Ruth Cross

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 impact of conditional cash transfers on child health in low- and middle-income countries: a systematic review

ObjectivesThe review aimed to assess the effectiveness of conditional cash transfers (CCTs) in improving child health in low- and middle-income countries.MethodsSeven electronic databases were searched for papers: MEDLINE, EMBASE, PubMed, PsychINFO, BIOSIS Previews, Academic Search Complete, and CSA Sociological Abstracts. The included studies comprised of randomised controlled trials and controlled before-and-after studies evaluating the impact of CCTs on child health. Due to the substantial heterogeneity of the studies, a narrative synthesis was conducted on the extracted data.ResultsSixteen studies predominantly from Latin American countries met the inclusion criteria. The outcomes reported by the studies in relation to CCTs’ effectiveness in improving child health were reduction in morbidity risk, improvement in nutritional outcomes, health services utilisation, and immunisation coverage.ConclusionsThe review suggests that to a large extent, CCTs are effective in improving child health by addressing child health determinants such as access to health care, child and maternal nutrition, morbidity risk, immunisation coverage, and household poverty in developing countries particularly middle-income countries. Of importance to both policy and practice, it appears that CCTs require effective functioning of health care systems to effectively promote child health.

Motivational Interviewing Interventions and Alcohol Abuse Among College Students: A Systematic Review

Objective. The study sought to assess the effectiveness of Motivational Interviewing (MI) interventions in reducing alcohol consumption among college students, as compared to no intervention or alternative interventions. It also sought to identify the potential moderators to MI intervention effects. Data Source. Database sources consulted included Cochrane Central Register of Control Trials, PsycINFO, PsycARTICLE, PsycLIT, CINAHL, and MEDLINE. Study Inclusion and Exclusion Criteria. Included studies were (1) underpinned by experimental, quasi-experimental, and nonexperimental designs; (2) studies in which participants were either college males only or females only or both; and (3) studies in which adaptations of MI were based on key MI principles. Excluded studies were (1) non-English language studies; (2) studies not published from 2000–2012; (3) studies in which participants were not college students; (4) studies in which intervention was not delivered by face-to-face approach; and (5) studies that failed to embark on postintervention follow-ups. Data Extraction. A total of 115 abstracts were screened. These were narrowed down to 13 studies from which data for the study were extracted. Data Synthesis. Selected studies were underpinned by experimental, quasi-experimental, and nonexperimental designs. Owing to the heterogeneity in selected studies, a narrative synthesis was used. Results. MI interventions were found to be effective in reducing alcohol consumption among college students, when compared to alternative interventions or no intervention. Potential moderators of MI intervention effects were identified to include practitioners adherence to MI techniques and individuals drinking motives. Conclusion. MI presents itself as a promising tool that can augment the many existing social-environmental strategies of health promotion.

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.

Evidence-based practice in local public health service in Ghana

Abstract While the role of evidence-based public health in improving health outcomes is frequently touted, there remains a dearth of research examining the use of evidence in public health service particularly in low- and middle-income countries. Therefore, the aim of this research was to examine the use of evidence in local public health service in Ghana, a lower middle-income country. Semi-structured in-depth interviews were conducted with local health managers from 11 District Directorates of Health in Ashanti Region. Three organising themes emerged from the interview transcripts: understanding of evidence-based public health; the process of using evidence; and the value of evidence in public health practice. The study suggests that though evidence-based practice was not new to the local health managers, its application was very low. The process of using evidence commenced with making a decision about the direction of a programme which had been already prioritised and planned by other high-level actors and then various sources of information, including available research evidence, were used to justify the decision. The study has revealed that there is an urgent need for pre-service and in-service training programmes that build and maintain common skill sets and language among local public health practitioners in Ghana to accomplish evidence-based public health goals. Similarly, giving local health managers flexibility to prioritise and make decisions would result in increased uptake of evidence in local public health service.

An evaluation of the condom distribution scheme (C-Card) with young people in northeast England:

Aims: To evaluate a local C-Card scheme from the perspectives of young people in order to determine how well it had worked in improving access to condoms and in providing young people with appropriate information to make healthier choices around safer sex. Methods: Secondary analysis of a year’s worth of existing registration and monitoring data routinely collected by the C-Card scheme, two focus group discussions with 14 young people (eight males and six females) and a short questionnaire-based survey of 55 young people. Results: The evidence suggested that the C-Card scheme is an effective tool for ensuring that young people know how to use a condom correctly. Ease of access and increased knowledge were key issues of effectiveness to emerge from the findings. The scheme also served as a mechanism for young people to be referred on to other sexual health services and the data appear to indicate that this was something that was taken up by young people. Conclusions: The young people who used C-Card generally viewed the scheme as an effective mechanism in terms of accessing condoms and the number of outlets available for acquiring condoms. In order for C-Card to become successful with young people, advertising needs to be improved to increase their awareness of the scheme.

Using peer research processes to understand strategies to support those with severe, multiple and complex health needs

Objectives: There has been an increased focus in policy discourse on individuals with severe, multiple and complex needs. This paper seeks to understand how best to enable these individuals to take greater control over their health. Design: Qualitative, user-led, peer research. Setting: Large urban UK city. Method: Trained peer researchers with previous experience in contexts of severe and multiple disadvantage gathered data using a snowball sampling approach from 21 individuals engaged in a service specifically designed to provide for their needs. Results: The study identified enabling factors that create conditions for individuals with severe and multiple disadvantage to take greater control of factors impacting on their health and social situations. These included working holistically with individuals, understanding the interconnected issues impacting on health, developing trusting relationships with professionals and working within a positive framework that fosters self-belief and which is focused on salutogenesis rather than pathogenesis. Conclusion: There exists a set of enabling factors that may support individuals facing particular challenges in their lives. While derived from within a specific geographical context, findings have relevance to other settings in relation to ways of working. Peer research demonstrates itself to be a research approach well suited to understanding lived experiences.

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.