Empowerment

community empowerment

1. Copyright ©2008 by Pearson Education, Inc.
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Community Health Nursing, 5/e
Mary Jo Clark
Community Empowerment
13
CHAPTER

2. Community Health Nursing, 5/e
Mary Jo Clark
Copyright ©2008 by Pearson Education, Inc.
Community Empowerment
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)

3. Community Health Nursing, 5/e
Mary Jo Clark
Copyright ©2008 by Pearson Education, Inc.
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).

4. Community Health Nursing, 5/e
Mary Jo Clark
Copyright ©2008 by Pearson Education, Inc.
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.

5. Community Health Nursing, 5/e
Mary Jo Clark
Copyright ©2008 by Pearson Education, Inc.
Community Empowerment
•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

6. Community Health Nursing, 5/e
Mary Jo Clark
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Empowerment:
The Means to ‘increasing control over’
•Personal
•Organizational
•Family
•Community/ collective

7. Community Health Nursing, 5/e
Mary Jo Clark
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Levels of Empowerment
•Individual and community empowerment
•Horizontal and vertical empowerment
•Continuum empowerment

8. Community Health Nursing, 5/e
Mary Jo Clark
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Individual Empowerment
•Individual community member
•Focuses on improving individual skill and
self-esteem

9. Community Health Nursing, 5/e
Mary Jo Clark
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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)

10. Community Health Nursing, 5/e
Mary Jo Clark
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Community Empowerment
•Community at large
•Addresses increased civic participation

11. Community Health Nursing, 5/e
Mary Jo Clark
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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.

12. Community Health Nursing, 5/e
Mary Jo Clark
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Collective Empowerment
Social change
Values and behaviours (stigma, societal norms)
Political change
Policy & legislation (minimum wage, taxation)
Economic change
Policy & legislation (welfare and benefits)

13. Community Health Nursing, 5/e
Mary Jo Clark
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Horizontal Empowerment
·Problem solving using community’s own
resources

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Mary Jo Clark
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Vertical Empowerment
•Change power structures outside the
community

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Mary Jo Clark
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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

16. Community Health Nursing, 5/e
Mary Jo Clark
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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

17. Community Health Nursing, 5/e
Mary Jo Clark
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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.

18. Community Health Nursing, 5/e
Mary Jo Clark
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•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)

19. Community Health Nursing, 5/e
Mary Jo Clark
Copyright ©2008 by Pearson Education, Inc.
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.

20. Community Health Nursing, 5/e
Mary Jo Clark
Copyright ©2008 by Pearson Education, Inc.
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.

21. Community Health Nursing, 5/e
Mary Jo Clark
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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.

22. Community Health Nursing, 5/e
Mary Jo Clark
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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.

23. Community Health Nursing, 5/e
Mary Jo Clark
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Community Empowerment

24. Community Health Nursing, 5/e
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

25. Community Health Nursing, 5/e
Mary Jo Clark
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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

26. Community Health Nursing, 5/e
Mary Jo Clark
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Community Mobilization
•Population-based assessments,
interventions, and evaluations
•Problem-specific
•May result in empowerment if actions and
efforts are multifocal and health related

27. Community Health Nursing, 5/e
Mary Jo Clark
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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

28. Community Health Nursing, 5/e
Mary Jo Clark
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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

29. Community Health Nursing, 5/e
Mary Jo Clark
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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

30. Community Health Nursing, 5/e
Mary Jo Clark
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Nursing Model of Community
Organization for Change
•Assessment/reassessment
•Planning/design
•Implementation
•Evaluation/dissemination

31. Community Health Nursing, 5/e
Mary Jo Clark
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Community Organization Model
•Community analysis
•Design initiation
•Implementation
•Maintenance/consolidation
•Dissemination/reassessment
•Role of community health nurse

32. Community Health Nursing, 5/e
Mary Jo Clark
Copyright ©2008 by Pearson Education, Inc.
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

33. Community Health Nursing, 5/e
Mary Jo Clark
Copyright ©2008 by Pearson Education, Inc.
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

34. Community Health Nursing, 5/e
Mary Jo Clark
Copyright ©2008 by Pearson Education, Inc.
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

35. Community Health Nursing, 5/e
Mary Jo Clark
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Process of Community Empowerment
•Assessment
•Planning
•Strategies for implementation
•Evaluation

36. Community Health Nursing, 5/e
Mary Jo Clark
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Empowerment Process
•Empowerment activity
•Planning empowerment strategies
•Implementation of strategies
•Evaluating the outcomes of empowerment
activities

37. Community Health Nursing, 5/e
Mary Jo Clark
Copyright ©2008 by Pearson Education, Inc.
Community Assessment
•Selection of approaches
–Community needs-based solutions
–Assets-based approach
–Dimensions of health and community
indicators
•Quality of life indicators
•Provocative indicators

38. Community Health Nursing, 5/e
Mary Jo Clark
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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

39. Community Health Nursing, 5/e
Mary Jo Clark
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Coalition Development
•Resource acquisition
•Development of maintenance subsystem
•Production
•Goal attainment

40. Community Health Nursing, 5/e
Mary Jo Clark
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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

41. Community Health Nursing, 5/e
Mary Jo Clark
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Community Workers
•Natural helpers
•Community volunteers
•Community health workers

42. Community Health Nursing, 5/e
Mary Jo Clark
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Evaluation
•Participatory evaluation
–A partnership approach to evaluation
–Engages those with interest in all aspects

43. Community Health Nursing, 5/e
Mary Jo Clark
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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

44. Community Health Nursing, 5/e
Mary Jo Clark
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Participatory Evaluation Criteria
•Basic principles
–Community participation/ownership
–Collaboration among stakeholders
–Promote change on multiple levels
–Transform power relationships

45. Community Health Nursing, 5/e
Mary Jo Clark
Copyright ©2008 by Pearson Education, Inc.
Role of Community Health Nurse
•Active proponents of and participants in
community empowerment
•Advisory role
•Facilitative role
•Discovery role
•Decision role