has not been well studied in developing countries. The objective of this study was to explore the role of woman''s empowerment and household wealth in the association between a woman''s educational status and infant mortality.

Methods

The association between a woman''s educational status and infant death, and the role of woman''s empowerment and household wealth in this relationship, were examined among married women in Ethiopia through a secondary, serial cross-sectional analysis utilizing data on birth history of married women from three rounds of the Ethiopian Demographic and Health Survey. Univariate, bivariate, and multivariate analyses were conducted to examine the association between woman''s education and infant death, and the possible mediation or moderation roles of woman empowerment and household wealth.

Results

Female education and empowerment were inversely associated with infant death. The results indicated mediation by empowerment in the education-infant death association, and effect modification by household wealth. Both empowerment and education had strongest inverse association with infant death among women from the richest households.

Conclusion

The findings suggest an important role of female empowerment in the education-infant death relation, and the complexity of these factors according to household wealth. Woman empowerment programs may prove effective as a shorter term intervention in reducing infant mortality.     

The role of the print media in informing the community about safety in public hospitals in Victoria, Australia: the case of "golden staph".

OBJECTIVE: In this article the authors explore how the print media contribute to information and education of the community on issues of safety and quality in the health services, since this is an important avenue of such information and education for many members of the community. STUDY DESIGN: The authors undertook a qualitative study of a random sample of articles in the Australian print press between 1996 and 2004 where "golden staph" was presented as a major issue of risk to the safety of consumers of health services. The content of each article was examined with reference to several criteria including title, the source of the article, and the metaphorical language employed by the journalist. RESULTS: Results show that while the articles are substantially accurate as sources of information on concrete events, they do not serve as sources of education on issues of safety, typically apportioning blame and serving to maintain the status quo. CONCLUSION: The authors conclude that print media are not a good source of community education in areas of safety and quality and do not assist members of the community to participate in addressing issues of safety in health services.     

Environmental education and nursing: a necessary integration

Environmental issue should be discussed in educational actions, because this debate leads people to reflect on what is ecologically healthy. It was aimed to reflect on Health promotion, Environmental education and Nursing. This is a reflexive study on environmental health in three groups: Promotion of environmental and human health; Educational actions in Environmental health; and Nursing and Health education. It was verified that environmental education is a theme that includes human well-being, being necessary actions of health promotion that qualify individual and community to practice their empowerment and autonomy.     

Power versus participation in health service teams: a delicate balance.

The purpose of this paper is to critically review the effectiveness of a participative management approach within health service teams. It questions the reality of staff empowerment as an essential product of this approach, and examines the influence of power issues on the degree of empowerment that the organization may allow. The benefits and challenges of staff participation are highlighted, with reference to the manager's role in the participation process. The article concludes by advocating the positive use of power in order to maintain the integrity and effectiveness of a participative management approach.     

卫生类高职院“三位一体”职业素质教育体系的构建探索--以江苏建康职业学院为例

职业素质教育体系的构建是卫生类高职院校的重要课题。该文以为江苏建康职业学院例,总结分析相关实践经验,提出：以构建将素质教育融入专业教育的课程体系为基础,强化学生实训实践为保障,深化校院（医院）企合作为抓手的卫生高职人才素质教育“三位一体”模式,实现了第一课堂、第二课堂与第三课堂的有机结合,全面提升学生的职业素质。     

The multiple meanings of "empowerment" in the health promotion proposal

Starting with a review of the literature and documents pertaining to health promotion in the developed countries, highlighting the Canadian output, the author reflects on the multiple meanings ascribed to the "empowerment" category/strategy. After a summary of the conceptual development of health promotion ideals, the paper analyzes the theoretical aspects of "empowerment", suggesting its classification into two main approaches: psychological and community-based. The author contends that community "empowerment" helps define health promotion as a proposal aimed at transforming the status quo and the production of healthy subjects. The paper concludes by exploring the potential contributions of social/community "empowerment" to health education practices and reorganization of the Brazilian National Health System (SUS).     

Health and safety education for workers with low-literacy or limited-English skills.

Low literacy and limited English proficiency have become a growing concern for health and safety educators. With one-fifth of the workforce reading below an eighth-grade level and possibly another tenth having limited English skills, health and safety educators and unions have increasingly become aware that current training programs often surpass the language and literacy abilities of workers being trained. This article describes the dilemmas facing health and safety professionals in incorporating knowledge about language and literacy skill levels. It documents creative strategies and new programs, largely based on participatory and popular education approaches, to provide training that simultaneously matches worker needs and leads to worker empowerment.     

Sexuality: Dealing with parents

Parents are an essential part of the team when it comes to providing the sexuality education developmentally disabled individuals require in order to function to their fullest potential as adult human beings. Professionals must make every effort to offer parents the opportunity to examine their own feelings and to learn about issues of sexuality and disability if they hope to gain their support for a sex education program for their children. Understanding the process of desensitizing parents to the issue of sexuality and supporting their concerns related to feelings versus safety will be the keys to gaining this support.This article is reprinted by permission of Psych-Media, Inc. It appeared in the April 1990 issue (Volume 9, Number 4) ofThe Habilitative Mental Healthcare Newsletter.     

Powerlessness, empowerment, and health: implications for health promotion programs

PURPOSE AND SCOPE. This article reviews the health and social science research relevant to both the role of powerlessness as a risk factor for disease, and the role of empowerment as a health-enhancing strategy. The research literature surveyed includes studies that address these key concepts from the fields of social epidemiology, occupational health, stress research, social psychology, community psychology, social support and networks, community competence and community organizing. Definitions are provided to operationalize these sometimes loosely-applied terms. IMPORTANT FINDINGS. Powerlessness, or lack of control over destiny, emerges as a broad-based risk factor for disease. Empowerment, though more difficult to evaluate, can also be demonstrated as an important promoter of health. MAJOR CONCLUSIONS. Given the importance and currency of these concepts of powerlessness and empowerment, a model of empowerment education is proposed for health-promotion practitioners. Measurement of empowerment raises issues for researchers on how to test the multiple personal and community changes that may result from an empowering education intervention.     

Leveraging HIPAA to support consumer empowerment

The consumer empowerment movement needs to provide consumers with more access and control of their healthcare records. The premise of this article is that there is a fundamental market shift towards consumer empowerment--and technology is the driving force. We contend the results will satisfy the intent of the HIPAA mandate. Two restrictions impede the market from moving toward real consumer empowerment. First, managing one's own health history record is difficult because the complete record is segmented in disparate systems that are difficult to integrate. This is because unique identifiers and consistent coding are nonexistent. Second, security and control of patient identifiable health information is still evolving. There is no consensus among providers for Internet security, as we can see by all the legislative privacy bills trying to address the issue. HIPAA is both a legislative mandate and an enabler of the next healthcare paradigm. Providers must comply with the HIPAA mandates for electronic data interchange (EDI) code sets, administrative simplification, and privacy and confidentiality protocols. By recognizing HIPAA as part of a consumer-driven movement, organizations can incorporate empowerment strategies into a planning process that creates consumer options in healthcare and leverages HIPAA compliance to benefit both providers and consumers. This article suggests methods for meeting HIPAA compliance through innovative consumer empowerment methods.     

赋权增能理论在癫痫患者健康教育中的应用效果

目的评价以赋权增能理论为指导的健康教育在癫痫患者中的应用效果。方法将122例癫痫患者进行配对处理分组,对照组和观察组各61例。对照组按常规进行健康教育,观察组以赋权增能理论为指导进行健康教育,患者出院后3、6、12个月在门诊复诊时进行生活质量评分。结果 2组患者出院后3月再发作率均为4.91%;2组患者生活质量总分为（66.12±17.20）分和（63.50±19.38）分,差异无统计学意义（P〉0.05）,但2组患者生活质量评分均明显高于入院时（P〈0.01）;出院后6、12个月观察组再发作率为11.48%、39.34%;对照组再发作率为37.70%、67.21%（P〈0.05）;出院后6、12个月观察组生活质量评分高于对照组（P〈0.01和P〈0.05）。结论以赋权增能理论为指导的健康教育,可降低癫痫患者再发作率,提高癫痫患者的生活质量。     

Correlates of gender characteristics,health and empowerment of women in Ethiopia

Background

The low status of women prevents them from recognizing and voicing their concerns about health needs. This study aimed to examine the relationship between gender characteristics, health and empowerment of women in an attempt to understand between 2005 and 2011.

Methods

Data from the Ethiopia Demographic and Health Survey (EDHS) 2005 and 2011 were used. Bivariate and multivariate analyses were used to determine the relative contribution of the predictor variables. The hypotheses tested in this study were that gender (men and women), health and empowerment of women in region are highly significant with women’s education and work status.

Results

Study findings showed that the low status of women and their disempowerment are highly associated with poor health outcomes. In both 2005 and 2011 men school ages were positively associated with their attainment in primary education, whereas for women it was negatively related with their attainment in some education. In both 2005 and 2011 women in the richest wealth quintile had the highest odds ratio of relating to some education. The results show that the odds ratios of women with some education (within the richest wealth quintile) has improved from 6.39 (in 2005) to 10.90 (in 2011), whereas among men there has been a decrease from 10.33 (in 2005) to 2.13 (in 2011). The results indicated that in 2005 and 2011, when comparing the percentage distribution of both genders on employment status and type of occupation, the percentage of men who were employed was higher than women. The percentage of males who were engaged in the agricultural-type of occupation was higher than that of women. Men and women knowledge about family planning methods have been improved, yet, there are wider gender gaps in family planning users.

Conclusions

The officials such as policy makers, planners, program managers and government and non-government organizations need to addressed. The issue of child marriages in order to minimize the number of girls who never attend school or drop out to become wives Planners should also work on improving family planning to empower women. There was a significant relationship between status of women and quality of healthy life, and this relationship appeared to differ by education and work status.

     

Behavior Change or Empowerment: On the Ethics of Health-Promotion Goals

One important ethical issue for health promotion and public health work is to determine what the goals for these practices should be. This paper will try to clarify what some of these goals are thought to be, and what they ought to be. It will specifically discuss two different approaches to health promotion, such as, behavior change and empowerment. The general aim of this paper is, thus, to compare the behavior-change approach and the empowerment approach, concerning their immediate (instrumental) goals or aims, and to morally evaluate the strengths and weaknesses of these two goal models, in relation to the ultimate goal of health promotion. The investigation shows that the behavior-change approach has several moral problems. First of all, it is overly paternalistic and often disregards the individual’s or group’s own perception of what is important—something that also increases the risk of failed interventions. Furthermore, it risks leading to ‘victim blaming’ and stigmatization, and to increased inequalities in health, and it puts focus on the ‘wrong’ problems, i.e., behavior instead of the ‘causes of the causes’. It is thereafter shown that the empowerment approach does not have any of these problems. Finally, some specific problems for the empowerment approach are discussed and resolved, such as, the idea that empowering some groups might lead to power over others, the objection that the focus is not primarily on health (which it should be), and the fact that empowered people might choose to live lives that risk reducing their health.