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Health Care Analysis
Published in: Health Care Analysis 2/2008

01-06-2008 | Original Article

Empowerment: A Conceptual Discussion

Author: Per-Anders Tengland

Published in: Health Care Analysis | Issue 2/2008

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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.
Footnotes
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.
 
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Metadata
Title
Empowerment: A Conceptual Discussion
Author
Per-Anders Tengland
Publication date
01-06-2008
Publisher
Springer US
Published in
Health Care Analysis / Issue 2/2008
Print ISSN: 1065-3058
Electronic ISSN: 1573-3394
DOI
https://doi.org/10.1007/s10728-007-0067-3

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