Empowerment in Health Promotion - Essay Example

? Empowerment in health promotion Introduction The success of projects developed in complex and demanding environments, such as the healthcare sector, is depended on a series of variables; most commonly, it is necessary that all the terms of the process, as defined by its nature, are met. The ability of its initiators to respond to its needs is also of critical importance. Current paper focuses on empowerment as a tool for developing health promotion schemes. Empowerment is a concept related to various activities; in the healthcare sector empowerment reflects the support provided to individuals so that they can act independently for improving their health. The aspects of empowerment, as used in general and in particular in the healthcare sector are presented below; emphasis is given on the theoretical approaches used for explaining the involvement of empowerment in the healthcare sector. It is proved that empowerment can be viable in health promotion but only if certain conditions exist; the internal and external environment of each case and the ability of the medical staff involved in the relevant schemes are quite important for ensuring the success of empowerment in the specific field. The differentiations identified in the interpretation of empowerment in health promotion can be considered as justified, taking into consideration the significant differences that can be identified in healthcare settings worldwide, as this issue is analytically explained below. 2. Meaning of empowerment In order to understand the role of empowerment in health promotion, it would be necessary to refer primarily to the context of empowerment, i.e. its characteristics and mission, as identified in various social areas. Then, its use in health promotion could be evaluated taking into consideration the needs of the specific sector, as identified in healthcare settings worldwide. In accordance with Ginnodo (1997) the development of an accurate definition on empowerment is a challenging task. The reason is that the specific concept is extremely generic, having the ability to incorporate a wide range of roles and activities. In a broad explanation of this term, the following definition could be given: empowerment is ‘to provide with the means and opportunity to make decisions and take actions which directly affect the customer’ (Ginnodo 1997, p.33). Based on the above definition, the following key characteristics of empowerment should be highlighted: empowerment needs to be provided, in other words, it cannot be assumed as existing. Rather it should be clearly given, under the terms that it can be used appropriately, meaning the skills and the capabilities of the person who is provided with empowerment (Barry et al. 2006). In any case, the discretion provided through empowerment is rather limited. In accordance with Ginnodo (1997) empowerment is differentiated from ‘dumping and anarchy’ (Ginnodo 1997, p.34). This means that empowerment needs to be based on specific rules/ suggestions which will be ordered without discriminating – always under the terms that the ‘empowered’ is able to understand and follow the particular orders. On the other hand, the elements and the requirements of empowerment can be differentiated across social and business activities; in business, the term empowerment is considered as a key tool for increasing motivation and self-confidence of employees (Quinn et al. 1998). From this point of view, in business area, empowerment is related to concepts and initiatives as organizational supervision, criteria of reward and job design (Quinn et al. 1998). Indeed, when empowerment needs to be evaluated as an element of the business environment, emphasis should be given to the following issue: at what level empowerment has actually promoted self-efficacy across the organization. At this point, the skills of the manager can be also revealed taking into consideration the tasks allocated to employees – under the terms that the goals set need to be achievable, based on the skills of each employee (Quinn et al. 1998). In different fields, empowerment can focus on different needs; however, its requirements and goals are similar. For instance, in the study of Narayan-Parker (2005) reference is made to the use of empowerment for fighting the global poverty. The specific role of empowerment can be identified in the World Development Report 2000/2001; in the above report, empowerment is not directly defined, rather reference is made to a series of activities, which are believed to act towards such direction, i.e. to empower people for achieving specific targets. The activities, which could be characterized as having the characteristics of empowerment, are, in accordance with the above report, the following ones: a) the increase of responsiveness of governments to global poverty, b) the elimination of social exclusion and discrimination and c) the establishment of institutions which can respond to various social needs (Narayan-Parker 2005). Theorists have used different approaches in order to explain the role and the needs of empowerment, as a strategy of coping with the needs of a particular group of people. The post-modern theory on empowerment is an indicative example. In accordance with the specific theory, the conditions in the internal and external environment, in which empowerment is developed, are likely to influence the mode of behaviour used for promoting empowerment. The above conditions are characterized as ‘empowerment terrains being depended on who is present, meaning the internal environment and the context, meaning the external environment’ (Vollman et al. 2007, p.108). The above mentioned framework has the following advantage: the control on the internal and external environment ensures that the appropriate mode of behaviour will be used for developing empowerment; in this way, the risks for a potential failure are minimized. However, the above approach has also a significant disadvantage: the conditions in the internal and the external environment are difficult to be standardized; even if standardized for a particular period of time, they are likely to start changing shortly, creating new terms of action (Holland 2007). Through a different approach, empowerment has been related to basic human needs, such as ‘food, shelter and income’ (Black et al. 2009, p.180). The above elements are characterized as ‘health prerequisites’ (Black et al. 2009, p.180). Empowerment which can intervene in health promotion needs to address these prerequisites; in such role, empowerment is characterized as a social movement, rather as an initiative developed within a specific social environment (Black et al. 2009). 3. Empowerment in health promotion 3.1 Forms of empowerment in health promotion As noted above, current paper focuses on the relationship between empowerment and health promotion. The above relationship has been explained using different theoretical frameworks and interpretations. In the study of Leddy (2006) the development of health promotion in order to meet the changing customer needs is analytically explained. It is revealed that health promotion usually focuses on the change of the behaviour of individual; however, it seems that the intervention of health promotion in human behaviour is not standardized. The following approaches have been used for explaining the above phenomenon: a) the medical approach; in the context of this approach health promotion is believed as emphasizing on ‘the correction of health problems using appropriate treatment and focusing on the control of risk’ (Leddy 2006, 10); b) the individual (also known as behavioural) approach; this approach focuses on the prevention of diseases rather on their treatment; in accordance with the above approach, the prevention of health problems is achieved through the change of a person’s lifestyle and behaviour (Leddy 2006); c) the socioenvironmental approach; it is the specific approach which is most based on empowerment. In the context of this approach, ‘the psychological, social and environmental aspects of health’ (Leddy 2006, p.l0) are reviewed and changed, if necessary, through empowerment. It is in this approach that the value of empowerment in health promotion is made clear. On the other hand, Tones et al. (2001) note that the past models of health promotion are not viable in modern society – taking into consideration the significant changes in the social and economic ethics and trends. It is explained that currently, the empowerment model of health promotion is the most appropriate for supporting the develoment of health promotion in healthcare settings worldwide. In accordance with Tones et al. (2001) the above model focuses not on the prevention of disease but on the influence of the decisions of individuals, as this influence is reflecting in the change of their behaviour (Tones et al. 2001, p.49). At a next level, it is explained that the above model can be successful only if all its requirements are met; reference is made to the three elements of the model which should exist in order for the model to perform effectively. These elements are the following ones: a) the empowerment of individual, meaning the empowerment provided to each person individually, a common aspect of empowerment in the healthcare sector, b) the community empowerment, meaning the empowerment provided to the people of a whole community (Tones et al. 2001, p.50); it is a mode of empowerment which a bit more difficult to be developed – compared to the individual empowerment presented above, since the effectiveness of such schemes require the existence of careful planning and close monitoring of all the project’s phases; c) the re-frame of health services; this mode of empowerment could be rather characterized as not behavioural but rather administrative, referring to the update and restructuring of the healthcare services as provided within a specific healthcare setting (Tones et al. 2001, p.50); it is assumed that in healthcare settings of significant size, such schemes are difficult to be developed. On the other hand, the specific mode of empowerment can be attempted at higher level, meaning at the level of the state, being incorporated in the reform of a country’s healthcare system; such schemes are quite difficult to be fully completed, but if they are successfully completed they are likely to result to significant benefits for both the state and the individual – since an effective empowerment scheme can lead to the increase of the quality of healthcare services, thus to the improvement of the performance of a country’s healthcare system. On the other hand, Potvin et al. (2008) noted that empowerment can be particularly proactive for health care promotion, but the level of its effectiveness, as a tool for developing successful health care promotion schemes, is not standardized; in fact, it is revealed that different strategies need to be developed each time empowerment is used for health care promotion. The choice of the most appropriate strategy – among those available – is the key requirement for the success of empowerment in health care promotion. A potential strategy which could guarantee the success of empowerment in health care promotion would be the following one: emphasis is given on the development stage of the empowerment scheme (Potvin et al. 2008, p.169). It is suggested that at this stage previous schemes of similar nature and scope are used, in the context that findings from similar practices would be valuable for identifying potential risks when attempting empowerment in health care promotion. Another important strategy for developing effective empowerment schemes in health care promotion would be the following one: emphasis should be given on power required for the completion of these schemes (Potvin et al. 2008, p.170). The term power in the above case is used for reflecting the dynamics of the case, i.e. the ability of the initiators to respond to the needs of the scheme but also the resources employed for the particular project (Potvin et al. 2008); it is implied that the resources required for the effective development of this scheme should be available, otherwise, the chances for the success of the scheme would be limited. 3.2 Is empowerment viable in healthcare? Empowerment is a necessary element of healthcare services. In fact, in the study of Green et al. (2010) the lack of empowerment in healthcare sector is described as a significant problem that could lead to the radical deterioration of the quality of the sector’s services (Green 2010). However, it is noted that empowerment, as an element supporting health promotion, should be developed through a series of phases. The relevant hierarchy is described as follows: a) informational control – referring to the acquisition of information required for the development of the project, b) cognitive control, meaning the process of information trying to identify those criteria that would exist for the specific initiative to be successful, c) decisional control, meaning the development of a decision, using the information acquired and processed in the above two phases, d) behavioural control which refers to the identification of the skills required for the successful development of the specific scheme, e) existential control, meaning the control regarding the conditions of the environment; at this phase, emphasis should be given to the following fact: are the conditions of the environment appropriate or preventive for the specific project? The effective development of this task, could lead to the limitation of the project’s risks, f) contingency control: in order for individuals to respond positively to the particular scheme it would be necessary that they are persuaded on their freedom to decide, i.e. they should be given the impression that they are have the full control over their decision – even if, by nature, they could not achieve such target since they are likely to be under severe pressure that reduce their crisis (Green et al. 2010). In accordance with Raeburn et al. (1998) empowerment is not just a theoretical framework; rather it is an activity with specific perspectives and requirements. For this reason, its success requires the primary investigation of the condition in which the relevant scheme will be developed; the identification and the evaluation (as possible) of the practical implications of these schemes are also quite important for its success. In this context, the findings of the research developed by John Lord and his colleagues in Ontario can help to understand the terms under which empowerment can effectively be involved in health promotion. The above project was entitled as the ‘Empowerment Research Project’ (Raeburn 1998, p 64) and led to the following finding: individuals can be ‘empowered’ even if they are under severe pressures, meaning the barriers related to their social environment or to their personal perceptions (Raeburn 1998). The above findings verify the view developed above that empowerment in health promotion is viable even if the environment, internal or external is not supportive to the specific scheme. Another example of the power of empowerment in health promotion is obesity; the ability of medical staff to empower individuals to change their lifestyle and their behavior in order to fight the specific problem is significant, even if the problem is not always emergent (Gard et al. 2005). 4. Conclusion The expansion of empowerment in health promotion cannot be denied. The review of the literature published in the specific field proved that empowerment could be quite effective when used in the specific field. However, the criteria for the evaluation of the success of empowerment in this role vary – under the influence of the local social and organizational ethics, which can justify, more or less, different approaches for empowering people in a healthcare setting (Macdowall et al. 2006). A key finding of the research developed for this study has been the following one: the effectiveness of empowerment in health care is highly depended on the ability of nurses to develop such strategies. More specifically, it has been made clear that nurses are more like to be involved in empowerment compared to medical practitioners(Gorin et al. 2006). The key reason is that the communication between nurses and patients is close, being based on continuous communication and exchange of information (Chambers et al. 2008). Under these terms, when having to evaluate the potential use and value of empowerment in health promotion, reference should be made to the following issues: a) are nurses appropriate skilled to empower patients, b) which would be the criteria on which the effectiveness of empowerment in a healthcare setting should be evaluated and c) are there alternative modes of behavior available for achieving the targets set (Piper 2009). In general, it could be stated that empowerment is the most effective strategy for coping with patients – referring especially to empowerment in the healthcare sector. However, in order for this strategy to be effective, it is necessary to be developed within a particular framework, meaning the capabilities of nurses, the level of the psychological support provided to the patients but also the ability of the patients to accept and follow the suggestions made – it is at this point that the skills of nurses to identify the needs of each patient and provide appropriate suggestions are proved (Whitehead 2000). Also, the success of empowerment in health promotion has been related to different factors, such as the active participation of all individuals engaged to this initiative (Carey 2000) but also to the alignment of these schemes with the current social ethics (Duncan et al. 1996). Of course, the negative aspects of empowerment cannot be ignored; the most common problem of empowerment is the discrimination, using various social criteria. This problem is emphasized in the study of Laverack et al. (2010) which reference is made to the discrimination faced by prostitutes in New Zealand when need to be empowered regarding their health. The social status of the above individuals has excluded them for healthcare services of satisfactory quality, as the other people across the country. On the other hand, Talbot et al. (2005) have noted that health should not be promoted as a commercial product, since such behaviour would lead to the decrease of the value of health as a right independent from economic interests, an issue which is set under consideration when empowerment is used in health promotion. The above issues show that empowerment in health promotion is effective but only if being developed using the principles of equality and fairness. References Barry, M., Jenkins, R. 2006. Implementing mental health promotion. Cambridge: Elsevier Health Sciences Bartholomew, K., Parcel, G., Kok, G. 2011. Planning Health Promotion Programs: An Intervention Mapping Approach. Hoboken: John Wiley and Sons Black, J., Furney, S., Graf, H. 2009. Philosophical Foundations of Health Education. Hoboken: John Wiley and Sons Carey, P. 2000. Community health and empowerment, in Kerr, J. 2000. Community health promotion: challenges for practice. London: Bailliere Tinball, Chapter 2, pp.27-47 Chambers, D., Thompson, S. 2008. Empowerment and its application in health promotion in acute care settings: nurses’ perceptions. Journal of Advanced Nursing, pp.130-137 Duncan, P., Cribb, A. 1996. Helping people change – an ethical approach: Health Education Research. Vol. 11, No. 3, pp. 339-348 Gard, M., Wright, J. 2005. The obesity epidemic: science, morality and ideology. London & New York: Routledge. Chapter 7, pp.126-152 Ginnodo, B. 1997. The Power of Empowerment: What the Experts Say and 16 Actionable Case Studies. Arlington Heights: Bill Ginnodo Gorin, S., Arnold, J. 2006. Health promotion in practice. Hoboken: John Wiley and Sons Green, J., Tones, K. 2010. Health Promotion: Planning and Strategies. London: SAGE Publications Holland, S. 2007. Public health ethics. Cambridge: Polity Laverack, G. 2004. Health promotion practice: power and empowerment. London: SAGE Laverack, G & Whipple, A.  2010.  The sirens’ song of empowerment:  A case study of health promotion and the New Zealand Prostitutes Collective.   Global Health Promotion, pp. 17:33 Macdowall, W., Bonell, C., Davies, M. 2006. Health promotion practice. Understanding public health. London: McGraw-Hill International Naidoo, J., Wills, J. 2000. Health promotion: foundations for practice. Cambridge: Elsevier Health Sciences Narayan-Parker, D. 2005. Measuring empowerment: cross-disciplinary perspectives. World Bank Publications Piper, S. 2009. Health Promotion for Nurses: Theory and Practice. Oxon: Taylor & Francis Potvin, L., McQueen, D., Hall, M. 2008. Health Promotion Evaluation Practices in the Americas: Values and Research. New York: Springer Purdy, M., Banks, D. 1999. Health and exclusion: policy and practice in health provision. London: Routledge Quinn, J., Davies, P. 1998. Ethics and empowerment. Hampshire: Macmillan Press Raeburn, J., Rootman, I. 1998. People-centred health promotion. John Wiley and Sons Skelton, R. 1994. Nursing and empowerment: concepts and strategies. Journal of Advanced Nursing, 19, 415-423 Talbot, L. & Verrinder, G. 2005. Promoting Health: The primary health care approach, Elsevier Australia, Marrickville, N.S.W., pp. 215-236 Tones, K., Tilford, S. 2001. Health promotion: effectiveness, efficiency, and equity. Cheltenham: Nelson Thornes Vollman, A., Anderson, E. 2007. Canadian Community as Partner: Theory & Multidisciplinary Practice. Carol Stream, IL: Lippincott Williams & Wilkins Whitehead, D. 2000. Health Education, behavioural change and social psychology: nursing’s contribution to health promotion? Journal of Advanced Nursing, 34(6): 822-832 Read More