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Empowerment: A Conceptual Discussion

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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.

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Notes

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. 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.

  8. 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.

  9. 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].

  10. 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.

References

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

    Google Scholar 

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

    Article  Google Scholar 

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

    Google Scholar 

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

    Google Scholar 

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

    Article  Google Scholar 

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

    Google Scholar 

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

    Google Scholar 

  8. 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.

    Google Scholar 

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

    Google Scholar 

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

    Google Scholar 

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

    Google Scholar 

  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.

    Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

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

    Article  Google Scholar 

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

    Google Scholar 

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

    Google Scholar 

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

    PubMed  CAS  Google Scholar 

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

    Google Scholar 

  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.

    Google Scholar 

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

    Google Scholar 

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

    Google Scholar 

  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.

    Google Scholar 

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

    Google Scholar 

  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.

    Google Scholar 

  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.

    Google Scholar 

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

    Google Scholar 

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

    Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

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

    Google Scholar 

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

    Google Scholar 

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

    Article  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

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

    Google Scholar 

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

    Google Scholar 

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

    Google Scholar 

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

    Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  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.

    Google Scholar 

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

    Article  Google Scholar 

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

    Google Scholar 

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

    Google Scholar 

  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.

    Article  Google Scholar 

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

    Article  Google Scholar 

  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.

    Google Scholar 

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

    PubMed  CAS  Google Scholar 

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

    CAS  Google Scholar 

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

    Google Scholar 

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

    Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

I would like to thank Lennart Nordenfelt and Bengt Brülde for valuable comments on earlier versions of this paper.

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Correspondence to Per-Anders Tengland.

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Tengland, PA. Empowerment: A Conceptual Discussion. Health Care Anal 16, 77–96 (2008). https://doi.org/10.1007/s10728-007-0067-3

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