Theory of Health Empowerment

The theory of Health Empowerment^– is based, in part, on Rogers’ Science of Unitary Human Beings.^,  Particularly influential is Rogers’ principle of integrality perspective of human beings as integral with their environment in their daily living and health experience; characterized by pattern, self-organization, diversity and innovative change; and as holding individual values and views about health. The theory identifies health empowerment as emerging from a synthesis of personal resources and social-contextual resources. Personal resources reflect unique characteristics of older adults such as self-capacity. Social-contextual resources include support from social networks and social service support. Empowerment from this perspective is a dynamic health process that emphasizes “purposefully participating in a process of changing oneself and one’s environment, recognizing patterns, and engaging inner resources for well-being.” Health empowerment emphasizes facilitating one’s awareness of the ability to participate knowingly in health and health care decisions.^,  The HEI is a theory-based intervention designed to promote the use of personal resources and social contextual resources with the goal of enhancing well-being in homebound older adults. Health empowerment theory is expressive of a human health pattern of well-being and is viewed as a relational process that emerges from the recognition of personal resources and social contextual resources^, . This process facilitates purposeful participation in the attainment of health goals and the promotion of individual well-being.

Problem Definition

Older adults, particularly homebound older adults, are a vulnerable population at risk of losing their independence as their health declines. Challenges of aging among older adults include economic security, access to community services, and health care. According to Bolnick,^,  older adults with declining health related to chronic conditions often have multiple unmet social and health care needs. These needs may best be met through informal and formal home care services as a basis for delaying or preventing institutionalization. Studies suggest that older adults prefer to stay in their homes for as long as possible, but are unaware of resources in their community to help them remain in their home. As adults age, their health needs become more complex, and recognition of personal resources and social contextual resources to achieve health goals may be limited due to their limited awareness and access to resources. The growing number of older adults and associated social and health care needs underscore the importance of facilitating awareness of and access to personal and social contextual resources to promote well-being. Despite vulnerabilities, older adults also have strengths that can be built upon to promote well-being. Strengths include personal resources, specifically, self-capacity,^,  social contextual resources, specifically, social networks, and social service utilization.

Research with older adults has identified personal resources as including unique characteristics, which comprise more than demographic characteristics. In a study of older women, Shearer found that personal resources reflected unique characteristics such as self-capacity. Self-capacity included promoting change and growth through acknowledging personal strengths and advocating for self. Acknowledging strength included the participants’ perception that they were strong individuals, had a purpose in life, and were protectors and caregivers to their family. As a personal resource, recognition of self-capacity enhanced their ability to participate in problem solving to make meaningful changes in their well-being.

Social contacts and supportive networks are essential to the health of older adults. The extent of social networks and support available for older adults are related to a number of physical and psychological health outcomes that impact well-being. Decreased or lack of social network function is consistently associated with risk of dependency and a reduced level of function.^,  In those aged 80 and older, Camacho and colleagues found that consistent involvement with others in the community led to higher levels of functioning. Qualitative research has found mentoring relationships or supportive peer relationships as necessary ingredients for the empowering process to progress theory.^–

In a study of participants in a senior congregate meal program, Shearer and Fleury found that social resources fostered health empowerment through consistent availability and support in negotiating life changes within the aging process. Support included providing information, feedback, and reinforcement as well as acknowledging and encouraging the open expression of feelings. For participants, contextual resources included community and organizational structures, which built individual and collective capacity through opportunities to remain active in the community, to create and sustain valued friendships, and to stay physically and mentally active. These structures included but were not limited to neighborhood resources and clubs, government-funded programs such as senior centers and social service programs, transportation in the form of dial-a-ride or cab connection, and other government-funded social services programs.

Awareness of and access to resources may be particularly important among homebound older adults with chronic illness, representing a critical area for intervention by community health nurses. However, the needs of many older adults are not being met because they do not possess skills essential to identify and obtain key resources. Given older adults’ increased likelihood of living alone, suffering from chronic illness, spending a greater percentage of their lifetime disabled, and living in poverty, relevant, specific interventions are needed that focus on fostering the recognition and awareness of, and ability to access personal resources and social contextual resources. The HEI is one such intervention developed to increase older adults’ access to personal and social contextual resources.