Empowerment is related to health among Swedish adolescents

1. Empowerment is related to health among Swedish adolescents Lars Jerden 1,2,3 Gunilla Burell 4 Hans Stenlund 1 Lars Weinehall 1,3 Erik Bergström 1,5 1Epidemiology and Public Health Sciences, Umeå University, Sweden 2Center for Clinical Research Falun, Sweden 3Research Department, National Institute of Public Health – Sweden 4Department of Public Health and Caring Sciences, Uppsala University, Sweden 5Pediatrics, Department of Clinical Sciences, Umeå University, Sweden

3. “Empowerment is defined as a process wherein people assert control over factors which affect their lives” Ref: Connelly LM, Keele BS, Kleinbeck SV, Schneider JK, Cobb AK. A place to be yourself: empowerment from the client's perspective. Image J Nurs Sch. 1993 Winter;25(4):297-303. Empowerment

4. Personal control, perceived power is central  Broad concept, including self-efficacy, competence and social interaction  Different levels: Individual, group and community level of analysis  In our study we have focused on the individual level Empowerment

5. All students in 7th grade(n = 1 046) in seven schools, representing varying number of inhabitants, geographical areas, and levels of education among parents. Study population

6. To examine if empowerment is associated with self-rated health and health behaviour (among Swedish adolescents) Aim

7. Västerbotten Province (2 schools) Dalarna Province (5 schools) Sweden

8. A questionnaire was constructed with questions about empowerment, socio-demographic characteristics, self-rated health and health behavior. Half of the empowerment questions were selected from the Swedish part of the Health Behavior in School-Aged Children survey (HBSC), and from other established Swedish surveys. The rest were constructed for the study. Construction of the instrument

9. Development of the instrument 21 preliminary“empowerment items”combining HBSC and new questions Test-retest (204 student) The final 17 “empowerment items” 4 items with Kappa < 0.4 were dropped

10. Self-efficacy Health-related competence From items to dimensions The final 17 “empowerment items” 3 dimensions Social interaction

11. Self-efficacy Self-efficacy related items Item scores for reply alternatives 3 2 1 To what degree can you yourself Very much Rather much Not very much + influence your well-being? Not at all Do you know what to do in order to feel well? Yes, most often Yes, sometimes No, seldom How often do you feel helpless? Never Seldom Sometimes + Often + Always

12. Health-related competence Health related competence items Item scores for reply alternatives 3 2 1 When you feel bad: do you know the reason? Yes, most often Yes, sometimes No, seldom Do you know how your body functions? Yes Uncertain No Do you know what to do if you get a headache? Yes Uncertain No Do you know what to do in order to avoid stress? Yes Uncertain No Do you know what to do if you become stressed? Yes Uncertain No Do you know what to do if you feel bad mentally? Yes Uncertain No Do you usually feel that things that happen in your daily life are difficult to understand? No Yes, sometimes Yes, most often

13. Social interaction 3 2 1 Never Seldom Sometimes + Often + Alvays No, seldom Yes, sometimes Yes, often Yes, most often Yes, sometimes No, seldom No Once or twice + About once a week + A few times Several times a week No, seldom Yes, sometimes Yes, most often Yes, most often Yes, sometimes No, seldom Yes, most often Yes, sometimes No, seldom Social interaction items Item scores for reply alternatives How often do you feel left aside? Does it happen that you are alone, although you don ´t want it? Do you have as many mates as you want? Have you been mobbed during the last year? Do you find it embarrassing to speak in front of your class? Do your teachers usually care about your opinion? Are you taking part in decisions in your family?

14. Empowerment dimensions and total empowerment vs parents education levels 2,33 Self-efficacy 2,24 * University/college 2,37 Health Related Competence Lower 2,32 2,29 Social Interaction 2,28 6,99 Empowerment 6,86 * 0,0 2,5 5,0 7,5

15. Empowerment dimensions and total empowerment vs gender 2,36 Self-efficacy 2,21 *** Boys 2,35 Health Related Competence Girls 2,34 2,26 Social Interaction 2,30 * 6,98 Empowerment 6,85 0,0 2,5 5,0 7,5

16. Empowerment dimensions and total empowerment vs self rated health 2,33 Self-efficacy 1,72 *** High Health Related Competence 2,37 Low 2,03 *** 2,29 Social Interaction 2,08 *** 7,00 Empowerment 5,82 *** 0,0 2,5 5,0 7,5

17. Empowerment dimensions and total empowerment vs smoking habits 2,30 Self-efficacy 1,94*** No smoking 2,36 Health Related Competence Smoking 2,12*** 2,28 Social Interaction 2,21 6,95 Empowerment 6,26*** 0,0 2,5 5,0 7,5

18. Empowerment is closely related to self-rated health and health behaviour (among Swedish adolescents). Empowerment dimensions are influenced by gender and by educational level of parents Conclusions

19. e-mail: lars.jerden@Ltdalarna.se www.Ltdalarna.se/VIP