Do we say empowerment when we mean improvement of self-efficacy?

Why do so many health care providers talk about empowering their patients? Examples include: “Health empowerment, health literacy and health promotion” “Using home telehealth to empower patients to monitor and manage long term condition” and the “Diabetes Empowerment Process Scale.”

If you read my work, you know I don’t use the term empowerment, because I agree with Jane Vella (2002):
“Teachers do not empower adult learners; they encourage the use of the power that learners were born with.”

Patients don’t say, “I need empowerment” or “You need to give me some power here.” They say, “I can’t do that.” That’s self-efficacy.

If you really think about it, health care providers don’t have extra power to give to patients. And how do you give power, anyway? By authorizing patients to make decisions for themselves? Really? And how do you measure this transfer of power?

Like Dorothy in the Wizard of Oz, patients had the power all along. They just need to learn how to use it.

No, I think what these health care providers are talking about is self-efficacy. Self-efficacy is the level of perceived confidence and comfort in completing a specific task. It is the belief, “I can do that.” Self-efficacy is measurable (“on a scale of one to ten, how confident are you that you can . . .”). There are defined interventions to improve self-efficacy: Self-efficacy can be enhanced through skills mastery, modeling, reinterpreting the meaning of symptoms, and persuasion. (Lorig, 1996)

Providing education and information can lead to skills mastery, so patient education is certainly a part of this process. But it’s not everything. If your learner has the skills, but still feels powerless and lacking confidence in a certain situation, learner lacks self-efficacy. This can be improved with coaching.

So let’s move toward defining this problem with the operational term: self-efficacy. It can be defined. It can be measured. And there are interventions to modify it.

Please don’t say empowerment when you mean improvement of self-efficacy.

Lorig, K. R. (1996). Patient Education and Counseling for Prevention. from
Vella, J. (2002). Learning to listen, learning to teach: The power of dialogue in educating adults (Revised ed.). New York: Jossey-Bass. page 10

©2010, Fran London, MS, RN

4 Responses to “Do we say empowerment when we mean improvement of self-efficacy?”

  1. Nita Pyle says:

    Thanks Fran, for expanding on empowerment. I was able to remove the word from a description of our department. It always bothered me but I really didn’t know why. Thanks for putting it into words. Nita

  2. I’m relieved to hear I’m not the only person bothered by the term “empowerment.” Thanks for your comment!

  3. Arturo Acevedo says:

    Actually, self-efficacy is a component of the empowerment process (View: Bennett Cattaneo and Aliya R. Chapman). Therefore, it is possible that a case of low self-efficacy is actually an empowerment problem.

  4. Arturo Acevedo, I stand my by statement that we can’t give people power, so the term empowerment is misleading. If we get lost in the jargon we miss opportunities for action.

    The authors you refer to say, “The components of the model are personally meaningful and power-oriented goals, self-efficacy, knowledge, competence, action, and impact. Individuals move through the process with respect to particular goals, doubling back repeatedly as experience promotes reflection.” They call this the empowerment process.

    But they actually are talking about self-development. The Individuals already have the power (the capacity to do something or act in a particular way). They have trouble with skills, like goal-setting, self-efficacy, knowledge, and competence. If we focus on those, specifically, we can help them.

    I know, it’s semantics. But words direct our actions.

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