The concept of empowerment in actual health promotion and education practice has been a long standing concern among health experts in majority of critical health settings. This is attributed to the fact that numerous health programs which are key in various national settings are continuously being formulated to address problems that appear to have a nature of revolving (Mathews & Helen, 2005). The successful integration of health activities in the formal health care setting demands significant stakeholder involvement in order to achieve the desired efficacy of the implemented health programs. In order to impact positively on the relevance of health promotion with regard to empowerment fundamentals there is need to assess the relative scope of health promotion, analyze principles of health promotion, study contextual influence on effectiveness of programs, establish linkages between health promotion and education, analyze ethical issues in the health programs implementation, establish policy and program interrelations, and study case studies with regard to empowerment.
Understand the theoretical frameworks of health promotion practice
The Scope of Health Empowerment and Promotion in at community level
The application of empowerment in health promotion and education at the community level is a duty primarily reserved to the governmental health authorities. This suggests that empowerment programs which are the majority and potentially emanate from the private sector must involve the governmental authorities at all the significant levels of health service provision seen in the community and which include primary, secondary, tertiary, and quaternary levels (Mathews & Helen, 2005). In a bid to enhance the achievement of the empowerment objective in health promotion, there is need for the health promotion programs to inculcate community capacity domains since these usually form a significant element of health promotion. In real sense, community capacity domains entail the potential involvement of local leadership, community participation, the empowerment of respective community organizational structures, the development of the ability of member to ask ‘why?’, the development of problem assessment capacities, community resource mobilization, the development of potential linkages to others, the achievement of equitable relationships and outside agents, and the achievement of community control over the running programme (Green & Tones, 2010).
The Principles in Guiding Health Promotion Practice used with regard to Empowerment
The efficacy of empowerment as a prime factor relies primarily on the application of principles guiding health promotion. The potential achievement of a competent health promotion practice involves the application of community analysis, dissemination or reassessment of service potentials, the initiation of a working design, maintenance and consolidation, and subsequent implementation (Green & Tones, 2010). These factors affect the achievement of empowerment initiatives, based on an individual and community perspective.
Empowerment initiatives of health promotion are essentially an enhancement of sustainability of the proposed variables of healthcare. In contemporary practice health promotion usually involves, “Sustainability by virtue of integrating activities into community structures, establishing a positive organization climate to encourage the retention of staff and volunteers, having an ongoing recruitment plan for staff and volunteers, and acknowledging the contribution of volunteers” (Green & Tones, 2010). The element of incorporating community structures and other critical human resource components form an important element of achieving empowerment objectives.
In order to achieve health empowerment objectives there is need for personal level involvement between promoters of the program and subsequent implementation of proposed strategies that will lead to achievement of the desired health outcomes which are essentially an element of empowerment. According to Kerr (2000), “One of the tenets of community action is for members of the community to be involved in the process and involved from the outset. This includes encouraging people not only to express their own problem(s), but to also develop the processes that will enable them to identify their problem(s). This requires a dialogue between the health promoter and the community to explore and utilize needs assessment procedures that serve the agenda of the community and not that of the health promotion agency” (p.36). The inclusion of needs assessment component leads to better achievement of empowerment goals as it serves to strengthen health promotion initiatives.
Contextual Influences on Effectiveness of Health Promotion Practice
Empowerment is mainly determined by the influence of contextual variables. This is because it leads to the incorporation of context differences during formulation of health promotion initiatives which take into account the recurring health problems in a particular setting (Magdalene, 2005). In order to ascertain whether the empowerment initiatives in the designed health promotion program are achieved according to the initially set targets of empowerment then there is need for the promoters to design an evaluation program that will be used to ascertain empowerment goals. “Early dissemination of the evaluation finding in an appropriate manner will contribute to maintaining the visibility of the programme and provide a boost for those involved. Formative elements of evaluation will assist in shaping the development of the programme and a final summative evaluation will identify what has been achieved and lessons learned, which should inform future programmes” (Green & Tones, 2010). The lessons learnt are essentially used to ascertain the level to which health empowerment is visible as seen from an individual and community perspectives.
Linkage Between Health Promotion and Empowerment
This usually involves the art of obtaining updates through community analysis in order to identify significant changes, making an assessment of the effectiveness of interventions, and obtaining summary reports of finding for different representative constituencies, which assist in the formulation of future plans (Green & Tones, 2010). Empowerment therefore represents the attainment of the health promotion and education initiatives in the daily livelihood as seen in a community setting and which are potentially reflected at individual levels.
Appreciate ethical issues within the theory and practice of health promotion and health education
Ethical Standards in the Practice of Health Promotion and Education
The nature of health promotion and education involves handling human related activities, which introduces the factor of consent to carry out some of the strategies, for instance, getting permission the community’s ascent to implement run a stop smoking campaign. In addition, the implementations of these strategies usually involve the embracing of certain critical community principles and values. The factor that empowerment is centered on an individual’s and community’s perspective, it therefore means that ethical perspectives take centre stage in development of the health promotion initiatives. In this case, empowerment initiatives will naturally revolve around matching program goals with ethical standards. According to Naidoo and Wills (2000), “Health promoters need be clear that what they do involves certain values and principles about what is ‘good’ health and heath promotion. Beneficence, justice and respect for persons and their autonomy are fundamental ethical principles in health promotion” (p.130).
Factors leading to the Emergence of Ethical Issues
According to the World Health Organization, health promotion is essentially described as helping people to gain sufficient control over their lives, through allowing people to identify community concerns, explore, develop and gain skills and the necessary strategies to act on them through potential development of a bottom-up strategy that explores various skills of a particular promoter (Naidoo & Wills, 2000). In this process of developing such a program various concerns are bound to arise regarding how the people are treated in the program, the respective roles assigned to them in the program and the respective levels of involvement in terms of planning, running of the program and handing over program fundamentals after the community has been empowered. Furthermore, according to Arnold (2006), “A set of moral values underpins the empowerment construct in health promotion” (p.52).
Ethics and Empowerment: Application and Reality
In the contemporary practice seen in the health care program environment, the following entities of ethical concerns need to be taken into consideration: the significant promotion of autonomy and self-esteem, prompt measures taken to counter discrimination and prejudice, the potential recognition of actions based on social, economic, and environmental health determinants, the significant development of empowerment manifested through influence and informed choices, the sustainability of the program, the respective accuracies in the form of information flow seen in professional, public, local and national agencies, and significant focus on health promotion methods and processes (Naidoo & Tones, 2000).
The aim of empowerment in a program is usually to attain significant level of success by taking into account ethical concerns both at community and individual levels. According to Naidoo and Wills (2000), “When we talk of empowerment, we need to distinguish between self empowerment and community empowerment. Self empowerment is used in some cases to describe those approaches to promoting health which are based on counseling and which use non-directive, client-centered approaches aimed at increasing people’s control over their own lives” (p.98). This therefore implies that in order to avoid the developing conflicts in the process of running the program due to the lack of understanding whether the respective program goals are focusing on community or individual components. Ordinarily, ethical issues will arise in both in community centered approaches and individual centered mechanisms. For instance, there could be accusations emanating on the basis of the relative individual and community competencies which are associated with the fundamental aspect of exploitation of the individual’s or community’s prevailing situation for personal or group gains. This normally occurs in programs which have been orchestrated in total disregard of the community fundamentals. For instance, one could consider a program that aims at promoting health care outcomes through avoidance of cigarette smoking. Here various issues are bound to arise on account of interpretation. “But it is the interpretation of this sort of activity correct? How easy is it to reconcile a wish to reduce risk with a commitment to empowerment? Can we dispute the idea of benefit almost automatically accruing from raising the issue of ‘risky’ behavior and hoe it could be changed? What do we mean, in any case, by ‘risk’ and ‘benefit’ in this sort of context?” (Cribb & Duncan, 2002).
However, the practice of assessing a health promotion activity with regard to its applicability is bound to many levels of difficulties due to the occurrence of potential ambiguities and complexities through assessing the basic contention of health promotion as to whether it can be classified as a ‘good practice’ which will determine the relative level of openly testing levels of ethical acceptability (Cribb & Duncan, 2002).
Develop an understanding of health policy and its relationship to the theory and practice of health promotion
Health Policy Formulation in regard to Empowerment and Health Promotion
During policy formulation there is need to involve all the critical stakeholders and other potential beneficiaries of a program of any nature. To be more specific the policy needs to be tailored around the achievement of individual and community empowerment initiatives (Magdalene, 2005). The policy should therefore stipulate the manner in which health promotion will be designed in a manner that gives credence to the achievement of empowerment in the long run. “The proposal should therefore entail, “preparation, including the development of a culturally appropriate definition for empowerment, setting a baseline for each domain, strategic planning and the assessment of resources, evaluation and visual representation” (Laverack, 2007). This therefore gives proof and performance that the resources which have been used as input in the health promotion program are indeed leading to an emancipation of empowerment initiatives. The respective policies should therefore entail a critical component of empowerment in regard to the desired health outcomes.
Health Policy Enforcement Issues in Theory and Practice of Health Promotion
The formulation of a policy usually leads to its potential application in a particular context in which it is generally accepted. This therefore demands assessing the respective levels of competencies in terms of individuals abiding by the initial variables and deliberations of the program. In order to subjectively ensure that the health promotion and education initiatives that are appropriately guided by the policy goals of either the governmental or private entities, then there is need to incorporate an efficient enforcement program that would entail the inclusion of all stated variables. According to Laverack (2007), “It is the beneficiaries who also identify concerns, who have increasing control of the programme and are able to develop strategies to address their concerns” (p.69). This would therefore entail developing an enforcement program that is essentially fixated on a domains approach capable of formulating strategies that can create a lasting community empowerment.
Develop a sustained and researched discussion of identified key concepts in health promotion.
Case Studies on Health Promotion and Empowerment
In a certain health program christened ‘Better Nutrition, Better Health’ focusing on an older population between the ages 50-65 years, the initiative entailed preparation of health messages aimed at sensitizing these group of people to adopt better and healthy strategies in health (Reinhardt et al, 2005). The program focused on influencing the manner in which these people carry out themselves from the perspective of daily nutritional uptake. An assessment was also focusing in the daily nutritional needs of this group of people and these were matched with the current recommended standards by the World Health Organization (Reinhardt et al, 2005). During formulation of strategies, the promoter approached key decision making individuals among this group of people, and these involved identifying existing group representatives, and other relevant stakeholders who act as a gateway to this community. The promoter then formulated messages based on the theme of the program ‘Better Nutrition, Better Health.’ These messages were then disseminated to the group using a special health education forum that involved designing a focused group discussion. The deliberations from the focused group discussions were then meant to implemented in a progressive manner, for instance, this was done on a weekly basis after which individuals submitted their practices of the suggested nutrition plans and further submitted their feedback. The feedback provided including nutrition plans adopted were used to formulate a mode of assessing the achievement of empowerment goals focusing on individual and group cluster variables. Another form of assessment involved bringing into focus the long-term perspectives and strategic implementation of the program. The evaluation of the program indicated that 65% of individuals successfully adopted the proposed nutritional plans through behavior change models leading to significantly positive response (Reinhardt et al, 2005).
According to Laverack (2007), “It is important to use interpretations of power and empowerment that are relevant and important to the participants, set within their cultural context. Westernized concepts of power and empowerment can have different interpretations to those in social settings in non-westernized countries. The idea is to use terms that have been identified and defined by the clients themselves to provide a mutual understanding of the programme in which they are involved and toward which there are expected to contribute” (p.69). In this particular programme if the designers of the programme were to potentially achieve outstanding responses in terms of empowerment from their health promotion initiatives then these would entail subjecting the field and population variables to analysis through pursuance of qualitative methods.
In this particular program it can be recognized that certain elements were missing leading to the potential failure of the program to achieve its initial empowerment goal. According to Naidoo and Wills, “For people to be empowered they need to: recognize and understand their powerlessness; feel strong enough about their situation to want to change it; feel capable of the Case study where empowerment ideas were really guiding the health activities and assess the results from the program” (2000).
Furthermore Kerr (2000) admits, “The aim of empowerment is to challenge that power base. This will only occur if there is a process of conscientisation, or critical consciousness raising” (p.29). In the ‘Better Nutrition Better Health’ campaign, there was significant adoption seen from the 65% adoption of the proposed nutritional plans indicating a partially working empowerment strategy for the entire program. Kerr (2000) adds that, “First, it is clear that empowerment is a continuous phenomenon as reflection upon action will lead to the development of further plans for change” (p.29). This was visible as seen in the level of success rate of the program and its potential to lead to future prospects focusing on the respective adoption of the program initiatives. Laverack (2004) observes that, “Problem assessment builds capacity when the identification of problems, solutions to the problems and actions to resolve the problems are carried out by the community. When these skills do not exist or are weak, the role of the practitioner will be to assist the community to make an assessment of its own problems” (p.50). In this program, focused group discussion was used in order to allow the participants to make their own deliberations which reflects empowerment.
The Integration of Empowerment Concept in the Actual Realm of Health Promotion and Education
The actual integration of the empowerment concept in the health promotion goals demands the implementation of new strategies using a participatory approach that matches the context and setting. According to Green and Tones (2010), “although lip service is pain to the discourse of empowerment, top-down programmes maintain unequal power structures in society, Such programmes address issues defined by professionals and empowerment, in this context, becomes a means of achieving predefined goals” (p.171
In addition, the participatory framework needs to pursue a tested strategy, for instance, the promoter needs to identify an information flow and retention mechanism. According to Green and Tones (2010), “…the mismatch between discourse and practice to lack of clarity in how to operationalize empowerment within conventional top-down planning…the two can be reconciled without empowerment being used instrumentally to achieve behavior change goals, but that this requires consideration of empowerment at each stage of the planning process” (171). In addition to this there is need to split the participants into working group clusters in order to facilitate better adoption. As Laverack (2004) puts it, “The development of small mutual groups by concerned individuals is the start of collective action. This provides an opportunity for the health promoter to assist the individual to gain skills and is a locus for developing stronger social support systems and opportunity networks, interpersonal connectedness and social cohesion” (p.49).
The paper deliberations suggest the idea that the inclusion of empowerment in this health promotion and education fundamentally relies upon the relevance of the empowerment fundamentals and the need to assess the relative scope of health promotion. This way according to Laverack (2004), “Individuals become more critically aware of the broader issues in addition to learning the skills for assessing their immediate problems and needs” (p.51). Moreover, there is need to implement an analysis of principles of health promotion, study contextual influence on effectiveness of programs, establish linkages between health promotion and education, analyze ethical issues in the health programs implementation, establish policy and program interrelations, and study case studies with regard to empowerment.