Achieving women’s health equity and empowerment is a global priority. In a Western context, women are often disempowered by the value society places on body size, shape or weight, which can create a barrier to health. Health promotion programs can exacerbate women’s preoccupations with their bodies by focusing outcomes toward achieving an “ideal” body size. Women’s health promotion activities should be empowering if the desired outcomes are to improve their health and well-being long-term. This review sought to identify key elements from health promotion programs that aimed to empower women. A search was conducted in PubMed, MEDLINE, Web of Science, Scopus, CINAHL complete, and Academic Search Premiere databases. The search yielded 27 articles that collectively reported on 10 different programs. Through thematic synthesis, each article was analyzed for (1) key program features employed to empower women and (2) how such programs evaluated women’s health. Seven themes resulted, of which five describe key empowering features (active participation, social support, sustainable change, holistic health perspective, strength-based approach) and two evaluation characteristics (assessment across multiple health domains and a mixed-method design). The findings from this review can assist health promoters to design and improve initiatives that aim to empower women.
AppelmanY.van RijnB. B.Ten HaafM. E.BoersmaE.PetersS. A. E. (2015). Sex differences in cardiovascular risk factors and disease prevention. Atherosclerosis, 241(1), 211–218. https://doi.org/10.1016/j.atherosclerosis.2015.01.027
BaconL.AphramorL. (2011). Weight science: Evaluating the evidence for a paradigm shift. Nutrition Journal, 10(1), 1–13. https://doi.org/10.1186/1475-2891-10-9
4.
BéginC.CarbonneauE.Gagnon-GirouardM.MongeauL.PaquetteM.TurcotteM.ProvencherV. (2019). Eating-related and psychological outcomes of Health at Every Size intervention in health and social services centers across the province of Québec. American Journal of Health Promotion, 33(2), 248–258. https://doi.org/10.1177/0890117118786326
5.
CarbonneauE.BéginC.LemieuxS.MongeauL.PaquetteM.TurcotteM.LabontéM.ProvencherV. (2017). A Health at Every Size intervention improves intuitive eating and diet quality in Canadian women. Clinical Nutrition, 36(3), 747–754. https://doi.org/10.1016/j.clnu.2016.06.008
6.
DebateR.ZhangY.ThompsonS. (2007). Changes in commitment to physical activity among 8- to 11-year-old girls participating in a curriculum-based running program. American Journal of Health Education, 38(5), 276–283. https://doi.org/10.1080/19325037.2007.10598982
7.
DoorisM.FarrierA.FroggettL. (2017). Wellbeing: The challenge of “operationalising” an holistic concept within a reductionist public health programme. Perspectives in Public Health, 138(2), 93–99. https://doi.org/10.1177/1757913917711204
8.
FreireP. (1973). Education for critical consciousness. Bloomsbury.
9.
FuernissK.JacobsJ. (2020). We Are Strong: Strategies for fostering body empowerment in a boxing program for middle school girls. Journal of Sport Psychology in Action, 11(1), 45–56. https://doi.org/10.1080/21520704.2019.1693456
10.
GabrielK.DeBateR.HighR.RacineE. (2011). Girls on the Run: A quasi-experimental evaluation of a developmentally focused youth sport program. Journal of Physical Activity and Health, 8(Suppl. 2), S285–S294. https://doi.org/10.1123/jpah.8.s2.s285
11.
Gagnon-GirouardM.BéginC.ProvencherV.TremblayA.MongeauL.BoivinS.LemieuxS. (2010). Psychological impact of a “Health-at-Every-Size” intervention on weight-preoccupied overweight/obese women. Journal of Obesity, 2010, Article 928097. https://doi.org/10.1155/2010/928097
12.
GaleottiS. (2015). Empowering pre-adolescent girls: Girls on the Run experiential learning program exploratory study. Journal of Experiential Education, 38(4), 407–423. https://doi.org/10.1177/1053825915603578
13.
GreenJ.CrossR.WoodallJ. (2019). Health promotion planning and strategies (4th ed.). Sage.
HubertyJ.EhlersD.ColemanJ.GaoY.ElavskyS. (2013). Women bound to be active: Differences in long-term physical activity between completers and noncompleters of a book club intervention. Journal of Physical Activity and Health, 10(3), 368–378. https://doi.org/10.1123/jpah.10.3.368
16.
HubertyJ.VenerJ.RansdellL.SchulteL.BuddM.GaoY. (2010). Women bound to be active (years 3 and 4): Can a book club help women overcome barriers to physical activity and improve self-worth?Women & Health, 50(1), 88–106. https://doi.org/10.1080/03630241003601103
17.
HubertyJ.VenerJ.SchulteL.RobertsS.StevensB.RansdellL. (2009). Women bound to be active: One year follow-up to an innovative pilot intervention to increase physical activity and self-worth in women. Women & Health, 49(6–7), 522–539. https://doi.org/10.1080/03630240903424020
18.
HubertyJ.VenerJ.SidmanC.MeenderingJ.BlissmerB.SchulteL.FlohrJ.RansdellL. (2008). Women bound to be active: A pilot study to explore the feasibility of an intervention to increase physical activity and self-worth in women. Women & Health, 48(1), 83–101. https://doi.org/10.1080/03630240802132120
19.
IachiniA.BeetsM.BallA.LohmanM. (2014). Process evaluation of “Girls on the Run”: Exploring implementation in a physical activity-based positive youth development program. Evaluation and Program Planning, 46(1), 1–9. https://doi.org/10.1016/j.evalprogplan.2014.05.001
20.
LaverackG. (2016). Public health: Power, empowerment and professional practice (3rd ed.). Palgrave.
21.
LeblancV.ProvencherV.BéginC.CorneauL.TremblayA.LemieuxS. (2012). Impact of a Health-At-Every-Size intervention on changes in dietary intakes and eating patterns in premenopausal overweight women: Results of a randomized trial. Clinical Nutrition, 31(4), 481–488. https://doi.org/10.1016/j.clnu.2011.12.013
22.
LeongS.GrayA.HaszardJ.HorwathC. (2016). Weight-control methods, 3-year weight change, and eating behaviors: A prospective nationwide study of middle-aged New Zealand women. Journal of the Academy of Nutrition and Dietetics, 116(8), 1276–1284. https://doi.org/10.1016/j.jand.2016.02.021
23.
LindacherV.CurbachJ.WarrelmannB.BrandstetterS.LossJ. (2018). Evaluation of empowerment in health promotion interventions: A systematic review. Evaluation & the Health Professions, 41(3), 351–392. https://doi.org/10.1177/0163278716688065
24.
LindwallM.LindgrenE. C. (2005). The effects of a 6-month exercise intervention programme on physical self-perceptions and social physique anxiety in non-physically active adolescent Swedish girls. Psychology of Sport and Exercise, 6(6), 643–658. https://doi.org/10.1016/j.psychsport.2005.03.003
25.
MartinJ. J.WaldronJ. J.McCabeA.ChoiY. S. (2009). The impact of “Girls on the Run” on self-concept and fat attitudes. Journal of Clinical Sport Psychology, 3(2), 127–138. https://doi.org/10.1123/jcsp.3.2.127
26.
MensingerJ.CalogeroR.StrangesS.TylkaT. (2016). A weight-neutral versus weight-loss approach for health promotion in women with high BMI: A randomized-controlled trial. Appetite, 105, 364–374. https://doi.org/10.1016/j.appet.2016.06.006
27.
MensingerJ.CalogeroR.TylkaT. (2016). Internalized weight stigma moderates eating behavior outcomes in women with high BMI participating in a healthy living program. Appetite, 102, 32–43. https://doi.org/10.1016/j.appet.2016.01.033
28.
MensingerJ.MeadowsA. (2017). Internalized weight stigma mediates and moderates physical activity outcomes during a healthy living program for women with high body mass index. Psychology of Sport and Exercise, 30, 64–72. https://doi.org/10.1016/j.psychsport.2017.01.010
29.
MezaB.MarttinenR. (2019). The GIRL curriculum: Co-constructing learning about body image through empowering after-school programming. Journal of Youth Development, 14(4), 216–231. https://doi.org/10.5195/jyd.2019.771
30.
O’HaraL.TaylorJ. (2018). What’s wrong with the “War on Obesity?” A narrative review of the weight-centered health paradigm and development of the 3C framework to build critical competency for a paradigm shift. SAGE Open, 8(2). https://doi.org/10.1177/2158244018772888
31.
ÖstlinP.EckermannE.MishraU. S.NkowaneM.WallstamE. (2006). Gender and health promotion: A multisectoral policy approach. Health Promotion International, 21(1), 25–35. https://doi.org/10.1093/heapro/dal048
32.
PedersonA.GreavesL.PooleN. (2014). Gender-transformative health promotion for women: A framework for action. Health Promotion International, 30(1), 140–150. https://doi.org/10.1093/heapro/dau083
PfisterG.With-NielsenN.LenneisV. (2017). Health discourses, slimness ideals, and attitudes to physical activities. German Journal of Exercise and Sport Research, 47(1), 15–24. https://doi.org/10.1007/s12662-017-0438-3
35.
ProvencherV.BéginC.TremblayA.MongeauL.BoivinS.LemieuxS. (2007). Short-term effects of a “Health-At-Every-Size” approach on eating behaviors and appetite ratings. Obesity, 15(4), 957–966. https://doi.org/10.1038/oby.2007.638
36.
ProvencherV.BéginC.TremblayA.MongeauL.CorneauL.DodinS.BoivinS.LemieuxS. (2009). Health-At-Every-Size and eating behaviors: 1-Year follow-up results of a size acceptance intervention. Journal of the American Dietetic Association, 109(11), 1854–1861. https://doi.org/10.1016/j.jada.2009.08.017
37.
RichardsonR. A. (2018). Measuring women’s empowerment: A critical review of current practices and recommendations for researchers. Social Indicators Research, 137(2), 539–557. https://doi.org/10.1007/s11205-017-1622-4
38.
SchuetteS.CorderoE.SlosburgK.AddingtonE.VictorsonD. (2017). A scoping review of positive lifestyle and wellness interventions to inform the development of a comprehensive health promotion program: “HealthPro.”American Journal of Lifestyle Medicine, 13(4), 336–346. https://doi.org/10.1177/1559827617704825
39.
SenG.ÖstlinP. (2009). Gender as a social determinant of health: Evidence, policies, and innovations. In Gender equity in health: The shifting frontiers of evidence and action (pp. 1–46). Routledge. https://doi.org/10.4324/9780203866900
StrömbäckM.FormarkB.WiklundM.Malmgren-OlssonE. (2014). The corporeality of living stressful femininity: A gender–theoretical analysis of young Swedish women’s stress experiences. Young, 22(3), 271–289. https://doi.org/10.1177/0973174114533464
42.
StrömbäckM.Malmgren-OlssonE.WiklundM. (2013). “Girls need to strengthen each other as a group”: Experiences from a gender-sensitive stress management intervention by youth-friendly Swedish health services: A qualitative study. BMC Public Health, 13(1), Article 907. https://doi.org/10.1186/1471-2458-13-907
43.
StrömbäckM.WiklundM.Salander RenbergE.Malmgren-OlssonE. (2016). Gender-sensitive and youth-friendly physiotherapy: Steps toward a stress management intervention for girls and young women. Physiotherapy Theory and Practice, 32(1), 20–33. https://doi.org/10.3109/09593985.2015.1075639
TenglandP. (2007). Empowerment: A goal or a means for health promotion?Medicine, Health Care and Philosophy, 10(2), 197–207. https://doi.org/10.1007/s11019-006-9027-1
46.
ThomasJ.HardenA. (2008). Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Medical Research Methodology, 8(45). https://doi.org/10.1186/1471-2288-8-45
TirleaL.TrubyH.HainesT. (2013). Investigation of the effectiveness of the “Girls on the Go!” program for building self-esteem in young women: trial protocol. SpringerPlus, 2(1), 683. https://doi.org/10.1186/2193-1801-2-683
49.
TirleaL.TrubyH.HainesT. (2016). Pragmatic, randomized controlled trials of the girls on the go! Program to improve self-esteem in girls. American Journal of Health Promotion, 30(4), 231–241. https://doi.org/10.1177/0890117116639572
50.
TomiyamaA. J.AhlstromB.MannT. (2013). Long-term effects of dieting: Is weight loss related to health?Social and Personality Psychology Compass, 7(12), 861–877. https://doi.org/10.1111/spc3.12076
51.
TriccoA. C.LillieE.ZarinW.O’BrienK. K.ColquhounH.LevacD.MoherD.PetersM. D.HorsleyT.WeeksL.HempelS.AklE.StrausS. (2018). PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and explanation. Annals of Internal Medicine, 169(7), 467–473. https://doi.org/10.7326/M18-0850
52.
TylkaT.AnnunziatoR.BurgardD.DanielsdottirS.ShumanE.DavisC.CalogeroR. (2014). The weight-inclusive versus weight-normative approach to health: Evaluating the evidence for prioritizing well-being over weight loss. Journal of Obesity. https://doi.org/10.1155/2014/983495
53.
United Nations. (2015). Transforming our world: The 2030 agenda for sustainable development. https://sdgs.un.org/2030agenda
54.
Van BelleS.RifkinS.MarchalB. (2017). The challenge of complexity in evaluating health policies and programs: The case of women’s participatory groups to improve antenatal outcomes. BMC Health Services Research, 17(1), 687. https://doi.org/10.1186/s12913-017-2627-z
55.
WallersteinN. (1992). Powerlessness, empowerment, and health: Implications for health promotion programs. American Journal of Health Promotion, 6(3), 197–205. https://doi.org/10.4278/0890-1171-6.3.197
WallersteinN.BernsteinE. (1988). Empowerment education: Freire’s ideas adapted to health education. Health Education Quarterly, 15(4), 379–394. https://doi.org/10.1177/109019818801500402
58.
Warwick-BoothL.CrossR. (2017). A delivery model of a gender specific intervention approach: Lessons for policy makers. In NicoM.TaruM.PotočnikD.SalikauA. (Eds.), Needles in haystacks: Finding a way forward for cross-sectoral youth policy (pp. 241–255). European Commission and the Council of Europe.
59.
Warwick-BoothL.CrossR. (2018). Evaluating a gender-specific intensive intervention programme: Young women’s voices and experiences. Health Education Journal, 77(6), 644–655. https://doi.org/10.1177/0017896918759568
WeissM.KippL.ReichterA.EspinozaS.BolterN. (2019). Girls on the Run: Impact of a physical activity youth development program on psychosocial and behavioral outcomes. Pediatric Exercise Science, 31(3), 330–340. https://doi.org/10.1123/pes.2018-0168
62.
WigginsN. (2011). Popular education for health promotion and community empowerment: A review of the literature. Health Promotion International, 27(3), 356–371. https://doi.org/10.1093/heapro/dar046
63.
World Health Organization. (1986). The Ottawa Charter for health promotion.
64.
ZimmermanM. A.EismanA. B.ReischlT. M.Morrel-SamuelsS.StoddardS.MillerA. L.HutchisonP.FranzenS.RuppL. (2017). Youth Empowerment Solutions: Evaluation of an after-school program to engage middle school students in community change. Health Education & Behavior, 45(1), 20–31. https://doi.org/10.1177/1090198117710491
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
