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QUALITATIVE STUDY
J Edu Health Promot 2018,  7:31

Empowerment of women and mental health improvement with a Preventive approach


1 Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
2 Department of Counseling, Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran
3 Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
4 Social Determinants of Health Research Center, Isfahan, Iran

Date of Submission28-Jun-2017
Date of Acceptance06-Aug-2017
Date of Web Publication09-Feb-2018

Correspondence Address:
Miss. Rahele Samouei
Social Determinants of Health Research Center, Isfahan University of Medical Sciences, Isfahan
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jehp.jehp_72_17

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  Abstract 

Aim and Background: Mental health and empowerment are two of the women's essential needs. These two related concepts play an important role in women's lives. Therefore, this study aimed to investigate empowerment of women and its relation with mental health problem prevention during difficult situations.
Methods: This qualitative study was conducted through semi-structured interviews with 33 experts in the fields of psychology, social sciences, women studies, medicine and crisis management specialists using snowball sampling in cities of Tehran, Isfahan, Tabriz, and Mashhad during the year 1395 (March 2016–March 2017). Samples were selected heterogeneously. The interview transcripts and codes were presented to the participants, and structural analysis was used for data evaluation.
Results: The factors related to empowerment of women with consideration to their mental health were determined based on Longew theory and interviews and include: welfare (primary needs (biological and security) and developmental needs (social needs and dignity), access (facilities and values), knowledge (about inequalities and rights), participation (in politics, decision-making and society), and control (implementation and institutionalization of the above-mentioned needs).
Conclusions: The indicators determined in this study show that empowerment has an important role in determining women's real position in society. Since women make up half of the population and affect society as a whole, the advantages of empowerment of women will be felt in the entire society.

Keywords: Empowerment, mental health, preventive, women


How to cite this article:
Shooshtari S, Abedi M R, Bahrami M, Samouei R. Empowerment of women and mental health improvement with a Preventive approach. J Edu Health Promot 2018;7:31

How to cite this URL:
Shooshtari S, Abedi M R, Bahrami M, Samouei R. Empowerment of women and mental health improvement with a Preventive approach. J Edu Health Promot [serial online] 2018 [cited 2018 Nov 17];7:31. Available from: http://www.jehp.net/text.asp?2018/7/1/31/225077


  Introduction Top


Mental health in all stages of life plays an effective and important role in national and ideal goals of every society.[1] This is especially important for women who make up half of the population and are important members of their families during financial austerity periods.[2] In this regard, changes in social attitudes are one of the methods for improving the mental health of women and reduce their mental problems [3] and are one of the important steps in their empowerment [4] which is a social and multifactorial phenomenon related to factors such as human rights, education, social and financial participation, security, lack of discrimination, equal opportunities, responsibilities, roles and lifestyles and physical, mental, and financial conditions of women.[5],[6]

Various studies and theories have introduced various factors and stages for the empowerment of women, for example, Longew proposed five stages of welfare, access, knowledge, participation, and control.[7] Kayanighalesard and Arsalanbod in their study stated that empowerment of women is an attempt for improving their financial, cultural, and social standing of women. They also emphasized the role of factors such as education, expanded medical insurance, and creation of household jobs in this empowerment.[8] In another study, Zadeh et al. investigated empowerment of women on four financial, social, political, and mental aspects.[9] In a longitudinal study on 539 Egyptian women, the results showed that single women attempt to gain social support and empowerment by taking advantage of education and financial activities before marriage.[10] The study on 200 female students in Lahore also showed that educational content, participation, and fanatical opportunities accessible to women affects their empowerment process.[11] A study in Italy showed that empowerment of women is significantly related to social norms about culture, women's roles in society and especially religious culture.[12] Another longitudinal study on married women showed the role of financial empowerment, and women's decision-making power in households [13] and a study in England showed that promotion of gender equality is one of the methods for the empowerment of women and improving their mental health.[14] Scientific studies also show that women's mental health is endangered when they are faced with gender discrimination such as nonequal access to education, society and employment.[3],[15],[16] Empowerment of women also shows its effect during accidents and disasters because it is related to discrimination against women often in the name of religion, tradition, and social norms and regulations.[17]

Given the fact that previous studies were based on the cultural situation of their country of origin and due to cultural nature of empowerment and mental health, it is necessary to conduct studies based on opinions of experts in Iran which is possible through qualitative studies. To this end, due to positive effect of empowerment of women on their mental health,[18] the importance of mental health in prevention or reduction of social and mental harms in crisis situations and difficult times and based on the important role of women in family and society, this qualitative study was conducted to determine the effect of empowerment on women's mental health with a preventive approach.


  Methods Top


This study uses the qualitative method with inductive logic. The experts in the fields of psychology, social sciences, women studies, medicine and crisis management specialists using snowball sampling in cities of Tehran, Isfahan, Tabriz, and Mashhad for face-to-face semi-structured interviews in the year 1395 (March 2016 to March 2017). Sampling was continued until achieving saturation, and a total of 33 interviews were conducted by coordinating an appointment over the phone and in the participants' offices. Interviews were recorded with the full consent of the interviewees and participants were assured about the confidentiality of the interviews and following of ethical principles and were also informed that more than one interview session might be necessary. Participants were also informed that they can leave the study at any time and that the information will be used without mentioning any names. The predicted length for thefirst interview was 45 min which was conducted without judgment from the interviewer, and in some cases, more interview sessions were needed. An interview guide with main and probing questions was used for each interview.

Some of the questions used included: Are women more vulnerable in regards to mental health in the society? How do you compare mental health and empowerment of women with other groups? What are the factors related to empowerment of women with consideration toward mental health?

To transfer findings and gaining access to knowledge, experience, and perspectives on the individual, heterogeneous samples were also selected and to increase reliability and verifiability, the text and code of each interview was presented to the interviewee. After each interview, the records transcript was created and structural data analysis was used to report the findings. To this end, first answers were divided into the smallest possible units, and their internal concepts were extracted. Then, each data point was compared with other data points to determine their similarities and differences, and data categorization became possible through repeated reviewing and aggregation of similar data points. To this end, first extracted codes with similar concepts were aggregated with each other and then the main categories were created and presented in the form of tables.


  Results Top


In the presents study 9 categories and 5 main themes were extracted from the interviews and are presented in [Table 1].
Table 1: Women's empowerment factors related to their mental health

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  Discussion Top


The findings of this study based on Longew theory and participants' answers are presented in [Table 1]. Thefirst stage of empowerment of women was identified as welfare including primary and developmental needs. In the Maslow theory, biological and security needs are the most basic needs of individuals. In other words, people need tofirst have adequate nutrition, sleep and a safe living environment before meeting their emotional, social and belonging needs that give them feelings of being valued. In this stage, women are in fact not empowered yet and only seem to use the welfare facilities. However, there is a minimum of empowerment in this stage which is the start of women entering other stages and their desire for reducing inequalities and receiving peace of mind. Such a desire takes women to the second stage which is “access.” In the society, women usually have less access to properties, healthcare and medicine and related facilities, leading to inequalities, most of which is created in the society itself. In this regard, two studies [8],[9] mentioned the effect of social factors on empowerment of women. The results of other studies emphasized the importance of education and financial independence of women,[10],[11],[13] stating that access to cultural, social, and financial resources affects empowerment of women. In this stage, women identify the gap between current and ideal situations and can start their attempts to improve their access to society. For such an attempt, the third stage, “knowledge,” is important. In this stage, thinking has more prominence compared to previous stages because in this stage women are familiarized with the roots and reasons for the inequalities, lack of empowerment and their mental health problems and will understand that most of these problems have social roots and can be changed. In this regard, Yount et al. and Bushra and Wajiha in their studies emphasize the importance of knowledge on empowerment of women.[10],[11] This finding confirms that women's knowledge about the current state of society is one of the stages in their empowerment. This leads to the need for equity, cooperation, and reaching the fourth stage of “participation.” Of course, simple participation is not enough and participation needs to be effective and useful. In other words, the goal of this stage is the participation of half of the population and using and sharing their useful and constructive ideas. In this regard, the study by Bonilla et al. states that women's participation in decision-making is one of the factors in their empowerment and Bozzano believes that empowerment of women is related to their role in society. Based on these results, although social limitations have managed to reduce women's participation, self-confidence, self-esteem, and women's demands play important roles in this stage. These demands should be made with knowledge about the results of cooperation which leads to the fifth stage or “control.” In this stage, by controlling their power and participation, institutionalize the results of their empowerment which leads to reduced inequality and better fairness. In this regard, Newbigging emphasizes the importance of gender equality for empowerment of women.[14] However, the results of this study showed that women do not have a desirable situation in this stage of empowerment.

In general, the study by Herrman confirms the relation between empowerment and mental health of women [17] and we can say that when empowerment stages and factors are correctly implemented, women's mental health also improves. Especially in difficult situations and disasters, this relation between mental health and empowerment can lead to better participation in controlling the situation.


  Conclusions Top


This study aimed to determine the experts' opinions on factors related to empowerment of women. One of the limitations of this study was the small number of experts and researchers in fields related to women's studies who were familiar with psychological aspects of empowerment.

Suggestions

This study suggests that women should gain knowledge and actively pursue their demands through participation and cooperation instead of being passive recipients of help and take responsibility for implementation of personal and social programs. The society also should consider the potential benefits and effectiveness of women and creates the basis for their empowerment and health.

Financial support and sponsorship

We would like to thank all participants whose opinions helped us reach the goals of our study. This study is the result of a PhD thesis and was carried out without outside financial support and sponsorship.

There were no conflicts of interest in this study.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Health Deputy Minister of Health, Treatment and Medical Education. Comprehensive Program to Improve the Mental Health of the Country (2011-2015). Ministry of Health and Medical Education; 2015.  Back to cited text no. 1
    
2.
Bradshaw S. Fordham M. Women, girls and disasters, a review for DFID. London Middlesex University; 2013.  Back to cited text no. 2
    
3.
Fisher J, Herrman H, Cabral de Mello M, Chandra P. Women's mental health. In: Patel V, Minas H, Cohen A, editors. Global Mental Health. New York: Oxford University Press; 2013: 354-84.  Back to cited text no. 3
    
4.
Leeder S. The global challenge of women's health. Med J Aust 2015;202:277.  Back to cited text no. 4
    
5.
Herrman H. Improving the mental health of women and girls: Psychiatrists as partners for change. World Psychiatry 2016;15:190-1.  Back to cited text no. 5
    
6.
Kaldi A, Salahshouri P. The investigation of social support's effect on women empowerment. J Iran Soc Dev Stud 2012;4:7-22.  Back to cited text no. 6
    
7.
Gholipour A, Rahimian A. Economic, cultural, and educational factors related to empowerment of head-of-household women. Soc Welf 2011;11:29-62.  Back to cited text no. 7
    
8.
Kayanighalesard S, Arsalanbod MR. Economic Empowerment of Women, According to the Experience of Japan. National Conference of Women and Rural Development, Ferdowsi University of Mashhad; 2014.  Back to cited text no. 8
    
9.
Zadeh A, Boodaqi M, Aghdasi A, Alamdari F. Empowerment of Women Heads of Household with an Emphasis on Local Strategies. Papers of the National Conference of Empowerment; 2011.  Back to cited text no. 9
    
10.
Yount KM, Dijkerman S, Zureick-Brown S, VanderEnde KE. Women's empowerment and generalized anxiety in Minya, Egypt. Soc Sci Med 2014;106:185-93.  Back to cited text no. 10
    
11.
Bushra A, Wajiha N. Assessing the socio-economic determinants of women empowerment in Pakistan. Procedia Soc Behav Sci 2015;177:3-8.  Back to cited text no. 11
    
12.
Bozzano M. On the historical roots of women's empowerment across Italian provinces: religion or family culture? Eur J Polit Econ 2017;49:24-46.  Back to cited text no. 12
    
13.
Bonilla J, Zarzur RC, Handa S, Nowlin C, Peterman A, Ring H, et al. Cash for women's empowerment? A mixed-methods evaluation of the government of Zambia's child grant program. World Dev 2017;95:55-72.  Back to cited text no. 13
    
14.
Newbigging K. Mainstreaming gender equality to improve women's mental health in England. The Psychology of Gender and Health. Ch. 12. London: Academic Press 2017: 343-61.  Back to cited text no. 14
    
15.
Devries KM, Mak JY, García-Moreno C, Petzold M, Child JC, Falder G, et al. Global health. The global prevalence of intimate partner violence against women. Science 2013;340:1527-8.  Back to cited text no. 15
    
16.
Garcia-Moreno C, Hegarty K, d'Oliveira AF, Koziol-Mclain J, Colombini M, Feder G, et al. The health-systems response to violence against women. Lancet 2015;385:1567-79.  Back to cited text no. 16
    
17.
Prevention of harmful practices in women and children. Lancet 2014;384:1722.  Back to cited text no. 17
    
18.
Herrman H, Swartz L. Promotion of mental health in poorly resourced countries. Lancet 2007;370:1195-7.  Back to cited text no. 18
    



 
 
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