literature searching and reviewing

So 3 hectic months have passed since my last posting where I was examining the idea of Complex Interventions and things have certainly moved on!
What became clear from my preliminary dabbles in the literature on Community Empowerment; Complex Interventions and Economic Evaluations was the overwhelming need to qualify what exactly I was searching for in a community to determine if they were 'empowered' or not. Whilst this remained vague and undetermined, chances of the project moving forward would be slim, resulting in an unstructured and mind-boggling mess of a project. Some consensus as to what the attributes of empowerment are needed to be reached. Even an economics newcomer such as myslef understands that known quantities are preferable to vague ones when attempting to conduct any sort of evaluation.

What does the Scottish Government envisage and how does this differ from work previously done in the academic field? Are there ideas of empowerment or power shifts in a community from other academic fields that could be applicable? My list of questions seemed endless. Through conducting a systematic search of literature it was hoped that some answers would be found. However, this was a multi-disciplinary search as no one individual field appeared to fully satisfy the full breadth of what I was hoping to cover. Acknowledging that Community Empowerment could potentially be addressed by numerous fields of academic interest meant my database search looked at databases which specialised in colleating work on the following topics:

Economic and Social History; Economics; Geographical and Earth Sciences (referring to human geography); life sciences; medicine; nursing and health care; psychology; public policy; sociology and urban studies. 

An additional concern arose when I tried to chose appropriate search terms. It must be noted here that this search was intended to be broad as it was felt that to specify so early on in the project could potentially limit the study's outcomes. Through gaining an initial understanding of the many contexts of community empowerment, it is possible that a more appropriate focus may be found, one that draws on the work from numerous backgrounds and builds upon work already done rather than merely satisfying a small niche. Aiming big!!

Terms previously mentioned in work on the theory of empowerment such as those by Laverack (2006) combined with visions described in UK policy documentation provided the premise for the search terms I would use in my literature search. For example, community owned; community capacity and personal empowerment.

Wading through literature both relevant and irrelevant has led to my current state of affaires - making sense of the ideas and theories and decifering how/if they relate to my work. Even from the initial stages of this process, a wealth of information has already been brought to my attention. Work centering around the idea of personal empowerment within self-help groups utilising a personal empowerment likert scale as individuals are asked to judge their own feelings of security and power both within their immediate circumstances and the wider surroundings (Johnson, Worell et al; 2005) - could such a scale identify an intrinstic link between how ones personal feelings affect their outlook and ability to partake within their community? Is security and control over housing and input into the decisions taken by the local housing association important to all residents? Or does this point to a larger deficientcy- they want control over these decisions because they are consulted on so few other factors? Is a power shift from government to local people necessary or is empowerment a grassroots activity that can only be facilited and built from within? Power, a finite resource? These are but a few of the questions and queries that I am starting to address through my reading of articles/project documents. Combined with my work on models of empowerment suggested by the likes of Worell (2003) and other psychological wellbeing scales and measurement instruments currently in use (EQ-5D, SF-6D etc), I am hoping to grasp what we can quantify and pinpoint some ACTUAL ATTRIBUTES OF EMPOWERMENT. Fingers crossed it makes for some interesting future reading!!

Complex intervention

Unlike my previously predicted focus for this last week I have attempted to focus on the challenges posed by the idea/concept of 'complex intervention'. The idea that health researchers use the notion of complexity to help them indicate the problems faced in evaluating the effectiveness of interventions which include far more varibles than those perhaps presented in a drug trial was not new to me. It seems only logical that when describing something with numerous components and possibilities the word 'complex' would appear. What was new to me was the 2 differing angles presented in literature such as that by Shiell, Hawe and Gold (2008). They explain that whilst yes interventions can be complex, there is an alternative viewpoint, that is that complexity is the property of a system not an intervention. That is, the idea that a system such as the human body or a school may be composed of numerous interventions and that by looking at the system as a whole one is able to establish an understanding of the the different relationships occuring between the different components or the different interventions. Currently in my mind, being able to contextualise the intervention and gauge a better understanding of the system occuring around it would allow the researcher to design/develop a more successful intervention, one that is appropriate and surely that through this understanding it would be possible to better appreciate what influences affected which feature of the intervention thus allowing for successful duplication of the intervention elsewhere with informed ,minor changes being made? This I have yet to read about but the next stage of this week will be getting to grips with the process of designing an intervention - what does it entail?
 So far I have understood that there are 5 stages:
pre-clinical theory -what has been done before? understanding the research that has gone before
modelling - identification of the key components or mechanisms
exploratory trial - tes of the actual trial - allowing changes to be made
the definitive trial
the long term implementation

I look forward to getting to grips with these and how the evaluation occurs!

First Week

Starting last tuesday the main tasks of my first week was to get confortable with the office environment and 2 key aspects of my subject area; Economic Evaluation and Community Empowerment.

Community Empowerment was one of those terms that had be carelessly thrown about and scattered throughout previous government policy documents and spatial strategies I had analysed during the time of my MSc. It had always been apparent to me that this term describes a desirable outcome - a state that many want to achieve through various initiatives and one that cannot be imposed or created by others outside the community in question.
However is it an outcome or a process? From my readings it became more apparent that what I once thought was infact only one (very plausible) argument and that numerous different perspectives surrounding this question exist. As South and Woodall (2010) explain, "Empowerment is about individuals and communities increasing control over their lives and their health". Yet how can this be done? Clearly instrinstic to the concept is an understanding that one can only be empowered through their own efforts and this is not a 'state' that can be imposed on them. Indeed in their joint report, COSLA and the Scottish Government (2009) highlight that whilst the government cannot compel or require anyone to become empowered they can "remove barriers, promote better opportunities and support those already involved".
Infact, the main emphasis of the argument/explanation provided by the Scottish Government was the importance of Community Empowerment as a means to invigorate democracy and its growth. The underlying statement throughout was the importance of empowerment as a way to bring communities together and allow them to have more of an influence over matters which relate directly to them. They argued that it was a process- people became empowered and the outcome was a positive change in actions and attitudes of the community as a whole. Yet how do you measure empowerment? This was the big stumbling block throughout the texts I encountered and the currently mystifying entity I have yet to solve. I understand that in order to think 'like an economist' I need to quantify my arguments. Therefore is it perhaps easier for me to maintain my original perspective of community empowerment as an end product? I believe that yes it would be easier, yet I am drawn to the arguments of the likes of Adamson and Bromiley (2008) who employ "the term 'community empowerment' to describe a process of decision-making and influence at a community or neighbourhood level by residents of that community".
I am starting to believe that there may be many 'states' or 'stages' of community empowerment and that a process is perhaps a more plausible outlook and perspective of this term. Relating it to my own experiences, when I have lived within a community where I feel my decisions and involvement have a direct impact on the matter in hand I have felt a rush, a feeling of empowerment (or was that just the feeling of self-worth) that has positively influenced my feeling of belonging within that community.
Clearly this is a question that I will have to address over time...along with Laverack's (2006) 'nine domains of empowerment'!