PurposeThis paper aims to review global adolescent empowerment programmes and develops and proposes a model that can be used with vulnerable adolescents. The model reflects theory and experience drawn from the literature.Design/methodology/approachThe review is a synthesis of articles on empowerment theory, models and programme evaluations. Literature is selected and critiqued that reflects aspects of empowerment as described by Freire or relating to empowering models that could be generalised and related specifically to vulnerable adolescent programmes. Vulnerable adolescents within the context of this paper have been identified as those experiencing social, economic, cultural or physical disadvantage.FindingsThe findings document that empowerment programmes do not fully integrate the theory or pedagogy of empowerment as described by Freire. In most cases the goals of empowerment programmes, when stated, do not reflect the transformative or social action aspects of empowerment theory. Nevertheless there are sufficient examples of successful empowerment programmes with marginalised populations to warrant more rigorous application and evaluation of empowerment theory with this population in a variety of social settings. The relationship between the facilitator and participants and the development of critical consciousness are two vital aspects of empowerment theory that are unexplored and need further study.Research limitations/implicationsMany empowerment programmes for vulnerable adolescents in resource‐poor countries have not been evaluated or have not been published. Lack of consistency in the use of terminology and evaluation also makes it difficult to compare studies.Originality/valueThis paper proposes a model of empowerment that could be effective in addressing the health needs of marginalised adolescents and is based on theory and field experiences.
BackgroundCommunity-based health workers and volunteers are not just low-level health workforce; their effectiveness is also due to their unique relationship with the community and is often attributed to social capital, an area not well studied or acknowledged in the literature.MethodsA qualitative meta-synthesis was conducted using the SPIDER framework and based on critical interpretive synthesis. The protocol was registered with PROSPERO, ID = CRD42018084130. This article reports on the qualitative data extracted from the final 33 articles selected from 147 full-text articles on social capital and community-based health systems.ResultsThree constructs were identified that enable community health workers to bring about changes in behaviour in the community: seeing their role as a service or a calling motivated by altruistic values, accompanying community members on their journey and the aim of the journey being empowerment rather than health. Community health workers feel under-resourced to provide for expectations from the community, to fulfil their non-health needs, to meet the expectations of their employers and to be able to deliver health services.ConclusionThe dichotomy of needs between the community and health services can be resolved if policy makers and programme designers examine the possibility of two cadres of community-based health workforce: full-time workers and part-time volunteers, with clear scopes of practice and supervision. Community health workers would primarily be concerned with task shifting roles demanded by programmes, and volunteers can focus on the wider empowerment-based needs of communities.
Growing numbers of adolescents are marginalized by social factors beyond their control, leading to poor health outcomes for their families and future generations. Although the role of the social determinants of health has been recognized for many years, there is a gap in our knowledge about the strategies needed to address these factors in health promotion. Drawing on a review of literature on health promotion for marginalized and out-of-school adolescents, this paper highlights some urgent areas of focus for researchers and policy makers addressing adolescent health. Social determinants of health affecting marginalized adolescents identified by the review were education, gender, identity, homelessness, poverty, family structure, culture, religion and perceived racism, yet there is little solid evidence as to how to best address these factors. More systematic research, evaluation and global debate about long-term solutions to chronic poverty, lack of education and social marginalization are needed to break the cycle of ill health among vulnerable adolescents.
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