Being in the same boat: An empowerment intervention in breast cancer self-help groups
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Background: Health is not merely the absence of disease – health also encompasses mental and social wellbeing, illustrating the term positive health. Empowerment, including promotion of sense of control and mastery in life, is a key tenet in the field of health promotion and is regarded as a state of positive health. While there is a growing body of empowerment theory and research, there is a further need for context-based knowledge of empowerment. Many women diagnosed with breast cancer experience heavy demands in the trajectories of disease and recovery, and struggle to regain a state of positive health. They also sometimes experience that their burdens are amplified by the lack of support from professional health workers and their ordinary networks of family and friends. Thus, interventions like self-help groups may fill in the gap to promote empowerment and health as they aim to provide mastery through mutual support and learning. Aim: The overall aim of this study was to promote participants' empowerment, and to develop and investigate the empowerment intervention of professionally led breast cancer self-help groups, and thus, to contribute to the development of context-based theoretical and practical knowledge of empowerment. Design and methods: Building on this foundation, an empowerment intervention study of three sequentially running professionally led breast cancer self-help groups was undertaken. The research design was inspired by participatory action research (PAR) and a co-operative inquiry perspective. The participants were involved as equal and active partners within the self-help groups but not in any of the scholarly parts of the study. The intervention included implementation of the empowerment perspective aiming to promote participants’ strengths, abilities, resources and sense of control. Halfway evaluations were conducted to discuss and potentially change group processes. In total, eighteen women recovering from breast cancer participated, of which four pre-terminated participation. Two professional facilitators, the researcher and a hired professional group leader, mediated the group discussions. Data were collected through multistage focus group interviews and participatory observation. The multistage focus group interviews, conducted at the first and last group session of each group and six months after the last session, constituted the main data. The focus group interviews aimed to explore and gain insight into participants’ empowerment processes and outcomes, as well as into any social support and interpersonal stress emerging within the self-help groups. Qualitative data analysis was conducted by using the analytic tools a) meaning categorisation; b) meaning condensation; and c) structuring of meaning through narratives. Findings: The data analysis revealed learning as an empowerment process including four subcategories: 1) consciousness-raising; 2) objective knowledge; 3) model learning; and 4) discovery of new perspectives about life and about oneself. The analysis further revealed both positive and negative aspects of social support. Among the positive experiences were a strong sense of fellowship, respect and acceptance, humour and laughter, and relief from not burdening family and friends. The negative experiences that occurred were mostly caused by group logistics and organisation, and a ‘bumpy’ group process in group three before the halfway evaluation. The analysis demonstrated that there were few elements of interpersonal stress in this study. Mutually shared experiences and the implementation of the empowerment perspective promoted an awareness of the participants’ strengths, abilities and resources which stimulated them to take action to make improvements in their recovery process as well as in life in general. Participation and sharing experienced broadened the participants’ horizons and promoted their self-awareness, positively contributing to expand their coping strategies. Conclusion: The study results revealed that empowerment strategies can not fully guarantee that negative group processes will not occur, but the findings document that the positive experiences overshadowed the negative experiences. The findings document that, for the majority of participants, the empowerment intervention promoted their empowerment processes and that the empowerment strategies were important for the re-discovery and confirmation of the participants’ strengths, abilities and resources, and for their sense of control in life. The findings further document that the empowerment perspective and intervention, and the information and insight gained from participation, were regarded as a valuable contribution to recovery.
Has partsPaper I: Stang, I., Mittelmark, M.B. (2009). Learning as an empowerment process in breast cancer self-help groups. Journal of Clinical Nursing, 18(14), 2049-2057. The article is not available in BORA due to publisher restrictions. The published version is available at: http://dx.doi.org/10.1111/j.1365-2702.2008.02320.x
Paper II: Stang, I., Mittelmark, M.B. (2008). Social Support and Interpersonal Stress in Professional-Led Cancer Self-Help Groups. International Journal of Mental Health Promotion, 10(2), 15-25. The article is not available in BORA due to publisher restrictions. The published version is available at: http://dx.doi.org/10.1080/14623730.2008.9721759
Paper III: Stang, I., Mittelmark, M.B. (2010). Intervention to Enhance Empowerment in Breast Cancer Self-Help Groups. Nursing Inquiry, 17(1), 47–57. The article is available at: http://hdl.handle.net/1956/9062