How to quote
Pisano González M. Empoderar a personas y comunidades para alcanzar bienestar. Metas Enferm jul/ago 2019; 22(6):3
Marta Pisano González
Doctora por la Universidad de Oviedo. Coordinadora Escuela de Pacientes de Asturias. Servicio de Promoción de la Salud y Participación. Dirección General de Salud Pública. Consejería de Sanidad. Asturias.
Contact email: MartaM.PisanoGonzalez@asturias.org
Versión en Español
To empower” is a term widely used nowadays, but not completely understood due to the complexity of its meaning. Even though it can appear simple in its definitions by the Royal Spanish Academy: “to make powerful or strong an underprivileged individual or social group”, and “to give someone the authority, influence or knowledge in order to do something”. The truth is that applying these concepts in the healthcare setting, and its contextualizing in the approach to chronicity, requires a deeper consideration.
The foundations of the health empowerment model had its origins in the University of Stanford, set by a nurse, Kate Lorig, and a psychologist, Albert Bandura, over 38 years ago. It was born out of a need: to support a vulnerable socioeconomic society to develop self-care strategies and responsibility for their own health, in order to improve their quality of life, their health experience, as well as that of their relatives, friends and community (1). Therefore, empowerment has a final goal that moves away from the power described in its definition, and looks for an improvement in quality of life, as a consequence of adapting and living fully with the condition presented by each person.
In order to achieve this objective, it is not enough to act exclusively upon the patients with a disease and their relatives. Empowerment also includes developing the understanding and skills of health professionals and those responsible for designing policies, so that they can guarantee that the patients, their loved ones, and the communities they are part of, will be treated with respect, dignity and the best care possible available.
To empower is to work as a team, to look for the meeting point between the scientific-technical expertise of the healthcare professional and the experience of living with the disease and care for people in their context. This is a context where each individual will develop (or not) personal skills, with the presence (or not) of an adequate support network, and where socioeconomic characteristics have a privileged influence upon the individual and the evolution of his/her disease (2). An increasing body of evidence shows the negative influence of social isolation upon health; its effects are comparable with the mortality risk factors, such as smoking and alcoholism, and it exceeds the influence of other risk factors such as lack of physical activity and obesity.
People benefit to a high extent when they can share experiences with other persons in a similar situation, and they will be able to make changes in their lifestyle, for their health and wellbeing, if they have support by others. This is the importance of working in and with the community (3). Therefore, empowerment becomes more complex: to enable individuals by increasing their capabilities, skills and knowledge, to develop understanding and skills among healthcare professionals, to develop policies that guarantee an improvement in care by persons and communities, to conduct scheduled interventions in the community, as well as to coordinate said actions so that all that has been previously described becomes possible.
It seems that we have come to a crossroads. But far from it, only one road is possible in order to be successful: to focus on the person, on their core of supporting relatives and friends. And from there, to start developing coordinated actions with the goal to empower: that is to say, to improve their experience and quality of life. The evidence available suggests many actions: personalized care, shared decision-making, health training, group or shared appointments, education for self-management, coproduction and segmentation of people according to their level of health literacy (4).
We must add to the previous approaches, the words that the European Patients’ Forum has used to define empowerment: education (relevant, in an easily understandable format), expertise (patients have an expertise that has to be taken into account by healthcare professionals), equality (between patients and professionals), experience (channeled by patient organizations), and engagement (patients involved in designing more effective healthcare for all, and in research to deliver new and better treatments and services).
Empowerment allows individuals, services, professionals and communities to work together in order to coproduce solutions and services. Because ultimately the solution is not to have health only, it is wellbeing.
1. Self Management Resource Center (SMRC). Articles about the Chronic Disease Self-Management Program [internet]. Palo Alto CA: SMRC; 2019 [cited 8 jun 2019]. Available from: https://www.selfmanagementresource.com/resources/bibliography/cdsmp
2. Hibbard J, GreeneJ. What the evidence shows about patient activation: better health outcomes and care experiences; fewer data on costs. Health affairs. 2013; 32(2):207-14.
3. Ahn S, Basu R, Smith ML, Jiang L, Lorig K, Whitelaw N, et al. The impact of chronic disease self-management programs: healthcare savings through a community-based intervention. BMC Public Health. 2013; 13(1):1141.
4. Rowlands G, Russell S, O’Donnell A, Kaner E, Trezona A, Rademakers J, et al. What is the evidence on existing policies and linked activities and their effectiveness for improving health literacy at national, regional and organizational levels in the WHO European Region? Copenhagen: WHO Regional Office for Europe; 2018 (Health Evidence Network (HEN) synthesis report 57).