HEALTH PROMOTION INTERNATIONAL
2
© Oxford University Press 2001. All rights reserved
Measuring community empowerment:
a fresh look at organizational domains
GLENN LAVERACK and NINA WALLERSTEIN1
UNICEF, Hanoi, Vietnam and 1Department of Family and Community Medicine,
University of New Mexico School of Medicine, Albuquerque, NM 87131, USA
SUMMARY
In 1986, the Ottawa Charter identified community
empowerment as being a central theme of health promotion
discourse. Community empowerment became a topical
issue in the health promotion literature soon afterwards,
though its roots also come from earlier literature in com-
munity psychology, community organizing and liberation
education. Subsequent international conferences to address
health promotion in Sundsvall, Adelaide and Jakarta have
acted to reinforce this concept. It is as relevant today as it
was more than a decade ago. The literature surrounding
health promotion has since moved onto other overlapping
theoretical perspectives, such as community capacity and
social capital. And yet the critical issue of making com-
munity empowerment operational in a programme context
Key words: community empowerment; health promotion; measurement
AN OLD PROBLEM
The many interpretations of community em-
powerment are based on understandings of this
concept as either a process or as an outcome
(Bernstein et al., 1994), and whether it exists as
an inter-personal phenomenon (Torre, 1986;
Rappaport, 1987; Swift and Levin, 1987), a broad
socio-political context (Friedmann, 1992; Craig
and Mayo, 1995) or an interaction of change
at multiple levels (Wallerstein, 1992). The main
discussion around this concept in relation to health
promotion/education occurred at the beginning
of the 1990s (Wallerstein, 1992; Israel et al., 1994;
Rissel, 1994). What seems to have been largely
ignored in this discussion was an analysis of the
specific organizational domains of community
empowerment and the way in which these
Vol. 16, No.
Printed in Great Britain
remains thorny and elusive. Community empowerment is
still difficult to measure and implement as a part of health
promotion. This article offers a fresh look at key theoretical
and practical questions in regard to the measurement of
community empowerment. The theoretical questions help
to unpack community empowerment in an attempt to
clarify how the application of this concept can be best
approached. The practical questions address the basic design
characteristics for methodologies to measure community
empowerment within the context of international health
promotion programming. The purpose of this article is to
allow researchers and practitioners to address again the
important issue of making community empowerment
operational.
influence the effectiveness and utilization of
this concept in a programme context. This is
significant because, as argued in this article, the
organizational domains offer a straightforward
way in which to view and measure community
empowerment.
The importance of community empowerment
as a central theme in health promotion has been
overshadowed since the mid-1990s by dis-
cussions about community capacity (Goodman
et al., 1998), community competence (Eng and
Parker, 1994), community cohesiveness (Geyer,
1997) and social capital (Putnam, 1995; Modra,
1998). Whilst these concepts are increasingly
becoming accepted as critical for promoting better
standards of living and possibly for mediating the
effects of poverty and inequities on health out-
comes (Wilkinson, 1997), they often lack the
179
180 G. Laverack and N. Wallerstein
dimension of social influence and transforming
power relations.
It is only by being able to organize and
mobilize oneself that individuals, groups and
communities will achieve the social and political
changes necessary to redress their powerlessness.
This remains the domain of community empower-
ment as a political activity, which enables people
to take control of their lives.
The old problem, therefore, is two-fold. The
first is one of providing sufficient clarity to this
complex concept so that the second, the dif-
ficulties involved in making it operational, can be
addressed practically. Whilst the conceptual
issues concerning measurement have been ad-
dressed previously in the literature (Wallerstein,
1992; Bernstein et al., 1994; Rissel, 1994), there
have been few attempts to address the practical
question of measurement, an exception to this
being the work by Fetterman et al. (Fetterman
et al., 1996).
A FRESH LOOK
The purpose of this article is to raise theoretical
and practical questions for the assessment of
community empowerment, with a focus on organ-
izational issues, and to offer a fresh look at the
ways in which to make this concept operational
in the context of health promotion programming.
The first questions consider key theoretical issues
for empowerment approaches.
• Who is the community in a programme context?
• What factors influence community empower-
ment?
• Is community empowerment a process or an
outcome?
The second set of questions considers key
practical issues for empowerment approaches.
• How can we build capacity as a part of the
programme approach?
• How can we promote empowerment beyond
attempts to measure it?
• How does the approach influence stakeholder
roles and responsibilities?
Before considering the practical aspects of the
design of a methodology it is necessary to unpack
community empowerment theoretically, in an
attempt to clarify how the measurement of this
concept can be best approached.
WHO IS THE COMMUNITY IN A
PROGRAMME CONTEXT?
Ward, Israel et al., and Bell and Newby agree
that communities consisting of heterogeneous
individuals may collectively take action toward
attaining shared and specific goals (Bell and
Newby, 1978; Ward, 1987; Israel et al., 1994).
However, as Zakus and Lysack point out, it is
necessary to consider carefully who are the
legitimate representatives of such ‘communities’
(Zakus and Lysack, 1998). Those individuals who
have the energy, time and motivation to become
involved in programme activities may, in fact, not
be supported by its members and may instead be
considered as elites. The dominant minority may
dictate the community needs unless adequate
precautions are taken to involve as many people
as possible.
The importance of recognizing that community
members can be heterogeneous and yet still have
the ability to share needs and interests can be
reflected by the difficulties experienced within
Aboriginal health services in Australia.
Aboriginal communities are often a collection
of families, language groups or clans who can be
in competition and who may be geographically
isolated. Scrimgeour points out that the term
‘community’ was applied to such settlements by
bureaucratic intellectuals because it provided a
convenient label for the assimilation of different
concepts and for a heterogeneous group of
people (Scrimgeour, 1997). This assumption
may have led to a lack of cooperation, direction
and collective action between the members of
Aboriginal groups.
Heterogeneous groups and individuals can
actually become more of a ‘community’ through
the process of programme planning, to the extent
that programme aims and objectives reflect, at
least in part, shared interests and needs of hetero-
geneous members. Individual, family or clan-based
differences may then be set aside as programme
participants begin to create a community identity
around the more tightly focused programme aims.
Involving programme participants in the identi-
fication of issues and concerns is therefore
crucial to ensure that the aims and objectives
are relevant and capable of working to overcome
other divisions. This does not preclude problems
of conflict arising during programme planning
and implementation, but can help to reduce
them. The members of the newly formed ‘com-
munity’ organize and mobilize themselves

around the programme aims, and this in turn
facilitates the means by which they empower
themselves.
WHAT FACTORS INFLUENCE
COMMUNITY EMPOWERMENT?
To be able to measure community empowerment
we must first address the question of what factors
influence this concept. The recent research by
Laverack provides clarification through the
identification and interpretation of nine organ-
izational areas of influence on community
empowerment in a programme context: (i) par-
ticipation; (ii) leadership; (iii) problem assess-
ment; (iv) organizational structures; (v) resource
mobilization; (vi) links to others; (vii) ‘asking
why’; (viii) programme management; and (ix)
the role of the outside agents (Laverack, 1999).
These organizational aspects of community
empowerment or ‘operational domains’ provide
a link between the inter-personal elements,
such as individual control (Everson, 1997), trust
and community cohesiveness (Geyer, 1997), and
the contextual elements such as the political
(Asthana, 1994), socio-cultural (Gordon, 1995)
and economic (Taylor, 1995) circumstances.
The operational domains represent those
aspects of community empowerment that allow
individuals and groups to organize and mobilize
themselves towards commonly defined goals of
social and political change. The organizational
aspects in themselves may act as a proxy measure
for social aspects of community empowerment
identified by other researchers. For example, the
existence of the domain of functional leadership,
supported by established organizational structures
with the participation of its members who have
demonstrated the ability to mobilize resources,
would indicate a community that already has
strong social support elements.
Tonon describes the actions of a Guatemalan
village in order to bring about improvements in
sanitation (Tonon, 1980). Leadership was repu-
tational from informal male opinion leaders in
the village. These people formed a committee and
held several meetings in collaboration with the
outside agent and with other community mem-
bers. The process took many months of social-
izing and meeting, and it was the cohesiveness of
the individual members that allowed a functional
organizational structure to be established in the
community.
Measuring community empowerment 181
IS COMMUNITY EMPOWERMENT
A PROCESS OR AN OUTCOME?
A further question is whether to view community
empowerment as a process or as an outcome.
Community empowerment has been commonly
viewed in the literature as both. As an outcome,
community empowerment is an interplay
between individual and community change with
a long time-frame, at least in terms of significant
social and political change, typically taking
7 years or longer (Raeburn, 1993). An example
of this type of outcome would be a change in
government policy or legislation in favour of
individuals and groups who have come together
around programmes and community actions.
Health promotion programmes typically have
a shorter time-frame. Baistow points out that
the community’s experience of being empowered
may therefore not be felt until long after the
intervention has been completed and it may not
be possible to assess empowerment outcomes,
as social and political change, during the pro-
gramme period (Baistow, 1995).
At an individual level, people may experience
a more immediate psychological empowerment,
such as an increase in self-esteem or confidence
which evolved from collective action (Labonte,
1998). Though partially measured as self-esteem
or self-efficacy, psychological empowerment is
a construct that incorporates the person’s per-
ceptions and actions within their social context
(Zimmerman, 1990).
The measurement of outcome might not take
into account the processes involved in community
empowerment, such as capacity building and
developing competencies, skills and critical
awareness. The outcome gained can also mean
different things to different people in the same
programme, and it is likely to be incremental and
often relative to the inter-personal relationships
of the person concerned. Kieffer provides an
example of a woman whose empowerment led
her to come to appreciate that officialdom and
title did not make any difference; her relation-
ship with these people changed such that she
then began to take control of her own life rather
than relying upon officials (Kieffer, 1984).
Zimmerman argues that a universal measure
may confuse our understanding of empowerment
by construing its effects as static outcomes rather
than as dynamic experiences: ‘the development
of a universal and global measure for empower-
ment (outcome) is not an appropriate goal because
182 G. Laverack and N. Wallerstein
it may not mean the same thing for every
person, organization, or community everywhere’
[(Zimmerman, 1995), p. 587]. Outcomes may also
fluctuate and depend on circumstance, where
people may experience empowerment in one
setting but not another, and at one time but not
another.
Community empowerment is most consistently
viewed in the literature as a process in the form
of a dynamic continuum, involving: (i) personal
empowerment; (ii) the development of small
mutual groups; (iii) community organizations;
(iv) partnerships; and (v) social and political
action (Jackson et al., 1989; Labonte, 1994; Rissel,
1994). The potential of community empower-
ment is gradually maximized as people progress
from individual to collective action along this
continuum.
The definition of community empowerment as
both a process and an outcome has implications
for the measurement of this concept. In a pro-
gramme context, the definition as an outcome is
limited by its long time-frame and contingent
nature. However, by measuring community em-
powerment as a process, it is possible to monitor
the interaction between capacities, skills and
resources at the individual and organizational
levels during the time-frame of a programme,
as well as community-level changes in healthy
conditions, policies and interpersonal structures.
It is the definition of community empowerment
as a process along a continuum that offers most
insight into the ways in which people are enabled
through the programme to maximize their
potential and to progress from individual action
to collective social and political change.
This complexity raises issues about the practical
design of approaches for measuring community
empowerment, addressed here in the second set
of questions.
HOW CAN WE BUILD CAPACITY
AS A PART OF THE PROGRAMME
APPROACH?
A range of participatory and collaborative
methodologies have been designed to undertake
assessments and to empower individuals and com-
munities: participatory rural appraisal (James,
1995), participatory research and action research
(Eng and Parker, 1994). However, the key to the
differentiation between participatory and
empowering approaches lies in the agenda and
purpose of these processes. Empowerment
approaches have an explicit agenda to bring
about social and political changes, and this is
embodied in their sense of liberation, struggle
and community activism. Participants gain power
as a result of a change in control over decisions in
the inter-personal relationships that influence
their lives. It is the participants themselves who
achieve these outcomes by seizing or gaining
power through a process of identifying problems,
finding solutions to these problems and then
implementing actions to solve them. Participatory
approaches do not necessarily seek emancipation
or empowerment.
Participants are involved in and contribute to
a programme which in turn may build their
capacities, skills and competencies, but does not
necessarily assist the community to gain or
seize more power through collective social and
political action. Participatory assessments motivate
the stakeholders to identify and build on their
strengths and to minimize their weaknesses
through their own efforts, based on their own
knowledge and experiences. Rifkin points out that
stakeholders are more likely to be committed if
they have a sense of ownership in regard to the
problems and solutions being addressed by the
programme (Rifkin, 1990). Programmes that
do not address community concerns and that do
not allow the stakeholders to participate in the
process of assessment have been shown not to
achieve their purpose (Rifkin, 1990). Capacity
can therefore be built into the design of a
methodology by allowing both a participatory
and empowering approach.
Participation allows the different stakeholders
of a programme to express their views, share their
experiences and to challenge existing knowledge
claims and paradigms. Different stakeholders
may have different opinions and a methodology
should allow individuals to participate in an
equal relationship between all parties (Arnstein,
1969). The techniques employed should promote
the involvement of each member through their
discussion and interaction with the other
participants.
Empowerment promotes capacity building
of heterogeneous individuals who have shared
interests and concerns, and strengthens their sense
of struggle and community activism through
the process of community empowerment. This
is reflected in their ability to move toward small
group activities, organizational structures and
links with others outside the community, along

with an increased awareness of the broader social
and political causes of their disempowerment.
HOW CAN WE PROMOTE
EMPOWERMENT BEYOND ATTEMPTS
TO MEASURE IT?
Measurement in itself is insufficient to empower
the stakeholders of a programme, and it is the
transformation of information, identified by the
stakeholders, into social and political action and
the ability to change inter-personal relationships
that is characteristic of an empowering approach.
This can be achieved through strategic planning
assisted by the utilization of ‘tools’ such as the
logical framework system of project planning.
This is a matrix setting out a clear statement
of objectives, identifying in advance suitable
indicators of progress and the prior assessment of
risks and assumptions toward programme success
(Cracknell, 1996). Logic models allow com-
munity groups to identify clearly their own causal
reasoning of an intended process and can en-
hance credibility through the evidence of change
(Goodman, 2000).
The strength of using the logical framework
system are that its design has validity, having
already been widely employed as a ‘tool’ for
programme management and evaluation, and
provides a simple and systematic approach to
strategic planning. However, the logical frame-
work system is one example of a ‘tool’ that should
be used appropriately to help stakeholders to
recognize their potential for action and change.
HOW DOES THE APPROACH
INFLUENCE STAKEHOLDER ROLES
AND RESPONSIBILITIES?
Empowering and participatory approaches
redefine the role relationship between the second-
ary and primary stakeholders. The role of the
outside agent has been traditionally viewed as
one of ‘expert’ or ‘professional’ or as an evaluator,
one who judges merit or worth (Patton, 1997).
This role is changed in an empowering approach
to be one that facilitates, enables, or as Fetterman
et al. describes, coaches and guides, the primary
stakeholders (Fetterman et al., 1996). The role of
the health promoter is to enable individuals and
groups to gain or seize power through their own
power-from-within. The evaluation itself can be
Measuring community empowerment 183
an empowering experience by building capacity,
competencies and the power-from-within of the
primary stakeholders.
The experiences of using empowerment
evaluation by Stevenson et al. demonstrates the
importance of first clarifying the roles and
responsibilities of all programme stakeholders
(Stevenson et al., 1996). They used a detailed
statement to define the expectations of the
various stakeholders and this was communicated
to all concerned in the programme. Once a
consensus had been reached it was only then
used as a reference document to guide the roles
and responsibilities of the stakeholders.
CONCLUSIONS
In this paper we have argued that the design of a
methodology for the measurement of empower-
ment must begin with a clear theoretical under-
standing of the concept, both as a process and as
an outcome, its different levels of analysis (indi-
vidual, organizational and community), and the
domains or factors that influence its utilization
and effectiveness. Next, the practical issues can be
addressed. The key points for the future design of
a methodology to measure community empower-
ment asserted in this article are summarized here.
• The concept of ‘community’ may be interpreted
as heterogeneous individuals and groups who
share common interests and needs, and who
are able to mobilize and organize themselves
toward social and political change.
• It is the interpretation of community empower-
ment as a process along a continuum that pro-
vides most insight into the measurement of the
competencies and capacities developed toward
social and political change within the time-
frame of most programmes.
• The process of community empowerment is
influenced by both social and organizational
areas of influence. However, it is the organ-
izational domains that present a straightfor-
ward way to define and measure this construct
as a process.
• The design of a methodology should be
participatory and have clear roles and respon-
sibilities for all stakeholders.
• The methodology should be an empowering
experience and provide a means to translate
the information gained into action through
strategic planning.
184 G. Laverack and N. Wallerstein
Empowerment has been theoretically well
addressed in the literature, with this paper em-
phasizing the less-well understood organizational
domains. It is the lack of practical methodologies,
underpinned by this theory and thoroughly field-
tested in different settings and cultural contexts,
that has been the main obstacle to making this
concept operational in health promotion pro-
grammes. This obstacle is not insurmountable,
but without evidence of the empowerment of
communities, funding will remain unavailable to
support these approaches. It is our responsibility
as researchers and practitioners to address this
important issue properly.
ACKNOWLEDGEMENTS
Thanks to Drs Ron Labonte, Kevin Brown and
Damien Ridge for their insights during the
preparation of this manuscript.
Address for correspondence:
Glenn Laverack
UNICEF
72 Ly Thuong Kiet
Hanoi
Vietnam
E-mail: glaverack@unicef.org
REFERENCES
Arnstein, S. R. (1969) A ladder of citizen participation.
Journal of the American Institute of Planners, July,
216–223.
Asthana, S. (1994) Community participation in health
and development. In Phillips, D. and Verhasselt, Y. (eds)
Health and Development. Routledge, London.
Baistow, K. (1995) Liberation and regulation? Some
paradoxes of empowerment. Critical Social Policy, 42,
34–46.
Bell, C. and Newby, H. (1978) Community Studies. George
Allen and Unwin, London.
Bernstein, E., Wallerstein, N., Braithwaite, R., Gutierrez, L.,
Labonte, R. and Zimmerman, M. (1994) Empowerment
forum: a dialogue between guest editorial board members.
Health Education Quarterly, 21, 281–294.
Cracknell, B. E. (1996) Evaluating development aid.
Evaluation, 2, 23–33.
Craig, G. and Mayo, M. (eds) (1995) Community Empower-
ment. A Reader in Participation and Development. Zed
Books, London.
Eng, E. and Parker, E. (1994) Measuring community com-
petence in the Mississippi delta: the interface between
programme evaluation and empowerment. Health
Education Quarterly, 21, 199–220.
Everson, S. A., Lynch, J. W., Chesney, M. A., Kaplan, G. A.,
Goldberg, D. E., Shade, S. B., Cohen, R. D., Salonen, R.
and Salonen, J. T. (1997) Interaction of workplace
demands and cardiovascular reactivity in progression of
carotid atherosclerosis: population based study. British
Medical Journal, 314, 553–558.
Fetterman, D. M., Kaftarian, S. J. and Wandersman, A.
(eds) (1996) Empowerment Evaluation. Knowledge and
Tools for Self-Assessment and Accountability. SAGE
publications, CA.
Friedmann, J. (1992) Empowerment: The Politics of
Alternative Development. Blackwell Publishers, Oxford.
Geyer, S. (1997) Some conceptual considerations on the
sense of coherence. Social Science Medicine, 44,
1771–1779.
Goodman, R. M. (2000) Evaluation of community-
based health programs: an alternate perspective. In
Schneiderman, N., Speers, M., Tomes, H., Gentry, J. and
Silva, J. (eds) Integrating Behavioral and Social Sciences
with Public Health. American Psychological Association
Press, Washington DC.
Goodman, R. M., Speers, M. A., McLeroy, K., Fawcett, S.,
Kegler, M., Parker, E., Rathgeb Smith, S., Sterling, T. D.
and Wallerstein, N. (1998) Identifying and defining the
dimensions of community capacity to provide a basis
for measurement. Health Education and Behavior, 25,
258–278.
Gordon, G. (1955) Participation, empowerment and sexual
health in Africa. In Craig, G. and Mayo, M. (eds)
Community Empowerment. A Reader in Participation
and Development. Zed Books, London, pp. 181–193.
Israel, B. A., Checkoway, B., Schultz, A. and Zimmerman,
M. (1994) Health education and community empower-
ment: conceptualizing and measuring perceptions of
individual, organizational and community control. Health
Education Quarterly, 21, 149–170.
Jackson, T., Mitchell, S. and Wright, M. (1989) The
community development continuum. Community Health
Studies, 8, 66–73.
James, C. (1995) Empowering Communities in the
Development Process: Participatory Rural Appraisal as
an Approach. University of Bristol, Bristol.
Kieffer, C. H. (1984) Citizen empowerment: a development
perspective. Prevention in Human Services, 3, 9–36.
Labonte, R. (1994) Health Promotion and Empowerment:
Reflections on Professional Practice. Health Education
Quarterly, 21, 253–268.
Labonte, R. (1998) A community development approach
to health promotion: a background paper on practice
tensions, strategic models and accountability require-
ments for health authority work on the broad deter-
minants of health. Health Education Board of Scotland,
Edinburgh.
Laverack, G. (1999) Addressing the contradiction between
discourse and practice in health promotion. PhD thesis,
Deakin University, Melbourne, Australia.
Modra, C. (1998) Exploring social capital: levels of
participation, trust and health in a suburban region of
Adelaide, South Australia. Celebrating Public Health:
Decades of Development, Decades of Opportunity,
Public Health Association of Australia, Hobart.
Patton, M. Q. (1997) Toward distinguishing empowerment
evaluation and placing it in a larger context. Evaluation
Practice, 18, 147–163.
Putnam, R. D. (1995) Bowling alone: Americas declining
social capital. Journal of Democracy, 6, 65–78.
Raeburn, J. (1993) How effective is strengthening com-
munity action as a strategy for health promotion?
ParticiACTION. No. 3. University of Toronto, Toronto.

Rappaport, J. (1987) Terms of empowerment/exemplars of
prevention. Toward a theory of community psychology.
American Journal of Community Psychology, 15, 121–147.
Rifkin, S. B. (1990) Community participation in maternal
and child health/family planning programmes. World
Health Organisation, Geneva.
Rissel, C. (1994) Empowerment: the holy grail of health
promotion? Health Promotion International, 9, 39–47.
Scrimgeour, D. (1997) Community control of aboriginal
health services in the Northern Territory. Menzies School
of Health Research, Darwin.
Stevenson, J. F., Mitchell, R. E. and Florin, P. (1996)
Evaluation and self-direction in community-prevention
coalitions. In Fetterman, D. M., Kaftarian, S. J. and
Wandersman, A. (eds) Empowerment Evaluation. Know-
ledge and Tools of Self-Assessment and Accountability.
SAGE publications, CA, pp. 208–233.
Swift, C. and Levin, G. (1987) Empowerment: an emerging
mental health technology. Journal of Primary Prevention,
8, 71–94.
Taylor, V. (1995) Social reconstruction and community
development in the transition to democracy in South
Africa. In Craig, G. and Mayo, M. (eds) Community
Empowerment: A Reader in Participation and Develop-
ment. Zed Books, London, pp. 168–180.
Measuring community empowerment 185
Tonon, M. A. (1980) Concepts in community empower-
ment: a case of sanitary change in a Guatemalan
village. International Journal of Health Education, 23,
1–16.
Torre, D. (1986) Empowerment: structured conceptual-
isation and instrument development. PhD thesis, Cornell
University.
Wallerstein, N. (1992) Powerlessness, empowerment and
health. Implications for health promotion programs.
American Journal of Health Promotion, 6, 197–205.
Ward, J. (1987) Community development with marginal
people: the role of conflict. Community Development
Journal, 22, 18–27.
Wilkinson, R. G. (1997) Income inequality and social
cohesion. American Journal of Public Health, 8, 104–106.
Zakus, J. D. L. and Lysack, C. L. (1998) Revisiting
community participation. Health Policy and Planning, 13,
1–12.
Zimmerman, M. A. (1990) Taking aim on empowerment
research: on the distinction between individual and psy-
chological conceptions. American Journal of Community
Psychology, 18, 169–177.
Zimmerman, M. A. (1995) Psychological empowerment:
issues and illustrations. American Journal of Community
Psychology, 23, 581–599.