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Raj A, Dey A, Rao N, Yore J, McDougal L, Bhan N, Silverman JG, Hay K, Thomas EE, Fotso JC, Lundgren R. The EMERGE framework to measure empowerment for health and development. Soc Sci Med 2024; 351 Suppl 1:116879. [PMID: 38825382 DOI: 10.1016/j.socscimed.2024.116879] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 01/24/2024] [Accepted: 04/09/2024] [Indexed: 06/04/2024]
Abstract
RATIONALE Women's empowerment is a UN Sustainable Development Goal and a focus of global health and development but survey measures and data on gender empowerment remain weak. Existing indicators are often disconnected from theory; stronger operationalization is needed. OBJECTIVE We present the EMERGE Framework to Measure Empowerment, a framework to strengthen empowerment measures for global health and development. METHOD We initiated development of this framework in 2016 as part of EMERGE - an initiative designed to build the science of survey research and availability of high-quality survey measures and data on gender empowerment. The framework is guided by existing theories of empowerment, evidence, and expert input. We apply this framework to understand women's empowerment in family planning (FP) via review of state of the field measures. RESULTS Our framework offers concrete measurable constructs to assess critical consciousness and choice, agency and backlash, and goal achievement as the empowerment process, recognizing its operation at multiple levels-from the individual to the collective. Internal attributes, social norms, and external contexts and resources create facilitators or barriers to the empowerment process. Review of best evidence FP measures assessing empowerment constructs, social norms, and key influencers (e.g., partners and providers) show a strong landscape of measures, including those with women, partners, and providers, but they are limited in assessing translation of choice to agency to achievement of women's self-determined fertility or contraceptive goals, instead relying on assumption of contraceptive use as the goal. We see no measures on collective empowerment toward women's reproductive choice and rights. CONCLUSION The EMERGE Framework can guide development and analysis of survey measures on empowerment and is needed as the current state of the field shows limited coverage of empowerment constructs even in areas which have received more study, such as family planning.
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Affiliation(s)
- Anita Raj
- Newcomb Institute, Tulane University, 43 Newcomb Place, Suite 301, New Orleans, LA, 70118, USA; Tulane School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2460 #8329, New Orleans, LA, 70112, USA; Center on Gender Equity and Health, University of California, San Diego, 9500 Gilman Drive, Mail Code 0507, La Jolla, CA, 92093, USA.
| | - Arnab Dey
- Center on Gender Equity and Health, University of California, San Diego, 9500 Gilman Drive, Mail Code 0507, La Jolla, CA, 92093, USA
| | - Namratha Rao
- Newcomb Institute, Tulane University, 43 Newcomb Place, Suite 301, New Orleans, LA, 70118, USA
| | - Jennifer Yore
- Center on Gender Equity and Health, University of California, San Diego, 9500 Gilman Drive, Mail Code 0507, La Jolla, CA, 92093, USA
| | - Lotus McDougal
- Center on Gender Equity and Health, University of California, San Diego, 9500 Gilman Drive, Mail Code 0507, La Jolla, CA, 92093, USA
| | - Nandita Bhan
- O.P. Jindal Global University, Sonipat Narela Road, Near Jagdishpur Village, Sonipat, Haryana, 131001, India
| | - Jay G Silverman
- Tulane School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2460 #8329, New Orleans, LA, 70112, USA
| | - Katherine Hay
- Center on Gender Equity and Health, University of California, San Diego, 9500 Gilman Drive, Mail Code 0507, La Jolla, CA, 92093, USA
| | - Edwin E Thomas
- Newcomb Institute, Tulane University, 43 Newcomb Place, Suite 301, New Orleans, LA, 70118, USA
| | | | - Rebecka Lundgren
- Center on Gender Equity and Health, University of California, San Diego, 9500 Gilman Drive, Mail Code 0507, La Jolla, CA, 92093, USA
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Hawash MM, Mohamed AAER, El-Sayed MM, El-Ashry AM, Hafez SA. Association between health-related empowerment and health-protective behaviors among community-dwelling older adults. Arch Psychiatr Nurs 2024; 48:59-67. [PMID: 38453283 DOI: 10.1016/j.apnu.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/25/2023] [Accepted: 01/16/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Empowerment is a broad concept seen as a critical approach for helping older adults who lack power to gain control over various aspects of their lives, including their health-protective behaviors. AIM The study investigated the association between health-related empowerment and health-protective behaviors in older adults. DESIGN A cross-sectional correlational research design was used by recruiting a convenient sample of 200 older adults. TOOLS The Elder Health Empowerment Scale and Health Protective Behavior Scale were used to collect the participant data. RESULTS It showed a significant positive correlation between health-related empowerment and health-protective behaviors in older adults (r = 0.891, p = 0.001), indicating that as health-related empowerment increases, engagement in health-protective behaviors also increases. Furthermore, health-related empowerment accounted for a large proportion of the variation in health-protective behaviors (85.7 %). CONCLUSION Overall, these findings suggest that there is a need for interventions to improve the health-related empowerment of older adults, particularly in terms of their ability to turn their health goals into actionable plans, overcome barriers to health, and make informed healthcare choices. However, the studied older adults generally engage in health protective behaviors; there is variability in the extent to which they engage in specific behaviors, which may provide valuable insights for developing targeted health promotion programs and interventions.
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Affiliation(s)
- Manal Mohammed Hawash
- Gerontological Nursing, Faculty of Nursing, Alexandria University, Egypt; Department of Public Health, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia; Research Centre of Advanced Materials -King Khalid University
| | | | | | - Ayman Mohamed El-Ashry
- Psychiatric and Mental Health Nursing, Faculty of Nursing, Alexandria University, Egypt.
| | - Sarah Ali Hafez
- Gerontological Nursing, Faculty of Nursing, Alexandria University, Egypt
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Moreira-Rosário A, Ismael S, Barreiros-Mota I, Morais J, Rodrigues C, Castela I, Mendes IC, Soares MI, da Costa LS, Oliveira CB, Henriques T, Pinto P, Pita D, de Oliveira CM, Maciel J, Serafim T, Araújo J, Rocha JC, Pestana D, Silvestre MP, Marques C, Faria A, Polonia J, Calhau C. Empowerment-based nutrition interventions on blood pressure: a randomized comparative effectiveness trial. Front Public Health 2023; 11:1277355. [PMID: 38026295 PMCID: PMC10679749 DOI: 10.3389/fpubh.2023.1277355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Empowerment lifestyle programs are needed to reduce the risk of hypertension. Our study compared the effectiveness of two empowerment-based approaches toward blood pressure (BP) reduction: salt reduction-specific program vs. healthy lifestyle general program. Methods Three hundred and eleven adults (median age of 44 years, IQR 34-54 years) were randomly assigned to a salt reduction (n = 147) or a healthy lifestyle program (n = 164). The outcome measures were urinary sodium (Na+) and potassium (K+) excretion, systolic (SBP) and diastolic (DBP) blood pressure, weight, and waist circumference. Results There were no significant differences in primary and secondary outcomes between the two program groups. When comparing each program to baseline, the program focused on salt reduction was effective in lowering BP following a 12-week intervention with a mean change of -2.5 mm Hg in SBP (95% CI, -4.1 to -0.8) and - 2.7 mm Hg in DBP (95% CI, -3.8 to -1.5) in the intention-to-treat (ITT) analysis. In the complete-case (CC) analysis, the mean change was -2.1 mm Hg in SBP (95% CI, -3.7 to -0.5) and - 2.3 mm Hg in DBP (95% CI, -3.4 to -1.1). This effect increases in subjects with high-normal BP or hypertension [SBP - 7.9 mm Hg (95% CI, -12.5 to -3.3); DBP - 7.3 mm Hg (95% CI, -10.2 to -4.4)]. The healthy lifestyle group also exhibited BP improvements after 12 weeks; however, the changes were less pronounced compared to the salt reduction group and were observed only for DBP [mean change of -1.5 mm Hg (95% CI, -2.6 to -0.4) in ITT analysis and - 1.4 mm Hg (95% CI, -2.4 to -0.3) in CC analysis, relative to baseline]. Overall, improvements in Na+/K+ ratio, weight, and Mediterranean diet adherence resulted in clinically significant SBP decreases. Importantly, BP reduction is attributed to improved dietary quality, rather than being solely linked to changes in the Na+/K+ ratio. Conclusion Salt-focused programs are effective public health tools mainly in managing individuals at high risk of hypertension. Nevertheless, in general, empowerment-based approaches are important strategies for lowering BP, by promoting health literacy that culminates in adherence to the Mediterranean diet and weight reduction.
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Affiliation(s)
- André Moreira-Rosário
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CINTESIS@RISE, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Shámila Ismael
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CINTESIS@RISE, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CHRC, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Inês Barreiros-Mota
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CHRC, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Juliana Morais
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CINTESIS@RISE, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Catarina Rodrigues
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CHRC, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Inês Castela
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CINTESIS@RISE, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CHRC, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | | | | | | | | | | | - Patrícia Pinto
- CUF Academic and Research Medical Center, Lisbon, Portugal
| | - Débora Pita
- CUF Academic and Research Medical Center, Lisbon, Portugal
| | | | - Janaína Maciel
- CUF Academic and Research Medical Center, Lisbon, Portugal
| | - Thaina Serafim
- CUF Academic and Research Medical Center, Lisbon, Portugal
| | - João Araújo
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CINTESIS@RISE, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Júlio César Rocha
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CINTESIS@RISE, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Diogo Pestana
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CINTESIS@RISE, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Marta P. Silvestre
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CINTESIS@RISE, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Cláudia Marques
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CINTESIS@RISE, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Ana Faria
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CINTESIS@RISE, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CHRC, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Jorge Polonia
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Porto, Portugal
- Hypertension and Cardiovascular Risk Unit, Unidade Local de Saúde Matosinhos, Matosinhos, Portugal
| | - Conceição Calhau
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CINTESIS@RISE, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
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Popay J, Halliday E, Mead R, Townsend A, Akhter N, Bambra C, Barr B, Anderson de Cuevas R, Daras K, Egan M, Gravenhorst K, Janke K, Kasim AS, McGowan V, Ponsford R, Reynolds J, Whitehead M. Investigating health and social outcomes of the Big Local community empowerment initiative in England: a mixed method evaluation. PUBLIC HEALTH RESEARCH 2023; 11:1-147. [PMID: 37929801 DOI: 10.3310/grma6711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Background Most research on community empowerment provides evidence on engaging communities for health promotion purposes rather than attempts to create empowering conditions. This study addresses this gap. Intervention Big Local started in 2010 with £271M from the National Lottery. Ending in 2026, it gives 150 relatively disadvantaged communities in England control over £1M to improve their neighbourhoods. Objective To investigate health and social outcomes, at the population level and among engaged residents, of the community engagement approach adopted in a place-based empowerment initiative. Study design, data sources and outcome variables This study reports on the third wave of a longitudinal mixed-methods evaluation. Work package 1 used a difference-in-differences design to investigate the impact of Big Local on population outcomes in all 150 Big Local areas compared to matched comparator areas using secondary data. The primary outcome was anxiety; secondary outcomes included a population mental health measure and crime in the neighbourhood. Work package 2 assessed active engagement in Big Local using cross-sectional data and nested cohort data from a biannual survey of Big Local partnership members. The primary outcome was mental well-being and the secondary outcome was self-rated health. Work package 3 conducted qualitative research in 14 Big Local neighbourhoods and nationally to understand pathways to impact. Work package 4 undertook a cost-benefit analysis using the life satisfaction approach to value the benefits of Big Local, which used the work package 1 estimate of Big Local impact on life satisfaction. Results At a population level, the impacts on 'reporting high anxiety' (-0.8 percentage points, 95% confidence interval -2.4 to 0.7) and secondary outcomes were not statistically significant, except burglary (-0.054 change in z-score, 95% confidence interval -0.100 to -0.009). There was some effect on reduced anxiety after 2017. Areas progressing fastest had a statistically significant reduction in population mental health measure (-0.053 change in z-score, 95% confidence interval -0.103 to -0.002). Mixed results were found among engaged residents, including a significant increase in mental well-being in Big Local residents in the nested cohort in 2018, but not by 2020; this is likely to be COVID-19. More highly educated residents, and males, were more likely to report a significant improvement in mental well-being. Qualitative accounts of positive impacts on mental well-being are often related to improved social connectivity and physical/material environments. Qualitative data revealed increasing capabilities for residents' collective control. Some negative impacts were reported, with local factors sometimes undermining residents' ability to exercise collective control. Finally, on the most conservative estimate, the cost-benefit calculations generate a net benefit estimate of £64M. Main limitations COVID-19 impacted fieldwork and interpretation of survey data. There was a short 4-year follow-up (2016/20), no comparators in work package 2 and a lack of power to look at variations across areas. Conclusions Our findings suggest the need for investment to support community organisations to emerge from and work with communities. Residents should lead the prioritisation of issues and design of solutions but not necessarily lead action; rather, agencies should work as equal partners with communities to deliver change. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research Programme (16/09/13) and will be published in full in Public Health Research; Vol. 11, No. 9. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Jennie Popay
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Emma Halliday
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Rebecca Mead
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Anne Townsend
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Nasima Akhter
- Department of Anthropology, Durham University, Durham, UK
| | - Clare Bambra
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Ben Barr
- Department of Public Health, Policy and Systems, The University of Liverpool, Liverpool, UK
| | | | - Konstantinos Daras
- Department of Public Health, Policy and Systems, The University of Liverpool, Liverpool, UK
| | - Matt Egan
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Katja Gravenhorst
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Katharina Janke
- Division of Health Research, Lancaster University, Lancaster, UK
| | | | - Victoria McGowan
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Ruth Ponsford
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Joanna Reynolds
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Margaret Whitehead
- Department of Public Health, Policy and Systems, The University of Liverpool, Liverpool, UK
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Saadati F, Nadrian H, Ghassab-Abdollahi N, Pashazadeh F, Gilani N, Taghdisi MH. Indices/Indicators Developed to Evaluate the "Creating Supportive Environments" Mechanism of the Ottawa Charter for Health Promotion: A Setting-Based Review on Healthy Environment Indices/ Indicators. Korean J Fam Med 2023; 44:261-267. [PMID: 37434481 PMCID: PMC10522467 DOI: 10.4082/kjfm.22.0215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/10/2023] [Accepted: 03/08/2023] [Indexed: 07/13/2023] Open
Abstract
This study aimed to identify the indices/indicators used for evaluating the "creating supportive environments" mechanism of the Ottawa Charter for Health Promotion, with a focus on built environments, in different settings. A search for literature with no time limit constraint was performed across Medline (via PubMed), Scopus, and Embase databases. Search terms included "Ottawa Charter," "health promotion," "supportive environments," "built environments," "index," and "indicator." we included the studies conducted on developing, identifying, and/or measuring health promotion indices/indicators associated with "built environments" in different settings. The review articles were excluded. Extracted data included the type of instrument used for measuring the index/indicator, the number of items, participants, settings, the purpose of indices/indicators, and a minimum of two associated examples of the indices domains/indicators. The key definitions and summarized information from studies are presented in tables. In total, 281 studies were included in the review, within which 36 indices/indicators associated with "built environment" were identified. The majority of the studies (77%) were performed in developed countries. Based on their application in different settings, the indices/indicators were categorized into seven groups: (1) Healthy Cities (n=5), (2) Healthy Municipalities and Communities (n=18), (3) Healthy Markets (n=3), (4) Healthy Villages (n=1), (5) Healthy Workplaces (n=4), (6) Health-Promoting Schools (n=3), and (7) Healthy Hospitals (n=3). Health promotion specialists, health policymakers, and social health researchers can use this collection of indices/indicators while designing/evaluating interventions to create supportive environments for health in various settings.
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Affiliation(s)
- Fatemeh Saadati
- Department of Health Education & Promotion, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Haidar Nadrian
- Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nafiseh Ghassab-Abdollahi
- Department of Geriatric Health, Faculty of Health Science, Tabriz University of Medical Science, Tabriz, Iran
| | - Fariba Pashazadeh
- Research Center for Evidence-Based Medicine, Tabriz University of Medical Science, Tabriz, Iran
| | - Neda Gilani
- Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad-Hossein Taghdisi
- Department of Public Health, School of Health and Medical Engineering, Tehran Islamic Azad University of Medical Sciences, Tehran, Iran
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Röger-Offergeld U, Kurfer E, Brandl-Bredenbeck HP. Empowerment through participation in community-based participatory research-effects of a physical activity promotion project among socially disadvantaged women. Front Public Health 2023; 11:1205808. [PMID: 37538266 PMCID: PMC10396770 DOI: 10.3389/fpubh.2023.1205808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/26/2023] [Indexed: 08/05/2023] Open
Abstract
Introduction Community-based participatory research (CBPR) approaches are associated with a range of positive impacts on empowerment. However, only a few studies have investigated the influence of different modes of target group participation on empowerment. The present study examined the empowerment processes and outcomes of women in difficult life situations through their participation as co-researchers in the form of Photovoice in "Stark durch Bewegung" (English: "Strong through Movement"), a CBPR project for physical activity (PA) promotion. The extent to which women's participation as co-researchers leads to empowerment was compared with other forms of participation. Methods The Photovoice approach consisted of three components: (1) photo task, (2) focus group interviews, and (3) exhibition of photos. It was then extended through participant observation. A total of 18 women took part in Photovoice. They took photos, were involved in four focus groups, helped in the analysis of data, and supported their exhibition. Two additional short focus group interviews in which four more women participated were conducted at the end of the project. The interview guideline was based on the SHOWeD questions proposed within the framework of Photovoice and enriched with various other questions (e.g., self-efficacy, social contacts, and community involvement). The data were analyzed based on a grounded theory approach. Results "Stark durch Bewegung" contributed to women's empowerment in several ways. By participating in the project's PA programs, the women reported numerous empowerment effects, such as improved self-efficacy, perceived competencies like swimming and language skills, and social networks. By participating as co-researchers, they perceived empowering processes on organizational and community levels that are comparable with other forms of participation (e.g., participation in a cooperative planning group) but also differ from them at relevant points (e.g., encouraging them to reflect on their own PA behaviors). The willingness to get involved in Photovoice was estimated to be significantly higher than in other possible forms of participation. Conclusion Our findings support the notion that health promotion interventions with marginalized groups can contribute to their empowerment on multiple levels when participants become equal partners in the CBPR project. Involving women as co-researchers has advantages over other forms of participation in terms of their empowerment.
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Lu F, Wong CKH, Tse ETY, Ng APP, Li L, Lam JSM, Bedford L, Fong DYT, Ip P, Lam CLK. The Impact of a Health Empowerment Program on Self-Care Enablement and Mental Health among Low-Income Families: Evidence from a 5 Year Cohort Study in Hong Kong. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5168. [PMID: 36982089 PMCID: PMC10049337 DOI: 10.3390/ijerph20065168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 06/18/2023]
Abstract
Health empowerment can be an effective way to reduce health inequities. This prospective cohort study evaluated the 5 year impact of a health empowerment program (HEP) on health outcomes among adults from low-income families. The Patient Enablement Instrument version 2 (PEI-2), Depression, Anxiety and Stress Scale 21 (DASS-21), and 12 item Short-Form Health Survey version 2 (SF-12v2) were administered at baseline and follow-up for both intervention and comparison groups. A total of 289 participants (n = 162 for intervention group, n = 127 for comparison group) were included in the analysis. Most of the participants were female (72.32%), and aged from 26 to 66 years old (M = 41.63, SD = 6.91). Linear regressions weighted by inverse probability weighting using the propensity score showed that, after follow-up of 5 years, the intervention group demonstrated significantly greater increases in all items and total scores for the PEI-2 (all B > 0.59, p < 0.001), greater decreases in the DASS depression score (B = -1.98 p = 0.001), and greater increases in the Mental Component Summary score of the SF-12v2 (B = 2.99, p = 0.027) than the comparison group. The HEP may be an effective intervention enabling adults from low-income families to manage their health-related issues and improve their mental health, as evidenced by our study.
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Affiliation(s)
- Fangcao Lu
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong 999077, China
| | - Carlos King Ho Wong
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong 999077, China
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong 999077, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong 999077, China
| | - Emily Tsui Yee Tse
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong 999077, China
- Department of Family Medicine and Primary Care, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518000, China
| | - Amy Pui Pui Ng
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong 999077, China
- Department of Family Medicine and Primary Care, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518000, China
| | - Lanlan Li
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong 999077, China
| | - Joyce Sau Mei Lam
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong 999077, China
| | - Laura Bedford
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong 999077, China
| | - Daniel Yee Tak Fong
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong 999077, China
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong 999077, China
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children’s Hospital, Hong Kong 999077, China
| | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong 999077, China
- Department of Family Medicine and Primary Care, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518000, China
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Kraun L, De Vliegher K, Ellen M, van Achterberg T. Interventions for the empowerment of older people and informal caregivers in transitional care decision-making: short report of a systematic review. BMC Geriatr 2023; 23:113. [PMID: 36855081 PMCID: PMC9976408 DOI: 10.1186/s12877-023-03813-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 02/08/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Care transitions across different settings necessitate careful decision-making for all parties involved, yet research indicates that older people and informal caregivers do not have a strong voice in such decisions. OBJECTIVE To provide a systematic overview of the literature about interventions designed to empower older people and informal caregivers in transitional care decision-making. DESIGN A systematic review (Prospero Protocol CRD42020167961; funded by the EU's Horizon 2020 program). DATA SOURCES Five databases were searched: PubMed, EMBASE, Web of Science, PsycINFO, and CINAHL. REVIEW METHODS The review included evaluations of empowerment in decision-making interventions for older people and informal caregivers facing care transitions, that were published from the inception of the databases up until April 2022. Data extractions were performed by two independent researchers and the quality of studies was assessed with the relevant JBI-critical appraisal tools. A narrative descriptive analysis of the results was performed. FINDINGS Ten studies, reporting on nine interventions, and including a total of 4642 participants, were included. Interventions included transition preparation tools, support from transition coaches, shared decision-making interventions, and advance care planning. Designs and outcomes assessed were highly diverse and showed a mix of positive and lacking effects. CONCLUSIONS There is a lack of research on how to empower older people and their informal caregivers in transitional care decision-making. Empowerment in decision-making is usually not central in transitional care interventions, and effects on actual empowerment are mostly not assessed. Conclusions on how to empower older people and informal caregivers in transitional care decision-making cannot be drawn.
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Affiliation(s)
- Lotan Kraun
- Nursing Departement, Wit-Gele Kruis van Vlaanderen, Brussels, Belgium. .,KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, University of Leuven, Leuven, Belgium. .,Department of Health Policy and Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel.
| | - Kristel De Vliegher
- Nursing Departement, Wit-Gele Kruis van Vlaanderen, Brussels, Belgium.,KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, University of Leuven, Leuven, Belgium
| | - Moriah Ellen
- Department of Health Policy and Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel.,Institute of Health Policy Management and Evaluation, Dalla Lana School Of Public Health, University of Toronto, Toronto, Canada
| | - Theo van Achterberg
- KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, University of Leuven, Leuven, Belgium
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Friska D, Kekalih A, Runtu F, Rahmawati A, Ibrahim NAA, Anugrapaksi E, Utami NPBS, Wijaya AD, Ayuningtyas R. Health cadres empowerment program through smartphone application-based educational videos to promote child growth and development. Front Public Health 2022; 10:887288. [PMID: 36311610 PMCID: PMC9611201 DOI: 10.3389/fpubh.2022.887288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 09/29/2022] [Indexed: 01/21/2023] Open
Abstract
Indonesia's health care system relies on non-health professionals called cadres to operate child health promotion programs in the Public Health Center (Puskesmas). Despite this effort, the child malnutrition rate remains high. This study aimed to identify and develop health promotion media that can assist health cadres in promoting child health. This study was divided into three-phase. The first phase was the need assessment using focus group discussion and knowledge, attitude, and practice (KAP); the second phase is video development, which involves medical students, general practitioners, pediatricians, and health promotion experts; and the third phase was video viewing by cadres and post-viewing tests for health cadres. A comparison of pre-test and post-test participants' total scores was performed with the student's T-test. Need assessment showed that the knowledge of the cadres needs improvement and there was a need for proper educational media material that can be used by the Puskesmas. Five videos were produced, four videos were about children's nutritional intake recommendations during four different age groups and one video was about the information and invitation to come to Integrated Health Service Post (Posyandu). There was a significant improvement from pre-test total scores to post-test total scores (p < 0.001). Smartphone application-based educational videos are effective and reliable child health promotion media for Puskesmas staff and parents.
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Affiliation(s)
- Dewi Friska
- Department of Community Medicine, Faculty of Medicine, Cipto Mangunkusumo Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Aria Kekalih
- Department of Community Medicine, Faculty of Medicine, Cipto Mangunkusumo Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Fergie Runtu
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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10
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Coulibaly K, Gosselin A, Carillon S, Ravalihasy A, Melchior M, Ridde V, Desgrées du Loû A. Is empowerment in sexual health measurable? A scoping review of definitions and measurement indicators. Health Promot Int 2022; 37:6730779. [PMID: 36173607 DOI: 10.1093/heapro/daac139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The concept of empowerment in sexual health is widely used in health promotion. This scoping review aims to identify how it is defined and measured. PubMed, Sage Journals, PsycInfo and the Web of Science are data sources. The inclusion criteria for studies were as follows: (1) an analysis of empowerment in sexual health, (2) quantitative evaluation and (3) publication in a peer-reviewed journal in French or English since January 1996. Data were extracted using a summary table of the definitions and indicators of empowerment in sexual health. Of the 2181 articles found, 29 met the inclusion criteria. Only 4 studies on 29 clearly defined empowerment in sexual health. Five dimensions emerged from the indicators used in the 29 studies in relation to sexual empowerment (social participation, participation in decision making, power to act, sexual health knowledge and gender norms), with two types of indicators: indicators unspecific to sexual health, which can be viewed as empowerment basic skills, and indicators specific to sexual health. Most studies concerned women and focused on individual empowerment, with a lack of measure of collective and structural levels of empowerment. Despite great heterogeneity in the definitions and indicators used, a set of core indicators emerged: participation in decision making, sexual negotiation power and sexual communication skills, knowledge and use of contraceptive methods, and HIV and sexually transmitted infections risk perception. This set could be systematically used in each study based on sexual empowerment concept, completed by supplementary indicators considering the specific context.
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Affiliation(s)
- Karna Coulibaly
- Université Paris Cité, IRD, INSERM, Ceped, F-75006 Paris, France.,French Collaborative Institute on Migrations, CNRS, Aubervilliers, France
| | - Anne Gosselin
- Université Paris Cité, IRD, INSERM, Ceped, F-75006 Paris, France.,French Collaborative Institute on Migrations, CNRS, Aubervilliers, France.,French Institute for Demographic Studies (INED), Aubervilliers, France
| | | | - Andrainolo Ravalihasy
- Université Paris Cité, IRD, INSERM, Ceped, F-75006 Paris, France.,French Collaborative Institute on Migrations, CNRS, Aubervilliers, France.,Institute for Research on Sustainable Development (IRD), Marseille, France
| | - Maria Melchior
- French Collaborative Institute on Migrations, CNRS, Aubervilliers, France.,ERES, Social Epidemiology Unit, IPLESP, INSERM S1136, Faculté de Médecine de Saint Antoine, Paris, France
| | - Valéry Ridde
- Université Paris Cité, IRD, INSERM, Ceped, F-75006 Paris, France.,French Collaborative Institute on Migrations, CNRS, Aubervilliers, France.,Institute for Research on Sustainable Development (IRD), Marseille, France
| | - Annabel Desgrées du Loû
- Université Paris Cité, IRD, INSERM, Ceped, F-75006 Paris, France.,French Collaborative Institute on Migrations, CNRS, Aubervilliers, France.,Institute for Research on Sustainable Development (IRD), Marseille, France
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11
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Tlusty K, Jackson M, Riley B, Blase T. Effects of diet education on empowerment for individuals who have an increased risk of developing breast or colon cancer: A pilot study. J Genet Couns 2022; 31:1138-1147. [PMID: 35502599 PMCID: PMC9790378 DOI: 10.1002/jgc4.1584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 04/10/2022] [Accepted: 04/12/2022] [Indexed: 12/30/2022]
Abstract
Strong evidence indicates following a healthy diet reduces cancer risk; however, the impact of diet education on empowerment on individuals with an increased cancer risk has not been evaluated. Study participants included patients who had met with a cancer genetic counselor without a history of cancer. Participants received pre- and post-diet education surveys including questions to measure empowerment and feedback for diet education in relation to cancer risk. Empowerment was measured using a ten-question survey adapted from the Genetic Counseling Outcome Scale. The diet education intervention consisted of viewing an infographic created for this study based on recommendations for diets that reduce cancer risk by the World Cancer Research Fund and American Institute for Cancer Research. Twenty-eight participants completed both surveys and reviewed the diet education intervention. There was no change in empowerment between pre- and post- diet education (mean change = -0.5; p = 0.49). Participants previously learned about the relationship between a healthy diet and cancer risk reduction from several sources including family and friends (25.0%), online (25.0%), and primary care providers (25.0%). Most participants preferred diet education to be delivered online (42.9%), followed by on paper (39.3%), and in-person delivery (17.9%). This pilot study promotes further investigation on the impact of diet or lifestyle education on individuals who have a predisposition to developing cancer. While the results demonstrated no change in empowerment because of diet education, the results established a desire for learning about a healthy diet related to cancer risk and preferences for the modes of delivering education.
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Affiliation(s)
- Kaitlyn Tlusty
- Division of Genetic Counseling EducationCollege of Allied Health ProfessionsUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - Mariah Jackson
- Division of Medical Nutrition EducationCollege of Allied Health ProfessionsUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | | | - Terri Blase
- Munroe‐Meyer Institute for Genetics and RehabilitationUniversity of Nebraska Medical CenterOmahaNebraskaUSA
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12
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Sauter A, Herbert-Maul A, Abu-Omar K, Thiel A, Ziemainz H, Frahsa A, Linder S, Herrmann-Johns A. "For me, it's just a piece of freedom"-Increased empowerment through physical activity promotion among socially disadvantaged women. Front Public Health 2022; 10:867626. [PMID: 35968425 PMCID: PMC9363839 DOI: 10.3389/fpubh.2022.867626] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 06/30/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Community-based participatory research (CBPR) is an effective health promotion approach for reaching socially disadvantaged groups. However, there is limited evidence on how such interventions and their effects can be reproduced across time and place. The present study examines the effects of BIG (i.e., movement as an investment in health), a long-standing German CBPR project. Since 2005, BIG has aimed to empower women in difficult life situations to increase control over their health determinants and reduce social inequalities by promoting physical activity. One of BIG's key features is its implementation in several German municipalities since 2005. This study explores (a) whether participation could change women's empowerment, and (b) how increased empowerment affects other areas of women's lives. Methods With a total of 63 interviewees (i.e., 40 participating women, 7 trainers, 3 project coordinators, and 13 stakeholders), we conducted 53 semi-structured qualitative interviews in five BIG communities between 2007 and 2011. Some interviews were conducted with two people simultaneously. The interview guide contained questions on various dimensions of empowerment (e.g., project engagement, increased self-efficacy, and developed competencies). Framework analysis was used for the analytical process. Results BIG contributed to women's empowerment in various ways, including increased self-efficacy, social network promotion, competency development, and increased motivation to change physical activity behavior. Women who took on added tasks and became more involved in project planning also strengthened their organizational empowerment. Furthermore, increased empowerment had a positive influence on the women's quality of life, family, and professional lives. Conclusion The novel findings helped in understanding the effects of a complex empowerment-based approach that promoted physical activity among women in difficult life situations. Future research should focus on the long-term effects of these programs and their transferability to other sites. Further effort is necessary in the area of public health policy.
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Affiliation(s)
- Alexandra Sauter
- Department of Epidemiology and Preventive Medicine, Medical Sociology, University of Regensburg, Regensburg, Germany
| | - Annika Herbert-Maul
- Department of Sport Science and Sport, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Karim Abu-Omar
- Department of Sport Science and Sport, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Ansgar Thiel
- Institute of Sports Science, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Heiko Ziemainz
- Department of Sport Science and Sport, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Annika Frahsa
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Stephanie Linder
- Department of Sport Science and Sport, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Anne Herrmann-Johns
- Department of Epidemiology and Preventive Medicine, Medical Sociology, University of Regensburg, Regensburg, Germany
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13
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Babatunde GB, Schmidt B, Gwelo NB, Akintola O. Defining, conceptualising and operationalising community empowerment: a scoping review protocol. BMJ Open 2022; 12:e056152. [PMID: 35504643 PMCID: PMC9066482 DOI: 10.1136/bmjopen-2021-056152] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Community empowerment is a core concept in health promotion theory and practice. Several authors have defined and conceptualised the term differently. However, we did not find any synthesis of the various definitions of, and meanings attached to, community empowerment and the various conceptualisations, operationalisations, and the indicators for measuring community empowerment in the health promotion literature. The aim of this scoping review is to characterise and synthesise various definitions, conceptualisations, operationalisations and indicators for measuring community empowerment in the literature. METHODS AND ANALYSIS This scoping review will follow scoping review methods outlined by Arksey and O'Malley. We will identify relevant studies from 1986 onwards, written in any language, conducted anywhere in the world, and published in PubMed, PsycINFO, CINAHL, Web of Science and Medline. Two reviewers will independently screen titles, abstracts and full-text articles, after which they will carry out data extraction and analysis. We will develop a numerical and narrative synthesis of the definitions, conceptualisations, operationalisations and measurements of community empowerment in relation to health promotion and/health outcomes. ETHICS AND DISSEMINATION This scoping review does not require ethics approval, as we will only include information from previously conducted studies and we will not involve human participants.
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Affiliation(s)
- Gbotemi Bukola Babatunde
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Bellville, Cape Town, South Africa
| | - B Schmidt
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Bellville, Cape Town, South Africa
| | - Netsai Bianca Gwelo
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Bellville, Cape Town, South Africa
| | - Olagoke Akintola
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Bellville, Cape Town, South Africa
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14
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Gago CM, Jurkowski J, Beckerman-Hsu JP, Aftosmes-Tobio A, Figueroa R, Oddleifson C, Mattei J, Kenney EL, Haneuse S, Davison KK. Exploring a theory of change: Are increases in parental empowerment associated with healthier weight-related parenting practices? Soc Sci Med 2022; 296:114761. [PMID: 35123371 PMCID: PMC8894077 DOI: 10.1016/j.socscimed.2022.114761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 01/25/2022] [Accepted: 01/27/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Parent health-related empowerment is defined as the process by which parents realize control over their life situation and take action to promote a healthier lifestyle. For decades, researchers have described the theoretical potential of empowerment in health promotion efforts, though few have empirically examined this hypothesized relationship. This study is one of the first to examine the relationship between parental empowerment and healthy weight parenting practices (i.e., food, physical activity, sleep, and media parenting), as a mechanism for early childhood health promotion in community settings. METHODS Low-income parents of preschool-aged children attending Head Start in Greater Boston between fall 2017 and spring 2019 were invited to complete a survey in the fall and spring of each academic school year (n = 578 with two surveys and n = 45 with four). Parental empowerment and healthy weight parenting practices were assessed using validated surveys. We used a multilevel difference-in-difference approach to estimate changes in healthy weight parenting practices score by changes in parental empowerment score. RESULTS Out of a possible score of four, the unadjusted mean (SD) score in fall was 3.20 (0.40) for empowerment and 3.01 (0.40) for parenting. An increase in parental empowerment was associated with an increase in healthier parenting practices (b = 0.14; 95% CI = 0.08, 0.20; p < 0.0001). CONCLUSIONS Parent empowerment may be an important target in interventions to prevent obesity in low-income children.
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Affiliation(s)
- Cristina M. Gago
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Janine Jurkowski
- Department of Health Policy, Management, and Behavior, State University of New York, Albany, NY, 12222, USA
| | | | | | - Roger Figueroa
- Division of Nutritional Sciences, College of Human Ecology, Cornell University, Ithaca, NY, 14853, USA
| | - Carly Oddleifson
- School of Social Work, Boston College, Chestnut Hill, MA, 02467, USA
| | - Josiemer Mattei
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Erica L. Kenney
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
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15
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Saadati F, Nadrian H, Hosseini Golkar M, Taghdisi MH, Gilani N, Ghassab-Abdollahi N, Fathifar Z. Indices and indicators developed to evaluate the "strengthening community action" mechanism of the Ottawa Charter for Health Promotion: a scoping review. Am J Health Promot 2022; 36:881-893. [PMID: 35081768 DOI: 10.1177/08901171211069130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine 1) the indexes/indicators used for evaluating the "strengthening community action" mechanism of the Ottawa Charter for health promotion, and 2) to extract the characteristics and key components of the indexes/indicators using a scoping review. DATA SOURCE In May 2020, the search was conducted across three databases; Medline (via Pub Med), Embase, and Scopus. INCLUSION AND EXCLUSION CRITERIA All primary studies relating to development, identification, and measurement of health promotion indices/indicators associated to the "strengthening community actions" were included. The review articles were excluded. DATA EXTRACTION The data were extracted to a data-charting form that was developed by the research team. Two authors reviewed the extracted data. Data Synthesis To summarize and report the data, a descriptive numerical analysis, and a narrative descriptive synthesizing approach were used. Results In total, 93 study articles were included. A majority of studies (82%) were conducted in developed countries. Different types of recognized indices were categorized into seven groups: social cohesion (n=3), community capacity (n=1), community participation (n=7), social capital (n=6), social network (n=3), social support (n=1), and others (n=5). CONCLUSIONS Having a collection of "strengthening community action" indices/indicators in hand, health policy-makers and health promotion specialists might be able to do their best in considering, selecting, and applying the most appropriate indices/indicators while evaluating community health promotion interventions in different settings.
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Affiliation(s)
- Fateme Saadati
- Dept. of Health Education and Promotion48432Tabriz University of Medical Sciences
| | - Haidar Nadrian
- Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.48432Tabriz University of Medical Sciences
| | - Mostafa Hosseini Golkar
- Health Foresight and Innovation Research Center, Institute for Futures Studies in Health48463Kerman University of Medical Sciences
| | | | - Neda Gilani
- Department of Statistics and Epidemiology, Faculty of Health,48432Tabriz University of Medical Sciences
| | | | - Zahra Fathifar
- School of Management and Medical Information48432Tabriz University of Medical Sciences
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16
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Chinn V, Neely E, Shultz S, Kruger R, Hughes R, Page R, Coad J, Thunders M. Next Level Health: a holistic health and wellbeing program to empower New Zealand women. Health Promot Int 2022:6505283. [PMID: 35024852 DOI: 10.1093/heapro/daab205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Improving equity in women's health requires gender-specific and empowering approaches. However, health programs often disempower women by adopting a 'one-size-fits-all' approach that emphasizes diet, exercise and weight loss over other important aspects like sleep and mental wellbeing. This article reports on the design of Next Level Health (NLH), a program that aims to empower women through developing a wide range of health behaviors to support their holistic wellbeing. NLH is grounded by ethics, theory and evidence to support women to make achievable, sustainable changes that are relevant to their everyday lives. Women utilized the NLH framework to develop an integrative health routine across six domains: physical activity, sleep, nutrition, eating behavior, self-care and stress management. The framework guided them to set small, incremental goals that were adaptive to their needs and built from their existing circumstances. Participants reflected on their progress with a facilitator during monthly meetings, accessed a social media support page and received monthly text messages. Health programs remain an essential approach to improving women's health alongside community- and policy-level strategies. The development of NLH exemplifies how evidence may partner with modern health promotion values to inform relevant and ethical program design for women.
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Affiliation(s)
- V Chinn
- School of Health, Victoria University of Wellington, Easterfield Building, Kelburn Parade, Wellington 6012, New Zealand.,School of Health Sciences, Massey University, Wallace St, Mount Cook, Wellington 6021, New Zealand
| | - E Neely
- School of Health, Victoria University of Wellington, Easterfield Building, Kelburn Parade, Wellington 6012, New Zealand
| | - S Shultz
- Kinesiology Department, Seattle University, 12th Ave, Seattle, WA 98122, USA
| | - R Kruger
- School of Sport, Exercise & Nutrition, Massey University, SH17, Albany, Auckland 0632, New Zealand
| | - R Hughes
- Tasmanian School of Medicine, University of Tasmania, Liverpool St, Hobart, TAS 7000, Australia
| | - R Page
- School of Health Sciences, Massey University, Wallace St, Mount Cook, Wellington 6021, New Zealand
| | - J Coad
- School of Food & Advanced Technology, Massey University, Riddet Road, Palmerston North 4410, New Zealand
| | - M Thunders
- Department of Pathophysiology & Molecular Medicine, University of Otago, Mein St, Newtown, Wellington 6021, New Zealand
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17
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Earle R, Littlewood R, Nalatu S, Walker J. Empowerment Approaches in Childhood Weight Management: A Systematic Review. Child Obes 2022; 18:2-30. [PMID: 34314612 DOI: 10.1089/chi.2021.0049] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Empowerment interventions facilitate individuals, organizations, and communities to gain better control over their health. They are distinctly different from traditional behavior change models and encourage participants to set their own health priorities and agenda. Current evidence suggests empowerment interventions are efficacious for smoking, sexual, and mental health outcomes. However, empowerment in childhood obesity (which remains a global public health challenge) is underresearched. This review systematically analyzed the evidence for empowerment approaches in childhood weight management. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. A search strategy was applied to six databases from inception to May 25, 2021. Evidence was appraised using The Academy of Nutrition and Dietetics Quality Criteria Checklist and National Health and Medical Research Council Levels of Evidence. Of the 9274 articles identified, 29 articles describing 14 programs met the inclusion criteria. Twenty-five studies rated positive and four rated neutral. Overall, the evidence body rated "B." Seventy-two percent of the 3318 participants were from priority populations, highlighting the unique ability of empowerment interventions to engage those most in need. Results demonstrate small to large improvements in participant body mass index with effect sizes ranging from 0.08 to 1.13. Throughout the literature, empowerment was measured inconsistently and usually with a surrogate marker. All studies were set in America or Canada. This review suggests empowerment should be further investigated in childhood weight management. Empowerment interventions represent a unique opportunity to meaningfully integrate self-determination to clinical childhood weight management practice and overcome current barriers related to priority population engagement.
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Affiliation(s)
- Renae Earle
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Robyn Littlewood
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, Queensland, Australia.,Health and Wellbeing Queensland, Milton, Queensland, Australia
| | - Simone Nalatu
- Health and Wellbeing Queensland, Milton, Queensland, Australia
| | - Jacqueline Walker
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, Queensland, Australia
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18
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Popay J, Whitehead M, Ponsford R, Egan M, Mead R. Power, control, communities and health inequalities I: theories, concepts and analytical frameworks. Health Promot Int 2021; 36:1253-1263. [PMID: 33382890 PMCID: PMC8515177 DOI: 10.1093/heapro/daaa133] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This is Part I of a three-part series on community empowerment as a route to greater health equity. We argue that community 'empowerment' approaches in the health field are increasingly restricted to an inward gaze on community psycho-social capacities and proximal neighbourhood conditions, neglecting the outward gaze on political and social transformation for greater equity embedded in foundational statements on health promotion. We suggest there are three imperatives if these approaches are to contribute to increased equity. First, to understand pathways from empowerment to health equity and drivers of the depoliticisation of contemporary empowerment practices. Second, to return to the original concept of empowerment processes that support communities of place/interest to develop capabilities needed to exercise collective control over decisions and actions in the pursuit of social justice. Third, to understand, and engage with, power dynamics in community settings. Based on our longitudinal evaluation of a major English community empowerment initiative and research on neighbourhood resilience, we propose two complementary frameworks to support these shifts. The Emancipatory Power Framework presents collective control capabilities as forms of positive power. The Limiting Power Framework elaborates negative forms of power that restrict the development and exercise of a community's capabilities for collective control. Parts II and III of this series present empirical findings on the operationalization of these frameworks. Part II focuses on qualitative markers of shifts in emancipatory power in BL communities and Part III explores how power dynamics unfolded in these neighbourhoods.
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Affiliation(s)
- Jennie Popay
- Division of Health Research, Lancaster University, Health Innovation One, Lancaster, LA1 4AT, UK
| | - Margaret Whitehead
- Department of Public Health and Policy, Whelan Building, University of Liverpool, Liverpool, L69 3GB, UK
| | - Ruth Ponsford
- Health Services Research & Policy, London School of Hygiene and Tropical Medicine, Tavistock Place, London, WC1H 9SH, UK
| | - Matt Egan
- Health Services Research & Policy, London School of Hygiene and Tropical Medicine, Tavistock Place, London, WC1H 9SH, UK
| | - Rebecca Mead
- Division of Health Research, Lancaster University, Health Innovation One, Lancaster, LA1 4AT, UK
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Chinn V, Neely E, Shultz S, Kruger R, Hughes R, Thunders M. Empowering Women in the Face of Body Ideals: A Scoping Review of Health Promotion Programs. HEALTH EDUCATION & BEHAVIOR 2021; 49:534-547. [PMID: 34628972 DOI: 10.1177/10901981211050571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Achieving women's health equity and empowerment is a global priority. In a Western context, women are often disempowered by the value society places on body size, shape or weight, which can create a barrier to health. Health promotion programs can exacerbate women's preoccupations with their bodies by focusing outcomes toward achieving an "ideal" body size. Women's health promotion activities should be empowering if the desired outcomes are to improve their health and well-being long-term. This review sought to identify key elements from health promotion programs that aimed to empower women. A search was conducted in PubMed, MEDLINE, Web of Science, Scopus, CINAHL complete, and Academic Search Premiere databases. The search yielded 27 articles that collectively reported on 10 different programs. Through thematic synthesis, each article was analyzed for (1) key program features employed to empower women and (2) how such programs evaluated women's health. Seven themes resulted, of which five describe key empowering features (active participation, social support, sustainable change, holistic health perspective, strength-based approach) and two evaluation characteristics (assessment across multiple health domains and a mixed-method design). The findings from this review can assist health promoters to design and improve initiatives that aim to empower women.
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Affiliation(s)
- Victoria Chinn
- Massey University, Wellington, New Zealand.,Victoria University of Wellington, Wellington, New Zealand
| | - Eva Neely
- Victoria University of Wellington, Wellington, New Zealand
| | - Sarah Shultz
- Seattle University, Seattle, WA, USA.,Massey University, Albany, New Zealand
| | | | - Roger Hughes
- University of Tasmania, Hobart, Tasmania, Australia
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Ravalihasy A, Rude N, Yazdanpanah Y, Kardas-Sloma L, Desgrées du Loû A, Gosselin A, Ridde V. Development and Validation of an HIV/AIDS Empowerment Scale for Impact Intervention Evaluation. An Example from the MAKASI Intervention. AMERICAN JOURNAL OF HEALTH EDUCATION 2021. [DOI: 10.1080/19325037.2021.1955230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Andrainolo Ravalihasy
- Centre Population et Développement (IRD, Université de Paris, Inserm ERL 1244 SAGESUD)
- Institut de Recherche Pour le Développement
- UMR 1137, Inserm, University of Paris, IAME
- French Collaborative Institute on Migrations, CNRS
| | - Nathalie Rude
- UFR Santé, EA 481 Neurosciences, Université de Franche Comté
| | | | | | - Annabel Desgrées du Loû
- Centre Population et Développement (IRD, Université de Paris, Inserm ERL 1244 SAGESUD)
- Institut de Recherche Pour le Développement
- French Collaborative Institute on Migrations, CNRS
| | - Anne Gosselin
- Centre Population et Développement (IRD, Université de Paris, Inserm ERL 1244 SAGESUD)
- French Collaborative Institute on Migrations, CNRS
- ERES, Social Epidemiology Unit, IPLESP, INSERM S1136
| | - Valéry Ridde
- Centre Population et Développement (IRD, Université de Paris, Inserm ERL 1244 SAGESUD)
- Institut de Recherche Pour le Développement
- French Collaborative Institute on Migrations, CNRS
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21
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Khani Jeihooni A, Mobaraei A, Kiani A, Afzali Harsini P, Karami Ghazi Khani S. The effect of the educational intervention on empowerment of male high school students in prevention of smoking. JOURNAL OF SUBSTANCE USE 2021. [DOI: 10.1080/14659891.2021.1916844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Ali Khani Jeihooni
- Department of Public Health, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amirhossein Mobaraei
- Department of Public Health, School of Health, Fasa University of Medical Sciences, Fasa, Iran
| | - Amin Kiani
- Department of Public Health, School of Health, Fasa University of Medical Sciences, Fasa, Iran
| | - Pooyan Afzali Harsini
- Department of Public Health, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Sjögren Forss K, Kottorp A, Rämgård M. Collaborating in a penta-helix structure within a community based participatory research programme: 'Wrestling with hierarchies and getting caught in isolated downpipes'. ACTA ACUST UNITED AC 2021; 79:27. [PMID: 33676556 PMCID: PMC7936426 DOI: 10.1186/s13690-021-00544-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 02/14/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND In the light of the existence of social inequalities in health, a CBPR (Community Based Participatory Research) programme for health promotion started in Malmö, Sweden, in 2017. The programme was based on a penta-helix structure and involved a strategic steering group with representatives from academia, voluntary organisations, the business sector, the public sector, and citizens from the community where the programme took place. The aim of this study was to explore how the penta-helix collaboration worked from the perspectives of all partners, including the citizens. METHODS Individual interviews, that were based on a guide for self-reflection and evaluation of CBPR partnerships, were conducted with the representatives (N = 13) on three occasions, during the period 2017-2019. A qualitative content analysis was used to analyse the interviews. RESULTS Six themes emerged from the analysis, including Challenges for the partners in the penta-helix collaboration; Challenges for the professionals at the local level; Citizen-driven processes are important for the penta-helix collaboration; Health promoters are essential to build trust between different sectors of society; Shift of power; and System changes take time. The analysis shows that the penta-helix collaboration worked well at the local level in a governance-related model for penta-helix cooperation. In the overall cooperation it was the citizen-driven processes that made the programme work. However, the findings also indicated an inflexibility in organisations with hierarchical structures that created barriers for citizen involvement in the penta-helix collaboration. CONCLUSION The main issue uncovered in this study is the problem of vertically organised institutions where discovery and innovation processes flow down from the top, thereby eliminating the essential input of the people and community that they are supposed to serve. The success of the programme was based on an interprofessional cooperation at a local level, where local professions worked together with voluntary organisations, social workers, CBPR researchers from the university, citizens and local health promoters.
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Affiliation(s)
- Katarina Sjögren Forss
- Department of Care Science, Malmö University Faculty of Health and Society, 205 06, Malmö, Sweden.
| | - Anders Kottorp
- Department of Care Science, Malmö University Faculty of Health and Society, 205 06, Malmö, Sweden
| | - Margareta Rämgård
- Department of Care Science, Malmö University Faculty of Health and Society, 205 06, Malmö, Sweden
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Trisnowati H, Ismail D, Padmawati RS. Health promotion through youth empowerment to prevent and control smoking behavior: a conceptual paper. HEALTH EDUCATION 2021. [DOI: 10.1108/he-09-2020-0092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThis paper aimed to review globally the empowerment programs for the prevention and control of smoking behavior among youths, to examine the role of empowerment in health promotion, to explore the stages of health promotion through community empowerment strategies including planning, implementation and evaluation. Finally, this paper will develop a model of youth empowerment to prevent and control smoking behavior that reflects theory and experience drawn from the literature.Design/methodology/approachThis review synthesized articles on community empowerment and health promotion, youth empowerment programs for tobacco prevention and control globally from books and electronic databases from the Universitas Gadjah Mada (UGM) library in the publication period 2000–2020. Relevant literature was selected and critically reviewed which reflected the role empowerment in health promotion, stage of community empowerment strategy as described by Laverack and youth empowerment concept in tobacco control as described by Holden.FindingsDocuments that specifically discuss empowerment programs for smoking prevention and control are still limited. The findings document that youth empowerment in tobacco control do not fully integrate the theory empowerment as described by Laverack and Holden. This paper provides information about the stages of youth empowerment, and a conceptual framework of youth empowerment for the prevention and control of smoking behavior. Youth empowerment is done through the direct involvement of youth in programs starting from program design, planning, implementation and evaluation. Indicators of the success of the empowerment process are reflected in the increase in the empowerment domain. Meanwhile, the output of empowerment can be seen from the individual- or group-level changes.Originality/valueThis paper proposes a model of youth empowerment for the prevention and control of smoking behavior among youths based on theory and experience in the field.
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Borges Rodrigues S, Parisod H, Barros L, Salanterä S. Two sides of the same well-child visit: Analysis of nurses' and families' perspectives on empowerment in health counselling. J Adv Nurs 2020; 76:3448-3463. [PMID: 32996623 DOI: 10.1111/jan.14554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 07/09/2020] [Accepted: 07/29/2020] [Indexed: 11/27/2022]
Abstract
AIMS To explore the degree of empowering health counselling in well-child visits, considering nurse and family perspectives and to examine its associated factors. BACKGROUND Empowerment has gained high priority in the world health strategy, being claimed for its benefits for people's health and well-being. DESIGN The design includes an exploratory cross-sectional, correlational study. METHODS We collected data between January 2018-October 2019 from a convenience sample of 82 families attending a 5-year-old well-child visit and 25 nurses at Portuguese health centres. Families and nurses assessed the same counselling session using parallel statements of the Portuguese Empowering Speech Practice Scale, grouped in two subscales (nurses' action and families' action). Questionnaires also included the Parent's Longitudinal Continuity in Primary Care scale, the Family Nutrition and Physical Activity tool and anthropometric and sociodemographic questions. We employed descriptive statistics, paired-samples t-test, analysis of variance and regression analysis. RESULTS Both nurses and families reported that empowerment had been practiced in high degree. The most practiced elements were those from nurses' action subscale (e.g. constructing a positive atmosphere) and the least practiced were from families' action (e.g. disclosure). A discrepancy between nurses' and families' ratings were found for individualized information and advice, disclosure and asking questions, with families reporting higher scores. Nurses' formal training in empowerment and obesity was associated with higher scores on the nurses' action subscale. The families' limited experience with a regular health centre and nurse and families having children with overweight were both associated with lower scores on the two subscales. CONCLUSIONS Although the positive experience by nurses and families is an important finding, the reasons for the differences in perceptions of empowerment require further research. IMPACT The Portuguese Empowering Speech Practice Scale can be a useful tool to evaluate services, both from professionals' and families' perspectives and to identify areas of improvement.
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Affiliation(s)
| | - Heidi Parisod
- Department of Nursing Science, University of Turku, Turku, Finland.,Nursing Research Foundation, Helsinki, Finland
| | - Luísa Barros
- Faculty of Psychology, University of Lisbon, Lisbon, Portugal.,CICPsi, Center for Research in Psychological Science, University of Lisbon, Lisbon, Portugal
| | - Sanna Salanterä
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland
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