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Partnering with adults as a process of empowering youth in the community : a grounded theory study Cargo, Margaret D. 1999

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PARTNERING WITH A D U L T S AS A PROCESS OF EMPOWERING Y O U T H IN THE C O M M U N I T Y : A GROUNDED T H E O R Y STUDY by M A R G A R E T D. C A R G O B.Sc , University of Waterloo, 1987 M . S c , University of Waterloo, 1989 A THESIS SUBMITTED IN PARTIAL F U L F I L L M E N T OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY in THE F A C U L T Y OF G R A D U A T E STUDIES Department of Health Care and Epidemiology We accept this thesis as conforming to the required standard THEl j^ IVER^rfY W B R I T I S H C O L U M B I A October 1998 ©Margaret D. Cargo, 1998 In presenting this thesis in partial fulfilment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department or by his or her representatives. It is understood that copying or publication of this thesis for financial gain shall not be allowed without my written permission. Department of /-/earth £at€~ and EtfdtmU The University of British Columbia Vancouver, Canada DE-6 (2/88) 11 ABSTRACT Health and social policies identify empowerment as a guiding ideal for health promotion, yet there is little theoretical understanding of youth empowerment. The need for theory to guide practice and research in working with youth in a health promotion context led to this grounded theory study to develop a theory of youth empowerment. A community health nurse acting on BC Ministry of Health's adaptation of the World Health Organisation's Healthy Cities Initiative initiated a community organising project in an inner city community of Vancouver, which merged with the Vancouver Board of Parks and Recreation Blueprint for Youth Services policy. The study was based on 32 months of participant observation where the researcher was a co-facilitator of a community organising effort aimed at engaging youth in identifying their quality-of-life issues, and developing and implementing their solutions. Of the ,123 youth entering the process, 66 attended at least three meetings of which 18 demonstrated ongoing commitment to the community action process. Partnering between adults and youth as the process of empowering youth emerged as the core category in the analysis, comprised of two sub-processes, Creating an Empowering Environment for Youth and Becoming Empowered. An empowering environment allowed youth to take responsibility in a welcoming social climate with enabling support from adults. The adults demonstrated their belief in the capacity of youth to act in the community, expected youth to take responsibility, cared for youth, and offered encouragement through acting-with interactions with young people. Youth felt welcome and participated in the process, taking responsibility for voicing, decision making and action on their quality-of-life issues. The adults transferred the power to youth by giving up their responsibility for voicing, decision making and taking action. By taking responsibility and acting in the community with enabling support, the youth became empowered by controlling the process and incrementally developing their competence, self-esteem, confidence and understanding, which cultivated their belonging to the community. Participating in an empowering process enhanced their development and set in motion a social change process that raised the consciousness of adults and influenced organisational practice. The theory identifies youth empowerment as an ecological construct and a capacity-building process. iir T A B L E O F C O N T E N T S Abstract i i List of Tables * x List of Figures x Preface X 1 x i i Acknowledgements ,• x i v Dedication » * » Table of Contents m P A R T A : T H E I N V E S T I G A T I O N 1 V Chapter 1: Introduction 2 Health Promotion Policy, Practice, Research and Theory 2 Purpose of the Study 5 Rationale for the Study - 5 Chapter 2: Literature Review 7 Use of the Literature 7 Adolescence 8 A Health Profile of Today's Youth 8 Adolescence from the Life Span Perspective 11 How Youth Spend Their Free Time: Turning Social Risk Into Social Opportunity 15 Summary of Literature on Adolescence 17 Empowerment 18 Focusing the Lens 18 Defining Empowerment 18 Control and Alienation in Health 20 The Concept of Participation 23 Empowerment as a Developmental Process 28 Empowerment as an Ecological Construct 29 i v Psychological Empowerment 29 Measuring Psychological Empowerment 30 i; Psychological empowerment studies 30 Indicators of psychological empowerment 32 Organisational Empowerment 32 Measuring Organisational Empowerment 33 Community Empowerment 34 Measuring Community Empowerment :38 Community empowerment studies 38 Community process, studies 39 i Current Issues in Empowerment Research 41 Empowerment as Process & Outcome: A False Dichotomy 41 The Level of Analysis: From Individual to Ecological 42 Moving Towards Substantive Definitions and Theories 44 Research Question 45 Chapter 3: Methodology 46 The Study 46 .Study Setting 46 Historical Background 48 Timeline 49 Participants 49 Entering the Field 50 Setting the Methodological Stage 52 Participant Observation 53 Participant Observation as Method 53 Participant Observation as Role 53 Participatory Research in Health Promotion 56 V Stance to the Study 58 Rationale for a Qualitative Approach ....58 Grounded Theory Methodology 60 Symbolic Interactionism 61 Nature ofthe Data 61 Observation Notes 62 Documents 64 Focus Groups 65 Brainstorming Session 68 Individual Interviews 68 Confidentiality of Responses 70 Ethical Considerations 70 The Analytic Method 7 2 Data Preparation and Management 72 Constant Comparative Method 73 Coding 74 Theoretical Sampling 75 The Case of Retrospective vs. Prospective Analysis 76 Data Analysis 76 Memos 79 Conditional Matrix 79 Standards 8 0 Credibility 8 0 PART B: FINDINGS 8 6 Theoretical Overview 8 6 The Core Category 8 6 v i Chapter 4: Creating an Empowering Environment 90 Welcoming Social Climate 90 Believing in youth 90 Providing Opportunities 93 Caring 97 Respecting 101 Encouraging 105 Synthesis 1 ° 8 Enabling Youth in the Community 109 Organising 109 Facilitating H I Teaching H5 Providing Feedback 118 Mentoring 120 Synthesis 1 2 4 Chapter 5: Becoming Empowered 126 Participating 126 Getting Involved 126 Staying Involved 133 Dropping Out 138 Synthesis 1 4 1 Acting in the Community 143 Controlling the Process 143 Voicing 150 Decision-making 154 Taking Action 158 Synthesis 1 6 2 v i i Developing Social Capacity 163 Confronting the Challenge 163 Building Competence 167 Developing Self-Esteem 181 Getting Confidence 184 Cultivating Belonging 186 Developing Understanding 190 Synthesis 195 Exerting Influence 196 Achieving Goals 196 Enhancing Youth Development 203 Transforming the Environment 212 Synthesis 219 Chapter 6: Implications 222 Strengths and Limitations 222 Strengths 222 Limitations 224 Comparing the Findings to the Literature 227 Ecology of Empowerment 227 Revisiting the False Dichotomy 230 The Concepts of Participation, Power and Control Revisited 231 Moving Towards Positive Health 234 Major Contribution 235 Implications for Policy and Practice 236 Policy Implications 236 Practice Implications 237 Implications for Further Research 241 v i i i Measurement Challenges 241 Issues for Future Research 245 The Researcher's Dilemma 246 E N D N O T E S 248 R E F E R E N C E S 252 A P P E N D I C E S Appendix A - West End Youth Project Summary 270 Appendix B - Phone Contact Sheet 281 Appendix C - Youth Interview Guides 283 Appendix D - Adult Interview Guides 293 Appendix E - Glossary of Grounded Theory Terms 299 Appendix F - Ethical Review 301 i x LIST OF TABLES Table 1: Assumptions guiding the participant observer role 55 Table 2: Theoretical framework for partnering as a process of empowering youth 87 X LIST OF FIGURES Figure 1: Partnering: the process of youth empowerment 220 x i PREFACE The study uses data from two grants awarded by the British Columbia Health Research Foundation to the West End Youth Project. The first grant to the West End Youth Project was funded by the B.C. Health Research Foundation through the Child Health Promotion Competition. The first grant was awarded to Patricia Ward at the Burrard Health Unit and James Frankish at the University of British Columbia Institute of Health Promotion Research from November 1, 1993 to April 31, 1996. The purpose ofthe project was to provide youth the opportunity to identify and take action on issues that were important to them, in the broader context of a community organisation effort. The process evaluation findings were submitted to the B.C. Health Research Foundation in a final report; the qualitative findings were analysed using theme analysis. This study adds considerable depth to these findings by describing and explaining a process theory of youth empowerment. The second B.C. Health Research Foundation grant, in effect from April 1995 to June 1997, focused on dissemination. The funds were used to develop a motivational videotape for practitioners on the youth empowerment, to enable youth to participate in an International Youth For Youth Conference, and to share project findings at a youth decision-making forum. x i i ACKNOWLEDGEMENTS This thesis was made possible by the support of so many people, most importantly, the young people and the adults in the West End. In accepting me as a researcher and a co-facilitator, they allowed me the opportunity to understand empowerment by being part of the process. They were my teachers. The knowledge I have taken away from this experience spills beyond the pages of this thesis. The Shazeen's, Allan's, Romana's, Mike's, Robin's, Vanessa's and Ulric's have become my inspiration, not only to continue with this research, but to have the courage to confront the challenges in my journey through life. I would like to extend a warm thanks to my supervisor, Lawrence Green, and committee members, Garry Grams, Judith Ottoson and Ruth Milner, who were more than patient and understanding as I worked through each chapter. Larry was a constant source of inspiration at every turn, enriching my academic experience with his wisdom and ongoing support. Without Garry, this theory would not have come to life. They were my enablers by believing in me and providing the ongoing encouragement when my enthusiasm waned and the end seemed beyond reach. I would like to acknowledge the intellectual challenge posed by Marjorie McDonald and Louise Potvin, who inspired me to think in creative and open-minded ways. One of the highlights of my doctoral program was the evaluation course with Judith, Marjorie and Louise, full of lively debate and discussion. Judith is truly a remarkable scholar, inspiring students to open doors for themselves, and supporting them along the way. I would also like to thank Rita Schreiber from the University of Victoria Grounded Theory Club for sharing her grounded theory expertise with me. Then there was Wendy, who soldiered with me until the very end, transcribing interviews and burning the midnight oil to put the final touches on the thesis. Looking back on this process, I realise that I could not have completed this thesis without the support of my family. They were always there to lend a helping hand. And my dear little Tyler, how you always found a way to make me laugh! Although this thesis is finished, the friendships and memories made in its creation will last a lifetime. As I walk through the West End, the halls of the U B C Institute of Health Promotion Research and Health Care & Epidemiology, I will remember all the smiling faces that I met along the way. x i This research was made possible, in part, by Health Canada through a National Health Research Development Program (NHRDP) Training Award and a British Columbia Health Research Foundation (BCHRF) Studentship Award. X I V DEDICATION Za moj Tata PART A: THE INVESTIGATION Part A of this dissertation is made up of three chapters. Chapter One, the introduction, provides overview of health promotion policy, practice, theory and research to locate the problem in the broader context of health promotion. It describes the study's purpose and rationale. Chapter Two reviews the relevant literature with respect to the study purpose. Chapter Three explains the philosophical and methodological assumptions that guided this study. 2 CHAPTER ONE: INTRODUCTION Health Promotion Policy, Practice, Theory, and Research Empowerment, a guiding principle for health promotion, is viewed as an enabling process (Green & Raeburn, 1988; Yeo, 1993) for the purposes of achieving social justice, reducing inequities, and achieving fairness (World Health Organisation, 1986; World Health Organisation, no date). Wallerstein (1992b) broadly defined it as "a social action process that promotes the active participation of people, organisations and communities towards the goals of increased individual and community control, political efficacy, improved quality of life and social justice" (p. 198). The construct of empowerment is linked to positive health through the definition of health promotion as "the process of enabling people to increase control over the determinants of their health" (World Health Organisation, 1986). The ideology embodied in the Ottawa Charter for Health Promotion can be thought of as a blueprint for health reflecting a set of shared assumptions about what constitutes health, and how it can be achieved. The relationship of empowerment to the positive construction of health marks an evolution in its conceptualisation beyond the traditional epidemiological perspective of health as the absence of disease (Lilienfeld & Lilienfeld, 1980), or emphasis on healthful lifestyle behaviour (Lalonde, 1974). It extends these earlier foci to the World Health Organisation's view of health as a resource for everyday living, which emphasises social and personal resources as well as physical capacities. From this perspective health is seen as a means to an end, rather than an end in itself (World Health Organisation, 1986). With the emphasis of health promotion on the role of social, economic, political, cultural and environmental determinants, health is viewed more broadly as an ecological relationship between individuals and their environments (Green & Kreuter, 1999; Green, Richard, & Potvin, 1996; Israel, Checkoway, & Zimmerman, 1994) where positive health and healthful lifestyle behaviours are enabled through conditions that are safeguarded or set in motion by educational, organisational, or regulatory efforts (Green & Kreuter, 1999). For practice, the policy change proposed by health promotion's notion of empowerment signals a shift from a top-down approach to the design, implementation and evaluation of categorical health programs to organisational and community processes aimed at engaging citizens in decisions that affect them in the 3 context of their everyday lives (Rappaport, 1985, 1987). The enabling processes outlined in the Ottawa Charter for Health Promotion as targets for action include: (a) building healthy public policy, (b) creating supportive environments, (c) strengthening community action, (d) developing personal skills, and (e) re-orienting health services. The Charter suggests that professionals, organisations and institutions need to take a step back and take on an advisory role rather than being controllers of the process. This means changing the nature of the power relationships among people and the dominant institutions of society from paternalism and authoritarianism towards egalitarianism borne out of grass-roots participation (Labonte, 1994). The Ottawa Charter for Health Promotion (World Health Organisation, 1986) has important implications for the theoretical lenses used by researchers to understand the ecological and more holistic conception of health. While theories of behaviour change and social-psychological theories of social learning, protection-motivation, and health beliefs must remain part of the health promotion specialist's repertoire, these micro-level theories need to be complemented by and linked with broader macro-level theories to provide an understanding of the social, environmental, cultural and political determinants of health. Our understanding of health as conveyed by the new health promotion movement can be enhanced by building on the rich tradition of social and political theory (Poland, 1992; Stevenson & Burke, 1992), and more specifically, by incorporating the perspectives of critical social theory (Eakin et al., 1996; Poland, 1992; Stevenson & Burke, 1992), and symbolic interactionism (Denzin, 1992; Strauss & Corbin, 1994). The argument is that social and political theory would provide for a greater understanding of key constructs to the field, such as empowerment (Stevenson & Burke, 1992). The call for a new perspective is consistent with the apparent movement in health promotion away from the false dichotomies and theoretical perspectives that focus exclusively on either social structure or individual action and towards perspectives that assess their reciprocal relationships (Eakin et al., 1996; Green & Kreuter, 1999). This movement is in parallel with an emergent theoretical perspective in sociology focusing on linking micro- and macroperspectives (Berman, 1978; Ritzer, 1992), and with a recent perspective that aims to break down the boundaries between single theories to find new ways of thinking about and exploring phenomena of interest (Litva & Eyles, 1995). This broader-based integrated approach of linking micro and 4 macro level factors is consistent with the ecological underpinnings of health promotion (Green et al., 1996), and public health (Dean, 1993; Koopman, 1995; Susser, 1995). The ideology of empowerment in health policy has further implications for health promotion research. Health promotion's methodology bears strong ties with the theoretical lens used to help health professionals understand and explain the ecology of health (Poland, 1992). The new health promotion movement casts doubt on the reliance and appropriateness of a postpositivist research methodology (Lewis, 1996; Lincoln, 1992; Poland, 1992). Empowerment is rooted in fairness and egalitarian relationships, a notion that is seemingly incompatible with the tenets of manipulation and control inherent in postpositivist research (Campbell & Stanley, 1963). Health promotion has a corresponding need to articulate more clearly its theoretical and philosophical assumptions that guide its methodological preferences (Caplan & Holland, 1990; Poland, 1992). Health promotion research has responded by including more participatory approaches to research and evaluation (Green et al., 1995), and by placing greater value on the role of qualitative methods (Baum, 1995; Mays & Pope, 1995a; 1995b; Pope & Mays, 1995; Wallerstein & Sanchez-Merki, 1994) to understand and explain the broader determinants of health. These methodological advances, however, challenge the epistemological foundations of postpositivism insofar as the researcher does not take on the role ofthe disinterested and objective scientist. In contrast, the researcher can take on a variety of roles that are more reflective of a subjectivist epistemology. Here, the researcher gains an understanding of a phenomena of interest, such as community empowerment, by getting to know and working in partnership with the participants in the community (Lincoln, 1992). Empowerment gives cause to expand our research repertoire to encompass alternative approaches to understanding a phenomenon of interest. The World Health Organisation encourages the involvement of young people in the promotion of health for others, as well as themselves (World Health Organisation, 1993). The framework views young people as a valuable resource in their environment. The Canadian Council on Social Development reinforces this view in stating the following: "every child deserves an equal chance to develop his or her full potential, and that our future depends on the ability of our young people to meet the demands of a complex society and a volatile community" (Canadian Council on Social Development, 1996, p. 5). This view converges with the 5 more recent national goals for healthy child and youth development aimed at promoting and protecting their health and well being through capacity-building and providing youth with meaningful opportunities in their environments (Health Canada, 1997).1 These goals call for a re-orientation of the way we think about adolescent health moving away from the focus on prevention to the promotion of youth health. Engaging youth in empowering processes is one means of promoting the positive health of youth. Purpose of the Study This study builds on the identified gap in health promotion policy, theory, research and practice in the area of youth empowerment. The purpose of the study was to generate a substantive theory of youth empowerment in the context of a community organisation effort aimed at enabling the empowerment of young people in an inner-city neighbourhood. The study used the grounded theory method, drawing on its theoretical roots of symbolic interactionism. Qualitative data were collected as part of a three-year participatory research project using participant observation. These data included observation notes, meeting minutes and other key documents, as well as personal and focus group interviews. Rationale for the Study This research was inspired out of an existing gap between the ideology of the Ottawa Charter and the paucity of available measures to assess the positive domain of health related to empowerment, and more specifically, youth empowerment. There is considerable debate in the literature over the philosophical assumptions and the underlying paradoxes associated with empowerment, in addition to its theoretical and empirical basis (Bernstein et al., 1994; Israel et al., 1994; Rappaport, 1987; Riger, 1993; Rissel, 1994; Wallerstein, 1992b). Despite the significance of empowerment to health promotion and related fields of inquiry (Hanna & Robinson, 1994; Kriesberg, 1992; Rappaport, 1987; World Health Organisation, 1986), the relationship between policy or program development with empowerment theory and research is described as "tenuous" (Perkins & Zimmerman, 1995). Developing a theory of youth empowerment was viewed as the bridge between the ideas embodied in policy and its measurement. Without a theoretical understanding of empowerment, health promotion and epidemiology will remain entrenched in a paradigm devoted to the assessment of health as the absence of 6 disease and of behaviour as compliance with professional prescriptions, or ad hoc measures of empowerment that account for very little variance in the dependent variable. The development of practice-based theory is viewed as one strategy for bridging the gap between policy and practice (Milburn, 1996). The practice-based theory in this study blends the subjectivist epistemology of participatory research with grounded theory to develop an understanding of youth empowerment. In this respect, the study takes on the challenge of a subjectivist epistemology in conducting community health promotion research. This research is intended to contribute to the current knowledge base in youth health promotion, a knowledge base that is currently deficient of youth empowerment theory. 7 C H A P T E R 2: L I T E R A T U R E R E V I E W The purpose of this chapter is to review the literature in two content areas: adolescence from the perspective of life-span developmental psychology, and empowerment from the perspectives of health promotion, community psychology, sociology, education, and social work. This chapter begins by conveying the use ofthe literature in the context ofthe grounded theory study, then an overview of adolescence and adolescent health. Next, it reviews the empowerment literature in general, within which resides the discussion of youth empowerment. This chapter aims to weave together the strands from these two disparate areas of the literature to form a picture of what is known, and what remains unknown about youth empowerment. Use of the Literature The literature may be used in different ways in a grounded theory study. A literature review would be omitted in a pure Glaserian approach to a grounded theory study (Glaser, 1978). My use ofthe literature, however, is aligned more closely with Strauss's use ofthe literature to stimulate theoretical sensitivity by orienting the researcher to relevant concepts and relationships (Strauss & Corbin, 1990). Since the goal of grounded theory is discovery, the researcher should not be immersed in the literature to the point of stifling their ability to see new categories and connections in the data. The academic and technical literature on empowerment was reviewed at the outset of this study in 1993. At that time, little was available in the area of empowerment in health promotion more generally, and youth empowerment more specifically. The academic and technical literature has grown considerably since the start ofthe study. I reviewed the additional literature as the concepts were relevant to the categories identified in the analysis. It is appropriate to go back to the literature after a category has been identified in the analysis to assess one's findings with those of others (Strauss & Corbin, 1990). The influence ofthe literature on theory development was documented in the theoretical memos, a core technique ofthe grounded theory method. My challenge is to present this review of literature in a way that preserves the synthesis gained from the study. 8 Adolescence The purpose of this section is to contextualise the study by reviewing the key concepts related to adolescence. This section begins with an overview ofthe health profile of today's youth and the measures used to assess youth health. This is followed by a discussion of adolescence from the life-span perspective, integrating the concepts of resilience and developmental pathways to demonstrate how social risk can be turned into social opportunity by impacting the ways youth spend their free time. A Health Profile of Today's Youth Hardly a day passes without the media referencing the societal problems of youth drug use, violence and crime. Youth are viewed as risk-ridden, as problematic, and as harmful to others in society. As a period of development, adolescence is framed most often as a period of risk, rather than a period of opportunity (Baumrind, 1987; Calabrese, 1987; Erikson, 1975; Takanishi, 1993a). To some extent, adolescent health has become synonymous with the concept of behavioural risk and risk behaviour (Jessor, 1991, 1993). The negative frame around the picture of adolescence has been influenced by the biomedical and disease prevention orientation of epidemiology (Duncan, 1988; Kellam & Horn, 1997; Lilienfeld & Lilienfeld, 1980). Therefore, the prevention paradigm is oriented with the negative construction of health, or the view of health as the absence of disease. Prevention is based on a needs model and starts with a problem (Albee, 1981; Rappaport, 1981) such as smoking, alcohol use, pregnancy, HIV-AIDS, or violence. Starting with the problem has been driven by categorical funding programs, despite research demonstrating common peer, personal, familial, and environmental determinants of these behaviours. Moreover, these targetted behaviours tend to cluster among the same youth (Jessor, 1982; Jessor & Jessor, 1977). These behaviours are referred to as problem behaviour, conceptualised as at-risk behaviour that departs from the norms and regulations of society, or are otherwise deemed inappropriate or undesirable according to socially-defined expectations (Jessor, 1982). For example, a moderate level of alcohol use is acceptable for adults, but not for those under 19.2 As suggested by the terms, "at-risk behaviour," "health-compromising behaviour" and "problem behaviour," prevention focuses on negative health outcomes. Thus, primary prevention places an emphasis on fixing deficiencies by 9 reducing, weakening or eliminating at-risk behaviour to prevent a health problem or negative health outcome from occurring by intervening before the behaviour develops or the problem occurs (Perry & Jessor, 1985). Behaviours that place youth at risk for compromised health are operationalised in terms of their prevalence or incidence, the hallmarks of epidemiological measurement (Lilienfeld & Lilienfeld, 1980; Miettinen, 1985). International (King, Wold, Smith, & Harel, 1996), national (Health and Welfare Canada, 1990; Health Canada, 1996) and provincial surveys (McCreary Centre Society, 1993) tend to focus on the measurement of the negative indicators of youth health. A national youth smoking survey showed that 24 percent of youth aged 15 to 19 were current smokers with little difference between boys and girls (Health Canada, 1996). A provincial health survey found three-quarters of surveyed youth tried marijuana at least once in their lifetime, and the majority of youth started drinking between the ages of 11 and 14 (McCreary Centre Society, 1993). Combine the use of marijuana and/or alcohol with driving, and one has a potentially life damaging or fatal effect. Injuries are identified as the leading cause of death among 15 to 19 year olds, with the leading cause, of death due to injuries attributed to motor vehicle accidents and suicide (Canadian Institute of Child Health, 1994). As for other potentially life changing behaviours, one has to look no further than unprotected sexual intercourse. Over 36,000 teenagers became pregnant in 1987 (Health and Welfare Canada, 1990). Sexually transmitted diseases remain a major problem (Health and Welfare Canada, 1990), the most devastating of which is HIV. Surveillance statistics reveal that 20 percent of the people with AIDS are 20 to 29 years old. Given the possible latency period of seven or more years, it has been suggested that many of these young adults were infected during their adolescent years (DiClemente, 1992; Health and Welfare Canada, 1989). As suggested by the findings, youth are at-risk for negative physical and mental health outcomes, resulting in disability, chronic diseases, such as cancer and heart disease, and death. Youth are at the greatest risk for being involved in problem behaviour during a time when they perceive themselves to be the least vulnerable to the negative effects of their decisions and actions (Leventhal & Keeshan, 1993). For some, the realisation of their perceived invulnerability will come quickly through pregnancy, lifelong coping with the guilt of killing or injuring another while drinking or driving, or confinement in a wheelchair, for example. For others, the realisation will come during adulthood when 10 reflection on their teen years will make them wonder why they did the things they did. While some may escape morbidity or sure death, others may not be so fortunate. Evidence suggests that the mental of health of Canadian youth is on the decline. The suicide rate among youth has increased fourfold from 1969 to 1991 from 5.3/100,000 to 23/100,000 (Canadian Institute of Child Health, 1994). The Adolescent Health Survey found that for the region of Vancouver, 13 percent of youth considered suicide at least once in the year prior to the survey, while 11 percent went ahead to plan a suicide with five percent reporting that they attempted suicide and two percent reporting injury from suicide (McCreary Centre Society, 1993). This study found a strong relationship between low self-esteem and emotional distress, suicidal thoughts in the last year, and a history of sexual and physical abuse. Thus, the way youth felt about themselves placed them at greater risk for negative health outcomes. There are few indicators of positive health, and even fewer, of empowerment. Perceived health is the most commonly used question to assess one's health. While it is encouraging that there is an indicator of positive health, it is usually the only indicator of positive health. The majority of youth self-report their health as excellent or good while the minority of youth (14%) perceive their health as fair or poor (McCreary Centre Society, 1993). A greater proportion of youth with excellent or good health reported high self-esteem, positive body image, exercising three or more times a week, and doing above average in school. As well, self-esteem was associated with fair and poor perceived health status. In another survey, youth perceiving themselves as healthy tended to be happier, more confident and integrated into their social milieu more easily compared to those who rated their health as fair or poor (King et al., 1996). The picture of today's youth is influenced by the prevailing paradigm orientation. Most of the measures used to assess youth health reflect the view of health as the absence of disease. This has the effect of portraying a rather grim picture of youth. The picture of the positive health of youth is not so clear, given the paucity of measures that are used for its assessment. There is a growing rhetoric around positive health, yet few measures for its assessment. As suggested by Dean (Dean, 1993, 1994; Dean, Kreiner, & McQueen, 1993), epidemiological research is in need of theory to guide the development of more sophisticated measures of health, in this case, the positive domain of health. 11 Adolescence from the Life Span Perspective Adolescence is viewed as part of a continuum of ongoing development within the life span (Bronfenbrenner, 1979; Brooks-Gunn & Paikoff, 1997; Crockett, 1995; Garbarino, 1985; Lerner, 1995b; Maggs, Schulenberg, & Hurrelmann, 1997; Sugarman, 1986), a phase that is imbued with both change and purpose (Steinberg, 1995). It is generally viewed as the period of development between childhood and adulthood, spanning the ages between 10 and 21, and marked by change and integration at the physical, biological, psychological, social, cognitive, behavioural and social levels (Coleman & Hendry, 1990; Eisenberg, 1975; Elliott & Feldman, 1990; Irwin & Vaughn, 1988). The term adolescence is derived from the Latin term, "adolescere" meaning "to grow up" (Microsoft Corporation, 1998). This definition supports contemporary views of adolescence as a dynamic period of development, as the young person emerges from childhood and prepares himself or herself for the roles and responsibilities of adulthood (Crockett, 1995; Hamburg, 1993; Konopka, 1973; Mitchell, 1975; Offer & Schonert-Reichl, 1992; Petersen & Ebata, 1987). These and other authors recognise that adolescence is a period of development to be enjoyed for itself, and therefore should not be viewed only as a period of preparation for adulthood (Health Canada, 1997; Konopka, 1973). Theoretical perspectives suggest that each life stage is associated with specific developmental tasks which presupposes the presence of sensitive periods of learning, or teachable moments (Havighurst, 1961, 1972). Havighurst suggests that the successful achievement of the tasks lead to happiness, and success with future developmental challenges. In contrast, failure is hypothesised to spur unhappiness, social disapproval, and less facility in working through the challenges in later stages of development. During the course of adolescence, youth confront several developmental tasks including: (a) achieving new and more mature relations with peers; (b) coming to terms with gender roles; (c) becoming comfortable with bodily changes; (d) preparing for marriage and family life; (e) achieving emotional independence from parents and other adults; (f) preparing for economic independence, feeling able to make a living; (g) preparing for an occupation; (h) developing one's intellectual ability necessary for civic competence; (i) preparing for socially responsible behaviour; and (j) developing an ideology, or set of values to guide behaviour (Havighurst, 12 1961). Though the changes are largely social and emotional, or internal to the young person, the environment influences the adolescent experience. The notion of capacity building is inherent to each of these developmental challenges in that youth must adapt or respond to the challenges with which they are confronted in their environment. The ability of youth to recover from exposure to adverse social conditions or challenges, rather than yield to the stress and adversity, is referred to as resiliency in the literature (Garmezy, 1993). This finding has generated considerable interest in the resiliency of youth, launching a search for understanding on how youth overcome the odds despite the adversity, through the processes and mechanisms that enhances their ability to resist stressful life circumstances and promote their adaptation and competence. The key to resilience rests in the protective factors and processes that operate only in the presence of risk (Rutter, 1987), or as an interaction effect with the risk variable. Protection is more narrowly defined than resilience, and is distinguished by its concern with the modification ofthe young person's response to a particular constellation of life circumstances that places them at risk (Rutter, 1987). Protective processes in the ecological context of the child and adolescent can be viewed as countering risk when the protective process changes the life trajectory from risk to adaptation. An interpretation from the ecological (Bronfenbrenner, 1979; 1989) or developmental contextualist (Lerner, 1995a, 1995b) perspective would suggest that the transactions between youth with agents in their environment modify the risk in some way. Empirical research identifies individual, family, peer, school and community level protective processes as mitigating the effects of risk exposure (Benson, 1993; Blyth & Leffert, 1995; Blyth & Roehlkepartain, 1995; Jenkins & Smith, 1990; Resnick, Harris, & Blum, 1993; Werner, 1992; Wills, 1992). Individual level protective processes include competence, self-esteem, self-efficacy, sense of personal responsibility and religious commitment, while community level protective processes include belonging to a supportive community and bonding to family, school and social institutions. In other words, the protective processes operate in different domains of the youths' lives. Many studies tend to focus on the role of protective processes on one ofthe domains in the lives of youth, such as the individual domain or the school. As an example, a study of over 36,000 grade seven to 12 th graders, showed the protective function of caring 13 and connectedness, especially to the family and the school, on quietly disturbed and acting-out behaviour (Resnick et al., 1993). Rutter suggests that protective factors such as caring and connectedness function by lessening the impact of risk, reducing the negative chain reactions that may arise from risk exposure, establishing and maintaining self-esteem and self-efficacy, or providing young people with opportunities (Rutter, 1987). Few large-scale studies have examined protective factors across the multiple domains of youths' lives with respect to their deficits. Research at the Search Institute has studied the protective processes (internal and external assets) with respect to deficits (risks) using a sample of 46,799 grade six to twelve youth in 111 communities in 25 states (Benson, 1993). The external assets measured variables related to social support, control3 and structured time use, while internal assets measured educational commitment, positive values and social competence. Consistent with other research, there was a positive association between the number of deficits and involvement in at-risk behaviour. As the number of deficits increased in the personal and environmental domains of youths' lives, the greater their involvement in at-risk behaviour. Those youth with more internal and external assets in their lives were less involved in at-risk behaviour. The following five assets distinguished youth thriving or doing well, despite their exposure to sexual or physical abuse, living with parental addiction and living in a single-parent household: (a) having connections with adult-led, structured youth programs, (b) having caring, supportive and concerned adults in the family and at school, (c) having families that exercise control in the form of standards and discipline, (d) holding positive values such as helping others, and (e) having a strong educational commitment. Youth engaging in prosocial behaviours were less likely to be involved in at-risk behaviour. Among the findings of potential interest to this study is that youth participation in meaningful activities with supportive adults represents a protective mechanism for youth at risk. Youth participation in community organisations or volunteer programs has not been the focus of evaluation research, although some evidence corroborates the findings of the Search Institute. For example, participating in constructive leisure time activities or programs has been inversely related to delinquency (Larson, 1995), engaging in problem behaviours (Chung & Elias, 1996; Greene & Uroff, 1991), and alienation (Calabrese & Schumer, 1986). 14 Youth development occurs over time, and can be viewed in the broader context of developmental transitions and pathways (Crockett, 1995; Crockett & Crouter, 1995; Maggs et al., 1997; Petersen & Ebata, 1987; Schulenberg, Maggs, & Hurrelmann, 1997a; 1997b; Steinberg, 1995). Developmental transitions reflect the actual developmental changes that occur during the course of adolescence. The transitions inherent in intrapersonal (e.g., transitions in cognitive, identity, physical development) and interpersonal development (e.g., transitions in peer, family and romantic relationships) are viewed as foundational to youth transitions in roles (e.g., transition to motherhood) and settings (e.g., transitions from school to work, elementary to highschool) (Schulenberg et al., 1997a). The transitions in roles and settings may be conceptualised as ecological transitions defined as occurring "whenever a person's position in the ecological environment is altered as the result of a change in role, setting, or both" (Bronfenbrenner, 1979, p. 26).4 A role is more specifically defined as a set of behaviours and expectations associated with a position in society (p. 25). Thus, the ecological transitions associated with adolescence bring to bear a corresponding set of different or new set of expectations for youth (Petersen & Ebata, 1987). Youth development is viewed as progressing along multiple developmental pathways, referred to as "a route along which something moves" (Steinberg, 1995). It is taken to reflect patterns of structured change over time, and may incorporate a number of developmental transitions for a given youth, or group of youth (Crockett & Crouter, 1995). The pathway is influenced by the reciprocal and dynamic interaction of youth with their context, namely the following three sets of factors: (a) personal characteristics of the developing youth; (b) influences in their proximal environment; and (c) opportunities and constraints inherent in the broader social environment (Steinberg, 1995). Steinberg's use of the spaceship illustrates the influence of these forces in shaping the developmental path of youth: My vision of the adolescent's developmental trajectory, then, is not unlike that of a spaceship in flight: Its pathway is determined by the joint interaction of characteristics of the spaceship (e.g., the direction in which it was launched, the power of its thrust), characteristics of the immediate environment through which it travels (e.g., gravitational pulls of the various objects in space can alter its course), and features of the larger solar system that contain both the ship and the immediate environment (p. 249). Thus, the developmental pathway of youth is influenced by personal as well as environmental factors. From the health promotion perspective, there is considerable potential for influencing the developmental trajectory of youth. This can be achieved by implementing the strategies outlined by the Ottawa Charter for Health Promotion through building healthy public policy, creating supportive environments, strengthening community action, developing personal skills and re-orienting health services in support of youth-related initiatives. How Youth Spend Their Free Time: Turning Social Risk into Social Opportunity Youth often complain about not having things to do, or places to go (British Columbia Youth Council, 1992; Reid & Tremblay, 1994; Rutman, 1995; Wallbank-Macfarlane-Tindall, 1997). About 42% of youths' waking hours is spent as discretionary time, meaning it is "unstructured," "unsupervised" and "unproductive" (Carnegie Corporation of New York, 1994). We must acknowledge, however, that some "down time" is a normal part of everyday living. Youth spend a considerable amount of this time hanging out with friends, watching television, listening to music, or playing computer games (King et al., 1996). After school hours, the summer time, and evening or late night hours, or those times when youth are not in school, have been identified as particularly problematic (Witt & Crompton, 1996). There are many reasons why youth have so much free time available to them. Demographic profiles are changing with many youth belonging to single parent or guardian families, or to families in which both parents work. With high unemployment rates, more mature and experienced adults now fill jobs available to youth in times of economic prosperity. In Canada, the unemployment rate for youth aged 15 to 24 has been at about twice the average rate for all groups (Statistics Canada, 1989). Youth unemployment has put many youth in the position of living at home into their early to mid twenties. A study by the William T. Grant Foundation (1988) found that a greater proportion of men in their twenties were living at home in 1985 compared to 1960. Some ofthe agents influencing the amount of unstructured time available to youth are social and economic in nature, but the risk may be intensified by the lack of constructive opportunities for participation in their proximal environment (Takanishi, 1993a). It has been suggested that the historical changes leading youth to take on fewer responsibilities may have transformed adolescence into a waiting period of enforced leisure with fewer responsibilities and less adult contact (Nightingale & Wolverton, 1993), referred to as the "prolongation of youth" (Cote & Allahar, 1994). 16 The concern over the amount of unstructured time available to youth is the effect it may have on their health and well being, positive or negative. Research shows that youth who have a lot of discretionary time on their hands are more likely to engage in health-compromising behaviour (Caldwell & Smith, 1995). At a forum sponsoring focus groups around the province, youth attributed the problems in their communities to the lack of constructive recreational alternatives, often resulting in hanging out on street corners, vandalism, drunk driving, minor crimes and sexual experimentation (British Columbia Youth Council, 1992). From the developmental perspective, youth involvement in at-risk behaviour satisfies specific psychosocial needs (Jessor, 1982; 1991) related to affect regulation, self-definition and social compliance (Cargo, 1989; Glynn, Leventhal, & Hirschman, 1985). Smoking and drinking provide youth with a means to achieve goals that may otherwise seem out of reach, to show rejection towards adult authority and conventional norms, to cope with anxiety and failure, to express solidarity with friends, to affirm attributes of themselves, and to show their transition to a more mature status (Jessor, 1982, 1991). Some youth find their needs for sense of belonging, self-worth, companionship and excitement satisfied through gang or cult affiliation (Clark, 1992). The symbols and rituals associated with the roles assumed within the gang positively reinforce an identity that is inspired and affirmed by the group (Vigil, 1988). The theoretical literature on adolescent development suggests that the choices and decisions made by youth can have a profound impact on their developmental trajectory. It is the first time in the life cycle that individuals have the cognitive capacity to think in abstract and hypothetical terms and to reflect on the short-and long-term consequences of their actions. Youth involved in health-compromising behaviours such as unprotected sexual intercourse, driving while under the influence of alcohol, or joining a gang are at greater risk for experiencing potentially negative outcomes that can alter their life course. These include an early transition to parental responsibilities which may preclude youth from furthering their education or vocational training, or suffering from a disability caused by injury. Longitudinal research shows that youth who are highly unconventional in their behavioural tendencies tend to remain so into early adulthood, although youth initially less unconventional or deviance prone tend to become more conventional over time (Jessor, 1982; Jessor & Jessor, 1977). Even though youth may age out of unconventionality, one can ask what the cost is to 17 youth achieving their potential, and fulfilling the developmental challenges associated with adolescence and young adulthood (Havighurst, 1961; 1972). Summary of Literature on Adolescence There is a need to broaden the rather narrowly focused conceptualisations of adolescence as a period of risk to a period of opportunity (Petosa, 1986; 1989; Takanishi, 1993a; 1993b), and from an emphasis on health as the absence of disease to health as a resource for everyday living. The emphasis placed on risk behaviour, referring to those behaviours that compromise the psychosocial aspects of successful adolescent development, suggests that at risk is more than just the physical health of youth (Jessor, 1991). Youth are at risk for having difficulties achieving the developmental tasks of adolescence which are essential for youth to become functioning adults (Erikson, 1968; Greenberger, 1984; Havighurst, 1972; Jessor, 1993). Thus, prevention through risk reduction will not sufficiently address the health concerns of today's youth. Complementary approaches need to promote the positive health of young people by providing youth with meaningful social opportunities for participating in their proximal environments, such as participating in empowering processes. 18 Empowerment This section reviews the literature on empowerment to inform the direction of the study. A critical review of the empowerment literature guides the discussion of concepts. The etymology of empowerment is defined and applied more broadly to the health promotion context leading to a discussion of the concepts of power, control and alienation. The concepts of participation, empowerment as a developmental process, and an ecological construct are then reviewed. This section concludes by discussing the theoretical and measurement issues related to the current state of knowledge development. An overall summary of the literature review serves as a preface to the research question, which was based on the current state of knowledge development at the outset of this study. Focusing the Lens Understanding empowerment is a challenging endeavour. It is identified as ecological, developmental, as well as a process and an outcome, and linked to the concepts of power, control, and participation. The challenge becomes one of mapping the relationships between these concepts of process and context to come up with an understanding of empowerment. My review of the literature identifies several gaps, the foremost of which is the presence of a large number of untested propositions related to empowerment. In the absence of theory that explicates the relationships among the concepts, it remains difficult to gain understanding or develop standard measures of such a complex concept. Defining Empowerment An etymological analysis of the terms empower and empowerment illustrate the relationship of the construct to the concepts of power and participation. The etymology of the verb, "empower" and the noun, "empowerment" are reviewed in the section below to clarify their basic meanings. The term empowerment is comprised of three syllables: (a) the prefix, "em," (b) the word, "power," and (c) the suffix, "ment." Webster's Unabridged Dictionary defines the term, "power" in two ways that are of relevance to health promotion: (a) as the capacity to control and to impose one's will, authority, government or rule, and (b) the capacity to do something. Power is the Roman derivative of the Latin term "potere" meaning "to be able" and is expressed through the dimensions of "power-over" and "power-with." The expression "power-19 over" refers to an agent having power over another agent. It is based on hierarchical or top-down structures, more commonly referred to in the health promotion literature as centralised decision-making (Green, 1986). With this type of structure, the few power elite at the top ofthe hierarchy use their influence to control access to valued resources, set the agenda or make the decisions that affect those at the bottom ofthe hierarchy (Barr, 1995; Kriesberg, 1992). In other words, those who are affected by the decisions made by the power elite often have little or no say or influence in the decision-making process. Power, therefore, is concentrated in the hands of a few. This allows the power elite to control access to valued resources which, as pointed out by Barr (1995), contradicts the principle of equal opportunity fundamental to a democratic society. In contrast, the expression "power-with" refers to power as co-agency (Kriesberg, 1992). Power with is manifest in relationships of co-agency. These relationships are characterized by people finding ways to satisfy their desires and to fulfill their interests without imposing on one another. The relationship of co-agency is one in which there is equality: situations in which individuals and groups fulfil their desires by acting together. It is jointly developing capacity. The possibility for power with lies in the reality of human interconnections within communities, (pp.85-86). The notion power-with brings to bear a language of "assertive mutuality" as reflected by the terms interdependence, interconnection, co-operation, collaboration, sharing, the capacity to act, agency-in-community, co-action and mutuality used to describe the relationships (Kriesberg, 1992). The language of power-with is fundamentally enabling, and as suggested by Rappaport (1985), and conveys the forces of change that resides within individuals, groups and communities. The prefix "em" to the term empowerment is a Latin derivative of "en," meaning "put into." If power refers to an agent's capacity to do something, then the prefix is suggestive ofthe means by which agents put into the process. The means of putting into is through the process of participating. This analysis ofthe verb empower converges with the Webster Unabridged Dictionary definition of empower as "enabling others, or giving others abilities in order that they may obtain power through their own efforts," with one important distinction. This definition of empower may be more appropriately defined as "to enable others, or to develop the abilities of others so that they may obtain power through their own efforts." The adult education literature suggests that individuals cannot be given abilities per se. In contrast, skills and abilities develop over time with the opportunity for application in context and with accumulated life experiences 20 (Ford, 1994).5 The suffix "ment" bears two meanings: (a) the concrete result, object or agent of an action; and (b) action process. Thus, the noun "empowerment" carries two significant meanings, the outcomes associated with an empowering process, and the empowering process itself. As a process, empowerment is measured through the active participation of individuals, groups, agencies or communities (Wallerstein, 1992b). In this capacity, individuals work together to set an agenda, achieve consensus on their issues, develop an action plan and carry out activities to achieve their identified goals (Butterfoss, 1996; Rappaport, 1987). As an outcome, empowerment is measured by assessing the levels of psychological, group and community empowerment and related dimensions (Israel et al., 1994; Rissel, 1994), and involves some form of action (e.g., social action, community action) (Keenan & Pinkerton, 1991; Wallerstein, 1992b; Zimmerman & Rappaport, 1988) leading towards some form of individual, social, political, structural change (Israel et al., 1994; National Commission on Resources for Youth, 1982) and increased control over the determinants (personal, social, economic, political) that shape the lives of individuals, groups or communities (Wallerstein, 1992b; Zimmerman & Rappaport, 1988). Empowerment is best viewed as a population and context sensitive construct that defies broad4?rush definition; it can mean different things to different groups of people, in different domains in their lives (Perkins & Zimmerman, 1995; Zimmerman, 1995). This suggests that useful theories of empowerment should consider how characteristics of the population and the setting vary according to the dimensions of empowerment as a process and an outcome, the process of participating, and how power is distributed between the agencies, professionals and citizens engaged in the process. Control and Alienation in Health A review of the literature shows that empowerment gained its credibility in public health and health promotion through its absence, that is through the relationship of alienation, learned helplessness, lack of perceived control and powerlessness in the causal pathways to disease (Rissel, 1994; Wallerstein & Bernstein, 1988). The relationship between the lack of control and health is well established (Langer & Rodin, 1976; Seeman & Seeman, 1983). Karasek's research demonstrates increased rates of heart disease 21 among workers experiencing higher levels of job demands combined with low decision making latitude (Karasek, Baker, Marxer, Ahlbom, & Theorell, 1981; Theorell et al., 1984). In the youth literature, alienation has been empirically associated with a number of problem behaviours including delinquency (Calabrese & Adams, 1990; Mau, 1992), alcohol and drug use (Baumrind, 1987; Jessor, 1991; Jessor & Jessor, 1977; Thomas & Hsui, 1993), attempted suicide (Grosan & Milligan, 1991; Olivier, 1992), and youth violence (White, 1995). As an example, in a study of 2,756 youth, leisure alienation was significantly associated with regular cigarette smoking, heavy alcohol use, attempted suicide and depression (Caldwell & Smith, 1995). In this particular study, leisure alienation was operationalised as the rejection of adult structure and boredom, the former of which is identified as one ofthe functional meanings associated with youth drug use (Jessor, 1982). Further, a study of 376 high school and college youth found that the perceived loss of control and meaninglessness in life mediated the relationship between uncontrollable stress and substance use (Newcomb & Harlow, 1986). A related literature suggests that drug use among youth is a maladaptive coping response to environmental sources of stress (Olivier, 1992; Wills, 1992) such as peer pressure to smoke and use drugs (Biglan, Weissman, & Severson, 1985; Pentz, 1985). A review of the social support and competency literature demonstrates that social support and competence serve as protective factors for youth involvement in at-risk behaviours. In a study of 1,289 urban adolescents, family support and personal competence were inversely related to youth substance use. These protective factors, however, were the most important for youth with a high level of vulnerability (Wills, 1992), consistent with other findings (Mechanic & Hansell, 1988). Competence, then, serves as a protective factor for young people. One could argue, however, that developing competence represents a means for youth controlling their responses to environmental stressors. Thus, competence becomes a condition that allows youth control over their environment and in their environment. By demonstrating competence, youth control their environment, which in turn enhances their self-esteem and positive affect. This argument is consistent with Harter's empirical work on self-worth and competency where perceived competence was antecedent to self-esteem, which in turn lead to positive affect and an enhanced motivation for youth to act (Harter, 1986, 1988, 1990). Interpreted in the context ofthe research on resiliency, the. ability to control could serve as a 22 protective factor for youth at social risk through competence development, having a positive effect on self-esteem. Youth, however, require environmental opportunity to develop competencies in meaningful areas of their lives. Few studies in adolescence focus on the concept of control. In contrast, most of the attention has been placed on alienation, which is theoretically meaningful to empowerment since its presence suggests the absence of power and control, both of which are important to empowerment. The theoretical roots of alienation can be traced to youths' need for relatedness, sense of connection or attachment, a developmental need of adolescence (Bronfenbrenner, 1974; Mitchell, 1975; Oldenquist & Rosner, 1991), and a basic human need, the satisfaction of which is necessary for self-actualisation (Maslow, 1968). Human relationships are alienating to the extent that people are treated as objects, or manipulated to serve the objectives of others (Freire, 1970, 1973; Germino, 1972). Youth have been subjugated and controlled by agents within the primary institutions of their lives (Cote & Allahar, 1994). Our national policy "Achieving Health for A l l " has been criticised for viewing children as "passive beneficiaries of health care efforts taken by others on their behalf (Zeldin et al., 1990, p. 196). The family and the school contexts in particular, have been singled out as the primary institutions contributing to the cultivation of youth alienation (Bronfenbrenner, 1974; Calabrese, 1987; Calabrese, 1988; Gullotta, 1983; Mau, 1992; Mitchell, 1975; Newman, 1981). The breakdown of the traditional family unit, authoritative parenting styles, excessive job and social obligations on the part of parents, the reliance on the television (as the square babysitter), growing up in an abusive household, and single parents living in poverty have all been associated with contributing to child and youth alienation (Baumrind, 1987; Bronfenbrenner, 1974). As an example, schools have been characterised as alienating by their emphasis on pedagogical teaching rather than engaging youth as subjects of learning (Bronfenbrenner, 1974; Freire, 1970, 1973; Newman, 1981), and from their insulation from the broader community and neighbourhood (Bronfenbrenner, 1974). It seems that the treatment of youth by many of the prevailing institutions, agencies and organisations and their respective authority figures qualifies as "ageism," a term usually reserved for discrimination towards the elderly in society. It has been suggested that the failure of formal institutions to recognise the developmental needs of children and youth, because of 23 their disempowering policies and practices, contributes to the developmental vulnerability of youth (Cochran, 1988). Youth have been viewed as a marginalised segment ofthe population (Baumrind, 1987; Baumrind & Moselle, 1985). Youth feel like they do not have a voice, and cannot influence the decision-makers in their social environment. Focus group findings from a provincial forum found feelings of powerlessness to emerge as a theme (British Columbia Youth Council, 1992). This translates to adults not listening to the concerns and views of youth, a recurrent theme in the adolescent literature (DiBenedetto, 1992; Gibson, 1993; Hefner, 1988; Keenan & Pinkerton, 1991; Nessel, 1988; Rutman, 1995; Stivers, 1994; Wallbank-Macfarlane-Tindall, 1997). The powerlessness and lack of voice is perceived by youth as a violation of their right to be heard, and converges with the rights model orientation of empowerment (Rappaport, 1981). Empowerment addresses the issue of youth voice and their marginalisation in society. More specifically, youth empowerment is defined as the following. Youth empowerment is the process by which young people learn, through active participation in the relationships, events, and institutions that affect their lives, to develop and apply their capacity to transform themselves and the world in which they live. (National Commission on Resources for Youth, 1982, p.l) This definition of youth empowerment embodies several themes. It suggests that empowerment is based on the types of relationships that are established between youth, adults and institutions in the youths' social environment. Empowerment is described as a process of learning through active participation in the real world, and as a capacity building process where youth develop and apply their knowledge, skills and abilities in context. Thus, access to life experience and the opportunity to participate become important factors in the capacity-building process. Relatedly, learning is linked to opportunities for meaningful participation through the primary agents of socialisation (e.g., school, community centre, church, neighbourhood house). Further, empowerment is linked to personal and social change. More specifically, youth who have the opportunities for active participation will develop a greater sense of control of their lives, as well as learn to collaborate with others in influencing their communities. The Concept of Participation Community participation6 is defined as "a social process whereby specific groups with shared needs 24 living in a defined geographic area actively pursue identification of their needs, make decisions and establish mechanisms to meet these needs" (Rifkin, Muller, & Bichmann, 1988). Participation represents the means by which individuals within organisations and communities become empowered. Participation, however, is not synonymous with empowerment. The literature suggests that the characteristics associated with participation allow for the development of empowerment. Thus, while participation is a necessary condition for empowerment to occur, the conditions related to participating determine whether empowerment will develop or not. In the prevention paradigm, participation has been measured by the number of health education classes attended by youth. This was a simple form of measurement in that youth were passive recipients of categorical classroom-based programs. While they may have assumed a more active role in the classes through role plays, and activities, they were the receivers of the information. Basch (1984) found that youth needed to attend at least 66 percent of health education classes in a curriculum to obtain a positive benefit. Participation in the health promotion paradigm suggests that several factors need to be considered to understand its relationship to empowerment. The concept of participation is a defining feature of the new health promotion movement (Rappaport, 1987; Rissel, 1994; Robertson & Minkler, 1994; Wallerstein, 1992a). A qualitative analysis of the principle of participation in health policy traces the declaration and application of the concept back to 1946 when participation was viewed as 'active co-operation', a passive form of participation where public officials informed the public of problems and solutions to obtain input into a centralised planning system (Green, 1986). Since this time, participation has evolved into 'active participation' which refers to "the conscious and intentional involvement of the individual or population in question" in identifying his or her needs, setting priorities, and implementing solutions (Green, 1986, p. 229). Small group processes such as meetings, coalitions or committee structures represent one vehicle for participating. These small group processes are set in motion as a result of community organisation (Braithwaite, 1994; Butterfoss, 1996; Fawcett, 1995; Flynn, 1994; McMillan, 1995; Purdey, 1994), organisational development (Canadian Mental Health Association, 1995; Maton & Salem, 1995; Spreitzer, 25 1995), or population education approaches (Minkler & Cox, 1980; Wallerstein & Bernstein, 1988; Wallerstein & Sanchez-Merki, 1994). More specific examples of these processes include the Healthy Cities Process (Baum, 1993; Flynn, Ray, & Rider, 1994), the Healthy Schools Process (B.C. Ministry of Health and Ministry Responsible for Seniors, Spring 1994), the Freirian based Adolescent Social Action Program (Wallerstein, 1992a; Wallerstein & Bernstein, 1988; Wallerstein & Sanchez-Merki, 1994), the University of Kansas' framework for community health & development (Fawcett et al., 1995), and the Community Organisation and Development model (Braithwaite, Bianchi, & Taylor, 1994). The group provides the setting for developing an agenda, generating solutions, and planning actions, for example, through dialogue, listening, negotiation, the sharing of ideas, and group reflection. Participating in small group processes is considered a powerful locus of change for individuals, organisations and communities (Labonte, 1994). It is through group interaction that people gain feelings of control, capacity, coherence, connectedness and conscientization (Wallerstein, 1992b), or in some situations may feel intimidated, insulted, verbally abused, stereotyped, ignored, or otherwise disempowered. The elements that are essential to any community organisation and development process are those embodied by Freire's popular education methods (Freire, 1970, 1973; Shor, 1992).7 In a Freirian approach to education, people are the subjects rather than the objects of learning (Freire, 1970, 1973; Shor, 1992). Dialogue, listening, reflecting, and acting are the keys to Freire's educational methods and other population education techniques (CUSO Education Department, 1988). It is through dialogue that citizens and professionals can share their ideas, voice their particular perspectives and opinions with each other, and negotiate an action or a decision. It is through listening that respect is fostered, knowledge is accrued, and an appreciation for the diversity of opinions is developed. It is through reflecting that learning can occur; and through acting that social change can result. Committees, group meetings, and coalitions provide the forum where people come together to solve problems for health, identify issues and needs, and take action. While having the means for participating is a necessary condition for empowerment, the way in which citizens contribute to the process distinguishes empowering from disempowering processes. Empowering processes are those that involve active citizen participation in identifying needs, setting 26 priorities and taking action by implementing programs or solutions (Green, 1986). The distinction between active and passive participation, however, does not reflect a simple dichotomy. There are varying degrees of citizen non-participation, tokenism, and citizen power as conveyed by Arnstein's ladder of citizen participation (Arnstein, 1969), with eight rungs, each corresponding to the level of citizens' power in influencing a given plan or program. Power relationships are implicit in the ladder of participation. The lower levels of the ladder reflect greater power differentials between those who have traditionally held power in society, and those who have not. Movement towards the top of the ladder represents a more equitable distribution of power between different groups in society through shared decision-making and leadership. Arnstein's ladder of participation has been adapted and applied to children, the same interpretation of which can be applied to youth. The adaptation is not data based, but is inherently useful for understanding the different forms of participation and their relationship to power. Hart's (1992) typology is broken into models of genuine participation and non-participation. Manipulation, decoration and tokenism are associated with non-participation. With manipulation, adults use children to support specific causes that are made to look as if they are inspired by children. The children, however, have little or no understanding of the issues, and are probably not aware of the actions that are being undertaken. With decoration, adults also use children in an ornamental way to support a cause. It differs from manipulation in that the causes are not conveyed as inspired by children. Tokenism illustrates the level of participation in which youth are supposedly given a voice, but have little or no choice about the subject, the style of communicating the issue, or the opportunity to formulate their own opinions and ideas. From reviewing these models of non-participation, the power imbalance between adults and children becomes clear. Children do not have a meaningful role in influencing decision-making or taking responsibility for leadership on issues that are meaningful to them. The same interpretation applies to youth. Hart's models of "genuine" participation, or those forms of participation likely associated with empowerment, have several characteristics in common. More specifically, children understand the intentions of the project and they understand who made the decisions concerning their involvement and why. Their roles are meaningful, rather than ornamental, and they volunteer for the project after it is explained to them. 27 Within this model, children are assigned to a project and informed about their roles, then they serve as consultants on a project designed and run by adults. Next, adults initiate a project but the decision-making is shared with children. Finally, projects are initiated and run by children under the direction of adults. The highest level of participation is characterised by projects that are initiated by children and decisions are shared with adults, reflecting a partnership between children and adults. Thus, the highest level of participation reflects a partnering process between adults and children where initiative leadership and decision making are shared. Young people can become involved in organisations and communities in different ways depending on the needs and resource availability of the hosting organisation. The forms of participation are characterised as episodic, developmental, and consultative or networking (Canadian Mental Health Association, 1995). The goal of episodic participation is to provide short-term and issue-specific ways of engaging young people. This may include participation in focus groups, forums, presentations and the development of proposals. No attempt is made to create an ongoing structure or process, and each activity is viewed as a discrete event. In contrast, a developmental approach to youth participation provides an ongoing structure for youth to participate in an organisation, or as part of a co-ordinated community organisation effort. The focus is on developing youth experience, knowledge and skill in an incremental fashion.8 The consultative or networking approach aims to develop a central co-ordinating group of young people who can identify and connect existing youth organisations and groups within their community. The co-ordinating youth group shares information and resources with other youth groups and acts as a resource to those organisations wishing to consult and/ or involve young people. This conceptualisation of organisational participation is useful for organisations and communities to determine the best way for them to work with young people given their goals and objectives. The concept of participation is essential to a theory of youth empowerment. From the literature, we know that the concept of power is intimately related to the process of participating. It has bearing on the way citizens contribute to the small group process. Hart's (1992) ladder of participation provides a useful conceptualisation on how youth may contribute to small group processes, like developmental organisational processes, where youth and adults work together to made decisions and take action. The process of youth participating in the context of an ongoing community organising effort aimed at enabling empowerment has not been studied, nor have the power relationships with adults and the institutions with which they interact in the microsystem. Thus, the concept of participation remains disconnected from the theory of youth empowerment with respect to the explication of the linkage. Empowerment as a Developmental Process Empowerment is described as a developmental process through which individuals, groups, organisations and communities evolve (Israel et al., 1994; Rappaport, 1987; Rissel, 1994; Wallerstein, 1992b). It is not an all-or-none phenomenon, but is marked by the progressive development of knowledge, skills and competence. Kieffer (1984) identified four stages of the personal empowerment process through retrospective experiential interviews with 15 grass-roots leaders involved in social activism. The 'era of entry' stage was motivated by an experience or a provocation. At this early stage of involvement, individuals participated at an exploratory level and were generally unsure and at a place of learning. Transition to the 'era of advancement' stage was marked by several factors, most notably a mentoring relationship and supportive peer relationships within a collective organisation, as well as the development of a critical understanding of social and political relations. The 'era of incorporation' stage was marked by the development of a growing political consciousness and dealing with the barriers to self-determination while the transition to the era of 'commitment' was characterised by the ability of individuals to apply their newly acquired participatory competence into everyday life. The Kieffer study makes an important contribution to the literature by identifying the stages associated with self-empowerment. Several questions, however, remain unanswered. Empowerment is identified as a developmental process, yet there is no knowledge of its application in health promotion at the individual, organisational and community levels of analysis, or their intersection. Given the ecological nature of empowerment, one could potentially explore the developmental progression of youth within youth-serving organisations within a community aimed at enabling the empowerment of its young people. 29 Empowerment as an Ecological Construct Empowerment is viewed as an ecological and multilevel construct (Israel et al., 1994; Rappaport, 1987; Schulz, Israel, Zimmerman, & Checkoway, 1995; Speer & Hughey, 1995; Wallerstein, 1992b) defined by the levels of psychological, organisational, and community empowerment. From the ecological perspective, health is viewed as the "product of the interdependence between the individual and subsystems ofthe ecosystem" (Green et al., 1996), namely valences 9 related to the microsystem, mesosystem, exosystem, and macrosystem (Bronfenbrenner, 1979). The current principles ofthe ecological approach in the behavioural sciences are influenced by Bronfenbrenner's seminal work where the environment is conceptualised as a set of regions, each contained within the next, like a set of Russian dolls (Bronfenbrenner, 1979), and enriched by further developments in ecological systems theory (Alwin, 1996; Bronfenbrenner, 1989; Bronfenbrenner, 1996; Ford & Lerner, 1992; Lerner, 1982). Similarly, Susser (1996) uses the nested set of Chinese boxes to understand the role ofthe proximal and distal environment in affecting health from an epidemiological perspective. The levels ofthe ecological environment are referred to as the microsystem, the mesosystem, the exosystem, and the macrosystem. The system is characterised by reciprocal or bi-directional relationships across these levels of the ecological environment. Variables within each level of organisation interact with and influence variables at other levels ofthe system, and thus influence development and health. Thus, individuals are active participants in their development by acting on their environment, rather than remaining passive objects of environmental influences (Bronfenbrenner, 1979). Psychological Empowerment . Psychological empowerment is considered the defining element of empowerment theory due to its inter-relationship with other levels of analysis (Zimmerman, 1995). Psychological empowerment may be distinguished from organisational and community empowerment, but it also influences and is influenced by empowerment at other levels of analysis (p. 582). There is general consensus, at least among psychologists (including community psychologists) that psychological empowerment is best conceptualised as a higher order construct that subsumes other constructs 30 (Kieffer, 1984; McMillan, Florin, Stevenson, Kerman, & Mitchell, 1995; Perkins & Zimmerman, 1995; Rappaport, 1981; Wallerstein, 1992b; Zimmerman, 1995; Zimmerman & Rappaport, 1988). It has been the subject of considerable theoretical and measurement development relative to other aspects of empowerment. This, however, is not surprising given the emergence of the construct in community psychology.10 Psychological empowerment is a multidimensional concept defined by its interactional, interpersonal and behavioural components (Zimmerman, Israel, Schulz, & Checkoway, 1992). The interactional component refers to people's understanding of their community and socio-political environment, developing a critical awareness on how to acquire resources, as well as skills related to resource management, decision making, problem solving, and leadership. This component is viewed as "preparatory to participation" (p. 589) out of its relationship to those behaviours needed to influence outcomes. The behavioural component refers to the specific actions that people take in order to exercise their influence over the social and political environment through their participation. The intrapersonal component refers to people's perceptions about their capacity to influence the social and political systems in the environment that are important and relevant to them. It is defined by domain specific perceived control, domain specific self-efficacy, perceived competence and the motivation to control. Zimmerman suggests that it is people's perceptions that provide them with the incentive to participate in certain behaviour, like a committee, in order to influence an issue or outcome. Measuring Psychological Empowerment Psychological empowerment is pivotal in empowerment theory, as conceptualised by psychologists, and as such has been the focus of their measurement development and validation work (Rissel, Perry, & Finnegan, 1996a; Spreitzer, 1995; Zimmerman, 1989; 1990b; 1995; Zimmerman et al., 1992; Zimmerman & Rappaport, 1988). In this review, psychological empowerment is represented by two types of studies. The first type of studies directly assess psychological empowerment, while the second group of studies measure indicators related to sub-dimensions of psychological empowerment. Psychological empowerment studies. As an outcome, quantitative research findings show a positive relationship between participation (the behavioural component) in community agencies and the 31 intrapersonal and interactional components of psychological empowerment (Zimmerman & Rappaport, 1988). Further empirical work identifies perceived control ofthe intrapersonal component of psychological empowerment to distinguish groups defined by their participation (Zimmerman et al., 1992), that is, people involved in community activities and organisations reported higher levels of intrapersonal psychological empowerment (defined by a unified dimension of perceived control) than non-participants. Additional findings show a positive relationship between voluntary agency participation and scores on leadership competence and self-efficacy in the socio-political context (Zimmerman & Zahniser, 1991). And finally, members of politically-oriented volunteer organisations scored higher on measures of internal efficacy, external efficacy, and political efficacy than both members of non-political organisations and non-members. It would seem that the intrapersonal and interactional components of psychological empowerment are related to behaviour, also part of the psychological empowerment construct. One study highlights the measurement of psychological empowerment in a youth population (Rissel et al., 1996b). A grade eight class (N=60) participated in a PowerLines classroom-based curriculum where the aim ofthe program was to enable the empowerment of youth around alcohol use. Psychological empowerment was operationalised according to the dimensions of personal efficacy, recognition ofthe need for group participation, critical consciousness, and willingness to participate in collective action using 21 items. The dependent variable, alcohol-specific psychological empowerment, was predicted by greater active participation in the working group, self-efficacy and tendency to use alcohol, accounting for 46% ofthe variance in the outcome. There was no difference between baseline and follow-up scores on psychological empowerment suggesting that the program did not enable the empowerment of the students, or the survey was not sufficiently sensitive to detect the changes that did occur, or more time was required following the program for the psychological empowerment to take root ("sleeper effect").11 The program may not have allowed youth sufficient time to work in a group to address the issue of youth alcohol use, or motivated the students to participate in collective action. Psychological empowerment was positively associated with self-efficacy to refuse alcohol, and active participation, substantiating theoretical empowerment findings on adult populations. The findings contribute to the development of empowerment theory in a youth population, for 32 which there is little evidence to date. Indicators of psychological empowerment. Other studies tap into indicators related to the sub-dimensions of psychological empowerment. Participation in empowering processes has been associated with increased levels of awareness of issues, knowledge, self-confidence, self-esteem, efficacy, perceptions of perceived control, belief in action, development of more positive attitudes towards the practices of mutual assistance, sense of community, and critical thinking (Hefner, 1988; Kieffer, 1984; Lord & Hutchison, 1993; McMillan et al., 1995; Purdey et al., 1994; Schulz et al., 1995). Participants in community organising processes have demonstrated enhanced critical and analytical understanding of the social and political environment (Kieffer, 1984; Purdey et a l , 1994), as well as the root causes and effects of health problems, such as alcohol use (Wallerstein & Bernstein, 1988) and drug problems in the community (Kalnins et al., 1994). Skills and competencies, as one might expect, related to leadership, problem solving, and public speaking were also developed through the process of participation (Hefner, 1988; Kriesberg, 1992; Nessel, 1988; Purdey et al., 1994; Robottom & Colquhoun, 1992; Zimmerman & Zahniser, 1991). Youth publishing a newspaper, for example, learned specific skills related to editing and publishing, and more general skills related to management and shared decision making (Hefner, 1988). The specific nature ofthe skills and competencies developed will vary according to the particular project. Psychological empowerment is conceptualised as a higher-order construct and is viewed as essential to empowerment theory. There is theoretical and empirical support for the construct in adult populations, however, there is very little research to support the role of psychological empowerment in youth populations. The Rissel study (1996b) is the only study that directly measures psychological empowerment while the studies by Kalnins et al. (1994) and Wallerstein and Bernstein (1988) report on indicators that relate to psychological empowerment. The Hefner (1988) finding represents a story from the field and is not a research study. At present, the literature offers no explication ofthe relationship of psychological empowerment to youth participation in the context of a community development process. Organisational Empowerment At the organisational level, empowerment takes on two meanings (Israel et al., 1994). An 33 empowering organisation builds the capacities of its members, and enables them to influence decision making processes (Schulz et al., 1995). They are characterised by democratic management processes where members share information, and decision making (Israel et al., 1994). This type of environment engenders a sense of respect and value among its members (Kroeker, 1995). The notion of power surfaces in the descriptions of empowering organisations (Israel et al., 1994; Kroeker, 1995) in a way that is consistent with the manifestation of power-with at the level of practice. The transformation is one from power-over to power-with, where power in the form of decision making and leadership is shared among those engaged in the change process. An empowered organisation, on the other hand, has some influence within the larger system of which it is a part (Israel et al., 1994), and has the ability to influence the distribution of valued economic and social resources (Schulz et al., 1995). Thus, organisational empowerment refers to those processes that enable people to gain a sense of control within the organisation, as well as the larger community by influencing policies and decisions (Israel et al., 1994; Schulz et al., 1995). Measuring Organisational Empowerment Surprisingly, little empirical support for organisational empowerment emerges from the research literature. The majority of the research has tended to focus on psychological empowerment. Organisational empowerment, however, is represented in ecological studies that link psychological empowerment with organisational empowerment (McMillan, 1995; Schulz, 1995; Spreitzer, 1995). The McMillan study is considered an exemplary piece of research for its conceptualisation and statistical analysis, as compared with the other comparable studies in the review. Hierarchical linear modelling was used to examine group level relationships between the independent variables and collective empowering, operationalised as how much a coalition has been an empowering organisation. This study aimed to understand psychological empowerment in the context of community coalitions using self-report data collected from members of 35 community coalitions and interview data collected from three key informants from each community. The coalitions formed around the prevention of alcohol and other drug problems. Psychological empowerment was hypothesised as a higher-order construct, and operationalised as perceived knowledge and skill development, perceived participation competence, expectancies for future 34 individual contributions, perceived group/organisational accomplishments and expectancies for future group/organisational accomplishments. Psychological empowerment was related to participation levels, sense of community, and perceptions of positive organisational climate. The net benefits of participation, commitment, and positive organisational climate were the strongest predictors of an empowering organisation. Psychological empowerment and positive organisational climate were the two strongest predictors of organisational effectiveness. This study provides empirical support for conceptualising psychological empowerment as a higher-order construct attained through the process of active citizen participation. It further highlights the importance of the organisational climate to psychological empowerment. Of great interest is the relationship between empowering and empowered organisations. More specifically, organisations that were empowering of their members, over time, became empowered organisations in that they were able to influence the larger social system of which they were a part. The findings of this ecological study extend empowerment theory by providing empirical support for previously untested propositions and hypotheses. Organisational empowerment has not been the focus of empowerment research, yet organisations are pivotal in community organisation processes and in ecological conceptions of health promotion (Green & Ottoson, 1999; Green et al, 1996; Green & Kreuter, 1999). No empirical research has been published that explicates the relationship between empowering youth organisations and empowered youth organisations, an area worthy of further investigation. Community Empowerment Though there are many definitions of community empowerment,12 it is defined as "an intentional, ongoing process centred on the local community, involving mutual respect, critical reflection, caring and group participation, through which people lacking an equal share of valued resources gain greater access to and control over these resources" (Cornell Empowerment Group, 1989a, p. 2). The hallmark of community empowerment is people and organisations working together to achieve common goals (Hanna & Robinson, 1994; Israel et al., 1994; Perkins & Zimmerman, 1995; Schulz et al., 1995). An empowering community builds the collective capacities of organisations to work collaboratively towards common goals. Community 35 participation is the means by which citizens and organisational representatives contribute to the community process. The ability of the members to work together to identify problems, achieve consensus, take action, and access resources to address their issues is referred to as community competence (Cottrell, 1976). Similarly, community capacity refers to the ability ofthe community to take action on its identified goals and objectives in the present and in the future (Fawcett et al., 1995). Community competence appears to be the outcome of community capacity building characterised by the strategies of: enhancing experience and competence, enhancing group structure and capacity, removing social and environmental barriers as well as enhancing environmental supports and resources (Fawcett et al., 1995). The relationship between these two concepts, however, remains unclear in the literature. In any case, it would appear that community competence and community capacity are central to empowering community processes. In the context of community empowerment, community capacity building process would need to develop relationships with different sectors and institutions in order to access valued resources to address the identified community issue or problem (Speer & Hughey, 1995). An empowered community, much like an empowered organisation, has the ability to influence the larger system of which it is a part (Israel et al., 1994). The collaboration between organisations within the context of the community brings to bear the notion of co-empowerment referring to the ability of more than one group influencing the decision making process (Bond & Keys, 1993). The consequence ofthe interaction between collaboration and co-empowerment is synergy where the effectiveness ofthe organisation is greater than the contribution ofthe individuals or the separate parts. Thus, an empowered community is characterised by a vision of co-operation, and of sharing resources and responsibilities, rather than organisations within the community "doing their own thing." The outcomes associated with empowering community processes are related to: reduced morbidity, disability, premature mortality or negative health outcomes; striving for social justice; the reduction of inequities; greater gender equality; and enhanced quality of life and well being (Fawcett et al., 1995; Flynn et al., 1994; McMillan et al., 1995; Purdey et al., 1994). Intermediate outcomes related to community empowerment initiatives seem to relate to community capacity, community competence, psychological 36 empowerment and organisational empowerment. Little distinction is made in the literature on the level of outcomes associated with community empowerment. Community organisation and development processes include strategies for community empowerment as demonstrated by several health promotion interventions (Airihenbuwa, 1994; Flynn et al., 1994; Purdey et al., 1994; Wallerstein, 1992a; Wallerstein & Bernstein, 1988). The Healthy Cities Process, also known as the Healthy Communities process in Canada (Healthy Shires in Australia, Villes et Villages en Sante in Quebec), can be viewed as an exemplar of empowering community organisation practice. The Healthy Cities project was launched by the World Health Organisation in Europe in 1985 in response to a global health strategy called Health For All by the Year 2000 (Ashton, Grey, & Barnard, 1986). It was a European initiative intended as a vehicle for city-level health promotion efforts emphasising the promotion of healthy environments and lifestyles. The initiative corresponds with the expanded conceptualisation of health to include the capacity of individuals, groups and communities to define and create their own relationship with the environment, and thereby address the broader social, economic and political determinants of health (Boothroyd & Eberle, 1990). An emphasis is placed on local co-ordinated action to address the contextual factors that influence the health, well-being and quality-of-life issues of a given community (Hancock & Duhl, 1986). Healthy Communities is conceptualised as a cyclical process moving from a needs assessment to planning, to community action, and to evaluation and rejuvenation, after the initial entry phase (B.C. Ministry of Health, 1989). A "healthy city" is engaged in the process of creating and improving its physical and social environments, as well as developing its resources to enable people to support each other, and to develop its full potential (Hancock & Duhl, 1986). Similarly, a "healthy school" engages youth in meaningful opportunities for participation on issues that are important to them (B.C. Ministry of Health and Ministry Responsible for Seniors, Spring 1994). The West End Youth Project13 can be viewed as the grandchild of a Healthy Communities process that was initiated in the community by a community health nurse. The project embodies the basic principles of community organisation, as well as the Healthy Communities process. According to Ross (1967), community organisation is: 37 ... a process by which a community identifies its needs or objectives, orders (or ranks) these needs or objectives, develops the confidence and will to work at these needs or objectives, finds the resources (internal and/or external) to deal with these needs or objectives, takes action with respect to the needs or objectives, and in so doing extends and develops co-operative and collaborative attitudes and practices in the community (p. 40). The essence of the community organisation effort is for the community to work as an integrated unit on a given issue (Ross, 1967), which in the case of the West End of Vancouver, was to enable the empowerment of its young people. Community organisation, however, is not a homogeneous process. Rothman (1973) identifies three specific sub-types of community organisation models: (a) the social planning model, (b) the social action model, and (c) the locality development model. These models are based on different assumptions that affect the relationships between citizens and professionals. The social planning model places an emphasis on the technical aspects of the social problem solving process. The approach is based on the assumption that "experts" are required to apply their technical skills in order to mobilise the communities' resources to address their needs. A s such, the process tends to rely more heavily on external expert consultation in directing the process, rather than on grassroots participation by members of the affected issue. The "experts" may be planners, practitioners, academics, professional consultants, or some combination of these. The social planning model, unlike the other models, tends to place an emphasis on vertical relations between organisations and institutions within the community, rather than building horizontal relations between groups. Thus, a power differential is maintained through the community organising process. The social action model is primarily concerned with organising around an issue that affects a marginalised or disenfranchised group in the community. The social action process is aimed at bringing about social justice or democracy through changing the way the disenfranchised are treated by others, by the mobilisation of resources or through changes in professional and institutional practices. Community organisation efforts aim to redistribute power, resources, or the way decisions are made in the community, as well as to influence the policies that serve to guide the practice of agencies, organisations and institutions within the community. The locality development approach to community organising is based on the assumption that the best 38 way to bring about community change is through broad-based citizen participation at the local level. Citizens are active participants in setting goals and taking action on issues that are important to them. This form of community organisation overlaps with community development. As suggested by Rothman, its "prototypical" (p. 21) counterpart in the literature is community development.14 An emphasis is placed on grassroots participation often leading to advocacy groups lobbying for a particular cause. The West End Youth Project is more closely aligned with the locality development model of community organisation in its basic intent, with social action undertones. The blend of locality development and social action to the practice of the community organisation effort in the West End is consistent with Rothman's assertion that the boundaries between the models become blurred in practice (Rothman, 1973). Having diverse models of practice available can be viewed as an asset, in that the most appropriate approach or mix of approaches can be used to meet local needs. The appropriateness of the approach should be judged with respect to its fit with the goals and values of the project at hand. In the case of the West End Youth Project, an approach emphasising social planning would be somewhat incongruent with the empowerment of young people, an approach that assumes developing and nurturing vertical relations rather than maintaining horizontal relations. Measuring Community Empowerment The measurement of community empowerment is inherently ecological in that it is interdependent upon actions and interactions between organisations and individuals within the community (Israel et al., 1994). One study formally and explicitly assessed community empowerment as a multilevel construct (Schulz et al., 1995). Most studies use community organisation or development processes aimed at influencing empowerment at the individual or organisational level. Though empowerment is implicit in their approach, it is not explicit in the assessment. Studies falling into both categories are reviewed. Community empowerment studies. One study developed a measure of perceived control, viewed as a partial measure of empowerment, and assessed its relationship to individual, organisational and community empowerment among those participating in voluntary organisations and those who do not, using a sample derived from a large random-sample survey (Israel et al., 1994; Schulz et al, 1995).15 Compared with those 39 who were not involved in organisations, organisational participation was associated with higher levels of perceived control at individual and community levels, believing that taking action is an effective way to influence community decisions, an increased likelihood of taking action on community issues within the last year, as well as demographics related to being financially better off, older and having more education. Perceived effectiveness of taking action to influence community issues, and participation in organisations with a mandate to influence public policies were identified as important predictors of perceived control at the organisational and community levels for those volunteering in organisations. The study findings suggest that perceived control at the organisational level is most strongly linked with the perceived effectiveness of taking action, participation in organisations influencing public policy, and taking an active role in the organisation. Though this study extends empowerment theory, perceived control is a partial measure of empowerment. In addition, the demographic characteristics of those who participated in organisations suggest that the findings may not generalise to marginalised populations who tend to be less financially well off and have less education. A second longitudinal multiple case study using in-depth observation in three community settings sought to identify the organisational characteristics associated with empowering community settings. Organisational features associated with empowering community settings included a belief that inspires growth, an orientation towards strengths rather than deficits, a focus beyond the individual, the presence of an accessible and multifunctional role structure, and a support system that fosters a sense of community and shared leadership that is committed to the setting and its members (Maton & Salem, 1995). From the community level of analysis, organisational climate seems related to community empowerment, extending the finding from the McMillan study where positive organisational climate was related to organisational empowerment (McMillan et al., 1995). Community process studies. Community empowerment is inherent to many studies though it is not made explicit. Several studies indirectly demonstrate the linkage between empowering community processes and empowered communities. This can be inferred from the reported outcomes achieved through some ofthe reviewed studies. In the first example, a Healthy Communities intervention spurred the redistribution of 40 resources through shared decision making which, in turn, led to greater equity and social justice through the provision of health care services for the poor and needy (Flynn et al., 1994). In the second example, case studies of two participatory health development projects in Nepal led to greater social justice and gender equity through the disintegration of traditional social, economic, political and caste barriers (Purdey et al., 1994). The changes included women accounting for more than one-half of the memberships of the organised groups. What was most remarkable about the study was that women who were previously silenced, openly shared their ideas in a group. In both cases, the individuals developed aspects related to psychological empowerment in the context of broader community organising processes that enabled them to access resources to achieve their goals. The next community process study applies to youth. The Adolescent Social Action Program (ASAP) 1 6 follows an empowerment oriented prevention model based on an integration of Freire's empowerment education and protection-motivation theory. The program aims to reduce excess morbidity and mortality among high-risk youth by enabling their empowerment through participation in a social action program. Youth are trained to interview hospital patients and jail residents about problems related to drug and alcohol abuse, interpersonal violence, teenage pregnancy, and HIV infection. The youth then meet with group facilitators who lead the youth through a structured dialogue based on Freire's principles of empowerment education. The stories are used as triggers for youth to reflect on how the issues affect their own lives, and to serve as a stimulus for social action in their communities. One quantitative evaluation of the study has been reported (Bernstein & Woodall, 1987). A quasi-experimental evaluation using a pre-test, post-test design with one-month and eight-month follow ups found a statistically significant increase in the self-reported perception of riskiness of drinking and driving for the intervention group at the eight-month follow up. Control group participants showed a decrease in their perception of riskiness while youth in the program perceived it to be more risky to drink and drive. This finding is of great theoretical and practical significance in that youth perceive themselves as invulnerable to the consequences of their actions. Thus, participating in a collective social action process supported by the community not only has positive effects for the participating youth, but may potentially benefit others in the community through their collective actions in 41 the community. The literature on community empowerment remains unfocused. Concepts related to community empowerment are used interchangeably, and the linkages between psychological, organisational and community empowerment are unclear. Several ofthe studies in the literature, reported as qualitative studies, do not systematically apply qualitative methods in the collection and analysis of their data making it difficult to assess the findings. In addition, the best multilevel study of community empowerment in health promotion uses a partial measure of empowerment. As an ecological construct, there is a need for the explication ofthe linkages between individual, organisational and macro level factors on community empowerment. There is a need to explicate the relationship between empowering community processes and empowered communities. The lack of conceptual clarity around community empowerment may be a reflection ofthe current state of knowledge development. The development of theory may contribute to understanding a concept that remains elusive and ambiguous. Current Issues in Empowerment Research A review of the literature identifies three issues influencing the theory and measurement development of empowerment in health promotion. One issue concerns the false dichotomy between empowerment as a process and as an outcome. The second issue concerns the misplaced emphasis on the individual level of analysis and the importance of moving towards ecological analysis of empowerment. The third issue concerns moving towards substantive theories of empowerment to bring the concepts related to empowerment into greater focus. Empowerment as Process and Outcome: A False Dichotomy The literature refers to empowerment as a process and as an outcome, yet their relationship remains unclear, a topic of ongoing discussion in the literature (Rappaport, 1987; Robertson & Minkler, 1994; Simons-Morton & Crump, 1996; Wallerstein, 1992b). The lack of clarity points to the lack of understanding or theory that identifies the relationship between empowerment as a process and as an outcome. As currently viewed, empowerment remains tautological and requires theory to engender meaning. The conceptual distinction between empowering processes and empowering outcomes is viewed as a false dichotomy 42 (Cochran, 1992). The Cornell Empowerment Group views empowerment as an "ongoing process," or as an "evolving, recurring process in which outcomes produced in turn lead to a generative spiral to further participation in the process" (Cornell Empowerment Group, 1989b, p.2). Therefore, the relationship between empowerment as a process and as an outcome is not modelled by a simple cause-effect relationship (Cochran, 1992). Initial outcomes serve as the foundation for subsequent outcomes. Implicit in this view is the notion of building. Thus, the relationship between process and outcome is more complex and the modelling includes the dimensions of "change" and "time," and their interaction as "change over time." This points empowerment research in the direction of applying methods that account for the dimensions of change and time to build on the current state of knowledge. The Level of Analysis: From Individual to Ecological The emphasis placed by researchers on the measurement on individual level or psychological empowerment is a contradiction of its ecological basis (Rappaport, 1987). Spurred by the community mental health field, the field of community psychology has pioneered much ofthe conceptual and empirical work on the construct of empowerment. Its measurement, however, retains its disciplinary roots by using its psychological focus (Zimmerman, 1989; 1990a; 1990b; Zimmerman et al., 1992; Zimmerman & Rappaport, 1988; Zimmerman & Zahniser, 1991). From a health promotion perspective, an individual focus is limiting in that it decontextualises the important dialectic between the individual and broader social, political and economic factors. Riger (1993) argues that a focus on the assessment of individual perceptions of control downplays the importance of power dynamics and, relatedly, the distribution of power in society: The individual's experience of power or powerlessness may be unrelated to actual ability to influence, and an increase in the sense of empowerment does not always reflect an increase in actual power. Indeed a sense of empowerment may be an illusion when so much of life is controlled by the politics and practices at the macro level (p. 282). Without enabling the group towards addressing those environmental conditions that lead to their powerlessness, there is potential for a community process to reinforce a sense of psychological disempowerment that it aims to resolve (Riger, 1993; Wallerstein, 1992b). Decontextualising and reducing empowerment to the individual level ignores the social structural and historical context that shapes the internalised beliefs of individuals about their ability to influence changes in the social system. 43 Empowerment is concerned with changing the conditions in the environment that affect the distribution of power among individuals, as well as institutions (Albee, 1981; Labonte, 1989; 1994; Riger, 1993). This is the argument put forward by Lerner (1986) who made a distinction between real powerlessness and surplus powerlessness. Real powerlessness concerns the unequal power distribution in society by the 'few' who hold power over the 'many.' This is a direct attack on the structure of power in society that is not so easily changed, and that, over time, can cultivate a sense of surplus powerlessness among individuals. Surplus powerlessness refers to the internalised beliefs and perceptions that people have of their inability to influence change in the existing power structure. With surplus powerlessness, many people accept the status quo as a result of their belief that change cannot happen, resulting in a general apathy and unwillingness to struggle for greater control and influence. At an unconscious level, Lerner suggests that our perception of reality is influenced by our understanding of its relationship to all other objects and events. The dialectic between real and surplus powerlessness raises the question about how to measure the distribution or exchange of power among individuals engaged in an empowering process. Theoretical perspectives on participation suggest this as the heart of the measurement problem. The concept of power requires formal linkage to participation, and thus empowerment. Focusing the measurement of empowerment at the individual level contradicts the philosophical assumptions of the ecology of empowerment. One of the assumptions of the ecological approach is on the interdependence between individuals and agents in their environments. One-time quantitative measurements cannot capture the interdependence between people and their environment, nor the change that occurs as disenfranchised segments of the population change from reacting to their environment to acting on their environment. An ecological understanding of empowerment requires accounting for the influence of the environment on action and behaviour, rather than statistically controlling for the effect of the environment in the analysis, a current criticism of epidemiological research (Dean, 1993; Dean et al., 1993). Qualitative analysis can be used to describe and explain the linkages between individuals, groups, organisations, communities and the more distal agents of influence acting at the level of the microsystem. Thus, qualitative analysis can explain the interdependence within the system and across multiple levels of analysis. The 44 variation can be built systematically into the theory using multiple case studies. Analysing quantitative data across multiple levels of analysis, however, requires hierarchical linear modelling that adjusts for group level correlations in the presence of individual effects (Bryk & Raudenbush, 1992). Multiple regression analysis does not have the ability to make these adjustments. With the capacity of qualitative software to generate quantitative variables, research can easily capture context in a meaningful way that can enhance quantitative assessment of complex constructs such as empowerment. Moving Towards Substantive Definitions and Theories Empowerment has been referred to as a warm and fuzzy, one-size-fits-all concept on the basis of its use in the last decade in community psychology (Perkins & Zimmerman, 1995, p. 572), an argument that is applicable to health promotion as well. At first, there was a quest to come up with a global definition of empowerment (Zimmerman & Rappaport, 1988). In the post-modern era, this romantic notion has been abandoned for the appreciation of contextual and population-specific meanings that empowerment brings to bear (Perkins & Zimmerman, 1995; Rappaport, 1995; Zimmerman, 1995). Empowerment is now viewed as an "open-ended construct," its form and content determined by the characteristics ofthe population and the context (Zimmerman, 1995). One only need consider how the element of being treated with dignity, identified as a core element of empowerment for the physically and mentally challenged (Lord & Hutchison, 1993) does not surface in definitions of empowerment relevant to other populations. Thus, the lack of a universal definition is appropriate given the diverse needs of various populations since empowerment to each of these groups is likely to reflect certain population and context-specific considerations. The context and population specificity of empowerment points researchers in the direction of developing substantive theories of empowerment. Substantive theories are those based on research conducted in one particular substantive area (Glaser & Strauss, 1967) such as youth empowerment, as distinct from more generalised empowerment. A review of the literature highlights the paucity of theory and research in the area of youth empowerment. Empowerment research has tended to retain a focus on adults, often using convenience samples. The developmental issues inherent to the life stage of adolescence, in addition to the power issues arising from their dependence on adults, suggest that theories of empowerment could not be 45 extrapolated from adults to youth. The absence of youth empowerment theory that links the concepts of power, control, participation and the developmental issues inherent to adolescence leaves a gap between health and social policies upholding the ideals of empowerment with the practices of those institutions that are the primary agents of socialisation of today's youth. Developing theory is one way of bridging the gap between policy and practice, and a necessary step for the development of measures that capture the interdependence in the ecology of youth empowerment. Research Question Based on the review of literature, the study was guided by the following research question: What is the process of youth empowerment as it evolves in the context of a community organisation effort? 46 CHAPTER 3: METHODOLOGY Science is not achieved by distancing oneself from the world: as generations of scientists know, the greatest conceptual and methodological challenges come from engagement with the world. (Whyte, Greenwood, & Lazes, 1991, p.21). The Study This section provides the relevant information for understanding this study. First, the study setting is discussed. This is followed by a section on the historical background outlining the events leading up to my involvement in the study, and provides the necessary detail to understand how the community came to support its youth. Next, the study timeline and the characteristics of the study participants are reviewed. The section concludes with a discussion of how I gained entry into the community to conduct this study. Study Setting The West End of Vancouver, British Columbia, in Western Canada is a high-density, inner-city neighbourhood with 37,190 people living in about a 1.5 kilometre square area. It shares the peninsula with the downtown business district and Stanley Park. Land value in the West End is one of the highest in North America. People live in low and high-rise apartment buildings surrounded by a commercial strip on all four sides. Robson Street, "Vancouver's place to see and be seen," draws crowds of shoppers and people watchers from the community, those living outside the West End, and tourists. Shopping districts off Davie and Denman Streets offer a quieter alternative to the fast pace of Robson Street. The West End borders one of Vancouver's most popular and one of North America's largest urban parks, Stanley Park. This 400 hectare park is used by locals as well as Vancouver residents and visitors for its beaches on English Bay, as well as the outdoor swimming pool, cycling and walking trails, the 10-kilometre seawall, the kids' water park and for its scenic views. The commercial strip surrounding the high-rises, mostly apartment buildings borders scenic Stanley Park on its northern border which gives the West End the appearance of a resort to many outsiders. The demographics, however, convey another story. The West End is home to many families in transition such as those newly divorced or separated, persons with work or student visas, and immigrants from Eastern Europe and Asia. It is a mobile community, not surprising given the large number of rental units. For example, between 1986 and 1991, 72% of the 47 residents changed their place of residence compared to 58% of Vancouverites. The median household income was $26,604 in 1991 compared with $34,174 for the Vancouver area, with 29.5% of West Enders living in low-income households. A general index of health revealed the West End to have the second poorest score in the City of Vancouver (Rumel & Constanzo, 1992). Young singles between the ages of 20 to 39 make up 50%) ofthe West End population, followed by those aged 40 to 64 (29%) and seniors (16%). Children and youth under the age of 19 comprise only 5% ofthe overall population. Ofthe few households made up of families in the West End, single parents head 13.2%. The majority of the children and youth who live in the West End go to school in the West End (71%), however, a substantial minority of students (29%) travel from outside the West End (e.g., Richmond, Burnaby) to attend the.secondary school. There are two elementary schools in the West End (kindergarten to grade 7) with a total enrolment of 475 in the 1993/94 school year (including the alternative City School), a 9% increase in enrolment over the previous academic year. King George Secondary School had an enrolment of 443 in the 1993/94 school year, a 1.5% increase over the 1992/93 school year. Enrolment continues to increase with the current secondary school enrolment at 500 students. Relative to other secondary schools, King George is fairly small, and it is this smallness that makes the school a special place where staff and students know each other. As with other Vancouver communities, the student population is increasing with the influx of immigrant populations into the West End. The increase may be proportionately greater with the new multiple family high-rises built in and around the West End. The two schools are designated inner-city schools because of their constellation of demographic and social factors that place many ofthe students at risk for dropping out of school. The West End has a variety of community organisations and agencies providing services and programs. These include the West End Neighbours in Action, West End Community Centre, Burrard Health Unit, Gordon Neighbourhood House, Joe Fortes Library, West End Community Police Resource Office, West End Mental Health Clinic, and the West End Merchant's Association. The programs and services offered by these organisations and agencies are aimed at addressing the health and social needs ofthe community. Within this community, the West End Youth Project was employed to engage youth as active participants in planning and implementing solutions to their identified issues and needs. The community 48 organisation process was spurred by the West End Neighbours in Action, an action group formed out of British Columbia's adaptation of the World Health Organisations' Healthy Cities Initiative. Historical Background The West End Neighbours in Action was formed in June 1990 with funding from the B.C. Ministry of Health's Healthy Communities Initiative Fund to identify health needs and to develop strategies toward a vision of the healthy West End by the year 2000. A steering committee comprised of local citizens and community workers worked together to promote the Healthy Communities Initiative and to build partnerships with residents and neighbourhood associations. The West End Neighbours in Action are committed to improving the quality-of-life for those living and working in the West End with a goal "to strengthen health by increasing community control over the decisions that affect our health" (West End Neighbours in Action, 1992). The Healthy Communities Planning Process provides an ongoing framework for local citizens to participate in the identification of the issues, as well as to be part of the solution. With seed funding from the provincial Ministry of Health, a community needs assessment was conducted and the following issues were identified: youth, housing, mental health, recycling, safety, transportation, and childcare. Action groups were developed through a community forum to work on the identified issues. Although youth contributed to the initial focus groups, they were not engaged in the community organisation process any further. In 1992, the B.C. Health Research Foundation announced a Child Health Promotion Competition for any community organisation with a focus on the health promotion of young people. With young people already identified as a community priority, the West End Neighbours in Action built on the groundwork and applied to the competition. The groundwork in the first meetings included participation by members of most of the youth-serving agencies and groups in the West End, including parent groups associated with the schools. Most participants returned to later meetings and offered letters of support for the project. The Neighbourhood House and the community health nurses from the Burrard Health Unit had the time in their work schedule to continue the process with the support of school staff. Both nurses working in the elementary and secondary schools acted in their capacity to further the process. The University of British Columbia's Institute of Health Promotion Research was invited as the research partner. The Institute 49 collaborated with the community to develop the letter of intent and the grant proposal. A grant was awarded from the B.C. Health Research Foundation to the West End Neighbours in Action with the Institute of Health Promotion Research acting as the fiscal agent and evaluation team. The study proposed to address the following research question: Can a community organisation effort facilitate the process of youth empowerment by engaging youth as active participants in planning and implementing their identified issues and needs? This led to the creation ofthe West End Youth Project, referred to in this dissertation as the "community project" or the "project." In addition to my role as evaluation co-ordinator for the project on behalf of the Institute, I also conducted my dissertation research. A summary of the West End Youth Project and its major activities are provided in Appendix A. Timeline The data for this study were collected across a four to five year period. Participant observation data were collected for 32 months, from November 1993 to June 1996. In addition, interviews were conducted with adults and youth between June 1996 and June 1998, once I left the field as a participant observer. Participants The study participants included those adults and youth working in the community action process and those adults supporting the community action process through the community organisation effort, each of which are reviewed below. Overall, 72 adults from 20 different local, municipal and provincial agencies provided resource and enabling support to the youth participants on the project. The majority of these adults contributed support to the community organising process, rather than directly to the community action process. Only eight adults worked alongside the youth as they planned and implemented their action plans in the community. Of these, four adult practitioners worked with the youth for the duration of this study. I was included as one ofthe four adults. In addition, four university nursing students or health promotion researchers worked with the youth for a defined period of time, approximately four to five months. This group of adults provided youth with their primary source of enabling support during the community project. These practitioners, all female, were employed as community health nurses, school health nurses, or youth development workers in the community. 50 In addition to the adults, a total of 123 youth became involved in the 32 months of this study period, as documented through meeting minutes, observations, and participant feedback collected over the duration of the project. These youth were from grade 7 to 12, and between the ages of 12 to 19, at the time of initial entry. More girls than boys tended to get involved, though not disproportionately. Of those youth getting involved, 66 youth were involved for more than three meetings. Eighteen youth demonstrated commitment and ownership of the project by contributing on a continuous basis to project activities, and in assuming some level of responsibility for leadership. These youth were considered "core" youth in the community project. Another 20 youth were involved for a concentrated period of time and made a meaningful contribution to an important event or activity. Twenty-eight youth attended more than three meetings and contributed to the design of youth-related initiatives, but not to their implementation.17 Entering the Field In this study, I became a participant observer working with practitioners and young people as part of a participatory research project aimed at enabling the youth in identifying their quality-of-life issues, and in developing and implementing solutions. The research component of the study was concerned with understanding this process. The community defined the topic of the study. In this capacity, I was a researcher as well as a co-facilitator of the change process, providing ongoing guidance for the young people as they worked on their action plans. I also worked with the practitioners as part of the management team. Although not a youth practitioner, I learned many skills by being mentored by the community health nurses and the youth worker. Gaining entry into the community and establishing a rapport with the practitioners was less difficult than establishing a rapport with the young people. At the outset, a community health nurse at the Burrard Health Unit contacted the Institute of Health Promotion Research to work with the community to enable young people to have a voice, an issue identified through the Healthy Communities Process. The researcher's entry was supported and sought by the community to work on a social issue for which there was community support. Establishing a rapport with members in the community evolved over time, a process that was initiated by working with the community health nurse on writing a letter of support and a research grant to the 51 B.C. Health Research Foundation, and was facilitated by adhering to the principles of a participatory approach. As a co-facilitator of the change process, I worked directly with the young people in carrying out their action plans. This meant co-facilitating the meetings with the practitioners by chairing, taking minutes, providing technical support, helping them understand and work through planning issues, and reflecting on group experiences. Through these roles, I acquired an active membership role in the community and developed an insider's perspective ofthe youth empowerment process by working with the community members. At the beginning, the youth were sceptical of my involvement because of my affiliation with the university, later on sharing their first perceptions of me as a "snob" and "stuck-up." They thought I was there to get data for my thesis, and that my intention to participate in the process was not sincere. In order to prove my sincerity, I felt like I had to work twice as hard to earn their trust. Little did they know how nervous I was in my first field experience; I was just as scared and nervous to be in a group with them, as they were to be in a group of adults. Establishing their trust took approximately three to four months. I was learning how to facilitate the process by observing the community health nurses and through reflecting on the process at the management meetings. Over time the youth began to understand how research could be conducted to inform the change process, as an advocacy tool for youth, and to satisfy the needs for my dissertation. After gaining entry„I worked with the young people on their action plans (e.g., planning a reporting event, publishing a newspaper, advocating for a youth resource centre), and started to care about them as developing young adults and as people. They would call me at home or at work to get advice or help on how to do something, and at the same time we would talk about how things were going more generally in their lives (e.g., school, the test they, had coming up, moving, planning for graduation, going to university). My involvement with the young people on the project was the most intense over its first two and-a-half years, from November 1993 to June 1996. This intensity was due to my dual role as research co-ordinator for the project responsible for other research activities, and as graduate student collecting data for this study. In November 1993, a needs assessment was conducted using focus groups and nominal group processes with the youth. This was followed by the development of a survey based on the qualitative 52 information in which youth provided input into the refinement of the survey instrument, planned and implemented a youth forum, and implemented a planning workshop where youth developed action plans around each of their identified issues. This led to the formation of youth action groups around each of the identified issues. After the workshop, the youth worked on implementing their action plans. In May 1994, two of the practitioners were on strike, followed by holidays, leaving myself and the youth worker to facilitate the youth action groups until late July. The youth worker, however, was working on several other youth projects and was unavailable for most of the summer. In July and August, the youth were hired on a part-time basis to work on a master plan for the project and to start working on the newspaper. I found myself working intensely with the youth until late August 1994, at which time I had a baby and became less involved in the process. From October to December 1994,1 went back to the community about twice a month, maintaining contact with the practitioners and some of the youth. During this time, another researcher was working with the youth. In November, I returned to conduct individual interviews with the youth participating on the project. From January 1995 to June 1996,1 returned to the community, working with the youth and the adults as a co-facilitator of the process, resuming all of my prior responsibilities as an active member. From June 1996 to February 1997,1 worked as the adult co-facilitator with the newspaper group helping with the decision-making relating to the fund-raising for, and publication of West End Teen News (W.E.T. News) and with the youth development worker developing training resources.18 Feeling a commitment to the youth beyond my thesis, I worked with them as a volunteer until personal circumstances prevented my ongoing participation in the community. Although I have left the community, this experience will never leaye me; it has transformed me as a researcher and a person. Setting the Methodological Stage This section sets the methodological stage for the study by outlining the assumptions underlying the research and the data used for the study. Each source of influence guiding the study is reviewed, beginning with participant observation and followed by participatory research in health promotion. A rationale for a qualitative approach is provided, leading to a discussion of grounded theory methodology and it symbolic interactionist roots. Finally, the nature of the data is described. 53 Participant Observation In this study, I adopted the role of a participant observer, and used participant observation as a method of data collection. Participant observation as role and method are related in that the researcher assumes a particular role as he or she collects data in the field (Pearsall, 1970). My role as participant observer defined my relationship with the community members and thus the epistemological orientation of this study. Participant Observation as Method This study used participant observation as the method for data collection. It is the second most commonly used approach for collecting information in qualitative research (Morse & Field, 1995) and is a recommended approach for collecting data in grounded theory (Strauss, 1987). Participant observation combines interviews with document analysis, direct participation, and observation in the process, as well as introspection (Bogdan & Taylor, 1975). The variables of interest and their inter-relationships are defined in the context of the research setting. Participant observation, by definition, includes the use of multiple qualitative methods such as interviewing, observation, and document analysis. The process is purposely unstructured in its research design to allow the researcher to maximise the discovery and verification of theoretical propositions (Denzin, 1978). Ideally, the researcher revises and tests emergent hypotheses and theoretical propositions as part of the ongoing research process. Participant observation is flexible to allow for the iterative nature of theory development and testing. Participant Observation as Role The nature of the relationship established by the researcher with the research setting defines participant observation as a role. It refers to the "role" adopted by the researchers while they are researching in the context of interest. The roles of the participant observer reflect a continuum from objectivity to subjectivity based on the relationship of the researcher with the people in the field. The possible roles of the participant observer were classified by Gold (1969) into one of four categories: (a) the "complete participant" where the researcher becomes a full member of the community without the knowledge of the participants, the deception is deliberate and intentional, (b) the "participant as observer," where the researcher makes their role 54 known and forms relationships with the participants so that they may serve as respondents and informants, (c) the "observer as participant" where the researcher makes one visit or interview with the participant and no attempt is made to establish a relationship, and (d) the "complete observer" where the researcher is detached from the context and records observations mechanically or through one-way mirrors in the laboratory. In these roles the researcher tries to maintain an objectivist stance as much as possible. This is consistent with a symbolic interactionist perspective where researchers gather information from the participants while interacting with them in the field setting. Researchers aim to find a balance between immersing themselves in the context to capture the idiographic perspective while maintaining a modified objectivist stance so as not to bias the results. The typology of naturalistic research roles described by Gold (1969) are viewed as peripheral membership roles by Adler and Adler (1994) in which the underlying intent ofthe researcher is to capture the insider's perspective to understand human group life. The defining characteristic of peripheral membership is the absence or minimisation of participation in activities in the field setting (Adler & Alder, 1987). The field roles ofthe health promotion researcher and my role in this study are more consistent with the active and complete membership roles described by Adler and Adler (1987, 1994).19 In the active membership role, the researcher becomes more involved in the field setting and takes on responsibilities to further the group, but not to the point that they are fully committed to the values and goals ofthe group. Here, the researcher establishes a "close and meaningful bond with setting members" (Adler & Adler, 1994, p.380). In the complete membership role, the researcher becomes a genuine member of the group or setting during the research process in order to understand the experience of those in their naturalistic context. In this study, my actions reflect those ofthe active membership role by becoming a co-facilitator ofthe community action process. I did not become one ofthe "youth" in order to understand the experience of empowerment, as would be required to assume a complete membership role. The assumptions underlying my active membership role are adapted from Denzin's (1978) assumptions for the participant observer and are presented in Table 1. 55 Table 1: Assumptions guiding the active membership role 1. Sharing and participating in the community The idea is for the researcher to share, as intimately as possible, in the life and activities ofthe community. For this study, I worked as a co-facilitator with the practitioners and the young people on their action plans. 2. Active participation with the community Directly participating with practitioners and young people in their "symbolic world" (Denzin, 1979) entailed learning their language, and being familiar with current trends and fads, for example. As suggested by Denzin (1978, p. 185), this is not an easy process: "Learning a new language takes time, and acquiring a knowledge of what nonverbal gestures mean is often difficult." 3. Developing a role in the community I carved out a role in the community as part ofthe ongoing interactions and process that I was trying to understand. For me, this role evolved into being a member ofthe practitioner-oriented management team, as well as co-facilitating the group process as the youth planned and implemented their action plans. 4. A commitment to action In this participatory research context, a commitment to action entailed sharing in the decision-making and the leadership with young people and assuming some ofthe support roles ofthe practitioners working with the youth. 5. Respecting and honouring the knowledge of the people The stance ofthe researcher with respect to the participants was one of respect and honouring. As a researcher, I respected and valued the knowledge, skills and abilities ofthe practitioners and young people. The value of practice-based knowledge deepened as I became more involved in the process. Learning was a two-way process, and was incumbent upon remaining open to the ideas ofthe practitioners and young people in an honouring and respectful manner. 6. Being clear about your role. In the community project, I re-stated my role as a researcher at the beginning of project meetings. This happened all the way through the project. When new people entered the project, greater detail and background was provided on the project and on the researcher's role. New youth participants were required to take home a consent form to their parents and/or guardians. These membership roles represent a continuum from modified objectivity to subjectivity with respect to the nature ofthe relationship ofthe researcher with the field setting and the subjects or participants. Placing the relationship ofthe researcher with the field setting on a continuum spans across postpositivist and interpretive epistemological orientations. None of these membership roles is better or worse than others, however, some are more appropriate than others to achieve specific objectives in specific situations. A l l these roles have a place in health promotion research. Selecting the appropriate role depends on the intent ofthe research, the intended use ofthe research results, and the stage of knowledge development in a given area. The researcher role may also depend on its acceptability to the people intended to be studied. The active membership role was based on the assumption that by participating in the process and having a commitment 56 to the change process, the researcher was learning and understanding by doing (Cole, 19.91; Whyte, 1989). My active membership role was appropriate given the assumptions of the research around developing an understanding of empowerment, supported further by the assumptions of participatory research. In assuming this position and working with young people and the practitioners, the power differential and the perception of the researcher as an outside expert were not issues. The presence of a researcher observing from arm's length contradicts the assumptions of empowerment, as suggested by one of the teens: The adults can't just sit there and not say anything when we [youth] are making decisions. If they don't contribute then we think that they have ulterior motives. Participatory Research in Health Promotion Participatory research in health promotion has evolved out of a rich tradition of action research, action anthropology, new paradigm research, participatory action research (PAR), and participatory research in a variety of disciplines and service domains. These include education, organisational development, health and social services, agriculture, and community development (Green et al., 1995).20 Participatory research is defined as "systematic inquiry, with the collaboration of those affected by the issue being studied, for purposes of education and taking action or effecting social change" (Green et al., 1995, p.4).21 From this perspective, participatory research is an approach to research, rather than a specific method, though it does have elements of methodology. As an approach to research, participatory research is guided by diverse ontological, epistemological, and methodological assumptions including pragmatism, critical social theory, postpositivism, and interpretivism. The assumptions guiding the research depend on the nature of the research problem, the particular orientation of the researcher, and the research purpose. Participatory research is applied research that contrasts with the "professional expert" model of research rooted in the quantitative postpositivist paradigm in which the researcher is charged with the task of determining the facts in a given problem area (Whyte, 1989). The researcher is viewed as the "expert" and research is conducted on a population. There is an explicit power differential between the researcher and the researched, one that is magnified by the hallmarks of postpositivist research - control, manipulation and sometimes deception (Cook & Campbell, 1979). Action research (Lewin, 1946), participatory research (Hall, 1988) and participatory action research (Whyte, 1943) developed in response to the limitations of and dissatisfaction with traditional research, in which the focus was placed on the construction of instrumental knowledge and the separation of theory from solving practical problems. This study was conducted in the context of a participatory health promotion research project.22 It incorporated the key elements of participation, research, education, and action (Green et al., 1995) supporting the empowerment, participation, and fairness ideals set out in the Ottawa Charter for Health Promotion (World Health Organisation, 1986). Participatory research aims to break down the boundaries that separate the researchers from the researched (Yeich & Levine, 1992), in this case, the young people and their interaction with practitioners. Research was done, first and foremost with the young people, practitioners, and organisations in the community rather than on the community (Green et al., 1995). Decisions were shared between the researcher and the participants in the spirit of mutual respect for what each person brought to the research process. As suggested by Green and colleagues, "Participatory research requires shared power and control of decision-making rather than domination of the process by researchers" (p. 10). The research problem is typically a social problem calling for a collective solution (Park, 1993, p.8) and originates in the community by those who are affected by it in some way. In this study, the community recognised the need to involve young people in the identification of their issues and to become part of the solution. An integral part of participatory research is the active participation of the researcher and the people in the design, implementation, evaluation, and use of the results. In this study, key ideas emerging in the analysis were fed back to the practitioners and youth at weekly meetings. The information was used by the practitioners to inform their way of working with the youth, and by the youth to inform their planning and action. Further, youth and adults were involved in aspects of the research from survey development to the analysis, interpretation and presentation of the survey findings. The findings of this study were used by the youth and the practitioners for advocacy and education purposes throughout the project. This knowledge was intended to enable the participants to engage in the appropriate actions to remediate the problem, which, in this case, was defined as the lack of collective youth voice in the community. 58 Stance to the Study The absence of youth empowerment theory in the literature served as the motivation for this grounded theory study of youth empowerment. A community health nurse who approached the UBC Institute of Health Promotion Research with the idea for the West End Youth Project spurred my interest in the topic of youth empowerment. In the capacity of evaluation co-ordinator ofthe West End Youth Project, I was responsible for tracking the process of youth empowerment using participant observation. In addition to this, I used the project for my dissertation research. In October 1993, when the study started, I planned to develop and validate a measure of youth empowerment for my dissertation research. This idea fit with my research background in quantitative methods training from the University of Waterloo. The absence of youth empowerment theory in the literature, however, led me to abandon my original idea because it did not seem appropriate based on what was known in the literature at that time. This dissertation represents the beginning of my qualitative learning. I came into this study with quantitative leanings and a postpositivist way of seeing the world. At the beginning of this study, my biases around youth empowerment were against an authoritarian approach to working with the young people. My perceptions of empowerment were based on what was known in the literature at the time, characterised by a series of unconnected concepts and untested propositions. I found that my preconceptions were influenced by the assumptions underlying health promotion, namely, an ecological approach and health promotion as an enabling process. Rationale for a Qualitative Approach The face of health research is changing with the integration of social theory, qualitative methods, inductive thinking, and interpretive approaches in which scientific knowledge is constructed through the active involvement ofthe researcher with the research context (Eakin et al., 1996; Flynn et al., 1994; Lewis, 1996; Lincoln, 1992; Wallerstein & Sanchez-Merki, 1994). This expanded view of health research addresses the limitations associated with postpositivism, an approach to science that places an emphasis on quantitative methods, knowledge development through deductive-hypothesis testing, and an epistemological orientation where the researcher retains the stance ofthe disinterested scientist (Cook & Campbell, 1979). 59 Quantitative research methods have been criticised for contributing to the development of a body of scientific knowledge lacking the necessary theoretical complexity to understand the social, political, economic, and cultural factors associated with health and disease (Baum, 1995; Dean, 1993; Dean et al., 1993). To deal with this problem, health researchers are turning towards qualitative methods23 to answer or at least elaborate research questions considered essential to the progress of health research and practice (Baum, 1995; Faltermaier, 1997) such as theory development related to the rhetorical concepts of empowerment and participation (Baum, 1995). These concepts are central to health promotion theory, yet remain poorly explicated by a deductive hypothesis-testing approach and through qualitative studies that provide description but not explanation. Although health promotion is a practice-based field of inquiry, there is a gap between its theory and practice (Buchanan, 1994; Milburn, 1996). Many ofthe theories and theoretical concepts used to guide health research have been deduced from tacit knowledge, experience, and hunches at a level too general to be useful for health education theory (Mullen & Reynolds, 1978). In addition, poorly conceived theoretical concepts are of limited utility for the practitioner and may lead to the development of poorly operationalised measures. Although ecological health promotion places an emphasis on understanding the interdependence between individuals and their environments, the field has been criticised for its preponderance of decontextualised behavioural theories emphasising the cognitive functioning ofthe individual (Lupton, 1995). Understanding the relationships between individuals and their ecological contexts requires methods that account for this influence, rather than statistically controlling for its effect in the analysis. Qualitative methods are preferred in those circumstances in which contextual factors are poorly understood, uncontrolled, or situational (Holman, 1993), and in which the researcher pursues an understanding of a phenomenon and the conditions and circumstances under which it varies (Pope & Mays, 1995). Qualitative methods allow for the study of complex processes in their natural settings, in other words, by grounding the theory in the reality ofthe people (Milburn, 1996). Although the use of grounded theory in health research was advocated in the late 1970's (Mullen, 1978; Mullen & Reynolds, 1978), only recently has it gained recognition in health research as a systematic method that contributes to the 60 development of scientific knowledge by providing description and explanation of complex processes that are grounded in the real world (Bowling, 1997; Faltermaier, 1997; Wallerstein & Sanchez-Merki, 1994). Grounded Theory Methodology Grounded theory methodology complements the traditional empiricist approach to theory construction in which theories are based on some combination of literature review, tacit knowledge, hunches, insights and intuition by offering researchers a systematic method for developing theory grounded in its natural setting (Glaser & Strauss, 1967). As a methodology, grounded theory is rooted in the philosophical roots of pragmatism and the theoretical tradition of symbolic interactionism. Researchers, however, have applied the grounded theory method using subjectivist epistemological frameworks such as ethnomethodology (Knoblauch, 1993; Lester & Hadden, 1980) and social constructionism (Charmaz, 1990) to acquire an understanding ofthe phenomenon of interest. According to Strauss and Corbin (1994), grounded theory can be applied in the context of other philosophical and theoretical perspectives, and is considered the evolution ofthe methodology. Researchers, however, need to be clear on the theoretical and epistemological assumptions that guide their application ofthe method. Grounded theory offers a systematic qualitative approach to the analysis of textual data by the use of constant comparisons and theoretical sampling. The purpose of the grounded theory method is to generate conceptually dense theory through the application of constant comparisons and theoretical sampling using the techniques and procedures as outlined by Glaser (1978, 1992), Strauss (Strauss, 1987; Strauss & Corbin, 1990). Though originally conceived as a stand-alone method used primarily by sociologists, it has been used by many disciplines and fields such as social work, education, medicine, anthropology, psychology, nursing, and health education (Boneliel, 1996; Charmaz, 1980; Fujimura, 1987; Mullen, 1978). The grounded theory method was selected and applied in the context of a participatory health promotion study. The purpose of theory development was to enable the prediction and explanation of behaviour by systematically explicating the inter-relationships between concepts as they emerged from the data (Glaser & Strauss, 1967). From this perspective, theory generation is viewed as a "process of research" (p. 6) where the researcher moves back and forth between inductive and deductive modes of thinking in 61 constructing and verifying hypotheses in the data (Glaser & Strauss, 1967). It allowed me to apply a systematic set of procedures and techniques in the context of participatory research and a subjective epistemology. In other words, the methodology was well defined and could be applied using participatory research. Finding myself in the role as co-facilitator of the community action process, the interpretive basis of the method conformed with my subjective relationship with the community members. Symbolic Interactionism Grounded theory methodology is theoretically rooted in the symbolic interactionist tradition of the Chicago School of Sociology, which in turn is based on the philosophical perspective of pragmatism (Mead, 1934). Symbolic interactionism provides a theoretical lens to understanding human social life. Individuals are viewed as active participants in and shapers of their environment; people act and interact with each other based on significant symbols, where a symbol represents a vocal or other type of gesture. The symbols bear meaning and people interact with each other in their social world on the basis of the interpretations ascribed to these symbols, rather than merely acting as a result of conditioned responses (Hewitt, 1988). That is, they engage in symbolic interaction. Symbolic interactionism interprets human action and interaction within the broader context of social, political, cultural and economic factors, with a focus on understanding the interplay between macro and micro conditions (Strauss, 1993). I found the basic assumptions of symbolic interactionism consistent with ecological perspectives to understanding human development (Bronfenbrenner, 1979) and health behaviour (Green et al., 1996). The theoretical perspective of this study was influenced first by the ecological approach in health promotion and then symbolic interactionism. Nature of the Data This study relied on participant observation as the method for collecting information about the youth empowerment process over a 32-month period from November 1993 to June 1996. The information included: (a) observations from meetings, events, discussions with young people and practitioners from both formal and informal encounters in my role as a co-facilitator, (b) focus groups, (c) personal interviews, (d) meeting minutes, and (e) key documents (e.g., speeches, letters) collected over the course of the inquiry 62 process. The purpose of this section is to review how the method was applied to collecting information for this study, and to provide a description of the data and the theoretical concepts that guided the collection of information. Observation Notes I was a participant observer from November 1993 to June 1996. My participation in the community with the young people and practitioners on a particular day ranged from fifteen minutes to a full 8-hour day or evening event depending on the activity or meeting. The most frequent contact with the community was to participate in the meetings, which usually lasted a maximum of 90 minutes. Meetings were the major vehicle in which adults and young people shared their ideas and planned events and activities. In this capacity, I became the minute-taker at meetings since this was an activity that the young people did not volunteer to do. This enabled me to take notes during youth and practitioner meetings, documenting key quotations as much as possible, except when I was chairing or co-chairing a meeting. I found it difficult to take notes while chairing the meeting, and had to rely on my memory, though I could not resist the temptation to jot down a good quote. As part of the planning process, young people and practitioners talked on the telephone. I documented the content of my telephone conversations with the teens using a phone contact sheet as shown in Appendix A. I completed the same form with an adult contact if they provided comments and updates with respect to the youth. Because they cared about the research, the adults would call when they felt something important had happened that I would be interested in documenting. Important meant something positive or negative. In fact, when something negative had happened on the project or in the life of one of the teens, the adults would call, out of concern, and provide me the opportunity to offer extra support during the next encounter. Similarly, when I was concerned about a teen, I called one of the adults to share information. Thus, the telephone interaction proved important as it highlighted a different form and context for interaction. During group meetings, the field notes documented group decision making processes, interpersonal processes between adults and youth, youth putting their ideas into action, and the different types of supports they needed to carry out their actions. The notes included comments from the youth and adults working 63 together, the body language, the dialogue between practitioners and young people, and the sharing at the end of meetings, as well as my personal reactions. I recorded quotes as much as possible and looked for incidents or events out ofthe ordinary as they occurred to increase the variation in the data. As I stayed in the field, I was able to identify these incidents more quickly. In the early stages, this was more difficult because everything seemed important. As the youth made presentations, I documented the events leading up to their actions and following the event. Afterwards, I asked them how they felt about the experience, recording their feelings in my notes. At times, I was able to sit down and write verbatim responses, and they would check it over. I could only do this once they knew me, and could not do it as often as I liked. It would have been preferable to conduct unstructured interviews with a tape recorder, however, in doing this I believed I would have overstepped the fine line between maintaining and violating my relationship with the teens. In addition, any tape-recorded contact required active parental consent. This was an ongoing dilemma for me, one that I was unable to resolve given my lack of field experience. At first, my notes were more comprehensive in scope because everything seemed to matter. As I moved through the grounded theory analysis, my observations were guided by the emerging concepts, focusing the field observations. After coding a focus group transcription in April 1994, my observations became more focused on the adult-youth interaction, the decision-making process, and changes in the youth as they participated. I tried, however, to remain open to other events since concepts were still emerging in the analysis. As organisational and community level support factors were identified, these were included in greater detail in the observations. As I entered into axial coding, the observations were focused on the adult, youth, community, organisation, and policy categories. I found myself making detailed notes related to specific incidents as I noted patterns emerging in the data. The guidelines for participant observation notes suggested by Bogdan and Taylor (1975) and Bogdan and Biklen (1982) were adopted to ensure the consistency in recording information. Direct quotations were used to denote the actual words used by the participants. These quotations were always recorded on site. Close approximations of quotations were referred to in the text as, "The young person responded by saying something like " The observation notes were transcribed within 24 hours ofthe 64 meeting using a word processor. At times, however, I was unable to record the notes until 48 hours later. I added additional comments as I continued to reflect on a situation, remembering an expression or incident. When field contact was intense, and I was burning out from my dual role as co-facilitator and researcher, I found it difficult to keep track of what was happening in the field, and documented briefer notes. In the end, these notes proved very useful in the analysis. In some cases, I dictated my notes into a tape-recorder and transcribed them, making changes as necessary. Tape recording was especially useful for extended field contacts as the method of tape recording was more time efficient. This still took a considerable amount of time. This may became a preferred method of documenting participant observation with new voice-recognition computer software. Consistent with Bogdan and Taylor's (1985) experience, I found that it took approximately three times the length of field time to record observation notes on the computer. Overall, 132 sets of observations were used in the analysis. Documents I also collected documents as part of participant observation. Documents provided a useful source of information that could not be captured through direct observation or interviews. The documents were not used as a primary source of information in the analysis, but as a supplement. Some documents proved to be more important than others, like the youth mission statement, for example. In this study, 51 documents were used in the analysis and included the following: • meeting minutes from the action group meetings, the youth council meetings and the management meetings gathered from October 1993 to June 1996, • school bulletins announcing project events • youth action plans developed in the planning workshop in April 1994 • mission statement developed by the young people for the youth council • policy documents (e.g., recreation policy; practitioner guidelines with expectations and values) The minutes documented meeting attendance, responsibilities for chairing and recording (though these were sometimes missing), a summary of the discussion and the decisions made. Practitioners and young people also provided comments on the process during the meeting, and this material was captured in the minutes. 65 The minutes were helpful for those meetings in which I was unable to complete full observation notes, especially combined with the brief observations. I included the minutes recorded by others in the data set as well. The personal documents included letters and articles written by youth as well as written speeches presented by youth at various functions. These documents provide another frame of reference on how young people think about their participation in the project and those with whom they work. Focus Groups Focus groups were conducted separately with young people and practitioners. The focus group method outlined by Krueger (1988) was followed. The focus groups were tape-recorded using a professional tape recorder and transcribed by an experienced transcriber, or myself and checked for accuracy. I moderated the groups using a semi-structured interview guide.24 The community health nurse recorded notes and provided general reactions and impressions about the group discussion at the debriefing following the session. Probes were used to elicit more information from the group participants such as, "Can you tell me more about that?" "Does anyone see it differently?" "Does anyone have anything else to add?" "Can you give me an example of what you mean?" The number of participants in the focus groups varied from four to ten. The focus groups were conducted as part ofthe West End Youth Project for the dual purposes of gathering information to inform further action, as well as to capture the experiences of young people and practitioners in their own words. Overall, six focus groups were conducted, in November 1993 (2 focus groups with 14 youth), March 1994 (1 focus group with 10 youth), February 1995 (1 focus group with 4 practitioners), in June 1996 (1 focus group with 8 youth), and in January 1997 (1 focus group with 2 youth and 3 practitioners). A total of 22 different youth participated in the focus groups. Of these, 11 youth participated in one group only, 8 youth in two groups, and 3 youth in three focus groups. Below, the purpose and composition of each focus group is reviewed by the date of data collection. The interview guides for the focus groups are located in Appendices B and C. The first two focus groups25 were conducted before knowing that I would use this information for my thesis. The literature served as a guide for constructing the interview questions. These groups were 66 conducted for two reasons, (a) to gain youth insight into concepts related to empowerment, and (b) to ask the participating youth how we could get more youth involved in the project. The groups served as the starting point for building relationships with the young people. Of die 50 youth in the secondary school invited to participate in the focus groups, only seven attended on the day with signed consent forms.26 Given the lack of youth participation, the peer counsellors participated in a second focus group later in November (N= 7 youth). Thus, two groups were conducted approximately two weeks apart, with seven youth per group. A nominal group process followed each of the focus groups to provide youth the opportunity to identify those things that would make the West End a better place for youth to live and go to school. Each focus group lasted approximately 60 minutes, while the nominal group process required an additional 45 minutes. The third focus group, conducted in March 1994, was the starting point for grounded theory analysis. This group served two purposes: (a) to allow youth to reflect on their experiences in the project to gather ideas for open coding.27 and (b) to see how the project could improve the process and allow youth to take greater control. A l l 10 youth invited to the focus group attended. This group was comprised of eight participants on the project who were actively involved in planning a youth forum to report back survey findings to the community. Two of the youth participants were just becoming involved in the project. At this time in the project, there were fourteen participants. Since the focus group was held over lunchtime at the secondary school, the four youth in grade seven could not attend. The focus group was 45 minutes in duration. During open coding of this transcript, the indicators pointed to concepts related to the catalytic role of the adult, program implementation, and factors related to youth participation (e.g., entry and becoming stages of empowerment). The fourth focus group was conducted in February 1995 with four of the seven adults28 working with the young people in the West End. 2 9 The adult participants were the most involved with the youth, three of whom remained involved with the youth for the duration of this study. The purpose of this focus group was to collect more information relating to the categories emerging during open coding, namely, the catalytic role of the adult, the role of the organisation and the community in the project, and perceived changes among the youth. The perspectives and experiences of the adults were relevant to the concepts in the emerging theory of 67 youth empowerment. They possessed knowledge of the community and provided an additional perspective to my own on the perceived changes of the youth. At this point in the grounded theory analysis, I was moving back and forth between open and axial coding. The focus group was conducted as part ofthe regular management meeting and lasted about 40 minutes. The fifth focus group with youth, conducted in June 1996 with eight core youth participants, was part ofthe Camp Sasamat retreat. Ofthe 18 project youth invited to the retreat, only eight attended. Invitations were sent to youth participants who had been involved in advocating for the youth resource centre, working on the publication of W.E.T. News, the transition program, and the Youth Council over the last year. The 10 other youth did not attend the camp due to competing demands (e.g., work and family commitments, other social plans).30 The retreat would have provided me with an opportunity to conduct in-depth focus groups with three groups of six youth (N=l 8). I was disappointed in the turnout, however, the one focus group provided excellent information. The interview guide was based on theoretically relevant concepts emerging in the analysis. This group had three purposes: (a) to produce more information on youths' perceived role ofthe adult since some ofthe relationships in this category remained unclear; (b) to produce information on youth perceptions of shared decision making, leadership, perceived changes, and opportunities since these concepts required greater theoretical elaboration; and (c) to produce information on the theoretical concept of social criticism since I was not sure where this fit in the emerging theory. The observation data required supplementation with youth perceptions and feelings based on their experiences in the project. As a stimulus for the focus group, youth provided responses to perceived changes in themselves and the community on a piece of paper. The papers were then collected and used in the analysis. This focus group was 75 minutes in duration. A sixth focus group was conducted with a mixed group of young people and practitioners in January 1997 for another study. The two youth participants were members of community boards and were core participants in the project. Two other youth who were board and committee members did not attend the meeting, one due to family commitments, and the other was a "no show."31 One ofthe practitioners had worked closely with the young people since the very beginning of the community process, and the other two 68 young people worked with the youth participants in the context of two organisations. The purpose of this focus group was to obtain adult and youth input related to the support role of the adult for the purposes of another project. I used this opportunity to ask the youth project members to elaborate on their mentoring relationships with the adults to assess the relationship with youth development, which is why I included this focus group in the data set. Brainstorming Session A brainstorming session was conducted with five of seven invited youth in July 1994. The youth in the session were core participants on the project. The two other youth could not attend due to work obligations. The purpose of the session was for youth to identify project strengths and weaknesses by reflecting on their experiences as I facilitated the group process. The session was theoretically sampled to elaborate on the conditions related to youth participation. Individual Interviews Fourteen interviews were conducted with twelve different youth, and seven interviews were conducted with three different practitioners working with the youth. Thus, three youth were interviewed twice, and each practitioner was interviewed twice, while one practitioner was interviewed three times. The interviews followed a semi-structured interview guide to allow me to obtain information on theoretically relevant concepts as identified in the analysis, in addition to allowing the participants the opportunity to add new information while sharing their stories with me. As I moved towards selective coding, the interview questions assessed their reactions to the hypotheses in the theory. The interviews lasted from 45 minutes to 90 minutes, with most interviews lasting about one hour. A l l but two of the interviews were conducted in person in a private room at the community centre, the health unit, or the university. Two of the interviews were conducted over the telephone using a professional tape-recorder with telephone recording capabilities, at a convenient time for those being interviewed. Six of nine youth, considered major contributors to the project, were interviewed in November 1994. Two of the remaining three youth had graduated, while one youth agreed to the interview, but she did not return a follow-up call. I was less involved in the field at this time, and felt uncomfortable initiating further 69 phone contact. In pursuing the interview, I would have violated my ethics agreement. The interviews were conducted for two reasons: (a) to identify new categories relevant to the theory since I was in the process of open coding, and (b) to acquire more information on the emerging concepts in the theory. I interviewed nine of 11 youth from June to June 1998, prospectively as I was moving from axial to selective coding in the analysis. The interview guides varied according to the theoretical concepts relevant to the analysis. The remaining two youth agreed to the interviews, but did not call me back. I pursued one youth for an interview, and after three calls, I felt unjustified in calling again, given the ethics agreement. The other youth was very difficult to find since he had moved. Although he agreed to contact me through another practitioner, I did not hear from him. These youth would have enriched the analysis with respect to the dimension "enhancing youth development." One interview was conducted with two youth, the outcome of an unsuccessful focus group attempt. I had arranged a focus group, however, only two ofthe five youth confirming attendance arrived on the day. Although I was sceptical about the joint interview, it was one of the richest interviews as the two youth responded to the questions using colourful examples. At this point in the analysis, I was moving back and forth between axial and selective coding. Some properties in the theory were more developed than others. These interviews served four purposes: (a) to maximise the variation on the concepts related to the youth, (b) to verify the relationships between the categories, (c) to gather information on the relationship between empowerment and health, and (d) to resolve inconsistencies in the data. Youth had different points of view about empowerment and the orientation of adults in working with young people. I resolved the inconsistencies through the interview, enriching the data through the variation. I interviewed each ofthe three adults working with the youth throughout the project on two different occasions. The first interviews were conducted in spring of 1997. These interviews had four purposes: (a) to obtain more information on community and organisational support, (b) to verify the relationships emerging in the data, (c) to resolve contradicting perceptions, and (d) to check my interpretation of specific events that had occurred in the field. These interviews lasted 60 to 90 minutes. At the time these interviews were conducted, I was in axial coding and needed input to assess my interpretation ofthe data, while requiring theoretical elaboration on community and organisational indicators. 70 The second set of interviews with three adults was conducted between April and August 1998. Unfortunately, one of the interviews did not record. I discovered this soon after the interview and made notes and checked on my interpretation with the practitioner. Another interview was scheduled and tape-recorded. I discovered that one of the adjustments made after checking the tape-recorder was the cause of the problem. These interviews had three purposes: (a) to verify hypotheses emerging in the analysis, (b) to achieve theoretical saturation, and (c) to fill in categories that required further theoretical elaboration, more specifically, the overall social change process in the community. These interviews were shorter, lasting between 30 and 45 minutes. Confidentiality of Responses The majority of the information shared during the interviews and documented in the observations was not damaging to the youth, practitioners, or the agency should it become known through this study. I had an ethical obligation, however, to maintain confidentiality and anonymity of the collected data. Some of the incidents were contentious in that the participants referred to interagency turf issues, and interpersonal conflicts. While these data provided a rich source of variation for theory development, it became difficult to use specific incidents as examples in writing the findings. Since the data were collected in one community, these incidents are easily identifiable. I have tried to use the best examples to illustrate the theoretical concepts in writing the findings. In those situations where I was uncertain about using a quotation or a particular incident from the observations to illustrate a concept, I went back to the field to obtain verbal approval. To maintain confidentiality of the participants, their real names have been replaced with pseudonyms in the presentation of the findings. At times, agency names remain intentionally ambiguous. Ethical Considerations This study focused on studying the factors that influenced youth empowerment at the level of action and interaction. Initially, ethical review for the West End Youth Project was approved by the University of British Columbia Ethical Review Committee for the West End Youth Project. I obtained separate approval from the committee to use the data from the West End Youth Project for my dissertation. In addition, separate ethical approval was received to conduct the prospective interviews with the youth and the 71 practitioners on the project. The ethics approval forms are attached in Appendix E. Given my role in co-facilitating the process, ethical issues were a major consideration since I was developing a relationship with the youth. As I came to know the youth, I developed professional-personal relationships with them. Any concerns that I had over the mental or physical well being of the youth were directed to the practitioners, since this was beyond my level of skill and responsibility. I developed professional relationships with the practitioners on the project as we worked together. The adults and youth were made aware of the purpose of the research at the beginning of each meeting by myself, or the co-investigator, a practitioner on the project. We were careful to inform those involved in the process about the research component of the study.32 The youth were required to take home parental consent forms to participate in the study. Consent forms were given at the beginning of each meeting to new students as they joined the project. In October 1993, passive parental consent was allowed for observation; active parental consent was required for all tape-recorded instances.33 Youth provided assent to take part in the interview after receiving parental consent. Active consent was obtained for all interviews used in this study. The ethical approval posed a problem for obtaining youth interview data. The youth resented needing active parental consent for an interview, and felt that it undermined their ability to take responsibility for themselves, a notion that contradicted the assumptions of the community action process. I explained the reason for the consent procedure, and although they understood, it placed me in a difficult situation. Agency approval for the study was received by the Vancouver School Board, the Vancouver Board of Parks and Recreation, the West End Community Centre, in addition to the Burrard Health Unit and the West End Neighbours in Action, the major partnering organisations. 72 The Analytic Method The purpose of this section is to describe how the grounded theory method was applied in this study. It begins with a review of how the data were prepared and managed during the course of this study. An overview ofthe analytic method highlights the constant comparative method, coding and theoretical sampling. This is followed by a description ofthe data analysis process and those standards used to assess the knowledge claims derived from the research. Data Preparation and Management In this study, data management was facilitated by the use of ATLAS/t i , a qualitative data analysis software package (Muhr, 1994). ATLAS/t i was selected on the basis of its coding, memoing, search and retrieval, graphics and linkage capabilities. I found on-line coding, memoing, and diagramming of the evolving theory to contribute to the rigour ofthe grounded theory method. The program simplified data management. I could easily load the documents as primary texts, open a primary text memo to provide the rationale for theoretical sampling, and proceed with coding. The program stored the data set in a hermeneutic unit. The data consisted of interviews, observation notes, and documents. The interviews were transcribed by a secretary with transcribing experience or myself. The transcribed interviews were reviewed and edited by myself to ensure consistency in transcription style and formatting from interview to interview. The majority ofthe field notes were typed into a word processor following the observation session. About 15% ofthe observation notes were hand-written. In other cases, the telephone conversations were summarised onto a form. These texts were analysed offline after assigning a primary text number. Those documents selected for analysis through theoretical sampling were saved as ASCII files, imported into the text editor of ATLAS/ t i , and formatted for the analysis package. The documents imported into ATLAS/t i , referred to as primary-text documents, were automatically assigned a primary text number. At the time of analysis, a lined hard copy of the primary text was printed and read prior to on-line analysis to familiarise myself with the data and to gain a feel for the data before breaking it into its component parts (Marshall & Rossman, 1995; Seidel & Kelle, 1995). During on-line 73 analysis, codes were linked with other codes using the code linkage function and the rationale for linking the codes was documented in a memo. Focused code networks were formed automatically through the code-to-code linkages. The focused networks were saved as network views to serve as the starting point for further theory building with other theoretical codes. The theory-building process was enhanced by network functions in ATLAS/t i by providing a graphical representation ofthe relationships between the concepts emerging in the theory. After analysing a document, the primary-text was printed with its corresponding quotations, codes and memos, and reviewed off-line for accuracy and clarity of meaning. At this point, I found myself going back to write memos while reviewing the hard copy and refining the code-to-code linkages.34 Constant Comparative Method The use of constant comparisons employed in grounded theory (Glaser & Strauss, 1967, pp. 101-116) is a "time-honoured" technique with Aristotlean roots in the "method of differences" (Miles & Huberman, 1994, p. 254). With constant comparisons, new incidents, events or evidence are compared against other incidents, events or evidence to assess for: (a) similarities and differences, and (b) for the relationship between these incidents and events. This allows the researcher to identify and categorise concepts and to develop and test the theoretical propositions that comprise the substantive theoretical framework. The use of constant comparisons makes the data theoretically relevant through the minimisation and maximisation of differences and similarities of comparison incidents, events, and sources of evidence. Asking questions is an important part of making constant comparisons in the grounded theory analysis process (Glaser, 1978, 1992). It is incumbent upon the researcher to ask a set of questions throughout the analysis process that will allow for the discovery of categories and its associated dimensions. As I was moving through the analysis, I asked myself the questions suggested by Glaser: "What is this data a study of?" and "What category does this incident indicate?" (Glaser, 1978). The data are coded according to three levels of abstraction, from the most abstract to the least abstract they are: (a) categories; (b) properties ofthe category; and (c) types, conditions and circumstances ofthe properties and categories. I have referred to the latter as dimensions in the findings chapters. 74 Coding Coding is the basic term used for analysing qualitative data. Coding is concerned with placing descriptive labels to sections of text. Grounded theory progresses through three types of coding: (a) open coding, (b) axial coding, and (c) selective coding. Open coding is defined as "the process of breaking down, examining, comparing, conceptualising, and categorising data" (Strauss & Corbin, 1990, p. 61). During this stage of the analysis, the researcher uses open coding to identify categories, properties and their related types, circumstances, and conditions. The data are fractured into segments, which are then regrouped during axial and selective coding. In the next stage of the analysis, the researcher uses axial coding to focus on relating properties and conditions to a category, as well as to identify a theoretical coding family for the theory. Axial coding refers to "a set of procedures whereby the data are put back together in new ways after open coding, by making connections between categories" (Strauss & Corbin, 1990). This is in contrast to open coding where the data are "fractured" and the researcher's interpretive efforts are focused on identifying categories and their related properties and dimensions. The researcher enters the axial coding process with some categories and their related properties and dimensions. The categories remain unrelated to each other. Axial coding is used to identify the relationships between the different categories through applying the techniques of constant comparison and theoretical sampling. The categories can be inter-related in any number of ways. Glaser (1978), for example, identifies 18 different theoretical coding families. These are offered as an heuristic tool for conceptualising and organising the relationships between the variables in the data. Most data tend to fit the Six C s : cause, consequence, context, condition, covariance and contingency model (Glaser, 1978). Selective coding refers to the process of selecting the core category, systematically relating it to other categories, validating those relationships, and filling in categories that need further refinement (Strauss & Corbin, 1990, p 116). Selecting the core category typically emerges after several months of coding the data. The core category is defined by Strauss and Corbin (1990) as "the central phenomenon around which all of the other categories are integrated" (p. 116). Strauss (1987, p. 36) identifies several criteria forjudging which category should serve as the core category in the analysis. These include: (a) its centrality to as many 75 other categories and their properties as possible; (b) its frequency of appearance in the data; (c) it relates easily to other categories; (d) it has clear implications for a more general theory; (e) the theory develops as the details ofthe core are worked out in the analysis; and (f) it allows the researcher to build in maximum variation to the analysis through development ofthe category and its subcategories, properties and dimensions. The researcher usually moves back and forth between open and axial coding and between axial and selective coding as some categories develop more quickly than others. This was the case for this particular study. Theoretical Sampling Sampling proceeds according to theoretically relevant concepts in the theory (Strauss & Corbin, 1990, p. 176). Theoretical relevance refers to those concepts considered significant because of their repeated presence or notable absence in the comparison of incidents, and events documented in the observation notes or interviews. Theoretical sampling in grounded theory varies according to the stage of the theory development process. During open coding, sampling is open in order to maximise the discovery, naming and categorisation of phenomena (Strauss & Corbin, 1990). The aim of open sampling is to discover as many relevant categories as possible along with their properties and dimensions. In the next step ofthe analysis, running parallel with axial coding, relational and variational sampling techniques are used to maximise the finding of differences in the dimensions of emergent categories. This can be done either systematically or purposively. For the purposes of this analysis, interviews, documents, and observations were selected purposively from the database to maximise the variation at the dimensional level ofthe theoretically relevant concepts. Finally, discriminate sampling was used during selective coding to maximise opportunities for verifying the story line and for testing the relationships between categories and filling in those categories that were not yet fully developed. In selective coding, hypotheses were proposed and verified against the collected data as well as through prospective interviewing. The hypotheses were modified and verified again; only those hypotheses standing up against the data were integrated into the theory. 76 The Case of Retrospective vs. Prospective Analysis Ideally, data collection and analysis are ongoing through the research process, however, circumstances inherent to the research may conspire against prospective analysis. In this circumstance, data are collected and analysed retrospectively. Although an accepted application of the method, it is not the preferred use (Glaser & Strauss, 1967). In this study, the data were collected and analysed retrospectively and prospectively. The retrospective data analysis served to focus prospective data collection in the field with respect to the theoretically relevant concepts emerging in the theory. However, I was careful not to let these concepts limit the scope of my observations since the analysis was ongoing, with concepts still emerging in the analysis. These interviews enriched the theory and allowed me to achieve theoretical saturation on most concepts in the theory. They allowed me to verify relationships in the theory, and to ask pointed questions to resolve points of ambiguity, in addition to fill in categories that were thin on some dimensions. Although these interviews were conducted two years after the participants' experiences with the project, in my opinion their contribution to the analysis far exceeded doing exiting interviews based on unfocused questions. Data Analysis During open coding, the researcher identifies as many relevant categories, properties and their types, circumstances and conditions35 as possible using open sampling to maximise the discovery, naming, and categorisation of phenomena. The starting point for the analysis is arbitrary. My analysis began in the context of a grounded theory seminar of which I was a member. In this study, open sampling proceeded with a focus group often youth participating on the West End Youth Project in March 1994. I oriented myself to the interview through transcribing it and by reading through the transcript prior to the coding.36 The interview was coded by word or by phrase for the first nine single-spaced pages. The interview transcript was not very dense in that youth provided shorter responses to questions rather than paragraph-long answers. At that point, I stopped and organised the codes into conceptual groupings, as suggested by Strauss and Corbin (1990). Four categories or conceptual groupings emerged from this level of analysis, identified as: (a) the catalytic role of the adult, (b) program implementation, (c) the entry stage of empowerment, and (d) and the becoming stage of empowerment. 77 At this point in the analysis, the categories were unrelated to each other and many ofthe codes remained unaffiliated with a conceptual grouping. After I completed coding the transcript, documents were theoretically sampled based on the emerging categories in the analysis. This led to the retrospective analysis of the first focus group conducted in November 1993 where I asked the youth about the things that they did with adults, and about the types of choices available to them in their social environment to elaborate further on the role ofthe adult. Other properties, types, conditions and circumstances emerged related to the catalytic role ofthe adult including their orientation to working with young people. This transcript was rich with negative evidence, as they reflected on their experiences with adults who controlled decision-making. This was in contrast to the March 1994 focus group where the youth highlighted the positive aspects and hence the catalytic role of working with the adults in the context ofthe project. The youth also talked about the kinds of activities in which they were involved, and about the lack of opportunity for choices and for participating in the community. Many ofthe codes in this analysis clustered around the types of activities leading to the development ofthe category "activities." To elaborate on the conditions and circumstances related to the "activities" category, I theoretically sampled the corresponding nominal group process with this group of youth, and the second focus group conducted in November 1994. What struck me from this analysis, is what youth did not say. Youth were responding to adult-designed programs and activities, and were passive learners in the process. Their dissatisfaction was a response to a top-down approach to youth programming and to their passive role in the process. The analysis highlighted the role ofthe youth in decision making relative to adults. Based on this framework, seven sets of observation notes were theoretically sampled to compare and contrast how conditions and circumstances related to youth participating in the community process were similar or different to the top-down approach to youth programming. This analysis generated a string of substantive codes around listening to youth, asking questions, asking for input, willingness to listen, as well as the gesturing related to the interactional process. I was "stuck" in open coding for a long period of time, partly from inexperience, and partly due to the inherent complexity in the data. The purpose of open coding is to expose as many potentially relevant categories along with their corresponding properties and conditions. As I was coding the data, categories 78 related to the context emerged in the analysis, leading to the theoretical sampling of documents and minutes to relate community and organisational support to the interaction that was occurring at the microsystem level. As I moved into axial coding, I started to relate the categories to each other through proposing statements of relationships between concepts and verifying them in the data. At this point, however, I was moving back and forth between open and axial coding. I found writing the theory helped with the analysis. I did this using the theoretical memos logged during the course of the analysis, the diagrams, and printing searches related to the relevant dimensions, all the while asking myself questions: What is this data a study of? What category does this incident indicate? (Glaser, 1978). The gaps in the data led to theoretically sampling the youth interviews conducted in November 1994 and the brainstorming session, starting to make linkages between the categories in the data. As all of these interviews were analysed, I found myself linking the emerging support roles ofthe adult with youth changes. The catalytic role ofthe adult was associated with the properties of mentoring, illuminating, caring, teaching, facilitating at the level of interaction with young people and with the role of advocating, co-ordinating, and basing with the community. Through asking questions and proposing statements of relationships, I started to discover that teaching, for example, was associated with skill development. There were still several gaps in the theory, several links I was having trouble making. Some pieces like caring seemed to fit everywhere, and I was not quite sure where to put them. I found myself grouping youth skills together into different sub-groupings, but they did not really work. Given other circumstances, I was unable to engage in continuous analysis and found myself analysing the data in what is best characterised as spurts. However, I continued to work through analysing the interviews, going back and forth from the interviews to the observation notes, as time allowed. I returned to axial coding with greater continuity in early 1998. The memoing and diagrams allowed me to keep track of the developing theory as I moved into and out ofthe analysis. I found myself going back and forth between this "adult" piece and a "youth" piece. As I theoretically sampled observation notes, I found myself working around two pieces, an adult piece and a youth piece with related properties and dimensions. I found this confusing, thinking that grounded theory revolved around one major category, and questioned why I had two 79 categories that were so interdependent that I could not say one was more or less important than the other. In speaking with committee members, consulting grounded theory experts, and making a presentation to the University of Victoria grounded theory group, I came to realise that I was working with two sub-processes or categories. This lead to the identification of the core category as a partnering process between adults and youth, as expressed by two sub-processes, eventually to be named Creating an Empowering Environment and Becoming Empowered. The actual labelling of the sub-processes was not defined until the relationships between the concepts in the theory were verified, over and over again in the data, and the core category elicited an "of course this is what it is" response from the adult and youth participants. The last set of interviews, conducted over five months as I moved through the analysis, served as a form of member checking while I moved through axial and selective coding. It allowed me to saturate the categories and properties in the theory. In writing the theory, however, I uncovered areas that required further verification, leading to telephone contacts with three youth and three adults in the final stages of the writing. The theory was brought to closure through the writing. Memos Memos were used throughout the analysis to keep track of the theory development process. As I was analysing the data, I would write my thoughts and document the linkages using the memoing function in ATLAS/t i . During axial coding, I started to write my ideas into a notebook, as I found myself reviewing hard copies of the data away from the computer. In this study, the written records related to the formulation of the theory included theory memos, code memos, commentary memos, and method memos. The theory memos documented the relationships in the data and the explication and support for the hypotheses developed during the course of the study. The method memos tracked the theory development progress in terms of the work performed. Code memos detailed the definitions of the theoretical codes. Conditional Matrix In this study, the conditional matrix (Strauss & Corbin, 1990) was used as an analytic tool to describe and explain the theory of youth empowerment in the ecological context. In other words, youth empowerment at the level of action and interaction was interpreted in the broader context of the social, 80 economic and political conditions that influenced the actions related to youth empowerment. As an analytic tool, I found it helped with understanding how action and interaction between adults and youth were influenced by organisational and community support factors, in addition to policy. As youth took action to implement their plans, at times, they could not because of environmental constraints. It also contextualised the interaction as one piece of a broader social change process, which proved fundamental to understanding youth empowerment. Standards The criteria used to assess the knowledge claims derived from qualitative research is an area of continuing debate, surfacing in the literature as the "crisis of legitimisation" (Denzin & Lincoln, 1994). While several criteria are available to assess qualitative research, the debate revolves around what are the most appropriate criteria to use under certain methodological conditions (Corbin & Strauss, 1990; Kvale, 1995; Lincoln, 1995). Quantitative standards, in the past, have been applied to assess the knowledge claims derived from qualitative research (Kirk & Miller, 1986). Critics of this approach suggest that the standards of science should be modified to accommodate the products of qualitative research (Strauss & Corbin, 1990). The trustworthiness criteria developed by Guba and Lincoln (1989) represent an adaptation of the traditional canons of science for qualitative research. The trustworthiness criteria were applied to assess the knowledge claims derived from this grounded theory study. Trustworthiness refers to the credibility, dependability, transferability, and confirmability of the findings, each of which are reviewed below, as I have applied them in this study. I have applied Strauss and Corbin's criteria of generalizability to this study since this is most relevant for extending the findings of a grounded theory study (Corbin & Strauss, 1990). Credibility Credibility represents the qualitative counterpart of internal validity and refers to the congruence between the constructed realities of the participants and the realities conveyed by the researcher in the theory. Credibility is enhanced through prolonged engagement, member checking, persistent observation, peer debriefing, negative case analysis, and progressive subjectivity, each reviewed below. Prolonged engagement. Prolonged engagement refers to the researcher remaining involved in the 81 community for a sufficient period of time to overcome the effects of misinformation, distortion, or "presented fronts" on theory development. Distortions can affect the data in a number of different ways. The presence of the researcher in the community can elicit reactive rather than meaningful responses from the participants. Alternatively, the participants may present only what they think the researcher wants to hear, or portray themselves in a contrived manner. I found the participants were forthcoming in what they shared with me, and in the way they presented themselves, in part, by the sheer volume of negative evidence in the data. In one ofthe last interviews, however, I felt that one teen was trying to impress me with his/her knowledge. I did not use this section ofthe interview in the analysis. These situations are more likely to occur when rapport is not established between the researcher and the participants, which was not usually the case in this study. Rapport was established with most participants as I maintained involvement in the field. Prolonged engagement, however, can lead to over-involvement in the field, challenging the researcher's objectivity in the analysis (Guba & Lincoln, 1981). This was a potential concern in this study. The question becomes, to what extent do the relationships formed with the participants influence my ability to interpret the data? The reflective process inherent in participatory research combined with the participant's search for understanding ofthe process contributed to maintaining my "objectivity" in the analysis process. Objective is taken to mean judging the data fairly, without undue allegiance to particular parties. Without being true to the data, I could not inform the community action process, one ofthe goals of participatory research. There was one incident where I felt that I could not analyse the data fairly because of interpersonal conflict that arose within one of my working relationships. At that time, I stepped back from the analysis for one month, until it was resolved. This threat became less of a concern while out ofthe community context. While I maintained relationships with the practitioners throughout this process, I did not feel pressured or influenced to interpret the data in a particular way. Finally, two other researchers collected observation notes on the project, as I was involved. One researcher was involved for three months, and another while I was less involved in the field during a maternity leave. During these times, there was an overlap of notes. I found my assessments ofthe pattern of interaction between the adults and the youth were consistent with these researchers. 82 My role as a co-facilitator undoubtedly influenced the data, both positively and negatively. If my role led to the distortion of the data, I doubt that the theory would satisfy the theoretical criteria of work, fit and grab, as suggested by Glaser (1978). Member checking. According to Guba and Lincoln (1989), member checking is one of the most important techniques for establishing credibility. The labelling of the concepts in the theory, my interpretations of the data, and the hypotheses were verified through member checking, that is, by taking the theory back to the participants. Member checking occurred throughout the axial and selective coding process, until the final writing of the thesis. Member checking was integrated into the interviewing process by verifying hypotheses. As I moved into the final stages of the writing, I called the practitioners and youth with feedback from the analysis of their interview data, and changes in the theory. The thesis was then reviewed by one of the practitioners. Persistent observation. This refers to the researcher maintaining ongoing contact in the field to enable them to identify those aspects of the situation that are relevant to the theory. This was facilitated by prolonged involvement in the field, which allowed me to collect observation data and obtain ongoing feedback from the adults and the youth on the same incidents. These were incorporated into the field notes, or brief phone encounters. I could then check the different sources of information for similarities and differences as I moved through different phases of the analysis. For example, I was able to compare youth stories from the interviews with the observations. For youth interviewed at multiple time points, I could track changes in their perceived growth and development, and compare their perceptions with those of practitioners. Peer debriefing. Peer debriefing refers to the researcher discussing the emerging theory with her/his peers to gain fresh insight into the theory. Theory development is an intense process with the ultimate danger of becoming so immersed in the theory that one loses their perspective. During axial and selective coding, I remained in contact with a number of different colleagues to maintain and to enrich my theoretical perspective. Working with committee members at this time, speaking with other grounded theorists and colleagues, in addition to making two presentations lead others to challenge my interpretations of the data and 83 stimulated further thinking by asking questions. This facilitated the theory development process and suggested hypotheses for further verification. Negative cases analysis. Negative cases take on new meaning in the context of this study. It is intended to mean variation in the data, usually in an unpreferred direction. There were times, where positive cases were atypical, as reflected by the struggles inherent to the community action process. The project went through a period of struggling with youth participation while the youth pursued their goals. At one point, the youth became territorial which lead to interpersonal conflict and resulted in observations full o f negative incidents. At times, it was hard to find something positive, challenging me to rethink negative case analysis. I was able to capture this through persistent observation. A s well, the youth and the adults shared the positive and negative aspects of their experiences with me during the interviews. This was facilitated by my acceptance of community members. In the last set of interviews, I theoretically sampled youth who conveyed contradictory perspectives about the role of the adult in enabling young people. I also used the observation notes to cue adults and youth during the interviews to elaborate on negative incidents that had occurred, in part to check my interpretation, and as a cue for them to discuss other negative occurrences. Progressive subjectivity. This refers to the researcher monitoring their evolving abstractions ofthe theory over the course of analysis. If the data fulfils the researchers prior conceptions, then one must ask . whether the theory is grounded in the data. As I entered into the process, my understanding of empowerment was diffuse and unfocused, and certainly not focused on youth empowerment as a partnering process. M y preconceptions were informed by the assumptions of health promotion, as I understood it at the beginning of the study. I found, however, that much of what I had read on empowerment prior to this study acquired meaning as I went back to the literature, when I was writing up the findings. M y evolving conceptions ofthe theory are logged in the data set. M y struggle to accept the core as a partnering process, despite its obviousness, demonstrates in part my quest to pursue what was in the data rather than fulfilling any preconceptions that I may have had. 84 Generalisability. I have adopted an interpretation of generalisability that is most relevant for the findings of a grounded theory study (Corbin & Strauss, 1990). Traditionally, generalisability refers to generalising findings to some population. In the case of a grounded theory study, generalisability refers to the level of abstraction of the concepts, where "The more abstract the concepts, especially the core category, the wider the theory's applicability" (Corbin & Strauss, 1990, p. 15). Youth empowerment as a process of partnering is abstract, but not excessively abstract so as to be of little utility for practice, or for measurement. The theory identifies concepts that are supported by separate bodies of literature, for example, the mentoring and caring of the adults, or the belonging, self-esteem, competence, and youth development related to the youth component of the theory. These concepts, however, are embedded within high-levels of abstraction, namely social climate, enabling, participation, and social capacity. Thus, one generalises from grounded theory in the form of hypotheses and propositions for further testing and refinement. Transferability. To assist with the generalisation of hypotheses, however, one must know to which setting and populations the findings are transferable. Thus, the theory must specify the conditions under which it was discovered, consistent with Cronbach's (1982) view of reproducibility, which to some extent parallels Corbin and Strauss's view and Guba and Lincoln's (1989) notion of transferability. According to Strauss and Corbin (1990), the grounded theorist has a responsibility to specify the conditions under which the theory was discovered. This means that the researcher must link action and interaction at the level of the microsystem to organisational, community and policy level factors that have a bearing on processes within the microsystem. The research must also specify the conditions under which the theory was developed to allow other researchers to judge the transferability of the theory to another setting. This is achieved through thick description where the researcher provides detail of the population, the setting, the social and historical factors that influence the setting and the population. In this study, these conditions were included in the analysis using the conditional matrix and in the introduction and methodology chapters. Confirmability and dependability. Conformability and dependability are the parallel qualitative criteria for objectivity and reliability as used in traditional research. Confirmability is concerned with assuring that the data and interpretations are not simply constructions of the researcher's imagination, but are 85 grounded in the data. Dependability refers to tracking changes or shifts in the researchers maturing interpretation ofthe theory as they move through the data collection and analysis process. Therefore, it becomes imperative that the data can be traced back to their sources, that the theoretical relationships are coherent, and that the rationale for relating the theory is both explicit and implicit in the text. This means that both the theory and the process by which the theory was constructed are available for review. The references in support of the theoretical concepts and their linkages are logged in a separate copy ofthe findings. There were 415 sources of support, many of which were extracted from the same documents. The references were removed in the final printing ofthe findings to ensure anonymity ofthe sources. My thoughts and evolving conceptualisations were logged in the memos in the data set and in my hand written notes and diagrams. Using ATLAS/t i for data analysis provides an accessible means for tracking the data analysis process. 86 P A R T B : F I N D I N G S Theoretical Overview In this section ofthe dissertation I present the theoretical findings related to the core category of P A R T N E R I N G : T H E P R O C E S S O F Y O U T H E M P O W E R M E N T This section has two purposes: to present the theoretical concepts and linkages that emerged from the grounded theory analysis, and to tell the story ofthe process of youth empowerment in the community. The core category is described and explained in two chapters, each of which are presented separately in Chapter Four on Creating an Empowering Environment for Youth, and Chapter Five on Becoming Empowered. The Core Category P A R T N E R I N G : T H E P R O C E S S O F Y O U T H E M P O W E R M E N T 3 7 emerged as the core category in the grounded theory analysis. Youth empowerment as a partnering process is reflected by the relationships between the sub-processes: creating an empowering environment for youth and becoming empowered. The two sub-processes interact in the theory to describe youth empowerment as a partnering process between adults and young people where youth become empowered in an environment conducive to taking responsibility for their quality-of-life issues. The adults established the social climate for youth voicing, decision making and taking action and provided enabling support that fostered the development of youths' social capacity as they took responsibility and controlled the process, fostering their self-determination. In keeping with grounded theory tradition, the names assigned to the properties in the basic social process are characterised by gerund terms to engender the feeling of continuing process and change over time (Glaser, 1978). The overall theoretical framework is illustrated in Table 2. Each sub-process is described and explained by a set of properties and dimensions. The first sub-process, creating an empowering environment for youth is described and explained by two properties: (a) welcoming social climate, and (b) enabling youth in the community. This sub-process refers to the aspects of the social setting and the social roles ofthe adults in enabling youth to participate and to take responsibility for voicing, decision making and taking action in the community. The second sub-process, becoming empowered, is comprised of four properties: (a) 87 participating, (b) acting in the community, (c) developing social capacity; and (d) exerting influence. Youth become empowered as they were enabled in the context of a welcoming social climate. By acting in the community, youth incrementally developed their social capacity while exerting their influence.38 Table 2: Theoretical framework for partnering as a process of empowering youth Sub-process Properties Dimensions Creating an Welcoming Social Believing in youth Empowering Climate Youth voicing in the community Environment Youth decision-making in the community for Youth Youth taking action in the community Providing Opportunities The West End Youth Project Structuring the process Decision-making structures Caring Including youth Accepting youth Building trust Forming friendships . Buffering Respecting Acting-for youth Acting-with youth Encouraging Opening the door Inspiring with courage Motivating Enabling Youth Organising In the Getting organised Community Organising meetings Facilitating Guiding Mediating Enlightening Teaching Getting formal Getting informal Modelling Providing Feedback Offering advice Reassuring Reinforcing Mentoring Comforting Providing ongoing support Showing enthusiasm Committing 88 Sub-process Properties Dimensions Becoming Participating Getting Involved Empowered Having curiosity and interest Having a sense of social responsibility Needing to belong Expressing dissatisfaction Perceiving the project Organisational support Parent support Peer support Staying Involved Perceiving benefits Finding a place to belong Feeling supported Having a sense of social responsibility Having fun Organisational support Parent support Dropping Out Negative perceptions Apathy Experiencing tough times Moving on Acting in the Controlling the Process Community Taking responsibility Finding the balance Negotiating responsibility Voicing Getting the message out Gaining a voice Decision-making Getting comfortable Setting the agenda Taking Action Doing the work Advocating Developing Social Confronting the Challenge Capacity Learning through confronting Managing the stress Adapting Building Competence Voicing competence Participatory competence Leadership competence Advocacy Competence Sub-process Properties Dimensions Developing Self-Esteem Becoming Developing Feeling proud Empowered Social Feeling important Capacity Feeling good Finding meaning (continued) (continued) Gaining Confidence Believing in yourself Standing up for yourself Cultivating Belonging Belonging to the group Belonging to the community Developing Understanding Developing self-understanding Understanding the socio-political environment Exerting Achieving Goals Influence Experiencing success Making sense of the world Enhancing Youth Development Gaining autonomy Developing an identity Expanding opportunities Getting on track Realising potential Transforming the Environment Transitioning roles Establishing credibility 90 CHAPTER 4: CREATING AN EMPOWERING ENVIRONMENT The first sub-process, creating an empowering environment, refers to the action processes ofthe adult39 that make youth feel welcome to participate and take responsibility for acting in the community while promoting the development of their social capacity. Creating an empowering environment is comprised of two properties: (a) welcoming social climate, and (b) enabling youth in the community. Welcoming Social Climate Welcoming social climate is the first property of creating an empowering environment for youth. The social climate was characterised by the types of actions with which the adults engaged the youth in interaction. The welcoming social climate represented the small group process within which youth received enabling support from adults, as well as the characteristics associated with taking action in the community. In this study, the welcoming social climate was defined by: (a) believing in youth, (b) providing opportunities, (c) caring, (d) respecting, and (e) encouraging, each of which are reviewed below. Believing in Youth Believing in youth referred to the adults upholding and promoting a set of beliefs and expectations around the role of youth in the community, which provided the basis for the role transition of youth from passive to active members ofthe community. It was essentially these beliefs and expectations that set in motion a community organising process that established a welcoming social climate for youth participation, as conveyed by one ofthe community health nurses, below: Somebody needs to speak out in the beginning to believing kids to begin with, to say they are capable of things, "Let's let them try. Let's let them experience this." Then by doing it, you are expressing to the young people, "We believe in you." As conveyed above, the adults believed in the capacity of youth to act in the community. Beliefs about the capacity of youth to act informed the expectations related to youth acting in the community through the purpose statement for the West End Youth Project, as illustrated in the following excerpt from the terms of reference: To engage West End youth in identifying their own quality of life issues and solutions and involve them in the process of putting the solutions in place. 91 Thus, the beliefs were translated into expectations that youth would voice, make decisions and take action with the support of the community. These expectations were embodied in the terms of reference for the project, as well as the organisational policies and vision statements of the major collaborating agencies. Youth voicing in the community. First, the community-action process was based on the belief that youth could voice their ideas, opinions and concerns to others in the community, and the expectation that youth would voice their concerns. An excerpt from my observation notes illustrates a practitioner's belief and expectation in youth voicing as she introduced the project to the teens: This project40 is about young people having a say in what goes on in the West End. It's a way for all of you here to have a voice." I noticed that some of the sideline conversations had stopped, as the youth were now looking directly at the [adult]. "We want to involve young people from the beginning. The practitioner was trying to get youth to believe that they could share their ideas and opinions right from the very beginning of the project. Believing that youth could have a voice in the community was the beginning of awakening the youths' belief in themselves. Youth decision making in the community. Second, the community-action process was based on the belief and corresponding expectation by the adults, that youth could make decisions and would assume responsibility for making decisions related to their quality-of-life issues. This belief and expectation is illustrated by one of the community health nurses below: Eventually, we would like students to take a more active role in running this project. For example, decisions need to be made about money, and the budget and how we can keep students interested in the project. We'd like to involve you more in all aspects of decision making cause right now we are still making the decisions. We're asking you, but we aren't quite there yet. So um, what do we need before we can get you guys in the lead, in the driver's seat? What will it take to get you making decisions? The nurse expressed her belief and expectation that the youth would make decisions, recognising, however, that there was a process to youth making decisions in the project. Youth taking action in the community. Third, the community-action process was based on the belief and corresponding expectation that youth could and would take action on their quality-of-life issues in the community with the support of adults. This marked a transition from adults taking action on behalf of the young people in the community, to young people acting on their own behalf. This was demonstrated in the 92 data through the adults telling the youth, "We can do this, but we need to work together in our groups." In the example below, a practitioner conveyed to the youth their opportunity to plan a large event to report the findings from a school-wide survey to the community. Hanna [community health nurse] then asked how we should approach the principals about the plan for the reporting event, "This is your project," she exclaimed. Jane [youth] suggested that two or three people, "walk into their office with a plan and tell them about it." She suggested that it would be better to go the principal with a proposal in hand rather than going there to ask for school time, "otherwise the principal might not take us seriously." "Would any of you be willing to go see the principal and talk to her about it?" Hanna asked looking out at the teens. "I would," responded Jane, after a brief pause, after which Jordan, Mac and Veronica [participating teens] said they were interested. By believing in the capacity of youth to take action, the adults expected youth to act on their own behalf, rather than doing it for them, like Hanna could well have done. In the end, two ofthe youth approached the principal and the three of them came up with a modified version of their original proposal to accommodate the school timetable. While the community project was based on these beliefs, members of some collaborating organisations endorsed these beliefs in principle, but not in practice. In some cases, adults upheld these beliefs but could not devote their work time to partnering with the young people due to organisational constraints such as organisational mandates, the structure of their work time, and the orientation ofthe administrators. For those endorsing these beliefs and expectations in practice, these beliefs and expectations represented different points on a continuum by the major stakeholders partnering with the teens. The change agent set the standard for believing in the young people and served as a role model for those around her, myself included. These beliefs were strengthened with youth success and through observing their growth and development. The beliefs and expectations about youth were integrated into the West End Youth Project and the opportunities that the project for the young people. In other words, youth were viewed as assets and resources rather than community problems. The beliefs and expectations in turn influenced providing young 93 people with opportunities for meaningful participation in the community, as illustrated in the quotation below: Somebody needs to speak out in the beginning to believing kids to begin with, to say they are capable of things, "Let's let them try. Let's let them experience this. Let's give them an opportunity." And you have to create those opportunities in order for it to happen. I think that is the first part. Then by doing it, you are expressing to the young people, "We believe in you" even though they may never have heard that before, and they maybe don't even believe in themselves, but by the adults or the professional doing that, it is the beginning of the process of making the young people, or allowing the young people to believe in themselves. And also for other adults, other people in the community to be more aware that they may have not been including them and that they could be included. So I think it has to start at the very beginning, and then actually by the practitioners believing in the kids and telling them, it begins the process. Providing Opportunities Providing opportunities refers to the presence of meaningful and constructive opportunities for young people to take responsibility. In this particular study, opportunities became available to the youth through: (a) the West End Youth Project, (b) structuring the process, and (c) decision making structures, each of which are discussed below. The West End Youth Project.41 Providing youth with meaningful opportunities for participating was spawned by a shifting political climate in health and recreation policies. The philosophical assumptions of the new vision of health embodied in the World Health Organisations' Ottawa Charter for Health Promotion, the Healthy Cities Process 4 2 influenced the beliefs of the community health nurses. The vision of health as a resource for everyday living was translated into their practice through provincial support for the Healthy Communities Process. This initiative was aimed at creating conditions that supported health and improved equity in health through local health unit commitment to health promotion. Organisational support by their supervisors and colleagues facilitated the community health nurses to carry out this vision of health in their work. The community health nurses were encouraged to find new ways of integrating the vision of health into their practice, as conveyed by Hanna: The ideas started with the health department and they encouraged us to find ways to put those things into place, to find a new way to do our practice that would accomplish some of those goals (pause) and that would support people to have more control in their lives because we knew that those were some of the keys to making people healthier. It was that whole change in philosophy about how we could do prevention work instead of just looking 94 at lifestyle, to look at the community as a whole and how did the community support people. What were the things that would empower people to have more say? What would support them to feel that they had something to say and that they could make a difference in their own community? All those things are the things that was the change, and challenged us to really look at our practice The practice of community health nurses expanded to address the broader determinants of health. The nurses were encouraged to implement approaches to address this new vision of health, and were provided with the job flexibility and the decision-making latitude to do so. At the same time the community health nurses were setting the groundwork for the West End Youth Project, the Vancouver Board of Parks of Recreation developed and implemented its Blueprint for Youth Services. A youth development worker was hired in the local community centre with part of their work devoted to community development, the social development of youth and youth empowerment. Thus, the adults in the community came together with the support of health and recreation policies to advocate on behalf of young people and to create the opportunity for young people to engage in meaningful work. Structuring the process. Structuring the process refers to giving form and structure within the West End Youth Project, providing youth with a basic framework to follow. The structured process was a product ofthe community capacity building process where community agencies worked together with the change agent and the research partner to develop a road map for community action, the overall direction of which was determined by the youth. As conveyed by one ofthe teens, Jordan, the structure developed by the adults gave the teens some direction: They [the adults] offered an outline by which we could work with. Interviewer: What do you mean by outline? Well, you didn't know it was going to turn into a newspaper at the beginning, right? You had no idea. That was up to the youth. So you basically had an outline of what you were going to do, but after a certain point you didn't know, so you came to us with a budget with a certain idea of what you wanted to do, and then we took it from there, and you guided us If you guys hadn't of come, nothing would have happened. The youth wouldn't get it started on their own. We wouldn't know how to start it on our own. By providing a structure, the youth then had a road map to follow as a guide within which they created their own opportunities. As conveyed by Jordan, "nothing would have happened if the adults hadn't come." Thus, 95 an external agent was needed to initiate the social change process in the community leading towards the inclusion of young people into the community. Creating the opportunity was presented to the youth as a structured process, within which they were offered choices to determine the overall course of the project. Decision-making structures. Several opportunities were available to youth in the West End Youth Project through participating in its related decision-making structures. Within these structures the youth created their own opportunities and set their agenda, which allowed them to pursue their goals. Two types of participating structures were apparent in the community process: (a) youth structures for participating, (b) adult structures for participating. Youth structures for participating referred to those committees where membership was predominantly youth with adults providing Enabling43 support. These structures addressed the quality-of-life issues and concerns of young people. These structures included the youth council and the action committees that formed as issues were identified through the course of the project. The youth council was the umbrella youth organisation for the action committees and was represented by the action group leaders. The youth council formed for the following reason as illustrated by their mission statement: To create a united front that educates, supports, advocates for, and gives voice to youth in the community. It became a forum for the discussion of youth issues, planning and action within the community, and beyond the community. At the beginning of the community process, the action committees focused on the issues identified through the youth needs assessment: the lack of paid and volunteer jobs for youth, appreciating differences, DAS. (Drugs, alcohol and safety) - the concern for alcohol and drug use among use and the lack of personal safety, programs and activities were not based on the interests and needs of youth, environmental concerns, and the transition from elementary to high-school. Once the root causes between these issues were examined, the groups consolidated into three action committees centring on: (a) publishing a teen newspaper called W.E.T. News, (b) the transition program, and (c) advocating for a youth resource centre. The action committees changed over the course of the project based on the interests of the youth, and as new opportunities for participating became available. 96 At the beginning of the community process, the youth council (formerly known as the youth organising committee) met once per week, and later on, it met once per month. During this time, they planned and implemented a youth forum to report the findings of the youth needs assessment back to the school and interested community members, as well as an action planning workshop and presentations at Community Interaction Day. The newspaper group met weekly or biweekly. The transition action group was active annually from May until October to plan and implement activities to ease the transition from elementary to high school. The youth resource centre met as needed, about once per month. The committees met at different times, according to the amount of work that needed to be done. Adult structures for participating referred to those committees where youth held positions on traditionally adult-run boards and committees. They became voting members on agency boards and were required to submit a request for nomination, to be nominated by a member of the organisation, to be voted in, and then inaugurated. Youth on the project were represented on two community organisation boards, and two child and youth committees, as well as a temporary committee (the School Accreditation Committee) formed to address a particular issue that affected the youth. These groups met monthly. Here, youth influenced decision-making processes and actions that were relevant to the youth in the community, as well as other groups. When ideas were discussed, the adults expected youth to contribute, as conveyed by Veronica below: The adults look at you and ask you, "Well, do you agree with his position or what do you have to say?" And say, for example, you shy away and don't say anything, they'll look at you and they'll make you say what you think. Interviewer: How do they make you say what you think? Not make you say, but then they give you this look, or they'll ask you, "So what do you think?" And that way you have to talk. It's not like you hide away anymore saying, "well, I don't know what to say" because you have this whole bunch of people, or seven pairs of eyes or more staring at you, all waiting for you to say something. In accepting the youth on the boards and committees, there was an expectation that they would contribute to the committee. The committee structures became a forum for youth to Act in the Community, as will be demonstrated in the youth sub-process Becoming Empowered. Adults advocating on behalf of young people in the community spurred the implementation of the West End Youth Project, within which the youth created 97 their own committees. In some cases, adults like Taylor had to advocate for and educate board members in allowing youth to participate on the board, despite an organisational policy that expected that youth would participate on their board. Thus, ongoing advocacy by the adults in the community was necessary to include young people into the community's decision-making structures. The change process, however, was initiated through a change agent external to the youth. Caring Caring refers to the adults in the community showing a genuine concern for their youth, and caring about their ideas and opinions. Caring was demonstrated at two levels, the community and within the small group. The important aspects of caring are discussed with respect to: (a) including youth, (b) accepting youth, (c) building trust, (d) forming friendships, and (e) buffering. Including youth. Caring started with policies that supported the inclusion of people who did not have a voice in the community, as conveyed by the change agent spurring the community organising effort: Caring starts way back at the beginning with the idea. It started with Healthy Communities making sure that all the voices in the community would be heard, that they would be included. Caring about the youth in the community grew out of local implementation of the Healthy Communities Initiative where a community needs assessment identified youth as one of its issues, along with transportation, mental health, environment, safety and housing. Thus, the caring was borne out of an initial concern with including those groups who traditionally were not involved in decision making, and out ofthe realisation that power needed to be shared with citizens for their benefit and the benefit of the community. The West End became a caring community by providing opportunities for meaningful participation for its youth through the support of a community organising effort aimed at enabling their empowerment. Youth were recognised as assets and resources rather than community problems. Caring about young people and recognising their contributions to the community led to their inclusion in the community's decision-making structures through policy support and organisational commitment to the community organising process. The community project was the consequence of a community that cared about its young people. Accepting youth. Caring for youth meant caring for them as complete individuals from a holistic 98 perspective, as well as showing concern and regard for their ideas. Thus, acceptance was implicit in caring about youth and their ideas. The observation notes captured the caring ofthe adults as expressed through their gestures in their acting-with interactions with the teens. For example, take the normal introduction of young people to the meeting by the adults, as conveyed by the following excerpts from my observation notes: [The adult] stood up and welcomed all the teens to the meeting, "Welcome, its good to see so many of you here" she said with a big smile on her face. Eve responded by saying, "That's a good idea, but how can we get them to do that now that everyone has left?" The adult went up to Veronica and Mary as they were leaving and said, "Thanks so much for coming. It was wonderful seeing you again" with a beaming smile on her face. The adults demonstrated caring throughout the meetings, from welcoming the youth to the meetings with a cheery smile, to reinforcing their ideas during the meeting, to thanking them for attending the meetings. Caring about youth and their ideas was expressed through adults' interactions with youth, more specifically in demonstrating a willingness to listen, actually listening, questioning youths' ideas with sincerity and kindness while providing Enabling support. For youth, having adults care about their issues was essential to their participation in the process since many became involved out of their interest in a particular issue such as racism, the transition into high school, or the lack of jobs, for example. Though many youth became involved because they cared about a particular social issue, the reciprocation ofthe caring by the adults contributed to the welcoming social atmosphere. Ariel shared her feelings about how the caring of the adults contributed to her participation: Basically, I find caring important if I'm going to a group to talk about something because I like to know that people care not just about my ideas, they care about me as a person, as a youth. And if I feel that I'm not cared about, its more of a reluctance to participate. And I feel like the way you have made me feel, and Taylor, Hanna and Diane. They care about my ideas and about me as a person, me and my life, type thing. You need to know that you are respected, and just basically cared for. Caring about the youth when you come into the meeting, or whatever, you're coming to talk to the adult and as soon as you leave, you still know. It's not just like, "Oh, who cares." You know they still care. The youth talked about adults caring for her as a young person, beyond her contribution to the project, in addition to what she had to say. She perceived the adults as caring for her growth and development. Corroborating evidence from my observations and other interviews showed incidents reflective of caring 99 where the adults took it u