1. APPLICATION OF COMMUNITY
EMPOWERMENT TO PRACTICE
NR.110.500 Philosophical, Theoretical, and Ethical Basis for
Nursing
Sara Cawrse, Jamie Hatcher, Sandeep Lehil, & Jessica Vargas

2. INTRODUCTION
Apply the Community
Empowerment theory
to socio-economically
disadvantaged, urban
African Americans with
uncontrolled type 2
diabetes

3. PROBLEM & SIGNIFICANCE
 According to ADA, African Americans (AA) are at
high risk for diabetes
 In 2005, more than 18 million adults
had diabetes in the United States
 AA are 1.6 times more likely to develop diabetes
than non-Latino Whites
(Green, McClellan, Gardner, & Larson, 2006)

4. PROBLEM & SIGNIFICANCE
 AA tend to have poorer outcomes.
 Social, economic, and environmental factors
contribute to health disparities (Green, McClellan, Gardner, &
Larson, 2006).
 Differences in glucose control persist between AA
and Whites even after adjusting for socioeconomic
status, access to health care, and severity of
disease (Marshall, 2005).

5. PROBLEM & SIGNIFICANCE
 AA increased rates of
diabetic sequelae
including
 retinopathy,
 microalbuminuria,
 end stage renal
disease,
 lower extremity
amputation
 mortality
(Green, McClellan, Gardner, & Larson, 2006;
Marshall, 2005).

6. PROBLEM & SIGNIFICANCE
 AA less likely to attain glucose control
 Possible reasons:
 Poor compliance with self-monitoring
 Poor adherence to treatment
 Cost of test strips and drugs
 Literacy rates
 Lack of diabetic education
 Sociocultural components
 Physician related factors

7. PROBLEM & SIGNIFICANCE
 Patients who are able to control their
diabetes, (Green, McClellan, Gardner, & Larson, 2006; Austin & Claiborne, 2011):
 Often have friends or family with diabetes
 Seek out information about the disease
 Evidence-based self-management strategies
 Accurate perceptions of their own diabetes control
 Experience “turning point” events

8. PROBLEM & SIGNIFICANCE
 Further focus needed on:
 Preventing and controlling diabetes in this population
 Alternative interventions to traditional primary care

9. N U R S I N G T H E O RY: C O M M U N I T Y
EMPOWERMENT
 Developed by Eugenie Hildebrandt and Cynthia
Armstrong Persily (Persily & Hildebrandt, 2008)
 Middle range nursing theory
 Built off both empowerment and the community
development theories
 Creates a community involvement approach
 Members of the community take responsibility for
increasing their knowledge and decision-making
abilities.

10. N U R S I N G T H E O RY: C O M M U N I T Y
EMPOWERMENT
 Three main concepts:
Involvement
Lay Workers
Reciprocal Health
 Involvement:
 Done through planning, implementing, and intervening
as a group (Persily & Hildebrandt, 2008)

11. N U R S I N G T H E O RY: C O M M U N I T Y
EMPOWERMENT
 Lay Workers (Persily & Hildebrandt, 2008):
 Trained persons indigenous to the community to which
they live in and work in.
 Reach out to families in the community
 Know community cultural values firsthand
 Encourage preventative services, healthy
behaviors, and assist with access to social services

12. N U R S I N G T H E O RY: C O M M U N I T Y
EMPOWERMENT
 Reciprocal Health (Persily &
Hildebrandt, 2008):
 Actualization of
inherent and acquired
human potential.
 Occurs when
professionals and
community residents
work
together, respecting, an
d sharing what each
other has to offer.

13. N U R S I N G T H E O RY: C O M M U N I T Y
EMPOWERMENT
(Smith & Lierhr, 2008)

14. E VA L U AT I O N : S I G N I F I C A N C E
 Clearly addresses the metaparadigm concepts of
the person, the environment, health, and
nursing goals/processes.
 Person
 Environment
 Health
 Nursing goals/processes

15. E VA L U AT I O N : S I G N I F I C A N C E
 The metaparadigm propositions addressed include:
 life processes
 patterns of human-environment interaction
 processes that affect health
 interaction between health and environment
 Philosophical basis: the foundation of this theory is
that through empowerment change is possible.

16. E VA L U AT I O N : S I G N I F I C A N C E
 Merging of the empowerment theory and the
community development theory.
 Development: individuals and groups "grow through
community participant interaction and achievement
of identified goals."
 Empowerment: developing problem-solving
capacity and competence that allows individuals
and communities to gain mastery over their lives.
(Persily & Hildebrant, 2008)

17. E VA L U AT I O N :
CONSISTENCY & CLARITY
 Congruency between context and content
 Context
 Content

18. E VA L U AT I O N :
ADEQUACY & FEASIBILITY
Based on Fawcett’s (2005) criteria for adequacy of a theory, the Community
Empowerment Theory is pragmatically adequate and feasible.
 Feasible to implement practice derived from this theory,
 The practitioner has the legal ability to implement and measure the
effectiveness of theory-based nursing actions,
 Compatible with expectations for nursing practice,
 Theory-based nursing actions lead to favorable outcomes,
 Comparisons can be made between outcomes of use of the theory and
outcomes in the same situation when the theory was not used
 Outcomes are measured in terms of the problem-solving effectiveness of
the theory.
The Community Empowerment Theory has not shown to be empirically
adequate as a systematic review has not been done.

19. RATIONALE FOR THEORY SELECTION
 Significant disparities exist between AA and whites with
regards to diabetes management and the rates of
associated morbidity and mortality,
 AA face several barriers: including poor access to
care, limited resources for physical activity due to
residential barriers, and interference of care due to other
life events or stressors (Samuel-Hodge, et al., 2000).
 Can address barriers by:
 Bringing the care to the patient through lay-educators,
 Altering the care so that it is appropriate and reasonable for
the patient’s lifestyle and culture.
 For diabetes management to be effective, it must be
approached with an understanding of the population’s
social, cultural, and familial influence (Chesla, et al., 2004; Samuel-
Hodge, et al., 2000; Two Feathers, et al., 2005)

20. POSSIBLE SOLUTION
 Community health worker (CHW) programs have
shown promise in improving health behaviors and
health outcomes
 Particularly for racial and ethnic minority
communities and for those who have disparate
access to health care (Spencer, Rosland, Kieffer, Sinco, Valero, Palmisano, &
Anderson, 2011).

21. POSSIBLE SOLUTION
 CHWs use their ethnic, cultural, or geographic
backgrounds to promote health within their own
communities.

22. EXAMPLE OF THEORY IN USE
 In Heisler, Spencer, Forman, et al.
(2009), participants felt CHWs gave them “clear
and specific strategies on managing diabetes
care, nonjudgmental assistance to increase
confidence in maintaining diabetic care, and social
and peer support”.
 CHW programs may be effective in promoting more
effective diabetes care and patient–doctor
relationships among African-American adults with
diabetes than without CHW support
(Heisler, Spencer, Forman, et al., 2009).

23. POTENTIAL PROBLEMS WITH
IMPLEMENTING
 Most studies on community health workers have
not used a randomized controlled trial design.
 Studies have small samples in a localized
neighborhood and therefore have threats to
external validity.
 Potential problems may arise with training and
retaining community health workers when
implementing programs (Hill-Briggs, Batts-
Turner, Gary, Brancati, Hill, Levine, Bone, 2007).

24. REFERENCES
Austin, S. A., Claiborne, N. (2011). Faith wellness collaboration: A community-based approach to
address type II diabetes disparities in an African-American community. Social Work Health
Care, 50(5), 360-375.
Chesla, C. A., Fisher, L., Mullan, J. T., Skaff, M. M., Gardiner, P., Chun, K., & Kanter, R. (2004).
Family and disease management in African-American patients with type 2 diabetes. Diabetes
Care, 27: 2850-2855.
Fawcett, J. (2005). Criteria for evaluation of theory. Nursing Science Quarterly, 18(2), 131-135.
Gary, T. L., Bone, L. R., Hill, M. N., Levine, D. M., McGuire, M. Saudek, C., and Brancati, F. L.
(2003). Randomized controlled trial of the effects of nurse case manager and community health
worker interventions on risk factors for diabetes related complications in urban African
Americans., 37 (1), 23–32.
Greene, C., McClellan, L., Gardner, T., & Larson, C. O. (2006). Diabetes management among low-
income African Americans: A description of a pilot strategy for empowerment. Journal of
Ambulatory Care Management, 29(2), 162-166.
Heisler, M., Spencer, M., Forman, J., Robinson, C., Shultz, G., Graddy Dansby, G., Kieffer, E.
(2009). Participants' assessments of the effects of a community health worker Intervention on
their diabetes self-management and interactions with healthcare providers. American Journal of
Preventive Medicine, 37(6, 1), S270-S279.
Hill-Briggs, F. Batts-Turner, M., Gary, T. L., Brancati, F. L., Hill, M. N., Levine, D. M., Bone, L. R.
(2007). Training community health workers as diabetes educators for urban African Americans:
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25. REFERENCES
Madden, M. H., Tomsik, P., Tercheck, J., Navracruz, L., Reichsman, A., Clarck, T. C., & Werner, J.
J. (2011). Keys to successful diabetes self-management for uninsured patients: Social
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Marshall, M. C. (2005). Diabetes in African Americans. Postgraduate Medical
Journal, 81(962), 734-740.
Persily, C. A. & Hildebrant, E. (2008). Theory of community empowerment. In Smith, M. J. &
Lierhr, P. R. Middle Range Theories for Nursing (2nd Eds.). New York, NY: Springer Publishing
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