The meaning and the assessment of empowerment in patients with psychotic and affective disorders

Background: Empowerment is regarded as a crucial factor in modern psychiatric treatment. However, there are no suitable, standardized measurements to assess empowerment in the process of psychiatric treatment. Therefore it is neither possible to mark potential reasons for a missing empowerment orientation nor can we precisely determine the importance of empowerment for the treatment outcome.

Aim: In this study we examined the meaning of the term empowerment for people with affective (ICD-10 F30-F39) and schizophrenic (ICD-10 F20-F29) disorders as the basis for the development of a standardized measure instrument.

Methods: We have chosen a qualitative approach for examining the meaning of the term empowerment for patients with severe mental disorder. We conducted eight focus groups with outpatients from rural and from urban living areas. Participants were given semi-structured enquiries about what empowerment means to them in their daily lives. Focus groups were taped, transcribed and then analyzed by means of qualitative content analysis.

Results: We obtained a broad range of conceptual facets and deduced the following dimensions of empowerment: ”daily living” (finances, occupation, housekeeping/ housing situation, social relationships, spare time), “treatment” (treatment participation, knowledge of how to act, medication), “societal/ political” and “person” (hope, self-efficacy, self-esteem, acceptance). While the increase of control was mentioned as the common core of empowerment within these dimensions the definition of low and high levels of empowerment differed significantly between dimensions.

Conclusion: For people with affective and psychotic illness empowerment has a broad meaning closely related to increase the control over several dimensions of their daily life and their psychiatric treatment. For the development of a measurement instrument it is necessary to identify adequate definitions of high and low levels of empowerment for each dimension.