Describe how you would measure the outcomes that you identified in Discussion. Specifically, identify the two best measurement instruments tha

Measuring Instruments for Empowerment in Social Work: A Scoping Review

Thomas Noordink 1,2,*, Lisbeth Verharen2, René Schalk1, Marcel van Eck1 and Tine van Regenmortel1,3

1Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The

Netherlands 2Research group Strengthening Social Quality, HAN University of Applied Sciences,

Nijmegen, The Netherlands 3HIVA and Faculty of Social Sciences, University of Leuven, Leuven, Belgium

*Correspondence to Thomas Noordink, Academie Mens & Maatschappij, HAN University

of Applied Sciences, Kapittelweg 33, 6525 EN, Nijmegen, The Netherlands. E-mail:

[email protected]

Abstract

Empowerment is seen as an important thinking and working framework for social

work. Ideally, it is possible to measure the empowering effects of social work.

However, various factors complicate measuring empowerment, making it a difficult

exercise. In past decades many instruments for measuring empowerment have been

developed and there are many variations in the way these instruments have been de-

veloped. The aim of this review is to provide a comprehensive overview of the avail-

able instruments, scales or questionnaires that intent to measure the empowerment

of users of social work in different contexts of social work, by means of a scoping re-

view. A total of 2,711 studies were screened, resulting in 49 unique instruments for

measuring empowerment in contexts related to social work. The results show that the

found instruments are almost exclusively Patient-Reported Outcome Scales. Whilst

many instruments measure individual empowerment, only a few measure community

empowerment. The results also show that there are many variations in which instru-

ments operationalise empowerment. This overview provides social work organisations

and its researchers an overview of measuring tools necessary to measure the effects

of their efforts, allowing them to build on what is available.

www.basw.co.uk

# The Author(s) 2021. Published by Oxford University Press on behalf of The British Association of Social Workers.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/

licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and repro- duction in any medium, provided the original work is properly cited. For commer-

cial re-use, please contact [email protected]

British Journal of Social Work (2021) 51, 1482–1508 doi: 10.1093/bjsw/bcab054 Advance Access Publication March 30, 2021

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Keywords: Empowerment, measuring instruments, scoping review, social work

Accepted: February 2021

Introduction

Empowerment in social work

Empowerment is globally accepted as a central concept for social work, as can be seen in the international definition of social work, in which empowerment is stated as a core value (IFSW, 2014). Empowerment is seen as an important thinking and working framework within social work (Van Regenmortel, 2008).

The concept of empowerment seems regularly used by social workers. Professionals identify with it, partly because they tend to give meaning to empowerment in all sorts of ways. However, therein lies the risk that em- powerment becomes a vague concept that social workers link to every- thing they do (Van Regenmortel, 2002). As a result, the concept loses its substantive meaning and becomes an all-purpose word for things related to strengthening people, power, control and so on. That is an unnecessary result, since ‘empowerment’ is actually a theoretically well-founded scien- tific concept, which makes it possible to operationalise and measure em- powerment (Zimmerman, 2000; Steenssens and Van Regenmortel, 2014).

The value and complexity of measuring empowerment

Ideally, it is possible to evaluate the empowering efforts of social work and then determine the effects of these efforts. Gulikers (2016) empha- sises the importance of meaningfully justifying social work and its efforts. To do so, measuring instruments are needed that expose em- powerment as a result of social interventions. For years, professional practice has been looking for methods that can support the effects of social work (Hermans, 2008). In past decades many instruments have been developed that aim to measure different levels of empowerment.

However, measuring empowerment and determining whether the efforts of social workers lead to citizens being able to empower them- selves, is difficult (Jacobs et al., 2005; Wallerstein, 2006). The complexity of measuring empowerment is implied by theoretical assumptions that are involved when one wants to measure empowerment. Van Regenmortel (2002) inspired by the work of Rappaport and Zimmerman, states a few basic theoretical assumptions of empowerment, which are exemplary to the complexity of measuring empowerment.

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First, empowerment is an open-ended construct and a variable which can vary per context or person. It can occur in several degrees. Empowerment can have a different meaning for each person. Furthermore, it is not set in stone and can develop over time.

Second, empowerment is seen as a multilevel concept, in which differ- ent levels of analysis can be distinguished. Psychological empowerment, which relates to empowerment of individuals, organisational empower- ment and community empowerment (Zimmerman, 2000). These levels are often intertwined, interconnected, interdependent and can be both cause and effect. This implies the interactive nature of empowerment, the constant mutual influence between individuals and their environ- ments. Furthermore, these three levels can themselves be divided into underlying dimensions and components (Zimmerman, 1995).

The aforementioned factor that empowerment is an open-ended con- struct implies the complexity of developing universal measuring instru- ments (Zimmerman, 1995; Van Regenmortel, 2002). A ‘one size fits all’ solution does not seem likely. As a result, there are many different measures for different target populations and contexts. Such a fragmen- tation of instruments hinders maintaining an overview.

The available range of empowerment instruments

In the past decades, many instruments for measuring empowerment have been developed for specific contexts and there are many variations in the way these instruments have been developed (Peters et al., 2007). A few reviews make an inventory of available instruments for a specific target population, for example, the review by Bakker and Van Brakel (2012), Barr et al. (2015) or Herbert et al. (2009). There is no overarch- ing review of instruments that are available and relevant specifically for social work. It is imaginable that this is partly due to the fact that ‘social work’ as a context is hard to define (Van de Kamp et al., 2020). It includes many different target populations, problems and contexts.

A comprehensive overview of available tools to measure empower- ment in the various sectors of social work can be a useful starting point for social workers, when they want to measure empowerment within their own specific context.

The aim of this study

The aim of this review is to provide a comprehensive overview of avail- able instruments that intent to measure empowerment of users of social work in different contexts of social work, by means of a scoping review. Subsequently, this study aims to describe these instruments, distinguish- ing between dimensions of empowerment that are measured,

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psychometric properties of the instruments found and relevant contexts in which empowerment is measured.

A scoping review seeks to summarise key concepts and primary sour- ces and types of relevant research data concerning specific topics (Arksey and O’Malley, 2005). It differs from systematic reviews in many ways. For example, a scoping review’s purpose is to take stock of and map the available knowledge concerning a specific topic, whilst the pur- pose of a systematic review is to summarise the best available research (Pham et al., 2014). Also, to identify research gaps concerning the avail- able measuring instruments for empowerment, in the context of social work. What is not known and is thus a knowledge gap that requires the focus of research in order to fill the void.

Methods

A scoping review was conducted focusing on finding empowerment measures, which can be used for the context of social work. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines extension for Scoping Reviews (Tricco et al., 2018).

Eligibility criteria

In a first screening all articles that refer to empowerment measures, were included and screened. The original study of the referred to measure, was then included. Subsequently, articles were eligible when they reported instrument development or validation. Only articles in English or Dutch were included. All instruments that measure em- powerment in a context related to social work, were included, delin- eated as illustrated in the results section. In order to reduce the amount of outdated information, all articles must be referred to or reported in the past 15 years.

Articles were not eligible when the context of the study was not rel- evant for OECD countries. Also, instruments that include empower- ment as a subscale or bycatch, were excluded. Furthermore, translated instruments were excluded; the original study was then in- cluded. Editor letters, recommendations and opinion papers were ex- cluded. Work-related instruments, in which empowerment of professionals was measured, were also excluded since there is no spe- cific relation with social work.

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Information sources

To this end seven electronic databases were consulted (PsycInfo, Web of Science, MedLine, Eric, Embase, Cinahl, Sociological Abstracts) from 6 January to 3 February 2020. Subsequently, the reference sections of in- cluded papers, along with review articles that were found, were examined.

Search

Experimenting with different search strategies resulted in the following search input, with small variations to meet the specific properties of cer- tain databases:

TI (Empower* N3 (validit* OR specificity OR sensitivity OR measur*

OR Assess* OR Scale* OR Tool* OR instrument* OR screen* OR test

OR tests OR survey* OR questionnaire* OR score* OR apprais* OR

index OR checklist*)) OR AB (Empower* N1 (validit* OR specificity

OR sensitivity OR measur* OR Assess* OR Scale* OR Tool* OR

instrument* OR screen* OR test OR tests OR survey* OR

questionnaire* OR score* OR apprais* OR index OR checklist*)).

Given our desire to distil instruments that have the intention of mea- suring empowerment as a complete construct, it was decided not to operationalise the concept ‘empowerment’ any further.

The other concept ‘measuring’ was further operationalised for the search strategy, as seen above. A third concept, being ‘social work’ was not operationalised and not included in the search strategy. ‘Social work’ is considered a broad concept, which is hard to define (Van de Kamp et al., 2020). Limiting the search strategy by defining ‘social work’ would possibly lead to unwanted exclusion of studies.

Figure 1: Results per database.

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Article selection and data charting

A total of 5,198 articles were identified in the search, which was reduced to 2,711 after the removal of duplicates (Figure 1). The 2,711 remaining abstracts and titles were screened blinded by two researchers.

For 179 articles, the full text was assessed. In total, unique instrument for measuring empowerment in contexts related to social work, were found. The process of data selection is shown in Figure 2. Most of the selection challenges are related to defining social work as a context in which empowerment can be measured. As stated before, ‘social work’ was not operationalised and included in search strategies. The contexts eventually reported are not predetermined, but the result of inductive analyses, in which two researchers determined per study whether the de- scribed context was related to social work, based on their own expertise. The four-eyes-principle allows the researchers to compare and discuss differences and involve expertise of the supervisory committee consisting of Dutch and Belgium professors of social work.

Figure 2: PRISMA flowchart of study selection process.

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In this phase, instruments were excluded of which the context was not in line with the aim of this study. For example, the Kim Alliance Scale (Kim et al., 2001) was excluded since empowerment was not the con- struct primary intended to measure, but one of four subscales (collabora- tion, integration, empowerment and communication).

Data items

For included articles, we abstracted data on study characteristics, in- strument objectives and registration methods. In this way, an over- view was created with whom is measured, how is measured and what is measured.

Data concerning validity and reliability of an instrument have been added to give a basic impression of the quality of instruments found. Since it is our goal to provide an overview of what is available and not what is good, we choose not to make further statements about the qual- ity of instruments.

Synthesis of results

The data were compiled in a single overview as reported in the results section, in which 49 instruments have been elaborated by describing the aforementioned factors. No further synthesis of results is given, as we in- tend to describe what is available for social work.

Results

The results are clustered per context within social work. These clusters are presented as follows: parent and family support (9), mental health- care (8), childcare and youth work (8), elderly healthcare (3), medical healthcare (13) and other (8).

The results show that all measures are questionnaires and that, a few exceptions aside, they use Likert scales as scoring system.

The results further show that 40 of the 49 instruments are patient- reported outcome measures, questionnaires completed by patients to measure their perception of their functional well-being and health status (Department of Health, 2009). Five instruments use interviewer administration, one uses a parallel administration where the measures of patients and nurses are combined and two are unclear. One mea- sure of community empowerment uses an administration method where the questionnaire was self-administered at first and discussed towards consensus in the group thereafter. All instruments measure

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