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Empowerment interventions can bring about powerful changes in individuals and communities, enabling them to take control of their lives and forming a base for other learning. However, empowerment is a concept often used in the context of Indigenous health without clear articulation of what it actually means and involves. Simply enhancing knowledge about a social or health issue does not equal behaviour change. This is particularly the case in the context of post-colonial societies such as Indigenous Australia where people experience trans-generational grief and loss resulting from racism and other discriminatory government policies. Without this understanding it is difficult to effectively operationalise empowerment, let alone evaluate its effectiveness.
In this project, a 10-year collaborative Empowerment Research Program (ERP) was designed to assess the contribution of empowerment to addressing the social determinants of Indigenous health and wellbeing using two Indigenous-instigated community empowerment initiatives: Men's Support Groups, and a 50-hour Family Wellbeing (FWB) empowerment education program. The ERP represents one of the few attempts to systematically understand the nature of empowerment from the point of view of Indigenous-developed activities that aim to empower.
Evidence is building that empowerment interventions should be the first step in initiatives aimed at helping people engage and benefit from health and other capacity building programs, and to take advantage of any reforms made within macro policy environments. The development of tools to measure the impact of empowerment interventions, such as the Family Wellbeing Program (FWB) and Men's and Women's Groups, are crucial to validate the embedding of such programs in core service provision, thus enabling evaluation of outcomes to meet government requirements for accountability.
Qualitative research to date suggests that through promoting empowerment, wellbeing and social cohesion, participation in men's support groups and FWB education programs may be saving financial outlays through:
The ERP has also helped build skills among both Indigenous and non-Indigenous team members, delivering 50 TAFE level accreditations in Family Wellbeing Facilitation and five graduate diplomas in Indigenous Health Promotion, while recruiting seven higher degree research candidates since 2005, with two PhDs and one Masters by research completed through JCU in 2009. Recent uptake of FWB work throughout Australia and overseas in Papua New Guinea also demonstrates the transferability of the research to other contexts and settings.
Project key steps are as follows:
Findings to date have confirmed international evidence regarding empowerment as a social action process promoting:
However, there was a greater focus in the Indigenous Australian context on beliefs, personal values and the skills and desires to help others, reflecting Indigenous concepts of spirituality and holism in health. Significantly, the empowerment and related social and emotional wellbeing attributes and outcomes qualitatively described in the ERP findings to date resonate strongly with Australian (Grew et el 2007) and internationally identified evidence-based cost effective or 'best buy' mental health promotion programs (UK Dept. of Health 2009).
After 10 years of developmental research adapting and refining the FWB program in a wide variety of settings, an understanding of the dimensions and benefits of empowerment and the potential of these benefits to contribute nationally to improving Indigenous health has emerged.
The empowerment program has significant implications for health promotion and community development project design. Collaborative approaches that creatively integrate micro community empowerment initiatives such as FWB with macro policies and programs can maximise health gains at population levels. This requires partnerships with other agencies and organisations, and adapting and embedding FWB as the foundation for health and social programs. These include:
In the context of organisational change, the potential benefits of empowerment programs are twofold:
It is also possible to integrate the spiritual dimensions of health into social and emotional wellbeing programs, and this is an important way to support Indigenous families and communities make positive change and take greater control of their futures.
Among the factors that have contributed to the success of the FWB program are self determination and control over program conceptualisation and development, and the Indigenous notion of holism that addresses the physical, emotional, mental and spiritual dimensions of health. For instance, Aboriginal community men's groups promote participation and social inclusion and community cohesion, and work to shift social norms towards respect for self and others, responsibility and improved wellbeing for men and their families.
A key challenge in the use of psychosocial empowerment programs such as FWB relates to the time and resources required to achieve change at a population level. A long-term partnership approach to empowerment research that creatively integrates micro community empowerment initiatives with macro policies and programs are vital if health gains are to be maximised.
James Cook University