Health education and community empowerment: conceptualizing and measuring perceptions of individual, organizational, and community control

Abstract

The prevailing emphasis in health education is on understanding and changing life-style choices and individual health behaviors related to health status. Although such approaches are appropriate for some health problems, they often ignore the association between increased morbidity and mortality and social, structural, and physical factors in the environment, such as inadequate housing, poor sanitation, unemployment, exposure to toxic chemicals, occupational stress, minority status, powerlessness or alienation, and the lack of supportive interpersonal relationships. A conceptual model of the stress process incorporates the relationships among these environmental factors, powerlessness (or conversely empowerment), social support, and health status. The concept of empowerment has been examined in diverse academic disciplines and professional fields. However, there is still a lack of clarity on the conceptualization of empowerment at different levels of practice, including its measurement, relationship to health, and application to health education. The purpose of this article is to address these issues as they relate to the concept of community empowerment. It provides a definition of community empowerment that includes individual, organizational, and community levels of analysis; describes how empowerment fits within a broader conceptual model of stress and its relationship to health status; and examines a series of scales that measure perceptions of individual, organizational, community, and multiple levels of control. The article concludes with broad guidelines for and barriers to a community empowerment approach for health education practice.

PIP: The purpose of this article is to address the issues related to the concept of community empowerment. One concern being cited in this article is the lack of clarity on the conceptualization of empowerment at different levels of practice, including its measurement, relationship to health, and application to health education. In this article, the definition of community empowerment that includes individual, organizational, and community levels of analysis are mentioned. The concept of empowerment and how it fits within the broader conceptual model of stress and its relationship to health status is discussed. Another section examined the series of scales that measure perceptions of individual, organizational, community, and multiple levels of control. The concluding portion presents the guidelines for and barriers to a community empowerment perspective for health education practice.