Listen to this interviewee from Bangladesh:. My income and communication skills increased and improved. I was motivated to try and finally was successful in winning the election. From a simple housewife, I am now an elected member of the UP. That last quote highlights another plus of qualitative methods — they really help communicate project impact as do numbers, of course — maybe for different audiences. And how you do qualitative research matters.
Sure, it would be perverse in the extreme if we tried to measure empowerment by ignoring the nuance of voice and lived experience of those involved in order to generate another dry statistic. You can unsubscribe at any time by clicking the link in the footer of our emails.
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The definitions developed by women included having self-respect and value, and also sharing information with others. Womankind has also found Outcome Mapping a useful framework to help engage partner organisations in discussion on change, including empowerment — see the fourth article for more information shameless self plug!
Although I there was a certain amount of reluctance, given I like numbers, I settled on a qualitative approach. I felt there were few indicators of change that could be quantified, and there was no other way to collect rich data that could really illustrate the change as it was experienced. Excellent piece, thank you, Duncan. Your piece highlights the difference between evaluating in order to understand the impact your work is having which I think tends to be more qualitative and evaluating to provide evidence of VFM -ie for donors which tends to be more quantitative.
So if we genuinely want to understand how the human beings who we are purporting to help are affected by the things we are doing and asking them to, we need to really listen to them.
And then we need to resist the temptation to interpret what they are saying or get Rigorous Qual Consultants Inc to interpret it! Would you agree? Agree with the listening bit Sabita. Agnostic on Sensemaker, as I can never understand a word Dave Snowden says! I think we need to distinguish between the general ways that we behave, manage a programme, interact with people with different perspectives on the programme — and do more informal monitoring…with our 2 more formal approaches to understanding outcomes and impact — where well-designed evaluation, appropriately applied, can add tremendous value.
This article proposes indicators that could be added to individual or household surveys to generate internationally comparable data. Using such data, researchers could improve our understanding of connections between variables such as empowerment and income, governance, health and nutrition outcomes in different contexts and of their durability over time. Jupp, D. This paper presents the experience of a social movement in Bangladesh, which found a way to measure empowerment by letting the members themselves explain what benefits they acquired from involvement and by developing a means to measure change over time.
These measures have also been subjected to numerical analysis to provide convincing quantitative data which satisfies the demands of results-based management. The study shows how participatory assessments can empower and transform relationships, while at the same time generating reliable and valid statistics for what were thought to be only qualitative dimensions.
Graham, C. Kabeer, N. Are the values they reflect appropriate? This paper examines the measurement of three dimensions of empowerment: resources the conditions under which choices are made ; agency the process by which choices are made ; and achievements the outcomes of choices. It highlights problems of meaning and values — particularly the need for indicators to be triangulated — and suggests that methodologically pluralist approaches to measuring empowerment are required.
McDevitt, A. Opportunity structure is the institutional context in which choice is made, and this is measured by the presence and operation of formal and informal institutions, including the laws, regulatory frameworks, and norms governing behaviour.
Alsop, R. How can we determine whether and how projects and policies aimed at empowering stakeholders reach their intended goals?
Empowerment is recognised by the World Bank as one of the three pillars of poverty reduction, and is found in the documentation of hundreds of its projects.
To date, theory development and testing has been most extensive in the area of psychological empowerment. Zimmerman has described psychological empowerment as a process of change that involves intrapersonal, interactional and behavioural components Zimmerman and Rappaport, ; Zimmerman, , and has applied this to promote healthy behaviour among at-risk populations Perkins and Zimmerman, Others, such as Holden et al.
Holden et al. While important, psychological empowerment represents just one dimension of this concept, and programs that address this level only are at risk of neglecting social and political factors influencing health equity, that have a large bearing on the sustainability of health outcomes Rappaport, ; Chavis and Wandersman, ; Fawcett et al.
Organizational empowerment involves equipping individuals to exert control in achieving organizational effectiveness in service delivery and policy development Zimmerman, Community empowerment refers to processes of interaction between individuals and organizations to enhance community living, thereby effecting changes in a larger social system.
These levels of empowerment—psychological, organizational and community—are intimately linked and changes processed at one level have implications for the other levels. Furthermore, the interactions across these levels are culturally and contextually defined; therefore, processes of empowerment are likely to vary according to the community, organization or society where it is being operationalized Rappaport, Wallerstein Wallerstein, has described empowerment as one of the prerequisites for health.
Programs funded by the World Bank, USAID and WHO aim to build empowerment among youth, women and marginalized groups in communities and have applied community development, capacity building and policy change methods to achieve this Amin et al.
Wiggins et al. Wiggins, ; Wiggins et al. Studies show that initiatives to achieve empowerment can lead to health-related outcomes in a range of social and cultural contexts Israel et al. These outcomes include enhanced personal and coping skills, more effective use of health services Dixon et al. There is scope to improve knowledge about the role of empowerment in community participation, capacity building and health improvement through the development of instruments that can measure these constructs in health promotion research and evaluation.
These quantitative measures can complement the insights that can be gained from qualitative investigation of empowerment processes and outcomes, and can be used in evaluating the magnitude of project effects, assessing the relative impacts of different strategies and exploring the mediators and moderators of empowerment.
Herbert et al. Furthermore, several studies have tested instruments measuring empowerment in relation to management of selected diseases, so their applicability to the wider population is limited. For example, Bakker and Van Brakel Bakker and Van Brakel, reported on the measurement properties of 17 empowerment tools for use among people with disabilities in developing countries.
Although a range of tools measuring individual empowerment as a process or outcome of health programs exist, the measurement of community empowerment entails greater complexity and challenges Laverack and Wallerstein, Further, measuring these domains can be easier as a process, than as an outcome of health programs Laverack, Hence, greater scrutiny of the theoretical clarity, reliability and validity of empowerment tools is required to identify and address important questions on the role of empowerment in health promotion.
It is also necessary to determine the potential for these instruments to be used in different population groups and settings. The purpose of this study, therefore, was to systematically review the measurement properties of quantitative empowerment tools. This has entailed investigation of the process of instrument development, the constructs that are measured, the population groups with whom testing has been undertaken, and statistical analysis of reliability and validity.
The longer term purpose of this study is to facilitate research, evaluation and theory development concerning empowerment in health promotion. A systematic review has been carried out to evaluate the measurement properties of empowerment scales used in health programs. The start date was chosen as , because the literature on health-related empowerment has been on the rise since early s Herbert et al.
Using relevant MeSH words or sub-headings, the following combination of key words was used for our search: Empowerment. The retrieved articles from each of the databases were imported into an Endnote library. The bibliographical references of retrieved articles were manually searched, complemented by citation tracking using Web of Science databases and Google scholar, to identify additional relevant studies.
Table 1: Characteristic of the scales used in the review. Studies included were those that focused on the development of an empowerment scale or the adaptation of an existing scale, and reported on the results of reliability or validity testing. Excluded were studies published in a language other than English, books, reports, dissertations and non-peer-reviewed materials as well as those focusing on empowerment for disease management or the performance of narrowly defined roles e.
All searches were stored using an EndNote library. All potentially relevant studies were screened by one of the reviewers S. The initial screening of articles was done by reading the titles and abstracts. The assessment of measurement properties and the methods used in the development of each tool were independently performed by the three authors S.
Following extraction, the characteristics of studies were recorded, including country of origin, sample size, number of items in the scale, method of data collection, factors extracted and reliability scores, as shown in Table 1. The methodological quality of the scales was evaluated across three dimensions: item development, reliability, and validity Table 2.
Item development was evaluated by determining whether information from a literature review, empirical study or panel of experts, was used in instrument development. Reliability assessment addressed whether internal consistency and test—retest reliability were reported. Validity was assessed by examining the methods used to determine content validity if items measure the constructs of interest , structural validity degree to which the scores on the scales reflect the dimensionality of the construct , internal construct validity if relationships between scales are consistent with the hypothesis and external construct validity whether scales converge with and discriminate scores on other measures in the hypothesized way Mokkink et al.
Quality assessment of the measurement properties of the scales used in the review was done using a ratings scale Table 3 previously used in a systematic review of urbanicity scales Cyril et al. Scores ranged from 0 to 6: 0 if none of the above 6 criteria were fulfilled and 6 if all 6 criteria were fulfilled. Table 3: Ratings for each of the scales included in the review 1 if done and 0 if not done. Ratings for each of the scales included in the review 1 if done and 0 if not done.
Of the 20 studies retained for this systematic review, 17 were carried out in the USA, 1 in each of Australia, Canada and Estonia. Sample sizes varied from to participants.
The studies' populations varied, with seven studies focusing on culturally and linguistically diverse populations including African Americans and Hispanics, one study focused on Indigenous Australians and another on elderly people Table 1.
The number of items in the empowerment scales ranged from 5 to The number of domains covered ranged from 1 to 11, and included control, competence, participation, self-determination, power, self-esteem, self-capacity, identity, advocacy, assertiveness, motivation, political efficacy, leadership and positive relationships Table 1. Four studies did not refer to an explicit theoretical framework Zimmerman and Rappaport, ; Rogers et al.
In one study, an internal reliability measure was not provided Zimmerman and Rappaport, Test—retest reliability was reported in only three studies Koren et al. Only the study by Gagnon et al. Test—retest coefficients over a 2-week interval ranged from 0. One study, which developed the Growth and Empowerment measure for Aboriginal Australians, tested all four components of validity, namely content, structural, internal and external construct validity.
Content validity was assessed in 10 studies, and was determined by diverse methods, that included by a panel of experts to rate scale items, calculation of the Lawshe content validity ratio, factor analysis, following an a priori procedure, independent item ratings kappa coefficients and group discriminatory analyses Koren et al.
The internal structure or dimensionality of empowerment items i. External construct validity was assessed in 17 studies; of these, discriminant validity was reported in 3 studies that showed correlations ranging from 0. Empowerment is a principal, guiding value of contemporary health promotion, but there are few published examples of projects that have evaluated impacts upon empowerment at the individual or community level.
This review has identified a wide selection of empowerment scales and reported on their measurement properties, which may assist the development of evaluation indicators and measures, and contribute to evidence and theory building about the role of empowerment in health promotion.
Through the use of exploratory factor analysis, most of the studies identified multiple dimensions of empowerment within the scales. However, the extent of scale evaluation varied widely. Test—retest reliability was evaluated in just 3 of the 20 studies. Instrument responsiveness was not reported upon, and only one study examined the predictive validity of empowerment measures in relation to health behaviour Rissel et al.
This indicates that there is scope for trialing these measures to determine their suitability for use in program evaluation. Although empowerment is multi-faceted and embodies changes at individual, community and organizational levels, many studies focused upon psychological empowerment. Even the Socio-political Control Scale that was tested in three studies Zimmerman and Zahniser, ; Peterson et al.
Although one study measured organizational empowerment, it was specific to the context of mental self-help agencies and concerned the extent to which service users could influence organizational structures and decisions Segal et al.
If empowerment is addressed only at the individual level and not at community and organizational levels, then achievement of health outcomes may not be possible Israel et al. The limited attention given to community and organizational dimensions of empowerment in the instruments reviewed here indicates scope for further development of measures to better match the strong focus on participation in health promotion.
Most studies evaluated empowerment scales with middle-aged adults. Only one study was undertaken with elderly participants Gagnon et al. Some studies Rissel et al. Only a small number of the studies reviewed conducted group discriminant analyses that examined the ability of the scales tested to differentiate between more and less empowered individuals Zimmerman and Rappaport, ; Zimmerman et al.
Although several scales reviewed had an explicit theoretical basis, only a small number were developed following empirical, formative research Akey et al.
The Empowerment Scale, developed by Rogers et al. This formative research enabled the development of a framework for better conceptual understanding of attributes of psychological empowerment within the context of mental health care. This tool was further refined by Rogers et al. The lack of administration of empowerment scales to participants across a range of cultures may have resulted in an inadequate demonstration of external validity Akey et al.
The instruments measuring individual empowerment have largely been developed using a western, individualist orientation towards empowerment. This orientation places value on independence, personal autonomy, self-determination and rights-based decision making, in contrast with the orientation found in collectivist cultures where interdependence, promotion of hierarchy and mutual obligations and fulfillment of expectations based on ascribed roles and status is valued Oyserman et al.
While research about the measurement of empowerment spans several decades, there remains considerable scope for investigation of the role that empowerment plays as a determinant and mediator of health outcomes. It has been reported that empowerment is related to engagement with health programs and the perceived quality of services received Rogers et al.
Several studies also support the hypothesis that psychological empowerment is positively associated with participation in community activities Rogers et al.
There are few studies, however, which have shown that actions to improve empowerment lead to improved preventive health behaviours; those that are reported tend to focus on maternal and child health, water and sanitation and communicable diseases Wallerstein, Although empowerment has been a strong focus of health programs funded by the World Bank, WHO, USAID and other development agencies, there is limited information on the qualities of the empowerment measurement instruments used in needs assessment and project evaluation.
Interestingly, Laverack et al. Using validated and psychometrically sound tools to measure empowerment would assist the design, delivery and evaluation of empowerment strategies in health promotion programs.
Additionally, failure to take into account the ownership of power and capacity by the community in the design of empowerment measures could lead to misunderstandings and misguided programs that may, ultimately, result in disempowerment.
This highlights the critical role of formative research and content validity testing in the measurement development process, which would necessarily entail participatory and qualitative techniques. It is important to acknowledge that qualitative methods also have a vital and complementary role to play in understanding the meaning and experience of empowerment for different groups, and the attributes of health promotion strategies that facilitate individual, community and organizational empowerment Brandstetter et al.
Furthermore, given that empowerment is a complex multi-level construct, mixed-methods approaches Teddlie and Tashakkori, will facilitate a deeper understanding of the social and political dynamics through which this is achieved, for instance where community mobilization or policy advocacy is being undertaken.
In addition, studies using qualitative or mixed methods were not included, and a review of this literature would be a valuable next step in this research and might be undertaken by means of a meta-ethnography. This systematic review has described the psychometric properties of quantitative scales used in measuring empowerment in health promotion settings.
More importantly, it has highlighted gaps in the measurement of the various domains of empowerment using quantitative scales. Most scales measured the individual domain but failed to adequately measure the community and organizational domains, which are equally important for achievement of health program outcomes.
Failure to measure empowerment as a multidimensional construct may impede the process of evaluating empowerment both as a process and outcome of health programs. Furthermore, there has been limited social and cultural diversity in the study populations with whom empowerment measures have been tested and it would appear only a few instances where measures have been evaluated among persons with varying levels of empowerment.
A priority for future empowerment research is to investigate and explore methodologies such as mixed methods that would address the limitations of the tools examined in this review, particularly in the measurement of community and organizational empowerment.
Of notable significance is the framework developed by Laverack and Labonte, which enables the effective measurement of community empowerment within health programs. Such approaches will provide evidence to strengthen the design of health promotion programs, especially those concerned with addressing social disparities in health. Akey T. Educational and Psychological Measurement , 60 , — Google Scholar.
Amin R. Journal of Developing Areas , 32 , — Bakker L. A systematic literature review. Leprosy Review , 83 , — Bann C. Journal of Alternative and Complementary Medicine , 16 , —
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