Three of the programmes (Choisir de Maigrir?, Women Bound to be Active and HUGS) have been ongoing, two of which (Choisir de Maigrir? and Women Bound to be Active) have been implemented twice and reported on. Thus, the recent trials are informed by previous programme renderings, which consequently strengthen the support for their current strategies employed. For example, subsequent iterations of Women Bound to be Active placed greater emphasis of physical activity benefits unrelated to weight loss and establishing social support. Furthermore, four of the five programmes conducted follow-up assessments post-intervention, which strengthens the findings from these programmes in terms of outcome sustainability. Three of these programmes completed follow up assessments at one year ensuing post-intervention.
This review identified very few programmes (n = 5) that aimed to empower women in a Western sociocultural context with a focus on wellbeing. This paucity of research was recognised
42 Chapter 2 – Review by other investigators in the field (Tirlea et al., 2013). Not only were there few programmes to report on in this review, but they were highly varied based on the specificity of programme aims, samples of women studied, programme delivery and outcome assessment. Furthermore, the programmes were often vague, in particular surrounding the utility of empowerment and its evaluation. Accordingly, these factors should be considered when interpreting the findings from this review. Despite their diversity, the programmes identified reported promising outcomes for sustainable improvements to women’s wellbeing at one year follow up across multiple health domains. Thus, further research to build a larger evidence base in this area is necessitated given the prevalent and increasing rates of NZ women who experience poor health and related behaviours.
Furthermore, the majority of the programmes focused on at-risk populations. As mentioned in Chapter One, health advocates urge for a shift from preventing illness to promoting wellbeing (The Mental Health Commissioner, 2018). Such a shift would involve strengthening people’s health-related capacities in an effort to resist health deterioration. Thus, research is warranted to promote wellbeing among healthy populations.
Additionally, the most common delivery of the programmes required women to attend meetings on a weekly basis ranging between one and three hours. Such programme structures may be considered time-intensive, which could pose as a barrier to women’s participation. In particular, women who experience time constraints might find it difficult to attend these programmes. This barrier to participation is concerning for several reasons. First, time was reported as a primary barrier to participating in health behaviours (Huberty et al., 2013). Also, researchers reported that women’s experience of gendered and normalised pressures make taking time for themselves a challenge (Strömback et al., 2013). Based on these findings, it is likely that women who lack time would greatly benefit from an empowerment programme targeting wellbeing improvement. However, current programmes may be too time-intensive for these women to participate (Huberty et al., 2013). Future studies should consider structuring a programme that places lesser burden on women’s time investment and greater flexibility to women’s usual lives.
Another gap in the literature was the use of BMI to assess women’s health. Using BMI as an assessment is a limitation because it does not account for changes in body composition (e.g., muscle tissue and adiposity). Moreover, placing body weight or body size as an outcome measure is shown to be detrimental to health and disempowering (Bacon & Aphramor, 2011; O'Hara & Taylor, 2018; Tylka et al., 2014). Furthermore, assessment of other parameters would be more appropriate to evaluate healthy populations. Future empowerment programmes should incorporate other measures to evaluate women’s physical health, such as their fitness (Blair & Brodney, 1999; Warburton, Nicol, & Bredin, 2006). Such assessments would also align with a weight-neutral approach.
Of the five programmes, only two were evaluated using a mix of quantitative and qualitative data (Huberty et al., 2013; Huberty et al., 2009; Strömback et al., 2013; Strömback et al., 2016). Given the complex and holistic nature of these programmes, future studies should incorporate qualitative methods to provide a more complete picture of complex outcomes such as women’s holistic health and empowerment. Likewise, only two programmes reported on the evaluation of the programme’s implementation (process evaluation): the stress management course evaluated at post-intervention (Strömback et al., 2013; Strömback et al., 2016) and Women Bound to be Active surveyed at follow up one year post-intervention (Huberty et al., 2009). Future studies should report on the strengths and limitations of programme delivery to further inform successful strategies for empowerment programmes.
A further limitation is the way empowerment was inconsistently embedded in the programmes. For instance, Women Bound to be Active noted aims of empowering women, but made no explicit mention of empowerment strategies. Researchers (Wallerstein, 1992) have commented on the increasing use of the term “empowerment”, which consequently dilutes the core meaning of the concept and its utilisation in programmes for that matter (Lindacher et al., 2018). Thus, clearer definition of empowerment in programmes is needed within programmes.
44 Chapter 2 – Review
Conclusion
The current review identified five empowerment programmes that aimed to improve women’s health in relevance to a Western sociocultural context. Findings from this review highlight seven key characteristics of such programmes including five programme strategies and two considerations for programme evaluation (Table 3).
Table 3
Seven Key Characteristics of an Empowerment Programme for Women’s Health
Programme Characteristics Components
Strategies
Women’s active participation Reflection
Planning health activities Group discussion Practical activities
Social support Sharing personal experiences with others Group discussion
Building a supportive network Sustainable change Self-defined goal setting
Emphasising intrinsic motivation Support independence
Improve knowledge of self and body Holistic health perspective Mental health
Self-acceptance, stress management, self-esteem Physical health
Awareness of body and physiological cues, healthy eating, physical activity
Social health
Social support, connectedness with others Realise broad range of health behaviour benefits Weight-neutral approach Support holistic awareness of health behaviours,
motivation and body
Support acceptance of body/self Promote positive health behaviours Evaluation
Assessment of multiple health domains Behavioural (healthy eating, physical activity) Psychosocial (psychological wellbeing, psychological
distress, self-perception)
Physical (anthropometric, metabolic, fitness)
Mixed-methods Incorporating qualitative and quantitative data to evaluate outcomes and programme delivery
The reviewed programmes indicated promising outcomes for women’s long-term wellbeing across psychosocial, physical and behavioural health domains. However, existing literature for this research area is scarce. This review implores further investigation to develop an evidence-base for programmes to empower women over their health in relevance to a Western sociocultural context.