Empowerment Scores Research Articles

Structural and psychological empowerment and its influencing factors among nursing students in Oman.

This study explored the empowerment of nursing students to contribute to nursing education and recommend ways of increasing the engagement of nursing students in their training. The development of empowerment among nursing students leads to the maximum achievement of learning competencies and enables them to eventually become competent nurses. This study examined the relationship between student nurses' characteristics, structural empowerment, and psychological empowerment. A total of 185 nursing students were recruited through systematic sampling at Sultan Qaboos University, with a 92% response rate. Nursing students' level of psychological empowerment, in terms of meaning, competence, self-determination, and impact, and their level of structural empowerment, in terms of access to opportunity, support, information, and resources were investigated using a self-designed questionnaire. The results showed that "access to support" was rated as the highest dimension by the students, followed by "access to information," "informal power," "access to opportunity," "access to resources," and "formal power." The global empowerment mean score was 3.64 (SD=1.01), and the total structural empowerment score was 20.58 (SD=3.62). The multivariate multiple regression analysis revealed that students' year level and involvement in school organizations had multivariate effects on the four dimensions of psychological empowerment. Students who were involved in school organizations had higher scores for the dimensions of "meaning," "competence," and "impact" than students who were not involved in any school organization. Power can be either developed or acquired, and its definition is expressed based on the achievement objective. Age is not a barrier, as it had little or no impact on nursing student experiences and no correlation with structural empowerment.

Support Networks and Family Empowerment in Early Intervention

Despite the importance of empowerment and the support network of families who receive early intervention (EI) with a family-centered approach, there is little evidence of a relationship between these two variables and family characteristics that might influence this relationship. This study analyzes the correlations between the perception of empowerment of the families, the family supports used, and the socio-demographic factors of both the child and the family. The study consisted of 44 families who received family-centered EI services. Our results show that families mainly used formal supports, followed by informal supports, and, to a lesser extent, intermediate supports. This indicates that families with children who receive EI preferably use the support network based on EI programs, schools, and professionals. Along with this formal support network, primary caregivers rely on their partners, parents, or friends—that is, the informal support network. Family empowerment was not correlated with age, diagnosis, or the reason for referral to EI; on the other hand, it was related to the supports where the families with the lowest empowerment scores were those who made greater use of formal support over informal support. Early intervention professionals must know, from the first encounter, the type and level of support of each family to enhance the development of the child and promote empowerment in families.

Exploring a theory of change: Are increases in parental empowerment associated with healthier weight-related parenting practices?

IntroductionParent health-related empowerment is defined as the process by which parents realize control over their life situation and take action to promote a healthier lifestyle. For decades, researchers have described the theoretical potential of empowerment in health promotion efforts, though few have empirically examined this hypothesized relationship. This study is one of the first to examine the relationship between parental empowerment and healthy weight parenting practices (i.e., food, physical activity, sleep, and media parenting), as a mechanism for early childhood health promotion in community settings. MethodsLow-income parents of preschool-aged children attending Head Start in Greater Boston between fall 2017 and spring 2019 were invited to complete a survey in the fall and spring of each academic school year (n = 578 with two surveys and n = 45 with four). Parental empowerment and healthy weight parenting practices were assessed using validated surveys. We used a multilevel difference-in-difference approach to estimate changes in healthy weight parenting practices score by changes in parental empowerment score. ResultsOut of a possible score of four, the unadjusted mean (SD) score in fall was 3.20 (0.40) for empowerment and 3.01 (0.40) for parenting. An increase in parental empowerment was associated with an increase in healthier parenting practices (b = 0.14; 95% CI = 0.08, 0.20; p < 0.0001). ConclusionsParent empowerment may be an important target in interventions to prevent obesity in low-income children.

SMART Oncology Nursing: Literacy, Goals, Coaching, and Empowerment.

This study assesses the effect of a nurse-designed SMART educational intervention on goal attainment, patient empowerment, and satisfaction. A mixed-methods study design was used. 68 adults with cancer were recruited from an oncology research center and randomized to the immediate or waitlist control group. Empowerment was measured using the Patient Empowerment Scale, and health literacy was measured using the Cancer Health Literacy Test. Measures were completed by the immediate group at enrollment and by the waitlist control group after an eight-week waiting period to establish an updated baseline. Participants received four learning modules on goal setting and coaching to facilitate learning and activation of knowledge. Visit data were collected by nurses based on participants' written and oral responses. Goal attainment ranged from 67% to 100%. Patient empowerment scores were high at baseline and throughout. No significant differences were noted among the groups on goal attainment, empowerment, or satisfaction. RNs can deliver a SMART educational intervention using a universal health literacy approach to support adults with cancer in creating symptom management strategies and attaining self-care goals.

Women empowerment through agricultural technology: Case study of Mymensingh-Bangladesh

In Bangladesh, attention to women empowerment through agricultural technology adoption is not new, but it has not always been acted upon accordingly. This study attempts to carry out an investigation through using both quantitative and qualitative research tools to examine the extent of women's technology adoption in agriculture and their consequent empowerment attainment in selected villages of Mymensingh sadar. To achieve the objectives of the present study, necessary data were collected by using simple random sampling technique, the study selected total of 60 women respondents. The quantitative analytical tools employed to attain the specific objectives included various descriptive statistical measures, perception index and women empowerment index by adoption technology. The results of perception index analysis indicated that majority had moderate to high favorable perception on greater extent of women's engagement in adoption agricultural technology among which may had low to moderate favorable perception on consequent empowerment attainment. The findings show that almost in all cases, decision was taken jointly by male and female. It is very satisfactory case that decision is taken by female alone particularly in the cases purchase of agricultural equipment, maintenance of agricultural equipment, motivating to use agricultural technologies, selling of old machineries. The value of average women empowerment score is 1.81, which is below from the average empowerment score 2.

Effectiveness of distance education program on mothers' empowerment in exclusive breastfeeding: A randomized clinical trial.

Mothers need the necessary skills to be empowered in successful breastfeeding. This study aimed to investigate effectiveness of the distance education program on the mothers' empowerment in exclusive breastfeeding. A randomized clinical trial study was done on 72 nulliparous pregnant women 28-32 weeks with normal pregnancy. The qualified women were randomly assigned to the intervention and control groups based on the random-number table. The breastfeeding training packages were sent to women in the intervention group via Telegram every week from 32 until 37 weeks of gestation. The mothers' empowerment in breastfeeding (primary outcome) and the exclusive breastfeeding rate (secondary outcome) were assessed by questionnaires. Based on the repeated measured tests, although scores for all domains and also the total score of the mothers' empowerment in breastfeeding between two groups had increased during the study period, there was a significant difference between the increasing trends of the maternal empowerment domains in two groups (interaction P value <0.001). Also, the prevalence of exclusive breastfeeding (secondary outcome) at 6 months was significantly higher in the intervention group (81.8% and 57.1% in the intervention and control groups, respectively) (P = 0.028). Distance education could increase all domains of the mothers' empowerment in breastfeeding after delivery. Also, exclusive breastfeeding at 6 months after delivery was significantly higher in mothers who were receiving the distance education packages.

Women’s Empowerment Index in Cassava: An Innovative Tool for Gender Mainstreaming

Analysis of women’s empowerment in cassava was done among farm women and farmers who are involved in cassava cultivation in Kanyakumari district of Tamil Nadu. Snowball sampling technique was employed for collecting data using semi-structured interview schedule from 50 women and 50 men farmers involved in cassava cultivation. The women empowerment index in cassava was used for estimating the domains of empowerment and gender parity index. Results revealed that cassava women farmers were more empowered than their household male counterparts in the domains of community leadership and time allocation. Whereas, male farmers were more empowered than their female counterparts in production decision making, access to productive resources and control over use of income. It was found that the overall women empowerment score was 0.83 with 28 per cent of women in disempowered category.

Are women with more of 'social capital' more empowered? A cross-sectional analysis from rural Wardha, Central India.

Background:Despite international commitment and government policies and programmes, a vast majority of women of rural India are socially and economically deprived in the patriarchal sociocultural framework. Strategies to improve women empowerment need context-specific field-based evidence.Objectives:This study was undertaken to address the research question: “Are women with a higher level of social capital more empowered than their counterparts?”Methods:A community-based cross-sectional analytical study was carried out in the Wardha district of Maharashtra, where a two-stage cluster random sampling technique was used to select the 300 study subjects. The outcome variable, women empowerment was assessed using four domains: mobility, inter-spouse communication, household decision-making and asset ownership. The independent variables included social capital along with potential sociodemographic confounders. Multivariate linear regression was applied using the backward stepwise method.Results:The participants had better women empowerment percentage score in the “Household decision-making” domain compared to the other domains. The women empowerment score was found to be significantly higher in the participants with increasing age, higher education, those involved in business/service, above poverty line (ABL), nuclear family, married, and those having at least one living child. In the adjusted analysis, the social capital was found to be a significant determinant of women empowerment, along with age, education, religion, marital status and family type.Conclusion:The improvement of social capital in the form of community-based development projects through Self-Help Groups (SHG) and microfinance programmes need to be encouraged by the Government and NGOs, as this strategy has the potential to improve women empowerment through community-driven development.

Socio-demographic predictors of structural empowerment among newly qualified nurses: Findings from an international survey

ObjectiveTo examine the socio-demographic predictors of structural empowerment among an international sample of newly qualified nurses. MethodsA cross-sectional survey was conducted on 367 newly qualified nurses with up to 18 months of clinical experience. The nurses were recruited from 15 acute care hospitals across KSA, Jordan, and the UK. Data analysis was conducted using the t-test, ANOVA, and hierarchical regression analysis. ResultsSignificant differences in the total structural empowerment score were found among participants based on the type of universities where they graduated from (t = 2.36, p < 0.05), if they have received assertive communication training during undergraduate nursing education (t = 3.53, p < 0.05), number of months as qualified nurses (F = 4.79, p < 0.05), type of clinical ward settings they were working in (F = 5.1, p < 0.05), and the country where they were recruited from (F = 14.66) (p < 0.05). Furthermore, the country, type of clinical ward settings they were working in, and type of the university the participants graduated from were found to be significant predictors of the participants’ total structural empowerment score (F = 16.6, p < 0.05). ConclusionsThe findings underscore the unique contributions of the cultural contexts, type of clinical ward setting, and type of former educational setting towards the level of structural empowerment among newly qualified nurses.

Improved blood glucose control, cardiovascular health and empowerment in people attending X‐PERT structured diabetes education

AbstractThe aim of the audit was to assess the change in key health markers in people with, or at risk of, diabetes who attended X‐PERT structured diabetes education.Data from X‐PERT programmes are entered into a central database. Twelve‐month changes in anthropometric and clinical variables – and diabetes medication usage – are reported for programmes run between 1 January 2017 and 31 December 2018. Where appropriate, paired t‐tests were performed.In total, 29,703 participants were registered to attend a programme during this period, of which 23,118 (78%) attended at least one session. Of those who attended at least one session 18,039 (78%) completed a programme. Ninety‐nine percent (3342) of participants with clinical data available had type 2 diabetes. Meaningful reductions in HbA1c were seen (‐8.6mmol/mol, 95% CI ‐9.2 to ‐8.0mmol/mol [‐0.8%, 95% CI ‐0.8 to ‐0.7%]; n=2957; p&lt;0.001); and there were statistically significant reductions in body weight, BMI, waist circumference, fasting blood glucose, total cholesterol, low‐density lipoprotein cholesterol, triglycerides, total cholesterol to high‐density lipoprotein cholesterol ratio, and triglycerides to high‐density lipoprotein cholesterol ratio (all p&lt;0.001). No change in high‐density lipoprotein cholesterol was observed. Of the 1180 participants who were recorded as taking diabetes medication at baseline, 632 (54%) were able to reduce the number of medications they were taking and 278 (24%) were able to omit them entirely. Participant empowerment score increased by 20%.Improvements in glycaemic control, weight management and cardiovascular disease risk, as well as reduced medication requirements and an increased feeling of empowerment, were observed in people who attended X‐PERT structured diabetes education programmes. Copyright © 2021 John Wiley &amp; Sons.

Evaluating the experiences of individuals with personal health risks identified through expanded carrier screening

Expanded carrier screening (ECS) is used to identify individuals and couples at risk for having children with recessive or X-linked genetic conditions; however, personal health risks (PHR) can also be identified through this testing. There is limited data on how genetic counseling regarding PHR from ECS is perceived by the individual, or how they use this information. This study quantitatively surveyed individuals identified with these risks between September 2013 and March 2020. The 30-item survey included the validated Genomics Outcome Scale Short Form, the validated Genetic Counseling Satisfaction Scale, and original questions. Survey topics included pre-test knowledge of the possibility of discovering PHR through testing, satisfaction with pre-test education that addresses potential risks, perceived severity of PHR, empowerment by and understanding of information, anxiety levels related to their PHR, perceived genetic counseling support, and satisfaction with telehealth. A total of 416 completed surveys were analyzed using descriptive statistics, and linear and logistic regressions. The majority of participants were satisfied or extremely satisfied with pre-test education (n=328; 78.8%) and telehealth (n=329; 79.1%). However, more participants who were aware of the possibility of identifying PHR through ECS prior to testing were satisfied with pre-test education compared to those who were not aware. Additionally, a lack of prior awareness of PHR was associated with lower empowerment scores (p=.004). Those who were highly satisfied with genetic counseling were more likely to feel empowered and understand the information presented (p=.001). The majority of individuals used their PHR information following their results appointment (n=391; 94.0%). The results of this study suggest that receiving PHR information was useful and was positively influenced by both pre-test education and the genetic counseling process.

Patient empowerment: a way to improve the communication between young persons and healthcare providers

Abstract Background Through patient empowerment, it is possible to support persons with congenital heart disease (CHD) be autonomous, become actively involved in care and gain higher knowledge about their condition, treatment and/or lifestyle recommendations. Conceptual models suggest that patient empowerment is associated with other patient-reported outcomes (PROs). However, available evidence has not concluded whether patient empowerment is leading to improvements in other PROs or viceversa. Purpose The present study aimed to examine the direction of effects between patient empowerment and PROs in young persons with CHD. Methods As part of the STEPSTONES-CHD trial, adolescents with CHD from seven pediatric cardiology centers in Sweden were included in a longitudinal observational study (n=132). Data were collected when patients were 16 (T0) and 17 years old (T1). The Gothenburg Young Persons Empowerment Scale (GYPES) was used to measure patient empowerment on a scale from 15–75, which higher scores denoting a higher level of patient empowerment. Cross-lagged analyses between patient empowerment and PROs were undertaken. These analyses provide information related to the predominant direction of effects over time by comparing standardized betas. The model includes three types of relations, within time relations, which are the correlations between patient empowerment and variable X at T0 and T1. Autoregressive relations, which represent the prediction of patient empowerment or variable X at T1 by their respective value at T0. Cross-lagged is the last type of relation and it is the prediction of variable X at T1 by patient empowerment at T0 or the prediction of patient empowerment at T1 by variable X at T0. The model was replicated four times and the PROs included in the analyses were quality of life (linear analog scale), patient-reported sale (PedsQL generic 4.0), communicating with the healthcare provider (PedsQL cardiac 4.0) and transition readiness (RTQ). Results The sample comprised of 60.6% (n=80) boys. Overall, 13.2% (n=17) had a mild CHD, 62.0% (n=80) a moderate CHD and 24.8% (n=32) a complex CHD. The mean empowerment score was 52.6 (±10.7) at T0 and 53.2 (±11.7) at T1. We found a significant cross-lagged effect between patient empowerment and communication skills (β=0.28), signifying that a higher level of patient empowerment predicted a higher level of communication skills (see Figure 1). No other cross-lagged relationships were found. Conclusions Clinicians interested in improving the communication skills of their patients, may consider whether they can achieve this by targeting patient empowerment. Patient empowerment gives patients the tools they need in order to feel comfortable asking questions and expressing their needs in the care process. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Swedish Heart-Lung Foundation;Swedish Research Council for Health Working Life andWelfare;Swedish Children Heart Association;Swedish Research Council

Designing for empowerment impact in agricultural development projects: Experimental evidence from the Agriculture, Nutrition, and Gender Linkages (ANGeL) project in Bangladesh.

The importance of women's roles for nutrition-sensitive agricultural projects is increasingly recognized, yet little is known about whether such projects improve women's empowerment and gender equality. We study the Agriculture, Nutrition, and Gender Linkages (ANGeL) pilot project, which was implemented as a cluster-randomized controlled trial by the Government of Bangladesh. The project's treatment arms included agricultural training, nutrition behavior change communication (BCC), and gender sensitization trainings delivered to husbands and wives together - with these components combined additively, such that the impact of gender sensitization could be distinguished from that of agriculture and nutrition trainings. Empowerment was measured using the internationally-validated project-level Women's Empowerment in Agriculture Index (pro-WEAI), and attitudes regarding gender roles were elicited from both men and women, to explore potentially gender-transformative impacts. Our study finds that ANGeL increased both women's and men's empowerment, raised the prevalence of households achieving gender parity, and led to small improvements in the gender attitudes of both women and men. We find significant increases in women's empowerment scores and empowerment status from all treatment arms but with no significant differences across these. We find no evidence of unintended impacts on workloads and inconclusive evidence around impacts on intimate partner violence. Our results also suggest some potential benefits of bundling nutrition and gender components with an agricultural development intervention; however, many of these benefits seem to be driven by bundling nutrition with agriculture. While we cannot assess the extent to which including men and women within the same treatment arms contributed to our results, it is plausible that the positive impacts of all treatment arms on women's empowerment outcomes may have arisen from implementation modalities that provided information to both husbands and wives when they were together. The role of engaging men and women jointly in interventions is a promising area for future research.

The Effect of Cognitive-Behavioral Counseling on the Empowerment of Pregnant Women Under 18 Years Old

Background & aim: One of the major problems related to maternal and neonatal health in adolescent pregnant mothers is the low level of pregnancy empowerment. It seems that using cognitive-behavioral counseling approaches can help women to further strengthen their empowerment. The aim of this study was to determine the effect of cognitive-behavioral counseling on empowerment of pregnant women under 18 years old.Methods: This randomized controlled trial was performed in 2020-2021 on 64 pregnant women aged under 18 years referred to health care centers of Khaf, Iran. Participants were randomly allocated to two groups of intervention (n=32) and control (n=32). In the intervention group, cognitive-behavioral counseling was performed in the groups with seven members during 6 sessions (two 120-minute sessions per week for three weeks). The control group received the routine care. The research tool was Kameda and Shimada Empowerment Scale for Pregnant Women (ESPW). Data were analyzed using SPSS software version 25.Results: In the pre-intervention stage, there was no significant difference between the mean empowerment scores in the two groups of intervention (73.87 ± 8.95) and control (72.78 ± 7.36) (P = 0.59). However, in the post-intervention stage, the mean empowerment score in the intervention group (84.25 ± 6.13) was significantly higher compared to the control group (74.44 ± 9.24) (P= 0.001).Conclusion: Cognitive-behavioral counseling was effective in improving the empowerment of pregnant women under 18 years of age participating in the present study.

Effectiveness of empowerment-based intervention on HbA1c and self-efficacy among cases with type 2 diabetes mellitus: A meta-analysis of randomized controlled trials.

Objective:The aim of this study was to determine the effect of empowerment-based interventions on glucose metabolism control and psychosocial self-efficacy in people with type 2 diabetes mellitus (T2DM).Methods:The Cochrane Library, Embase, PubMed, and Web of Science electronic databases were searched up to 22 February 2021 for randomized controlled trials (RCTs) that evaluated the effectiveness of empowerment-based intervention versus conventional treatment in type 2 diabetes cases. At least two investigators independently screened the literature, extracted data and evaluated the methodological quality. We calculated the pooled effect size using the mean difference (MD) or standard mean difference (SMD) with 95% confidence intervals (CIs) through RevMan V 5.4.1.Results:Fifteen randomized controlled trials (RCTs) were eligible for inclusion in the present study. A total of 2344 adults (1128 in the intervention groups and 1216 in the control) were covered. Five of these studies involved 671 cases of psychosocial self-efficacy, and 4 studies included 622 cases of diabetes knowledge. The meta-analysis showed that compared to routine care, empowerment-based intervention was associated with reduced glycated hemoglobin levels (SMD −0.20; 95% CI −0.31 to −0.08; Z = 3.40, P < .001, I2 = 42%), increased diabetes empowerment scores (SMD 0.24; 95% CI 0.10–0.37; Z = 3.42, P < .001, I2 = 0%), and increased diabetes knowledge scores (SMD 0.96; 95% CI 0.55–1.36; Z = 4.61, P < .001, I2 = 80%).Conclusions:Empowerment-based intervention in adults with T2DM results in improvements in glycated hemoglobin, psychosocial self-efficacy and diabetes knowledge.

A study of the relationship between nurses’ experience, structural empowerment, and attitudes toward computer use

ObjectiveThis study examined the relationship between structural empowerment and nurses’ experience and attitudes toward computer use. MethodsThis study was conducted using a cross-sectional quantitative design. A total of 184 registered nurses from four hospitals in Jordan participated in the current study. Data were collected using a demographics questionnaire, the Conditions for Work Effectiveness Questionnaire-II (CWEQ-II), and the Pretest for Attitudes toward Computers in Healthcare (PATCH). ResultsThe median of experience in years among nurses was 5.0, ranging from one to 26 years. The mean score for the attitudes toward computer use was 61.90 ± 11.38. Almost half of the participants, 45.11%, were in the category of “feel comfortable using user-friendly computers.” The participants’ mean average of the total structural empowerment was 12.40 ± 2.43, and the values for its four subscales were: opportunity 3.57 ± 0.87, resources 2.83 ± 0.85, information 3.06 ± 0.79, and support 2.95 ± 0.86. The frequencies analysis revealed that most participants had a moderate level of empowerment (n = 127, 69.02%). The bivariate correlation between nurses’ experience and attitudes toward computer use was significant (r = −0.17, P < 0.05). The relationship between the total structural empowerment score and attitudes toward computer use was positive but weak (r = 0.20, P < 0.01). ConclusionThe results indicated that more experienced nurses are more reluctant toward computer use. However, creating an empowering work environment can facilitate nurses’ attitudes toward computer use.

Associations between women's empowerment and child development, growth, and nurturing care practices in sub-Saharan Africa: A cross-sectional analysis of demographic and health survey data.

Approximately 40% of children 3 to 4 years of age in low- and middle-income countries have suboptimal development and growth. Women's empowerment may help provide inputs of nurturing care for early development and growth by building caregiver capacity and family support. We examined the associations between women's empowerment and child development, growth, early learning, and nutrition in sub-Saharan Africa (SSA). We pooled data on married women (15 to 49 years) and their children (36 to 59 months) from Demographic and Health Surveys that collected data on child development (2011 to 2018) in 9 SSA countries (N = 21,434): Benin, Burundi, Cameroon, Chad, Congo, Rwanda, Senegal, Togo, and Uganda. We constructed a women's empowerment score using factor analysis and assigned women to country-specific quintile categories. The child outcomes included cognitive, socioemotional, literacy-numeracy, and physical development (Early Childhood Development Index), linear growth (height-for-age Z-score (HAZ) and stunting (HAZ <-2). Early learning outcomes were number of parental stimulation activities (range 0 to 6) and learning resources (range 0 to 4). The nutrition outcome was child dietary diversity score (DDS, range 0 to 7). We assessed the relationship between women's empowerment and child development, growth, early learning, and nutrition using multivariate generalized linear models. On average, households in our sample were large (8.5 ± 5.7 members) and primarily living in rural areas (71%). Women were 31 ± 6.6 years on average, 54% had no education, and 31% had completed primary education. Children were 47 ± 7 months old and 49% were female. About 23% of children had suboptimal cognitive development, 31% had suboptimal socioemotional development, and 90% had suboptimal literacy-numeracy development. Only 9% of children had suboptimal physical development, but 35% were stunted. Approximately 14% of mothers and 3% of fathers provided ≥4 stimulation activities. Relative to the lowest quintile category, children of women in the highest empowerment quintile category were less likely to have suboptimal cognitive development (relative risk (RR) 0.89; 95% confidence interval (CI) 0.80, 0.99), had higher HAZ (mean difference (MD) 0.09; 95% CI 0.02, 0.16), lower risk of stunting (RR 0.93; 95% CI 0.87, 1.00), higher DDS (MD 0.17; 95% CI 0.06, 0.29), had 0.07 (95% CI 0.01, 0.13) additional learning resources, and received 0.16 (95% CI 0.06, 0.25) additional stimulation activities from their mothers and 0.23 (95% CI 0.17 to 0.29) additional activities from their fathers. We found no evidence that women's empowerment was associated with socioemotional, literacy-numeracy, or physical development. Study limitations include the possibility of reverse causality and suboptimal assessments of the outcomes and exposure. Women's empowerment was positively associated with early child cognitive development, child growth, early learning, and nutrition outcomes in SSA. Efforts to improve child development and growth should consider women's empowerment as a potential strategy.

Co creating Healthy Footsteps - a supported self management programme for looking after your feet

The aim of the project was to integrate though a partnership approach the podiatry service, the Education Programme for Patients (EPP) and service users to stop one to one appointments with podiatrists for a routine appointment. We developed a 2 hour group session to deliver a more prudent way of providing education and information to promote self-care when looking after our own feet. This reduced the need to provide appointments for routine referrals, and improve access for those needing the care of a podiatrist. The referrals to podiatry have changed with a significant rise in high risk, complex, co morbid patients who required rapid assessment and intensive ongoing treatment. In January 2017 the manager of the Pembrokeshire podiatry service, EPP and service users explored a different way of supporting people referred to podiatry for a routine referral. An educational programme was identified, revised with the support of patients and the podiatry service and a pilot to test the Healthy Footsteps programme was implemented.• Evaluation of each session was planned and comments were written down from the service users who attended the pilot programmes to gain feedback and make changes.• The evaluation data from the pilot programmes led to changes to the manual• Volunteers to become lay tutors were identified from the service users who attended the programme.• Healthy Footsteps Train the Trainer programme developed.From April 2017 to November 2017, 569 routine referrals were sent to EPP to invite on to Healthy Footsteps. 12 programmes completed.137 had completed a course in this time of which• 49 discharged at the end of the education session• 48 were given appointments• 40 put on hold (given advice to try and discharged if not heard from at 6 months)In 8 months delivering Healthy Footsteps s reduced waiting lists by 66% Breaches of waiting times reduced by 58%.The outcome of the new way of working has resulted in :• Access to the service is improved for patients• More appropriate referrals• Programmes are delivered closer to home.• Clinic slots freed up for patients with complex podiatry needs i.e. Diabetic/ Vascular• Increased knowledge of Foot Health with the potential to reduce future referrals• Promote self-management /empower patients and carers Total of 197 pre course empowerment scores and 94 post empowerment scores collated. A response rate of 48%. Comments made by service users include; “This course was very well presented and covered many problems that apply to me and my feet” “Attending Healthy Footsteps session proved very beneficial, my symptoms have been greatly alleviated by wearing proper footwear. ”From the positive feedback and empowerment scores the next stage was to consider roll out across the three counties. We now run regular Healthy Footstep programmes in all three counties in Hywel Dda. Patients have the opportunity to access any community venue within a 6 week time slot.Healthy Footsteps training launched across Wales and enabled a sustainable model across HDUHB and Wales.

Nutrition Empowerment Score as Reliable Measurement of Self-Efficacy in a Community-Based Hands-On Nutrition Education Class

Describe a reliable measurement of self-efficacy used in a community-based hands-on nutrition education program. Self-efficacy is a concept reflected in health behavior models and theories used to describe individual and community behavior. This study identified a reliable measurement of self-efficacy among participants using the Nutrition Empowerment Score (NES). The score was created by the researcher and agency staff to quantify data related to self-efficacy. Extant post-survey responses from participants of a hands-on nutrition education (HONE) class in a community-based teaching kitchen (n=89) were analyzed to determine the NES. The NES score was a total score of zero to eight, from low to high, representing increasingly perceived benefits from the cooking class. Cronbach’s alpha (α) was used to determine the internal consistency of the NES. Mean NES and a low (0-2), medium (3-5), or high (6-8) NES were used to examine NES among the participant population. Qualitative data from open-ended post-survey responses used inductive analysis to triangulate data related to NES. It was determined that NES was a reliable measure (alpha=.788). Mean NES (6.56 ± 1.93) and 75% of participants with an NES of 6-8 reflected a high NES among participants. Qualitative statements reflected feelings of empowerment and high self-efficacy were expressed in the open-ended responses and supported the high NES scores from the quantitative findings. Findings suggested that nutrition related self-efficacy was accurately assessed and found to be high among participants in the study. Identifying NES as a reliable scale of measurement allowed researchers to examine the relationship between NES and other research variables in the study.

The One-Two Punch of High Wages and Empowerment on CNA Retention

The objective of this study was to examine the relationship between high wages and empowerment practices on certified nursing assistant (CNA) retention, necessary for providing high-quality care for nursing home (NH) residents. Measures of provider-level CNA empowerment and wages from the 2015 Ohio Biennial Survey were used to estimate two regression models on retention (n = 719), one without and one with an interaction term of high wages and high empowerment. Only in the context of the interacted model were NHs that provided both high wages and high empowerment associated with a 7.09 percentage-point improvement in the CNA retention rate (p = .0003). Individually, high wages and a high empowerment score were not statistically significant in either regression model. Retaining CNAs in NH communities requires a combination of empowerment practices (e.g., involving CNAs in decision-making about hiring other staff) and high hourly wages.