Next level health : the design, implementation and evaluation of a programme to empower women over their health :|ba thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Health Sciences, Massey University, Wellington, New Zealand

Abstract

New Zealand women often experience a narrow focus on weight or body size as a barrier to health. This dominant Western “weight-centred” discourse conflates health with weight and disempowers women from gaining control and autonomy over their health. This thesis aimed to design, implement and evaluate Next Level Health (NLH); a strengths-based programme founded on values of empowerment and holistic health. NLH aims to empower women over their health through incremental behaviour change within the context of their daily lives across six domains: physical activity, sleep, nutrition, eating behaviour, self-care and stress management. Fifty-eight women, aged 18-40 years completed NLH. A mixed-methods convergent design guided the evaluation of women’s outcomes and programme implementation. Data were collected via a series of surveys and physical measures. The outcomes assessed were women’s health-promoting behaviours (HPBs), physical, mental and social health and participant perceived outcomes. Process evaluation comprised the programme’s reach, fidelity and participant satisfaction. The findings were then analysed and integrated to determine women’s empowerment over their health. Collectively, the outcomes women experienced after NLH contributed to their empowerment by increasing their capacity for HPBs, adopting and experiencing a holistic health approach and enhancing their autonomy regarding their HPBs, health development and ability to generate a sense of success. Additionally, eight factors were identified that were key attributes of the programme that contributed to women’s empowerment or were vital for evaluating their success: (1) a small goals approach; (2) dialogue; (3) social support; (4) a multidisciplinary approach; (5) a strengths-based approach; (6) a weight-neutral approach, (7) assessment across multiple health dimensions and (8) a mixed-methods design for evaluation. In sum, the findings suggest that NLH successfully empowered women to gain greater control over their health. NLH overcomes common shortcomings of dominant health interventions by using a positive, multidisciplinary and empowering approach to promote women’s health that was adaptable to individual contexts, and exhibits potential for producing sustainable change. The current study contributes a novel programme and comprehensive evaluation providing evidence for a small, yet growing, body of empowerment research to promote women’s health.