Empowerment

Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Community Health Nursing, 5/e
Mary Jo Clark
Community Empowerment
13
CHAPTER

Mary Jo Clark
Definitions
• One of the three strategies of health
promotion.
– What are the other two strategies?
• “an enabling process through which
individuals and communities take control
over their lives and their environment”.
(Minkler &Wallerstien, 2005, p 26)

Mary Jo Clark
Health Promotion
• ‘Health promotion is the process of enabling people to
increase control over, and to improve, their health’.
(Ottawa Charter, WHO, 1986).
• ‘Health promotion is the process of enabling people to
increase control over the determinants of health and
thereby to improve their health.’ (Bangkok Charter,
WHO, 2005).

Mary Jo Clark
Health Promotion
• Enables people to increase control
(empowerment) over their lives and health
(gaining more power).
• Health promotion uses a range of
communication, capacity building and
empowerment interventions to achieve its
goals.

Mary Jo Clark
• Process of enhancing capacity of
communities to:
– Control their own lives
– Initiate change
– Mobilize and use resources
– Obtain services to address health problems
– Collectively counter health risk
behaviors/conditions

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Empowerment:
The Means to ‘increasing control over’
• Personal
• Organizational
• Family
• Community/ collective

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Levels of Empowerment
• Individual and community empowerment
• Horizontal and vertical empowerment
• Continuum empowerment

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Individual Empowerment
• Individual community member
• Focuses on improving individual skill and
self-esteem

Mary Jo Clark
Personal Empowerment
The goal of personal empowerment is to
increase feelings of value and a sense of
mastery.
Psychological empowerment integrates
perceptions of personal control, a proactive
approach to life, and a critical understanding of
the sociopolitical environment.
(Zimmerman, 1995)

Mary Jo Clark
• Community at large
• Addresses increased civic participation

Mary Jo Clark
Collective Empowerment
‘a process by which disadvantaged people work
together to increase control over events that
influence their lives’ (David Werner, 1988).
It is social organization and action aimed at
addressing an injustice or inequity.
It is used to influence those who hold power and
who use it to control other people.

Mary Jo Clark
Collective Empowerment
Social change
 Values and behaviours (stigma, societal norms)
Political change
 Policy & legislation (minimum wage, taxation)
Economic change
 Policy & legislation (welfare and benefits)

Mary Jo Clark
Horizontal Empowerment
• Problem solving using community’s own
resources

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Vertical Empowerment
• Change power structures outside the
community

Mary Jo Clark
Continuum empowerment
• Personal empowerment
• Development of small mutual support
groups
• Development of community organizations
• Development of coalitions of community
organizations and linking to outside
resources

Mary Jo Clark
Continuum empowerment
1 2 3 4 5
<-- ---------- ------------- ------- ------- ---->
Personal action
(adapted from Jackson et al, 1989; Labonte,
1990; Rissel, 1994)
Small
groups
Community
organisations
Partnerships
Action for
Social &
Political
Change

Mary Jo Clark
The fight for access to Herceptin®
• About 1 in 5 women with breast cancer have
tumours that are sensitive to treatment using
Herceptin®.
• Women’s groups campaigned for NHS Trusts in the
UK to fund the use of Herceptin® more widely.
• The minimum cost to pay for the treatment was well
beyond the means of most women with breast
cancer.
• The Trusts refused to fund the drug and preferred to
wait, for safety concerns, for a decision from the
National Institute of Health and Clinical Excellence.
• This outraged many women.

Mary Jo Clark
• The women took
actions such as sit-ins
outside hospitals and
petitions to their MPs.
• NICE was then put
under pressure to make
a quick decision.
• Eventually, the success
of a high profile court
case ensured that
Herceptin® was
approved for use on the
NHS.
(Boseley 2006)

Mary Jo Clark
An Empowered Community
The existence of functional leadership, established
community structures, participation and the ability to
mobilize resources are indicative of strong
organizational and social abilities and capture the
essential qualities of an empowered community.
A link between the inter-personal elements such as
individual control and positive relationships and the
collective elements such as community capacity,
mobilization and action.

Mary Jo Clark
The role in improving health
1. People can address their concerns in regard to
health when others do not or cannot.
2. To engage with and help individuals and
groups to empower themselves.
3. Mobilizes people towards broader collective
action to change the circumstances that can
lead to an improvement in their health.

Mary Jo Clark
The Professional Context
1. Identify your own power base - you cannot help
others to empower themselves without first
understanding your own power base.
2. Facilitate others to identify their own power
base by mapping, ranking and prioritizing their
concerns.
3. Enable others to build their capacity to find the
solutions to their concerns.

Mary Jo Clark
Research and Development
• PEOPLE
• PRACTITIONERS
• POLICY MAKERS
• Effective approaches to engage
with disadvantaged groups in
society.
• Professional competencies to
facilitate the empowerment of
people at all levels.
• Evidence of the link between
personal empowerment and
collective action.
• Evidence of the link between
empowerment and health
outcomes.

Mary Jo Clark

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Community Development
• Rejuvenation of communities
• Housing and business development
• Empowerment occurs when communities
take action and participate in health
related decision making for disadvantaged
groups

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Community Organization
• Aiding group to identify common
problems/goals
• Mobilize resources
• Develop and implement strategies for
reaching goals
• This process is more problem-specific
compared to community empowerment
where communities address more than
one problem

Mary Jo Clark
Community Mobilization
• Population-based assessments,
interventions, and evaluations
• Problem-specific
• May result in empowerment if actions and
efforts are multifocal and health related

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Community Building
• Continuous, self-renewing efforts
• Collective action aimed at problem solving and
enrichment
• Creates new or strengthened social networks
• Creates new capacities for group action and
support
• Creates new standards for the life of community
• Community building efforts may lead to
increases in community social capital
• May not focus specifically on health problems

Mary Jo Clark
Rothman’s Framework
(Refer to Table 13-1)
• Locality development
– Sense of community and group identity
• Social planning
– Focuses on resolution of specific problems
identified in the community
• Social action
– Increasing problem solving ability of the
community in general

Mary Jo Clark
Community Action Model
• Step 1: Train key members and identify issues or
concern
• Step 2: Conduct community diagnosis and
assess extent of the effect on community
• Step 3: Analyze diagnostic results
• Step 4: Select, plan, and implement actions
specific to the issue and identify desired
outcomes
• Step 5: Enforce or maintain action or activity

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Nursing Model of Community
Organization for Change
• Assessment/reassessment
• Planning/design
• Implementation
• Evaluation/dissemination

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Community Organization Model
• Community analysis
• Design initiation
• Implementation
• Maintenance/consolidation
• Dissemination/reassessment
• Role of community health nurse

Mary Jo Clark
Planned Approach to Community
Health (PATCH)
• Mobilize the community
– Identify appropriate community members to
participate
• Collect and organize data related to the issue
– Assist community members to design and conduct
community needs/asset assessment
• Choose health priorities
– Assist community members to prioritize issues and
select one for action

Mary Jo Clark
Planned Approach to Community
Health (PATCH) (continued)
• Develop comprehensive intervention plan with
multisectoral collaboration
– Assist community members to determine desired
outcome of action
– Identify and evaluate possible alternative approaches
to action
– Develop specific strategies for selected alternative
approach
• Evaluate the effectiveness of interventions
-- Assist community members in the development of
criteria to measure success and data collection methods
and in analyzing evaluative data

Mary Jo Clark
Natural Helper Model
• Use of natural helpers within the
community to promote community
empowerment
– Those whom other turn to naturally for advice,
emotional support, and tangible aid
– Examples: family, friends, neighbors, role-
related helpers, volunteers

Mary Jo Clark
Process of Community Empowerment
• Assessment
• Planning
• Strategies for implementation
• Evaluation

Mary Jo Clark
Empowerment Process
• Empowerment activity
• Planning empowerment strategies
• Implementation of strategies
• Evaluating the outcomes of empowerment
activities

Mary Jo Clark
Community Assessment
• Selection of approaches
– Community needs-based solutions
– Assets-based approach
– Dimensions of health and community
indicators
• Quality of life indicators
• Provocative indicators

Mary Jo Clark
Community Assessment Planning
Process
• Issue selection
– Identify specific targets of change
• Team building
– Encourage member participation and commitment
– Stages of team building
» Forming
» Storming
» Norming
» Performing

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Coalition Development
• Resource acquisition
• Development of maintenance subsystem
• Production
• Goal attainment

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Implementation Strategies
• Media advocacy
– Use of mass media to advance a social or
public policy agenda
– Functions
• Drawing public attention to an issue/power
inequities
• Focus attention on factors contributing to issues of
concern

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Community Workers
• Natural helpers
• Community volunteers
• Community health workers

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Evaluation
• Participatory evaluation
– A partnership approach to evaluation
– Engages those with interest in all aspects

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Steps of Evaluation
• Take stock of community status,
resources, capacities, challenges, and
programs
• Set goals for evaluation
• Develop evaluation strategies
• Document evaluation process/findings

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Participatory Evaluation Criteria
• Basic principles
– Community participation/ownership
– Collaboration among stakeholders
– Promote change on multiple levels
– Transform power relationships

Mary Jo Clark
Role of Community Health Nurse
• Active proponents of and participants in
community empowerment
• Advisory role
• Facilitative role
• Discovery role
• Decision role

Empowerment

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