Nelma B. Crawford Shearer

Health Empowerment Theory as a Guide for Practice

T he Administration on Aging forecasts that by 2020, approximately 55 million adults in the United States will be aged 65 and older, many of whom will come in contact with nurses as they seek health care for a variety of reasons. Many older adults are likely to live alone, suffer from chronic illness, spend more years and a greater percentage of their lifetime disabled, and have limited income. The process of aging and the experience of older age reflect lifelong interactions of individuals and their environment. As people age, their health needs become more complex, and recognition of personal resources and social-contextual resources as a basis for purposeful participation in the attainment of health goals may be limited. Our knowledge concerning the potential role for health promotion efforts to manage chronic illness and promote well-being in older adults remains relatively limited. Further, there is a paucity of intervention studies promoting well-being in older adults. Awareness of personal and social-contextual resources appear to play an important role in promoting well-being in older adults who experience chronic illness. Access to resources may be particularly important among older adults, representing a critical area for intervention by community health nurses. The challenge for nurses is to facilitate awareness of and access to personal resources and social-contextual resources. The purpose of this article is to describe a theorydriven approach to developing an intervention designed to foster personal resources and social-contextual resources through the promotion of health empowerment and purposeful participation in goal attainment, enhancing well-being in homebound older adults. The health empowerment theory guided the development of the Health Empowerment Intervention (HEI).

Empowerment: Reformulation of a Non-Rogerian Concept

The authors present a reformulation of empowerment based upon historical and current perspectives of empowerment and a synthesis of existing literature and Rogerian thought. Reformulation of non-Rogerian concepts familiar to nurses is proposed as a strategy to accelerate the mainstreaming of Rogerian thought into nursing practice and research. The reformulation of empowerment as a participatory process of well-being inherent among human beings may provide nurses with new insights for practice. This paper may also serve as a model for reformulating other non-Rogerian concepts and theories for wider dissemination across the discipline.

Randomized control trial of the Health Empowerment Intervention: feasibility and impact.

Background: Older adults prefer to stay in their homes for as long as possible but are often unaware of the resources in their community to help them to remain in their home. Access to resources may be important among older adults, representing a critical area for intervention. Objectives: The study aim was to evaluate the feasibility of the Health Empowerment Intervention (HEI) and to explore the impact of the HEI on the theoretical mediating variables of health empowerment and purposeful participation in goal attainment and the outcome variable of well-being with homebound older adults. Method: Fifty-nine eligible homebound older adults were randomly assigned to the intervention group or the comparison group. The HEI consisted of 6 weekly visits, whereas the comparison group received a weekly newsletter for 6 weeks. Participants were measured at baseline, after the 6-week protocol, and at 12 weeks. Data were analyzed using descriptive statistics, t test, &khgr;2, and analysis of covariance. Results: There was a significant difference between groups in education. The participants in the intervention found the sessions to be helpful in recognizing resources. In addition, participants in the intervention group had significantly higher scores in the mediator purposeful participation in goal attainment, F(2, 83) = 3.71, p = .03. There was no significant main effect for the mediator health empowerment; however, the intervention group increased in the subscale personal growth from baseline to 12 weeks, F(1, 83) = 3.88, p = .05. Discussion: This randomized control trial provided initial support for the hypothesis that homebound older adults receiving the HEI would find the intervention acceptable and have significantly improved health empowerment, purposeful participation in goal attainment, and well-being than an attentional comparison group receiving a weekly newsletter.

Empowerment Interventions for Older Adults

There has been much discussion regarding the need to empower older adults to make informed health decisions and to test interventions targeting empowerment to promote health among older adults. It has been suggested that an empowerment approach may nurture an older adult’s participation in health care decisions and promote positive health outcomes. The purpose of this article is to report the findings of a critical review of published empowerment intervention studies with community-dwelling older adults. A descriptive literature review was conducted to examine how empowerment is conceptualized across interventions, the guiding theoretical frameworks, the outcomes measured, as well as the health outcomes of these interventions. Based on the findings from this review, recommendations for future empowerment intervention research with older adults as well as implications for practice are proposed.

Social support promoting health in older women.

ABSTRACT Given the aging of women and their increased risk for health problems, it is important to explicate factors that may foster health promotion. While social support has been a concept of interest in predicting health promotion in women, the concept has been inconsistently defined and poorly explicated. A qualitative study was conducted to describe the types and processes of social support for health promotion in older women. Focus group interviews with 51 women, aged 55–93, were held. Data were analyzed using open coding to categorize data with attention to consistency and variance. Data explicated aspects of social support unique to health promotion in community-dwelling older women. Broad categories identified included connectedness and collectivism. Findings validate existing conceptualizations and provide an expanded perspective of social support by demonstrating aspects of support unique to the social context of older, community-dwelling women. Findings also provide a basis for development of socially relevant interventions designed to promote health and optimize health outcomes in older women.

An innovative approach to recruiting homebound older adults.

Recruiting older adults to participate in intervention research is essential for advancing the science in this field. Developing a relevant recruitment plan responsive to the unique needs of the population before beginning a project is critical to the success of a research study. This article describes our experiences in the process of recruiting homebound older adults to test a community-based health empowerment intervention. In our study, the trust and partnership that existed between the research team and Community Action Agency facilitated the role of the home-delivered meal drivers as a trusted and untapped resource for study recruitment. Researchers can benefit from thinking creatively and developing meaningful partnerships when conducting research with older adults.

The rhythm of health in older women with chronic illness.

Trends in population growth indicate that nurses increasingly will be caring for older adults, especially older women, who are at risk for less than optimal health due to chronic illnesses. The purpose of this qualitative study was to obtain a better understanding of the meaning of health from the perspective of older women. Focus group interviews with 51 women, aged 55 to 93, were held. Data were analyzed using directed qualitative content analysis. A Rogerian perspective of human health provided the broad conceptual lens for the study. Three themes explicating the meanings of health emerged from the data: realizing the potential for purpose, listening to energy flow, and purposefully participating in health-related changes. The three themes represented ways in which the women dealt with the paradoxes posed by their chronic illness. Findings captured the hopeful, although sometimes conflicting, meanings of health among the women as brought forth by experiences with chronic illness and the challenges of aging.

Relationships of contextual and relational factors to health empowerment in women.

The purpose of this study was to determine the relationships of contextual and relational factors to health empowerment in women with children. This study used a descriptive, correlational design to answer the basic research question: “What contextual and relational factors explain health empowerment in women?” The theoretical framework of health empowerment was based upon a synthesis of social and developmental perspectives and guided by a Rogerian view of the person-environment process. The analytic approach included bivariate correlations and a series of multiple regressions to identify factors explaining health empowerment. The contextual (demographic) and relational (social and professional support) factors explained 38% of the variance in health empowerment measured as knowing participation in change. For health empowerment, measured as lifestyle behaviors, the contextual and relational factors explained 43% of the variance. The results of this study offer partial empirical support for theoretical relationships. Findings provide a basis to generate additional nursing research focusing on the continuous mutual process of human beings and the environment, leading to theory-based interventions.

Combining motivational and physical intervention components to promote fall-reducing physical activity among community-dwelling older adults: a feasibility study

Purpose. To assess the feasibility of a new intervention, Ready~Steady, in terms of demand, acceptability, implementation, and limited efficacy. Design. Randomized controlled trial; repeated measures. Setting. Two rural communities in Itasca County, Minnesota. Subjects. Thirty participants were randomized to an intervention (n = 16) or attention-control (n = 14) group. Intervention. Ready~Steady combined two components: (1) motivational (motivational support, social network support, empowering education), and (2) fall-reducing physical activities (PAs; guidance to practice leg-strengthening, balance, and flexibility activities and walking). Measures. Acceptability questionnaire and Indices of Procedural Consistency (investigator developed), Community Health Activity Model Program for Seniors Questionnaire (confirmed with accelerometry), Short Physical Performance Battery, Perceived Environmental Support Scale, Social Support for Exercise Questionnaire, Goal Attainment Scale, Index of Readiness, and Index of Self-Regulation. Analysis. Descriptive statistics and a marginal approach to repeated-measures analysis of variance, using mixed-model procedures. Results. Attrition was 7% and mean attendance was 7.2 of 8 sessions, participants evaluated Ready~Steady as acceptable, and implementation fidelity was good. The intervention group improved significantly more than the attention-control group in PA behavior, F1,27 = 11.92, p = .002; fall risk (functional balance and strength), F1,27 = 14.89, p = .001; support for exercise from friends, F1,27 = 11.44, p = .002; and self-regulation, F1,26 = 38.82, p < .005. Conclusion. The Ready~Steady intervention was feasible as evidenced by low attrition and good attendance and implementation, as well as positive effects on targeted outcomes and theoretical mechanisms of change.

Exploring telehealth opportunities in domestic violence shelters.

Purpose To determine the degree of interest in using a computer for the purpose of accessing services from a nurse practitioner (NP) at domestic violence shelters (DVSs); and to identify issues of privacy and confidentiality that might arise from participation by victims of intimate partner violence (IPV) in a Telehealth intervention. Data Sources Focus groups with 19 women residing in two DVSs. Interviews were recorded, transcribed and themes were identified that answered the questions posed in the interviews. Conclusions Most of the women understood the term NP and were favorably inclined to seek services from one. Over half of the women were not familiar with computer use, but were willing to learn in order to receive health care services, both for episodic needs and for maintenance of chronic conditions. After learning of the method proposed to allow them to access an NP through the internet while still protecting their privacy and confidentiality, the women felt comfortable with this approach to meeting their health care needs. Implications for Practice Results from this study can be used to support the development and testing of Telehealth interventions for these victims of IPV.