ReviewPatient empowerment in theory and practice: Polysemy or cacophony?
Introduction
People who are told that they will have to live with a chronic disease often have to face major changes in their everyday life. Not only do they have to learn a lot about the disease and its treatment, they are also often told to integrate a number of new lifestyle or treatment-related behaviours into their everyday life. These behaviours may be difficult to adopt on a long-term basis, as they often conflict with existing behaviours, priorities or projects. Thus, the need for change occurs not only at a behavioural level, but also at a psychosocial level. Indeed, “being chronically ill is a total experience influencing all facets of life” [1]. As patients become aware of the life changes they will have to consent to in order to adjust to their disease, they may experience a distressing feeling of powerlessness. Powerlessness was defined by Freire (1973, cited by [2]) as occurring when an individual assumes the role of an “object” acted upon by the environment, rather than a “subject” acting in and on the environment. Powerlessness has been acknowledged as a determinant of ill health [3]. Conversely, empowerment may be considered as a health enhancing process [4], [5].
In the field of health-care, empowerment has been acknowledged as an alternative to compliance in order to guide the provider–patient relationship. Whereas in the more traditional compliance-oriented approach to health-care, patients are seen as the recipients of medical decisions and prescriptions, the empowerment-oriented approach views patients as being responsible for their choices and the consequences of their choices. However, there are many interpretations of the term “empowerment”, based on different understandings of the concept [6].
The idea of empowerment is rooted in the “social action” ideology of the 1960s and the “self-help” perspectives of the 1970s [2]. It puts an emphasis on the rights and abilities rather than deficits and needs of the individuals and communities [7]. In the 1990s, the Ottawa Charter for Health Promotion [8] has made empowerment a key issue in the theory of health-promotion, which focuses on positive health enhancement rather than only ill-health prevention, mainly through the improvement of social conditions [9]. In the field of community psychology or human resources development, empowerment has been conceptualised as being at the crossroads of individual and community or organisational development. In this perspective, individuals contribute to a common goal within a collective process of social change [3], [5], [9], [10]. In other words, one central feature of community or organisational empowerment is to make use of individual competence to collectively initiate changes.
In the field of health-care, an attempt to clarify the concept was done by Gibson [11]. Her analysis shows that a great number of characteristics are associated to the concept, making it difficult to think of empowerment consistently and in operational terms, in order to allow for its implementation in health-care settings. While some authors feel comfortable with the idea that empowerment may take on a different form in different people and within different contexts (e.g. [7]), other authors (e.g. [2]) have argued that in order to establish the utility of the term “empowerment” for theory as well as for practice, a precise and functional definition was needed.
This paper examines how the term “empowerment” has been used in relation to the care and education of patients with chronic conditions over the past decade. Based on the results of a literature review, we seek to establish whether it has acquired a consistent meaning and whether some guidelines on how to put it into practice may be issued.
Section snippets
Methods
Three international databases – Medline, Current Contents, and PsycInfo – were searched over a 10-year period (1995–2005), using two keywords: “patient education” and “empowerment”. The results of this search for each of the databases were 145, 59 and 18 articles, respectively. The abstracts of all articles were checked so as to select the articles according to five inclusion criteria:
- -
the article should concern adult patients with a somatic chronic disease (articles relating to psychiatric
Results
Our selection of articles included 27 research articles [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38] and 28 theoretical papers [39], [40], [41], [42], [43], [44], [45], [46], [47], [48], [49], [50], [51], [52], [53], [54], [55], [56], [57], [58], [59], [60], [61], [62], [63], [64], [65], [66]. As we generally expect a concept to be more systematically and precisely defined in
Discussion
The key features of an empowerment-based approach are ideology driven and concern choice and responsibility on the one hand, and skills-development so as to become more competent in relating to self and others, and dealing with one's disease, life and environment on the other hand. These features clearly posit empowerment within a humanistic approach of human motivation and development, which postulates that there is an intrinsic tendency in humans toward self-growth or “self-actualisation”
References (84)
- et al.
Empowering the patient in the consultation: a pilot study
Patient Educ Couns
(1996) Patient education for the millennium: beyond control and emancipation?
Patient Educ Couns
(1997)- et al.
Men with prostate cancer: influence of psychological factors on informational needs and decision making
J Psychosom Res
(2000) - et al.
Empowering diabetes out-patients with structured education: short-term and long-term effects of functional insulin treatment on perceived control over diabetes
J Psychosom Res
(2000) - et al.
Empowering patients: how to implement a diabetes passport in hospital care
Patient Educ Couns
(2002) - et al.
Provider–patient interaction in diabetes care: effects on patient self-care and outcomes. A systematic review
Patient Educ Couns
(2003) - et al.
Diabetes rehabilitation: development and first results of a multidisciplinary intensive education program for patients with prolonged self-management difficulties
Patient Educ Couns
(2004) - et al.
Promoting patient participation in consultations: a randomised controlled trial to evaluate the effectiveness of three patient-focused interventions
Patient Educ Couns
(2004) - et al.
One-year follow-up effects of diabetes rehabilitation for patients with prolonged self-management difficulties
Patient Educ Couns
(2006) - et al.
Does physician–patient communication that aims at empowering patients improve clinical ouotcome? A case study
Patient Educ Couns
(2006)
Developing empowering health counseling measurement. Preliminary results
Patient Educ Couns
Guided self-determination improves life-skills with type 1 diabetes and A1C in randomised controlled trial
Patient Educ Couns
Empowerment: from philosophy to practice
Patient Educ Couns
Empowerment techniques: from doctor-centered (Balint approach) to patient-centred discussion groups
Patient Educ Couns
The history of diabetes lay associations
Patient Educ Couns
Empowering patients: issues and strategies
Soc Sci Med
Speaking of illness: issues of first generation Canadian women. Implications for patient education and counselling
Patient Educ Couns
The importance of patient empowerment in health system reform
Health Policy
Current perspectives on patient education in UK
Patient Educ Couns
A step-wise role playing approach for teaching patient counseling skills to medical students
Patient Educ Couns
Patient empowerment and control: a psychological discourse in the service of medicine
Soc Sci Med
Patient empowerment: reflections on the challenge of fostering the adoption of a new paradigm
Patient Educ Couns
The activated patient: a review of the active patient concept
Patient Educ Couns
A health diary for the chronically ill
Citizen empowerment: a developmental perspective
Powerlessness, empowerment and health: implications for health promotion programs
Am J Health Promot
Health is empowerment
Adv Nurs Sci
Empowerment education: the link between media literacy and health promotion
Am Behav Sci
Measuring community empowerment: a fresh look at organizational domains
Health Promot Int
Studies in empowerment: introduction to the issue
Health promotion and empowerment: reflections on professional practice
Health Educ Quart
Citizen participation, perceived control and psychological empowerment
Am J Commun Psychol
A concept analysis of empowerment
J Adv Nur
Patient empowerment: results of a randomised control trial
Diabetes Care
Creating empowering meaning: an interactive process of promoting health with chronically ill older Canadians
Health Promot Int
Empowerment of men newly diagnosed with prostate cancer
Cancer Nurs
Patient empowerment and feedback did not decrease pain in seriously ill hospitalised patients
Pain
Increasing self-efficacy through empowerment: preoperative education for orthopaedic patients
Orthop Nurs
Psychosocial self-efficacy and personal characteristics of veterans attending a diabetes education program
Diabetes Educ
The diabetes empowerment scale: a measure of psychosocial self efficacy
Diabetes Care
Myth of empowerment in chronic illness
J Adv Nur
Cited by (513)
Adaptation and psychometric properties of the Greek version of Youth Efficacy/Empowerment Scale – Mental Health
2024, Children and Youth Services ReviewEffectiveness of the STEPSTONES Transition Program for Adolescents With Congenital Heart Disease—A Randomized Controlled Trial
2023, Journal of Adolescent HealthCare management to improve retail customers' and employees’ satisfaction
2023, Journal of Retailing and Consumer ServicesAssessing the impact of patient-involvement healthcare strategies on patients, providers, and the healthcare system: A systematic review
2023, Patient Education and CounselingEmpowerment of individuals in Iranian health systems: a qualitative study using the Z-cognitive map approach
2024, BMC Health Services Research