How do we know when someone has been empowered?

At the recent FIP congress in Abu Dhabi, I was invited to give a presentation on the roles of the pharmacist in empowering women to be authentic champions of change in the health care of their family and community, and present some of the key findings of FIP’s report on “Pharmacists supporting women and responsible use of medicines – Empowering informal care givers”.

You may be thinking, why women only, and not men? After all, men are also involved in the health care of their families and communities, and they are also informal care givers. Well, this is true. And while the role of men is not ignored, the evidence points to 75% of family caregivers being women.[1] [2] The time spent varies from approximately five hours to more than 40 hours per week, [3] which means that many women have care giver responsibilities in addition to their employment, and “work” only stops when they sleep.

In many cultures, societies and communities, women are regarded as the primary carers of children and family members, with responsibilities that extend into health, from identifying what is medically wrong with a family member to seeking treatment and providing support and daily care. Women are also involved in educating their children and family members about good hygiene, good eating habits, and about health and treatments for minor illnesses. Women are also frequent visitors to pharmacies. [4]

Pharmacists are therefore in an ideal position to educate women about medicines and health, to build an alliance with women, and empower and support women to better care for the health of their families. You can view this as empowering women as well as “training the trainers”.

How can we, as pharmacists, empower women or men, or anyone that we come across in our day to day work?

Firstly, we need to know what empowerment is and therefore what can we do to empower people. What knowledge and skills do we need?

Empowerment is the “process that helps people gain control over their own lives and increases their capacity to act on issues that they themselves define as important”. [5] We need to empower people in order to be able to practise effectively using a patient- or people-centred approach; patient empowerment is also a further outcome of effective patient-centred health care. Patient empowerment is critical to a person’s increased self-efficacy and the ability to self-care and self-manage, as well as care for the health of others. Patients are important partners in their health care: they are experts in their own medical conditions through their own lived experiences, and they are managing their own health and medical conditions daily.

To empower someone to be an active partner in their own health care and care of their family members requires a focus on three key domains:[6]

The health literacy of the individual, that is, their ability to find, understand and act on health-related information [7]
Their ability as well as that of the healthcare team to engage in shared treatment decision-making
The individual’s ability to self-manage
There are also other aspects of empowerment that need to be addressed, such as the individual’s self-efficacy, self-awareness and confidence, as well as coping skills.[6]

So, really, pharmacists must draw on all their medicines and health knowledge and expertise, communication and collaboration skills, and professionalism, and consider their social accountability, in providing person-centred care, including medicines and health services.

Knowing what empowerment means, and how we can empower people, brings us to ask ourselves how we know when someone has been empowered? This working definition from the EMPATHiE consortium6 clearly describes an empowered patient/person and what we as pharmacists should aim for when we set about empowering people:

An empowered patient has control over the management of their condition in daily life. They take action to improve the quality of their life and have the necessary knowledge, skills, attitudes and self-awareness to adjust their behaviour and to work in partnership with others where necessary, to achieve optimal well-being.
Empowerment interventions aim to equip patients (and their informal caregivers whenever appropriate) with the capacity to participate in decisions related to their condition to the extent that they wish to do so; to become “co-managers” of their condition in partnership with health professionals; and to develop self-confidence, self-esteem and coping skills to manage the physical, emotional and social impacts of illness in everyday life.
Throughout my pharmacy career, either as a practising community pharmacist or as an academic conducting research and educating future health professionals, I have aimed to empower, and have been guided by the principles of autonomy, informed and shared decision-making, and accountability. My vision remains quality use of medicines by those who take them, by those who give them and by those who control them.