The Idea of Empowerment

I found this week’s reading very insightful regarding the topic of empowerment and how culture affects this concept. There is currently a huge emphasis in the healthcare community on transitioning from handing health information down a professional chain to the layman to the practice of “empowering the patient” and facilitating “self-management.” Increasing patient engagement in their care and protecting their autonomy is lauded as a top priority. The following quote from the article is a very accurate expression of what I’ve been taught so far in my nursing education: “It is assumed that improved knowledge and a change in attitude are the twin engines that generate expected outcomes in behavior” (Airhihenbuwa, 1999). This idea has gone virtually unchallenged, but Airhihenbuwa provides an differing perspective. He brings to light the underlying basis of the western push for empowerment as (perhaps misguidedly) an effort of the highly educated to change the behavior of the “disenfranchised” on an individual level. He contends that effective empowerment must rely on manipulating environmental, cultural and political contexts rather than just personal choices within those infrastructures.  

This is a welcome perspective in my mind as I have witnessed firsthand the frustration of trying to instill change in people and feeling as though you’re talking to a brick wall. Even if you can get as far as helping people actually understand their health (not to mention the all-important task of figuring out what will make them want to change), if they lack resources or community support or financial stability, it will not come to fruition. Even in accomplishing the first two points, we are slowly realizing that imparting knowledge is not enough to incentivize behavior change (hence the focus on giving patients a collaborative role in their healthcare).  However perhaps what we are not realizing is that improving outcomes may have less to do with personal motivation and education and more to do with home environment, cultural values access to outside support, etc.

Culture indeed has a significant role to play. Although culture is talked about much more today than in years past, differing cultures are often presented as a factor to be aware of and acknowledged, but not necessarily to be embraced and integrated into care. One tends gets a sense of how various cultures clash with our western methods and how our “normal” care must be altered. Rarely do we see specific aspects of cultures exemplified as beneficial and helpful. 

What do you think? Do you see culture as an important factor in healthcare? What about the most important factor? Do you there is a place for individual patient empowerment or should our focus really be on collective empowerment of populations?