nach oben

Health Care Analysis

Erschienen in:

01.06.2008 | Original Article

Empowerment: A Conceptual Discussion

verfasst von: Per-Anders Tengland

Erschienen in: Health Care Analysis | Ausgabe 2/2008

Einloggen, um Zugang zu erhalten

Abstract

The concept of ‘empowerment’ is used frequently in a number of professional areas, from psychotherapy to social work. But even if the same term is used, it is not always clear if the concept denotes the same goals or the same practice in these various fields. The purpose of this paper is to clarify the discussion and to find a plausible and useful definition of the concept that is suitable for work in various professions. Several suggestions are discussed in the paper, for example control over life or health, autonomy, ability, self-efficacy, self-esteem, and freedom, and it is concluded that there are two plausible complementary uses, one as a goal and one as a process or approach. Empowerment as a goal is to have control over the determinants of one’s quality of life, and empowerment as a process is to create a professional relation where the client or community takes control over the change process, determining both the goals of this process and the means to use.

If we emphasize this criterion together with the homogeneity criterion, we shall find that the ‘list approach’ (definition through denotation) fails to give us a reasonable definition. The list approach puts a lot of stress on the language criterion and just lists all the attributes one believes belong to the concept (see [8] for such an approach). There are two disadvantages with this approach: first there is the problem of deciding when the list is complete, and, second, we do not have a criterion which helps us determine if something should belong to the list or not. The theory criterion fills this role.

This does not exclude the possibility that these changes in some cases do constitute increased control, e.g., if the person has a dysfunction. This illustrates Brülde’s point [4] that at one end of the dimension a change might be empowering, as when someone has very little control, while at another it might not, as when someone already has much control.

Note that some writers suggest that empowerment primarily means raising the individual’s sense of control (see [29]). There is, no doubt, something in this idea, but this sense of control has to come from having control, which is the more important aspect of the two. If not, we could manipulate people into sensing that they have control when, in fact, they do not.

Strictly, is seems that we also have to act on some of these desires for the definition to be acceptable [9]. The idea is that it is counter-intuitive to say that someone autonomously decided what projects to pursue, but where the individual never pursued any of them.

Note, however, that some of these instances, i.e., increased consciousness without control, might instead be (direct) increases in quality of life. We might desire to know as a goal in itself.

It is impossible to separate skills from knowledge, since skills are a kind of knowledge. However, some knowledge is practical and some is more ‘theoretical’ (or ‘propositional’, see [38]), and here, it appears, we are mainly (but not wholly) interested in the more practical aspects of knowledge.

Note also that the knowledge itself does not always lead to control; sometimes it is rather the education as such that does. It licenses you to work in a certain area, and guarantees that you have the relevant knowledge and skills that belong to the profession, i.e., it creates opportunities for control.

Note, however, that an increase in health according to Nordenfelt [24] is always an increase in control of one’s quality of life, i.e., of empowerment, since health is to be able to reach vital goals, and vital goals are one’s quality-of-life goals. So, according to this theory, an increase in health is sufficient, but not necessary, for an increase in empowerment.

It is interesting to note that while Amartya Sen writes little about empowerment, he writes a lot about freedom as capability, which turns out to be (more or less) the same thing as the ability to better control one’s life. He claims, for instance, that “[d]evelopment consists of the removal of various types of unfreedoms that leave people with little choice and little opportunity of exercising their reasoned agency” [39, p. xii].

Some definitions of freedom also include having internal as well as external control over actions and choices [3, 43], which means that autonomy becomes part of freedom.

Adams, R. (2003). Social work and empowerment (3rd ed.). Hampshire: Palgrave.

Bandura, A. (1982). Self-Efficacy mechanism in human agency. American Psychologist, 37(2), 122–147.CrossRef

Brülde, B. (2000a). Människans handlingsfrihet [The individual’s freedom to act]. Presens, 23/24, 3–6.

Brülde, B. (2000b). On how to define the concept of health: A loose comparative approach. Medicine, Health Care and Philosophy, 3, 305–308.

Brülde, B. (2007). Happiness theories of the good life. Journal of Happiness Studies, 8(1), 15–49.CrossRef

Brülde, B., & Tengland, P.-A. (2003). Hälsa och Sjukdom: En begreppslig utredning [Health and Disease: A Conceptual Investigation]. Lund: Studentlitteratur.

Carnap, R. (1971). The logical foundation of probability. Chicago: University of Chicago Press.

Chamberlin, J. (1997). A working definition of empowerment. Psychiatric Rehabilitation Journal, 20(4), 43–46, (http://www.power2u.org/articles/empower/working_def.html) 03012006.

Dworkin, G. (1988). The theory and practice of autonomy. Cambridge: Cambridge University Press.

10.

Eklund, L. (1999). From citizen participation towards community empowerment. Academic Dissertation: University of Tampere, Tampere.

11.

Foucault, M. (1977). Discipline and punish; The birth of the prison [Surveiller et punir: Naissance de la prison, Gallimard 1975]. London: Penguin Books.

12.

Foucault, M. (1986). Michel Foucault: Power/Knowledge. C. Gordon (Ed.), Brighton: Harvester Press.

13.

Freire, P. (1970 Pedagogy of the oppressed. New York: Continuum.

14.

Freud, S. (1976). Orientering i Psykoanalysen [Vorlesungen zur Einführung in die Psychoanalyse]. Stockholm: Natur och Kultur, 1976.

15.

Gibson, C. (1991). A concept analysis of empowerment. Journal of Advanced Nursing, 16, 354–361.PubMedCrossRef

16.

Hagquist, C., & Starrin, B. (1997). Health education in schools—from information to empowerment models. Health promotion international, 12(3), 225–232.CrossRef

17.

Illich, I. (1972). Deschooling society. London: Marion Boyars Publishers.

18.

Illich, I. (2001). Limits to medicine: Medical nemesis—The expropriation of health. London: Marion Boyars Publishers.

19.

Jones, P. S., & Meleis, A. I. (1993). Health is empowerment. Advances in Nursing Science, 15(3), 1–14.PubMed

20.

Laverack, G. (2004). Health promotion practice. Power and empowerment. London: Sage.

21.

Liss, P.-E. (2003). Begreppen vårdbehov, hälsa, empowerment och underordning. [The concepts need of care, health, empowerment, and subordination]. Research report: Linköping university.

22.

Lietaer, G. (1998). From non-directive to experiential. In B. Thorn & E. Lambers (Eds.), Person-centred therapy: A European perspective (pp. 62–73). London: Sage.

23.

Naryan D. (Ed.) (2002). Empowerment and poverty reduction: A sourcebook. Washington: The World Bank.

24.

Nordenfelt, L. (1995). On the nature of health: An action-theoretic approach (2nd revised ed.). Dordrecht: Kluwer.

25.

Nordenfelt, L. (1997). On ability, opportunity and competence: An inquiry into people’s possibility for action. In G. Holmström-Hintikka & R. Toumela (Eds.), Contemporary action theory (Vol I, pp. 145–158). Dordrecht: Kluwer.

26.

Nussbaum, M. (2000). Woman and human development. The capabilities approach. Cambridge: Cambridge University Press.

27.

O’Hara, M. (2006). The radical humanism of Carl Rogers and Paulo Freire: Considering the person-centered approach as a form of conscientiazao. In G. Proctor, et al. (Eds.), Politicizing the person-centered approach: An agenda for social change (pp. 115–126). Ross-on-Wye: PCCE Books.

28.

Proctor, G., Cooper, M., Sanders, P., & Malcolm, B. (2006). Politicizing the person-centered approach: An agenda for social change. Ross-on-Wye: PCCS Books.

29.

Raeburn, J., & Rootman, I., (1998). People-centered health promotion. Chichester: Wiley & Sons.

30.

Rawls, J. (1971). A theory of justice. Oxford: Oxford University Press.

31.

Rappaport, J. (1981). In praise of a paradox: A social policy of empowerment over prevention. American Journal of Community Psychology, 9(1), 1–25.PubMedCrossRef

32.

Rappaport, J. (1984). Studies in empowerment: Introduction to the Issue. Prevention in Human Services, 3, 1–7.

33.

Rappaport, J. (1985). The power of empowerment language. Social Policy, 16, 215–221.

34.

Rissel, C. (1994). Empowerment: The holy grail of health promotion? Health Promotion International, 9(1), 39–47.CrossRef

35.

Rodwell, C. (1996). An analysis of the concept of empowerment. Journal of Advanced Nursing, 23, 305–313.PubMedCrossRef

36.

Rogers, C. (1961). On becoming a person. Boston: Houghton Mifflin.

37.

Rogers, C. (1977). Carl Rogers on personal power. New York: Delacorte.

38.

Ryle, G. (1971). Knowing that and knowing how, in collected papers, Vol II Collected essays 1929–1968. New York: Barnes & Noble.

39.

Sen, A. (1999). Development as freedom. Oxford: Oxford U P.

40.

Skelton, R. (1994). Nursing and empowerment concepts and strategies. Journal of Advanced Nursing, 19, 415–423.PubMedCrossRef

41.

Starrin, B. (1997). Empowerment som tankemodell [Empowerment as a model for thought]. In E. Forsberg & B. Starrin (Eds.), Frigörande kraft—Empowerment som modell i skola, omsorg och arbetsliv. Stockholm: Gothia.

42.

Swift, C., & Levin, G. (1987). Empowerment: An emerging mental health technology. Journal of Primary Prevention, 8(1&2), 71–94.CrossRef

43.

Swift, A. (2006). Political philosophy: A beginners’ guide for students and politicians. Cambridge: Polity press.

44.

Tengland, P.-A. (2001). Mental health: A philosophical analysis. Dordrecht: Kluwer Academic Publishers.

45.

Tengland, P.-A. (2004). Empowerment: Mål eller medel för hälsovetenskaper [Empowerment: a goal or a means for the health sciences] In I. Nordin (Ed.), Rapporter från hälsans provinser. En jubileumsantologi. Linköping: Linköpings universitet, Tema H:s serie SHS, nr 32.

46.

Tengland, P.-A. (2006). The goals of health work: Quality of life. Health and Welfare, in Philosophy, Medicine and Health Care, 9, 155–167.CrossRef

47.

Tengland, P.-A. (2007a). Empowerment: A goal or a means for health promotion? Medicine, Health Care and Philosophy, 10, 197–207.CrossRef

48.

Tengland, P.-A. (2007b). A two-dimensional theory of health. Theoretical Medicine and Bioethics, 28(4), in press.

49.

Tones, K. (1997). Health promotion: Empowering choice. In L. Myers & K. Midence (Eds.), Adherence to treatment in medical conditions (pp. 133–160). London: Harewood academic publishers.

50.

Vickridge, R., & Ayub, R. (2003). Participation and empowerment. In T. H. MacDonald (Ed.), The social significance of health promotion (pp. 43–65). London: Routledge.

51.

Wallerstein, N., & Bernstein, E. (1988). Empowerment education: Freire’s ideas adapted to health education. Health Education Quarterly, 15(4), 379–394.PubMed

52.

Wallerstein, N. (1992). Powerlessness, empowerment and health: Implications for health promotion programs. Behavior change, 6(3), 197–205.

53.

WHO (1986). Ottawa charter for health promotion. WHO: Geneva.

54.

WHO (1998). Health promotion glossary. WHO: Geneva.

55.

Zimmerman, M. A., & Rappaport, J. (1988). Citizens participation, perceived control and psychological empowerment. American Journal of Community Psychology, 16, 725–750.PubMedCrossRef

Titel: Empowerment: A Conceptual Discussion
verfasst von: Per-Anders Tengland
Publikationsdatum: 01.06.2008
Verlag: Springer US
Erschienen in: Health Care Analysis / Ausgabe 2/2008
Print ISSN: 1065-3058
Elektronische ISSN: 1573-3394
DOI: https://doi.org/10.1007/s10728-007-0067-3

Springer Medizin

Abstract

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 2/2008

Action Research—a Necessary Complement to Traditional Health Science?

Leaping “Out of the Doubt”—Nutrition Advice: Values at Stake in Communicating Scientific Uncertainty to the Public

An Ethical Analysis of International Health Priority-Setting

Who Should be Involved in Health Care Decision Making? A Qualitative Study

Participatory Workshops are Not Enough to Prevent Policy Implementation Failures: An Example of a Policy Development Process Concerning the Drug Interferon-beta for Multiple Sclerosis

Well-Being and Health