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Gesundheitswesen 2008; 70(12): 715-720
DOI: 10.1055/s-0028-1102956
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© Georg Thieme Verlag KG Stuttgart · New York

Empowerment in Prävention und Gesundheitsförderung – Eine konzeptkritische Bestandsaufnahme von Grundverständnissen, Dimensionen und Erhebungsproblemen

Empowerment in Prevention and Health Promotion – A Critical Conceptual Evaluation of Basic Understanding, Dimensions and Assessment ProblemsT. Kliche 1 , G. Kröger 1
  • 1Universitätsklinikum Eppendorf (UKE), Institut und Poliklinik für Medizinische Psychologie, Hamburg
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Publication History

Publication Date:
11 December 2008 (online)

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Zusammenfassung

Das Konzept „Empowerment” wird trotz seiner Verbreitung oft als unbestimmt kritisiert. Daher wurde ein Konzeptueller Review über Empowerment in Prävention und Gesundheitsförderung durchgeführt. Einbezogen waren 62 deutsche und internationale Überblicksarbeiten, Reviews und Einzelstudien aus Prävention, Krankenversorgung, Rehabilitation, Versorgungsforschung sowie Pflege und Arbeitsbelastungen. Die Auswertung zeigte acht Hauptdimensionen von „Empowerment”: (1) Beteiligung an Entscheidungen, (2) Selbstwirksamkeitserwartung, (3) soziale Unterstützung und soziales Kapital, (4) Kompetenzen, (5) Inanspruchnahmeverhalten, (6) Fähigkeit zur Zielsetzung und -verfolgung, (7) Reflexionsvermögen und (8) Innovation. Deren Erhebung kann auf der Mikro-, Meso- und Makroebene erfolgen. Die Studien sind drei Grundverständnissen mit jeweils eigenen Fragestellungen und Operationalisierungen zuzuordnen: dem klinischen, dem organisational-professionellen und dem politischen. Diese Teilkonzepte sollten deshalb separat weiterentwickelt werden; empirische Arbeiten sollten möglichst alle acht Dimensionen erfassen.

Abstract

Empowerment is an important concept in health care, but despite its prevalence it seems to be more of a buzz word. Thus, a conceptual review on empowerment in prevention and health promotion was carried out. 62 German and international theoretical contributions, reviews and studies were incorporated, covering the fields of prevention, care and therapy, rehabilitation, health-care research, nursing and work-related stress. The analysis revealed eight main dimensions of empowerment: (1) shared decision-making, (2) self-efficacy, (3) social support and social capital, (4) skills and competences, (5) health care utilisation, (6) goal setting and attainment, (7) reflexive thought and (8) innovation. Their empirical assessment can be carried out on a micro-, meso-, or macro-level. Three distinct basic conceptual notions emerged from the analysis, each applying its own specific research questions and measurement instruments: clinical, organizational-professional and political understanding of “empowerment”. Therefore, these three specific conceptual notions should each be developed and tested separately, in particular in reviews, and empirical studies should embrace all eight subdimensions.

Schlüsselwörter

Empowerment - Prävention - Gesundheitsförderung - Review - Theorie - Messinstrumente

Key words

empowerment - prevention - health promotion - review - concept - measurement

Literatur

  • 1 Rogers ES, Chamberlin J, Ellison ML. et al . A consumer-constructed scale to measure empowerment among users of mental health services.  Psychiatr Serv. 1997;  48 ((8)) 1042-1047
    PubMedGoogle Scholar
  • 2 Finfgeld DL. Empowerment of Individuals With Enduring Mental Health Problems: Results From Concept Analyses and Qualitative Investigations.  ANS Adv Nurs Sci. 2004;  27 ((1)) 44-52
    PubMedGoogle Scholar
  • 3 Tengland P-A. Empowerment: A goal or a means for health promotion?.  Med Health Care Philos. 2007;  10 ((2)) 197-207
    CrossrefPubMedGoogle Scholar
  • 4 Laverack G. Improving Health Outcomes through Community Empowerment: A Review of the Literature.  J Health Popul Nutr. 2006;  24 ((1)) 113-120
    PubMedGoogle Scholar
  • 5 Wallerstein N. What is the evidence on effectiveness of empowerment to improve health? (Health Evidence Network report). Edition ed. Copenhagen: WHO Regional Office for Europe 2006
  • 6 Powers P. Empowerment as Treatment and the Role of Health Professionals.  ANS Adv Nurs Sci. 2003;  26 ((3)) 227-237
    PubMedGoogle Scholar
  • 7 Bröckling U. Empowerment: Fallstricke der Bemächtigung. Zwischen Gegenmacht und Sozialtechnologie.  Prävention. 2008;  31 ((1)) 2-6
    PubMedGoogle Scholar
  • 8 Swift C, Levin G. Empowerment: An emerging mental health technology.  J Prim Prev. 1987;  8 ((1)) 71-94
    CrossrefPubMedGoogle Scholar
  • 9 Kliche T, Töppich J, Kawski S. et al . Professional expectations about quality assurance: a review-based taxonomy of usability criteria in prevention, health promotion and education. DOI: 10.1007/s10389-006-0072-2.  J Public Health. 2007;  15 ((1)) 11-19
    PubMedGoogle Scholar
  • 10 Greenhalgh T, Robert G, Macfarlane F. et al . Storylines of research in diffusion of innovation: a meta-narrative approach to systematic review.  Soc Sci Med. 2005;  61 ((2)) 417
    CrossrefPubMedGoogle Scholar
  • 11 Kleining G. Von der Hermeneutik zur qualitativen Heuristik. Lehrbuch entdeckende Sozialforschung, Bd. 1. Weinheim: Beltz 1995
  • 12 Strauss AL. Grundlagen qualitativer Sozialforschung. Datenanalyse und Theoriebildung in der empirischen soziologischen Forschung. München: Fink 1994
  • 13 Aujoulat I, d’Hoore W, Deccache A. Patient empowerment in theory and practice: Polysemy or cacophony?.  Patient Educ Couns. 2007;  66 ((1)) 13-20
    CrossrefPubMedGoogle Scholar
  • 14 Hinz A, Brähler E, Schwarz R. et al . Fragebogen zur gesundheitsbezogenen Lebensqualität: Wie sinnvoll ist die Zusammenfassung von Einzelskalen zu Gesamtscores? DOI: 10.1055/s-2004-834630.  Psychother Psych Med. 2005;  55 ((3/4)) 221-228
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Anderson RM, Funnell MM, Fitzgerald JT. et al . The Diabetes Empowerment Scale. A measure of psychosocial self-efficacy.  Diabetes Care. 2000;  23 ((6)) 739-743
    CrossrefPubMedGoogle Scholar
  • 16 Kettunen T, Liimatainen L, Villberg J. et al . Developing empowering health counseling measurement: Preliminary results.  Patient Educ Couns. 2006;  64 ((1–3)) 159-166
    CrossrefPubMedGoogle Scholar
  • 17 Chamberlin J. A working definition of empowerment. Lawrence, MA: National Empowerment Center, Articles http://www.power2u.org/articles/empower/working_def.html [10.1.2008], 2008
  • 18 Tengland P-A. Empowerment: A Conceptual Discussion.  Health Care Anal. 2007;  16 ((2)) 77-96
    PubMedGoogle Scholar
  • 19 Khan KS, Kunz R, Klejnen J. et al .Systematische Übersichten und Meta-Analysen. Ein Handbuch für Ärzte in Klinik und Praxis sowie Experten im Gesundheitswesen. Berlin etc.: Springer 2004
  • 20 Lengerke T von, Rütten A, Vinck J. et al .Soziale und politische Partizipation als Parameter gesunder Lebensstile. In: von Lengerke T, Hrsg. Public Health-Psychologie Individuum und Bevölkerung zwischen Verhältnissen und Verhalten. Weinheim, München: Juventa 2007: 207-215
    Google Scholar
  • 21 Laverack G, Wallerstein N. Measuring community empowerment: a fresh look at organizational domains.  Health Promot Int. 2001;  16 ((2)) 179-185
    CrossrefPubMedGoogle Scholar
  • 22 Arneson H, Ekberg K. Measuring empowerment in working life: A review.  Work. 2006;  26 ((1)) 37-46
    PubMedGoogle Scholar
  • 23 Murphy S, Bennett P. Health psychology and public health: theoretical possibilities.  J Health Psychol. 2004;  9 ((1)) 13-27
    CrossrefPubMedGoogle Scholar
  • 24 Legewie H, Trojan A. Skript Gesundheitspsychologie – Gesundheitssoziologie für Studierende der Technischen. Universität Berlin und der Universität Hamburg: Theorie und Forschung zur Gesundheitsförderung http://www.ztg.tu-berlin.de/download/legewie/Skript-Ges-foerd.pdf [13.6.2007], 2000
  • 25 Wallerstein N. Powerlessness, empowerment, and health: implications for health promotion programs.  Am J Health Promot. 1992;  6 ((3)) 197-205
    PubMedGoogle Scholar
  • 26 Altman DG, Feighery EC. Future directions for youth empowerment. Commentary on application of youth empowerment theory to tobacco control. DOI: 10.1177/1090198104268683.  Health Educ Behav. 2004;  31 ((5)) 641-647
    CrossrefPubMedGoogle Scholar
  • 27 Jeschke K, Vossebrecher D, Zaumseil M. Empowerment in der Gemeindepsychologie. Zum Verhältnis von Gemeindepsychologie, Gesundheitsförderung und Public Health. In: von Lengerke T, Hrsg. Public Health-Psychologie Individuum und Bevölkerung zwischen Verhältnissen und Verhalten. Weinheim, München: Juventa 2007: 170-183
    Google Scholar
  • 28 Rissel C. Empowerment: the holy grail of health promotion?.  Health Promot Int. 1994;  9 ((1)) 39-47
    CrossrefPubMedGoogle Scholar
  • 29 Rappaport J. Terms of empowerment/exemplars of prevention: Toward a theory for community psychology.  Am J Community Psychol. 1987;  15 ((2)) 121-148
    CrossrefPubMedGoogle Scholar
  • 30 Rifkin SB. A framework linking community empowerment and health equity: It Is a matter of CHOICE.  J Health Popul Nutr. 2003;  21 ((3)) 168-180
    PubMedGoogle Scholar
  • 31 Laverack G. An identification and interpretation of the organizational aspects of community empowerment.  Community Dev J. 2001;  36 ((2)) 134-145
    CrossrefPubMedGoogle Scholar
  • 32 Wallerstein N. Empowerment and health: The theory and practice of community change.  Community Dev J. 1993;  28 ((3)) 218-227
    CrossrefPubMedGoogle Scholar
  • 33 Speer PW, Jackson CB, Peterson NA. The Relationship between Social Cohesion and Empowerment: Support and New Implications for Theory. DOI: 10.1177/109019810102800605.  Health Educ Behav. 2001;  28 ((6)) 716-732
    CrossrefPubMedGoogle Scholar
  • 34 Schulz AJ, Israel BA, Zimmerman MA. et al . Empowerment as a multi-level construct: perceived control at the individual, organizational and community levels.  Health Educ Res. 1995;  10 ((3)) 309-327
    CrossrefPubMedGoogle Scholar
  • 35 Elder NC, Regan SL, Pallerla H. et al . Development of an instrument to measure seniors' patient safety health beliefs: The Seniors Empowerment and Advocacy in Patient Safety (SEAPS) survey.  Patient Educ Couns. 2007;  69 ((1–3)) 100-107
    CrossrefPubMedGoogle Scholar
  • 36 Imhof RM. Selbstmanagement der Patientinnen und Patienten: Ein Konzept des Empowerment oder der Entsolidarisierung unserer Gesellschaft.  Pflege. 2005;  18 342-344
    CrossrefPubMedGoogle Scholar
  • 37 Salzer MS. Consumer empowerment in mental health organizations: Concept, benefits, and impediments. DOI 10.1007/BF02042724.  Adm Policy Ment Health. 1997;  24 ((5)) 425-434
    PubMedGoogle Scholar
  • 38 Dickerson FB. Strategies that foster empowerment.  Cogn Behav Practice. 1998;  5 ((2)) 255-275
    PubMedGoogle Scholar
  • 39 Powers TL. Improving health outcomes through patient empowerment.  J Hosp Mark Public Relation. 2004;  15 ((1)) 45-59
    PubMedGoogle Scholar
  • 40 Feste C, Anderson RM. Empowerment: from philosophy to practice.  Patient Educ Couns. 1995;  26 ((1–3)) 139-144
    CrossrefPubMedGoogle Scholar
  • 41 Zimmerman MA. Taking aim on empowerment research: On the distinction between individual and psychological conceptions.  Am J Communnity Psychol. 1990;  18 ((1)) 169-177
    PubMedGoogle Scholar
  • 42 Fazekas C, Semlitsch B, Pieringer W. Empowerment bei Diabetes mellitus: Theorie und Praxis. Wien Med Wochenschr 2003 (21/22)
  • 43 Aujoulat I, Simonelli F, Deccache A. Health promotion needs of children and adolescents in hospitals: A review.  Patient Educ Couns. 2006;  61 ((1)) 23-32
    CrossrefPubMedGoogle Scholar
  • 44 Vauth R, Kleim B, Wirtz M. et al . Self-efficacy and empowerment as outcomes of self-stigmatizing and coping in schizophrenia.  Psychiatry Res. 2007;  150 ((1)) 71-80
    CrossrefPubMedGoogle Scholar
  • 45 Corrigan PW, Faber D, Rashid F. et al . The construct validity of empowerment among consumers of mental health services.  Schizophr Res. 1999;  38 ((1)) 77-84
    CrossrefPubMedGoogle Scholar
  • 46 Trummer UF, Mueller UO, Nowak P. et al . Does physician-patient communication that aims at empowering patients improve clinical outcome? A case study.  Patient Educ Couns. 2006;  61 ((2)) 299-306
    CrossrefPubMedGoogle Scholar
  • 47 Zimmerman MA, Warschausky S. Empowerment Theory for Rehabilitation Research: Conceptual and Methodological Issues.  Rehabi Psychol. 1998;  43 ((1)) 3-16
    PubMedGoogle Scholar
  • 48 Svensson T, Müssener U, Alexanderson K. Pride, empowerment, and return to work: On the significance of promoting positive social emotions among sickness absentees.  Work. 2006;  27 ((1)) 57-65
    PubMedGoogle Scholar
  • 49 Varekamp I, Verbeek JHAM, Dijk FJH van. How can we help employees with chronic diseases to stay at work? A review of interventions aimed at job retention and based on an empowerment perspective.  Int Arch Occup Environ Health. 2006;  80 ((2)) 87-97
    CrossrefPubMedGoogle Scholar
  • 50 Barton R. Psychosocial Rehabilitation Services in Community Support Systems: A Review of Outcomes and Policy Recommendations.  Psychiatr Serv. 1999;  50 ((4)) 525-534
    PubMedGoogle Scholar
  • 51 Nowotny M, Dachenhausen A, Stastny P. et al . Empowerment, Lebensqualität und Partizipation in der neurologischen Rehabilitation: Eine empirische Studie an Schlaganfallpatienten und Angehörigen. DOI: 10.1007/s10354-004-0130-8.  Wien Med Wochenschr. 2004;  154 ((23–24)) 577-583
    CrossrefPubMedGoogle Scholar
  • 52 Kosciulek JF, Merz M. Structural Analysis of the Consumer-Directed Theory of Empowerment.  Rehabil Couns Bull. 2001;  44 ((4)) 209-216
    PubMedGoogle Scholar
  • 53 Roberts KJ. Patient empowerment in the United States: a critical commentary.  Health Expect. 1999;  2 82-92
    CrossrefPubMedGoogle Scholar
  • 54 Perkins DD, Zimmerman MA. Empowerment theory, research, and application. DOI 10.1007/BF02506982.  Am J Community Psychol. 1995;  23 ((5)) 569-579
    CrossrefPubMedGoogle Scholar
  • 55 Kurtz V, Dierks M-L. Empowerment im Gesundheitsversorgungssystem. Umsetzungen auf individueller und organisatorisch-gesellschaftlicher Ebene im deutschen Gesundheitswesen. In: von Lengerke T, Hrsg. Public Health-Psychologie Individuum und Bevölkerung zwischen Verhältnissen und Verhalten. Weinheim, München: Juventa 2007: 160-169
    Google Scholar
  • 56 Chinman MJ, Linney JA. Toward a model of adolescent empowerment: Theoretical and empirical evidence. DOI 10.1023/A:1022691808354.  J Prim Prev. 1998;  18 ((4)) 393-413
    CrossrefPubMedGoogle Scholar
  • 57 Miller RL, Campbell R. Taking Stock of Empowerment Evaluation: An Empirical Review.  Am J Eval. 2006;  27 ((3)) 296-319
    PubMedGoogle Scholar
  • 58 Corrigan PW. Empowerment and Serious Mental Illness: Treatment Partnerships and Community Opportunities.  Psychiatr Q. 2002;  73 ((3)) 217-228
    CrossrefPubMedGoogle Scholar
  • 59 Reybold L, Polacek GN. A critical perspective of health empowerment: The breakdown of theory-to-practice in one Hispanic subculture.  Fam Community Health. 2006;  29 ((2)) 153-157
    PubMedGoogle Scholar
  • 60 Nelson G, Lord J, Ochocka J. Empowerment and mental health in community: narratives of psychiatric consumer/survivors.  J Community Appl Soc Psychol. 2001;  11 ((2)) 125-142
    CrossrefPubMedGoogle Scholar
  • 61 Shearer NBC, Reed PG. Empowerment: Reformulation of a Non-Rogerian Concept. DOI: 10.1177/0894318404266325.  Nurs Sci Q. 2004;  17 ((3)) 253-259
    CrossrefPubMedGoogle Scholar
  • 62 Schlesselmann E. Empowerment: alter Hut – oder aktuelles Personalentwicklungskonzept? DOI: 10.1055/s-2007-963369.  Psych Pflege. 2007;  13 262-266
    Article in Thieme ConnectPubMedGoogle Scholar
  • 63 Manojlovich M. Power and Empowerment in Nursing: Looking Backward to Inform the Future. OJIN: The online journal of issues in nursing 2007 Jan. 31;Volume(12:1:1): http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume122007/No1Jan07/LookingBackwardtoInformtheFuture.aspx
  • 64 Ryles SM. A concept analysis of empowerment: its relationship to mental health nursing.  J Adv Nurs. 1999;  29 ((3)) 600-607
    CrossrefPubMedGoogle Scholar
  • 65 Brown M, Gordon WA. Empowerment in measurement: ,muscle‘, ,voice‘, and subjective quality of life as a gold standard. Doi:10.1016/j.apmr.2003.08.110.  Arch Phys Med Rehabil. 2004;  85 ((4 Suppl 2)) 13-20
    CrossrefPubMedGoogle Scholar
  • 66 McQuiston T. Empowerment evaluation of worker safety and health education programs.  Am J Ind Med. 2000;  38 ((5)) 584-597
    CrossrefPubMedGoogle Scholar
  • 67 Foster-Fishman PG, Salem DA, Chibnall S. et al . Empirical support for the critical assumptions of empowerment theory.  Am J Community Psychol. 1998;  26 507-536
    CrossrefPubMedGoogle Scholar
  • 68 Arneson H, Ekberg K. Evaluation of empowerment processes in a workplace health promotion intervention based on learning in Sweden.  Health Promot Int. 2005;  20 ((4)) 351-359
    CrossrefPubMedGoogle Scholar
  • 69 Anderson RE, Huang W-y. Empowering Salespeople: Personal, Managerial, and Organizational Perspectives.  Psychology & Marketing. 2006;  23 ((2)) 139-159
    PubMedGoogle Scholar
  • 70 Kettunen T, Poskiparta M, Liimatainen L. Empowering counseling – a case study: nurse-patient encounter in a hospital.  Health Educ Res. 2001;  16 ((2)) 227-238
    CrossrefPubMedGoogle Scholar
  • 71 Laschinger HKS, Finegan J, Shamian J. et al . Impact of structural and psychological empowerment on job strain in nursing work settings: Expanding Kanter's model.  J Nurs Adm. 2001;  31 ((5)) 260-272
    PubMedGoogle Scholar
  • 72 Erickson JI, Hamilton GA, Jones DE. et al . The Value of Collaborative Governance/Staff Empowerment.  J Nurs Adm. 2003;  33 ((2)) 96-104
    PubMedGoogle Scholar

Korrespondenzadresse

T. KlicheDipl.-Pol. Dipl.-Psych 

Universitätsklinikum Eppendorf (UKE)

Institut und Poliklinik für Medizinische Psychologie

Martinistr. 52 (S 35) 20246 Hamburg

Email: t.kliche@uke.de