Louise Warwick-Booth

Has empowerment lost its power

Empowerment is espoused as a flagship value ofhealth promotion. From the bold assertions in theOttawa Charter [1] and the Jakarta declaration [2]through to therecentcommitmentinNairobi[3], thediscourse of empowerment has been unwaveringthroughout. This short points of view paper intendsto stimulate critical discussion about the continuedvalue and use of empowerment in contemporaryhealth promotion. While empowerment has beenseen as a cornerstone of health promotion practiceand philosophy [4], we argue that unresolved chal-lenges associated with the concept may inhibit thecontinued primacy of empowerment within the dis-cipline. A recent evidence review of empowermentand its application to health and well-being (con-ducted by two of the authors and based primarilyon evidence published between 2000 and 2010) hasstimulated this assertion [5]. Lengthier discussionsabout these issues are currently being prepared forpublication; therefore, this short article intends tofocus on the definition of empowerment and, inthe authors’ point of view, the dilution of the con-cept from its original roots as a radical socialmovement.Empowerment,withitsoriginsinliberatorypeda-gogy, is generally viewed as an approach to enablepeople who lack power to become more powerfuland gain some degree of control over their lives andhealth [6]. This suggests that empowerment app-roaches must operate at various levels, from focuss-ing on both the individual through to organizationsand communities [7]. This perspective was capturedby Rappaport [8, p. 122] who suggested that em-powerment is:a process by which people, organzations andcommunities gain mastery over their affairs.This was further reaffirmed by Wallerstein[9, p. 198] who has referred to the concept as:...a social-action process that promotes theparticipation of people, organizations andcommunities towards the goals of increasedindividual and community control, politicalefficacy, improved quality of life and socialjustice.Labonte [10] describes empowerment as em-bodying both resistance to power structures throughadvocacy and processes such as community orga-nization, as well as community building and devel-opment. Thus, it is about giving and taking power inunison. In this respect, it is a zero–sum relationshipand power in essence is finite. For example,resources being directed at some people can causethe displacement of power (disempowerment) fromothers due to competition for the same resources[11, 12].In its widest and most radical sense, empower-ment concerns combating oppression and injusticeand is a process by which communities work to-gether to increase the control they have overevents that influence their lives and health [13].This is reflective of health promotion as it was in-tended tobe, albeit as an idealistic vision. Inthe pasttwo decades, however, the focus within publichealth and health promotion has increasingly

The community health apprentices project-the outcomes of an intermediate labour market project in the community health sector

This paper reports on the outcomes of the Community Health Apprentices Project, an intermediate labour market (ILM) project delivered in two neighbouring areas of Bradford, England. The project was illustrative of current UK policy in its attempt to both address unemployment and health inequalities. The aim of the paper is to improve understanding of the type and range of outcomes that can result from ILM projects based in the community health sector. A qualitative evaluation was undertaken and interviews were carried out with three groups of stakeholders: the community health apprentices, key informants in the placement organisations and the delivery partners. Findings show that both anticipated and unanticipated outcomes occurred in relation to increased skills for work, improved health and well-being and improved organisational capacity. While there are contextual factors which make this project unique, the findings illustrate the potential range of outcomes that can be achieved when social and emotional support is offered in tandem with work experience. The findings further highlight the organisational benefits of investing in local people to deliver community health work. The paper concludes that in order to build an evidence base for ILM approaches, a broader understanding of outcomes needs to be developed, taking into account social and health outcomes as well as economic indicators.

What makes health promotion research distinct

There have been concerns about the decline of health promotion as a practice and discipline and, alongside this, calls for a clearer articulation of health promotion research and what, if anything, makes it distinct. This discussion paper, based on a review of the literature, the authors’ own experiences in the field, and a workshop delivered by two of the authors at the 8th Nordic Health Promotion Conference, seeks to state the reasons why health promotion research is distinctive. While by no means exhaustive, the paper suggests four distinctive features. The paper hopes to be a catalyst to enable health promotion researchers to be explicit in their practice and to begin the process of developing an agreed set of research principles.

Health Champions and Their Circles of Influence as a Communication Mechanism for Health Promotion

Abstract: Health Champions are a growing component within the British public health workforce and their roles are now emphasised within the coalition’s Government’s public health strategy. However, there is the need for further exploration of the way in which Health Champions use interpersonal communication within their roles. This paper reports on the findings from a mixed method evaluation of one Health Champion programme in North East England. A key finding was the way in which Health Champions used circles of influence to communicate health knowledge and to try to achieve behaviour change, starting with themselves in the centre of their circle and then moving outwards to influence others such as family, friends and colleagues through their social networks. The paper argues that health champions act as healthy role models within their own circles of influence to successfully communicate health knowledge to those around them.

Locally Directed Policy and the Fostering of Social Capital Within Regeneration: The Case of Objective 1 South Yorkshire

This article reports the findings of a qualitative study on the impact of community-based research within the South Yorkshire Objective 1 Programme. Based upon semi-structured interviews with participants who conducted community-based research, the study highlights the social capital impacts arising from the use of such research within development practice particularly in terms of the formation of networks and the development of trust. Although community-based research can enhance social capital, the study demonstrates that this is a complex process and as such is not an easy tool to harness and use within the policy-making process.

Using community-based research within regeneration. The role of the researcher within community-based approaches – exploring experiences within Objective 1 South Yorkshire

Much attention has been given in recent years to involving community members in research within a number of fields including community development. Indeed, there is a large amount of literature outlining what this process involves and describes the benefits and problems of doing such research across a range of contexts. There has also been some discussion of the different approaches that can be applied under the umbrella of community-based research and their relationship to the outcomes associated with both successful and positive community development. Yet very little attention has been paid to the actual experiences of these lay researchers involved in community-based research in relation to their roles. The nature of the researchers role as work thus requires critical consideration. This article examines the role of lay researchers within four different approaches to community-based research used for the development of community action plans within the Objective 1, South Yorkshire context. This article reports upon differential roles and types of work in relation to both experiences and outcomes. The article, therefore, addresses what these different researcher roles tell us about community-based research and outlines the implications in relation to community development.

Health promotion education in changing and challenging times: Reflections from England:

Health education has changed in many ways since Health Education Journal was first published, with developments moving the discipline forward in ways not envisaged 75 years ago. While there have been recent concerns about the decline in status of health promotion and linked worries about health education, the contemporary evidence base has grown to support the delivery of good quality health education and the development of capable and skilled practitioners. Pedagogy has further developed as well, and new technology now enables health education to have broader reach through online teaching and learning, social media and open-access publications. Global challenges remain, however, and the context in England is one in which both education and practice face major trials despite the contribution that health education has made by those educated and trained in this setting over a period of many years.

Evaluating a gender-specific intensive intervention programme: young women's voices and experiences.

Background: Disadvantaged young women in England have been documented as having unmet needs. This has resulted in the growth of gender-specific intensive intervention programmes in which a more holistic women-centred service approach is implemented. Gender matters because structural inequalities (bias and disadvantaging societal conditions) that girls are born with influence health, their outcomes and associated inequalities. Aims and objectives: Policy-makers frequently call for the outcomes of intervention programmes to be quantified, and while this is important, it can miss opportunities for critical insights into the subjective experiences of participants as well as the context and circumstances within which change occurs. Methods: This paper reports on evaluation findings from a prototype project (The Way Forward) with a focus on holistic improvement using gender-specific methods and approaches to promote health for disadvantaged young women in a community setting. Findings: This paper documents the voices of young women within the project, illustrated through their creation of storyboards within focus group discussions and interview data from their support workers. Findings highlight the importance of the relational dimension of one-to-one support in achieving positive change in the lives of young women, as well as the complexity associated with efforts to improve their health.

It's the way I tell 'em! It is not what we teach but how we do it: using focus group discussions to research student perspectives on threshold concepts in health

This case study will introduce the reader to threshold concepts outlining what they are and how they are defined, before moving on to discuss a qualitative research project with undergraduate students to explore perceptions of threshold concepts within health. The study aimed to establish if threshold concepts within health are identifiable from a student perspective and to explore the teaching and learning processes by which students master such concepts. Focus groups were conducted with students at level 6 of an undergraduate health related degree (health studies), and this case study will outline the data collection processes undertaken within this research. This case study provides an account of the research process, taking the reader through the methods that were used describing focus group discussions with students as a data collection mechanism to both explore and try to gain understanding of the ways in which they learn. The case sheds light upon the challenges of conducting research with students that are being taught by staff who are also researching them, as well as highlighting the findings which show how students learn using the conceptual tool of thresholds as a way to explore processes of learning from the perspective of the student.

Creativity and innovation in focus groups: A storyboard approach

Extended work shifts of 12 hours or more have become a common scheduling strategy for nurses in several countries, though this is not the case in Norway. There, many managers, nurses, and union representatives have expressed concerns about whether nurses can function effectively while working long shifts. This study thus aimed to examine how long shifts influence nursing outcomes such as stress, continuity, and responsibility in Norwegian nursing homes. Data were collected during indepth interviews with 16 nurses employed at four different nursing homes who have worked 12–14-hour shifts. Results suggest that long shifts actually reduce stress and increase both work continuity and accountability, though these positive impacts of long shifts occur primarily when all departmental staff work long shifts. Furthermore, fewer shift changes mean more time spent with patients and better communication.Background: All health professionals, especially nurses, are uniquely positioned to identify, intervene with and educate women about risks associated with excessive alcohol use. Nurses can: identify women at risk for alcohol-exposed pregnancy (AEP); deliver evidence-based interventions to at-risk women and; provide referrals as necessary. The Centers for Disease Control (CDC) has funded University of Pittsburgh, School of Nursing in collaboration with University of Alaska and University of California at San Diego to disseminate information about alcohol screening and brief intervention (SBI) for prevention of AEPs and fetal alcohol spectrum disorders (FASD). Alcohol use among women of child bearing age (18 to 44 years) has remained high over the past several decades (CDC, 2014, 1999; SAMHSA, 2004). Alcohol use screening is not a routine standard of care, and yet, FASD training for nurses can be effective.