Fostering individual agency and wellbeing in women: an evaluation of the IMAGINE Kenya Initiative

Abstract

Background: A crucial driver of sustainable development and health is the empowerment of women. Multiple empowerment interventions exist, but gaps remain regarding their effect. Most programmes focus on the provision of needed outer resources, such as education or opportunity, yet neglect the crucial development of internal resources, such as self-efficacy (the belief in one's ability to act) and agency (ability to act and make choices). We assessed the effect of the IMAGINE Initiative in Kenya, a programme intended to empower individuals through a 4-day workshop aimed at increasing self-knowledge and translating this into an actionable growth strategy towards personal health and development goals that was culturally adapted for this setting. Methods: We identified 213 individuals from routine de-identified programme data who had applied to participate: 76 individuals had already completed the workshop and 137 individuals were awaiting entry to the workshop. Data for the full sample included sociodemographic information and self-reported wellbeing and hopefulness assessed by the Ryff well-being and Trait Hope scales. Qualitative interviews were conducted for 172 individuals (101 untrained and 71 trained) related to changes in health, relationships, education, and economics. To minimise confounders and bias, we did conditional logistic regression using 1:1 matched pair analysis (matched for sex, location, socioeconomic status, education, and age). Findings: Subscale analyses identified high levels of self-acceptance, purpose in life, and personal growth with no differences between trained and untrained individuals in this population. Workshop participants reported higher scores for positive relationships with others (ie, has satisfying, trusting relationships; odds ratio [OR] 2·00, p=0·041) and environmental mastery (ie, makes effective use of surrounding opportunities; 2·30, p=0·028) than did non-participants. Moreover, participants were more likely to report hope for the future (OR 2·63, p=0·020) and express agency (2·33, p=0·033). Qualitative analyses from 172 interviews showed that compared with untrained participants, trained participants were significantly more likely to report positive changes to their financial condition than were untrained participants (24/101; 24% vs 59/71; 83%; p<0·001), improved health (5/101; 5% vs 39/71; 55%; p<0·001), improved relationships (5/101; 5% vs 53/71; 75%; p<0·001), and improved access to education (7/101; 7% vs 13/71; 18%; p=0·036). Interpretation: This evaluation supports the premise that facilitating human agency, a foundational component of empowerment, is not just possible, but feasible. This enhanced agency, in turn, might catalyse participation in other health and development opportunities. These data suggest more rigorous evaluations are warranted to better identify the effect of this novel empowerment intervention on the well being of disenfranchised women worldwide. Funding: George Family Foundation.