Aspects of community health workers’empowerment in conducting health promotion activities in the community

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[抄録] 本研究の目的は，地域の健康づくりにかかわる保健推進員のエンパワメントの様相を明らかにすることである。それにより，保健推進員のエンパワメントを説明する仮説的な枠組みを構築する。MEDLINE，CINAHLおよび医中誌Webを用いて，保健推進員の意欲向上や主体化等にかかわる思考・認識や態度・行動の変容とそれに影響する要因が記述されている質的研究論文14件（英文4件，和文10件）を選定した。分析対象文献について，質的記述的に分析した。保健推進員の主体化や意欲向上等にかかわる思考・認識や態度・行動の変容は，9カテゴリ【活動の必要性を認識することにより活動意欲を持つ】【自己を開示することにより意見を表出する】【仲間意識を持ち組織の中で機能する】【自身の生活と活動を調整し健康を獲得する】【得た知識・技術を活用し自身や住民の状況に応じた活動を展開する】【活動を通して周囲との関係を形成する】【活動を評価し効果を実感する】【活動可能感を獲得する】【活動により満足感を得る】を得た。エンパワメントに影響する要因は，５カテゴリ《活動の契機》《活動の場》《核となる人の存在》《周囲の容認・協力》《保健師の支援》を得た。保健推進員のエンパワメントとは，活動の必要性を認識し，自身を調整しながら他の保健推進員との仲間意識を持って機能することで，住民や地域の状況に応じた活動を展開していくことであった。また，保健推進員自身が活動可能感や満足感を得ながら，周囲との関係を形成していくことで，地域の健康づくりが推進されていく可能性が示唆された。

[ABSTRACT] This study aimed to demonstrate the aspects community health workers’ empowerment in conducting health promotion activities in the community. We constructed a hypothetical framework to explain the empowerment of community health workers. Fourteen qualitative research articles（ 4 in English and 10 in Japanese） that described the changes in the thinking and behavior related to motivation and self-reliant attitude and behavior, and the factors influencing community health workers’ empowerment were identified from MEDLINE, CINAHL, and Japan Medical Abstracts Society Web version, and they were qualitatively and descriptively analyzed. The following nine categories of empowerment were identified: “Gaining motivation for activities by recognizing the need for activities,” “Expressing one’s opinion by revealing one’s self,” “Functioning with a sense of camaraderie in the organization,” “Becoming healthy by adjusting one’s lifestyle and activities,” “Expanding one’s activities in response to one’s self and residential status by using acquired knowledge and skills,” “Forming relationships with others through activities,” “Evaluating one’s activities and realizing their effects,” “Acquiring a sense of potential to act,” and “Acquiring a sense of fulfillment through activities.” The following five categories of factors influenced empowerment: “Opportunity to act,” “Place to act,” “Having a key person,” “Acceptance and cooperation from others,” and “Support from public health nurses.” Community health workers’ empowerment was characterized by expanding activities in response to residential and community status, by recognizing the need for activities and functioning with a sense of camaraderie with other community health workers while adjusting one’s behavior. Moreover, the present findings suggested that the formation of community health workers’ relationships with others while acquiring a sense of fulfillment and potential to act would facilitate health promotion in the community.