The main aim of the current study was to assess changes in ICRE in a sample of community members two years after the application of the empowerment expansion framework (see below) in the community of Rapla, Estonia. The specific objectives were as follows:

to assess the construct validity of the ICRE scale;

Several authors have defined empowerment as a construct that links individual strengths and competencies, natural helping systems, and proactive behaviours to matters of social policy and social change. Psychological empowerment is a process by which individuals gain control over their lives [4]. Empowerment is associated with feelings of competence to change a situation and with expectations of positive outcomes for one’s efforts [7,14,15]. Individual empowerment begins with an individual belief that what one is trying to accomplish is possible to achieve.

Researchers have noted that the development of a universal measure of individual empowerment may not be a feasible or appropriate goal, as empowerment differs among individuals, contexts and times [16]. Furthermore, empowerment is not understood as merely an individualistic characteristic; rather, it is related to perceived goals in one’s environment. The measurement of individual empowerment is problematic because empowerment may manifest in different forms of perceptions, behaviour, competencies and actions, and moreover, it may fluctuate over time [3].

Several researchers have identified somewhat different scales for the measurement of individual empowerment depending on the context and/or specificity of study group. Zimmerman [16] defined three components of IE: intrapersonal, interactional and behavioural. The intrapersonal component includes community-specific self-efficacy, motivation and intention to take action and control in an individual’s community. The interactional component refers to critical awareness and understanding of a given context. The behavioural component includes participation in collective action. In the context of ethnic identity, Gutierrez [17] specified group identification as a psychological component of empowerment for individuals. Parsons [18] identified characteristics of empowerment in the context of mental health services. One characteristic identified was the degree to which clients develop a critical awareness or critical thinking regarding system dynamics within the family or community with relation to power. McWhirter [19] described skill development, a characteristic that stresses skills in decision making and socialisation. Akey et al. [20] utilised data from 293 parents of children with disabilities living in three states in the USA and participating in family support programs aimed at empowering parents. The scale developed by these authors originally contained three subscales: attitudes related to control and competence, critical skills and knowledge, and participatory behaviour. Speer and Peterson [21] elaborated a 27-item scale for the measurement of IE and reported psychometric properties of a scale from a sample of 974 randomly selected people. They identified cognitive, emotional, and behavioural dimensions in community-organising contexts. The applicability of their measure was broad. However, they all recognised that modifications need to be made on the basis of the variety of contexts and settings in which empowerment may be applied.

Empowerment theory proposes that empowerment takes on different meanings in different settings [16]. The definition of ICRE employed in the current study combines multiple components: self-efficacy with self-confidence [22–24]; involvement in collective action (participation); motivation to be involved in community action [25]; willingness and intention to take action in the public domain [25]; and critical awareness that community issues are serious [9,26].

Self-efficacy is an individual’s confidence in their personal capability to organise and execute the course of action required to deal with prospective situations and belief in their capability to regulate their motivation, thought processes, emotional stages and the social environment, as well as behavioural attainment [4,14,25]. It is the belief that one has the skills and ability to achieve goals accompanied by perceived improvements in knowledge and skills through participation in community problem-solving processes [27]. Perceived self-efficacy with regard to dealing with community issues is associated with a sense of community [28,29] and with social action on community issues [14,15,25]. Perceiving that one can solve community problems is a prerequisite for community involvement [30].

Participation is the involvement in any community action that an individual attends without pay to achieve a common goal and/or social change [25,31].

Motivation is the belief that one should participate in community problem-solving processes as a responsibility to others [25,32]. Thus, people are motivated by a sense of moral responsibility to redress practices or change conditions that they perceive to be unfair [33].

Intention to participate is an anticipated outcome that is intended or that guides one’s planned action [25].

Critical awareness is the sense of the importance of community issues and understanding of the purposes of community action [27]. Critical comprehension and knowledge of social and political contexts is a prerequisite for the cultivation of both individual and collective resources and skills related to social action [23].

Essentially, ICRE is an active type of community orientation in which an individual wishes and feels able to shape his/her role and context [16]. The applicability of this measure is broad, but modifications need to be made on the basis of the variety of social work settings in which empowerment may be applied.

The current study was undertaken in Rapla County, Estonia, which is a small agrarian inland community of 37,000 inhabitants. There is high employment rate and relative poverty of Rapla County’s population is high in comparison to other regions of Estonia [34]. Several health promotion interventions have been initiated in Rapla, which have been directed to different health issues. Until the current study, previous assessments of health promotion initiatives were mainly focused on measuring changes in health outcomes. In 2002 an empowerment expansion study was designed simultaneously to expand empowerment in communities and to assess changes in the organizational domains of community empowerment and also in ICRE of the participants involved in community health promotion programs [35]. This evaluation was premised on a two-pronged approach that comprised an internal evaluation undertaken by the community members and an external evaluation undertaken by a person external to the programs. The current study is an external evaluation of the ICRE. The study involved participants from three community health promotion initiatives in Rapla County: the Safe Community program; Drug Abuse and AIDS Prevention programme; and Elderly Quality of Life program. Short description of the essence of community health promotion interventions is presented in Table 1.

The community workgroups constructed an empowerment expansion framework (Figure 1) to achieve and assess changes in empowerment and health in the three different programs that were being implemented [35]. The framework was based on models of empowerment evaluation, as suggested by Fettermann [36], and the parallel tracks model elaborated by Laverack [37]. Empowerment evaluation is a process through which community members in collaboration with health promotion practitioners learn to evaluate their own programs and work together toward the improvement of the quality of their common program using several pragmatic steps.

Empowerment evaluation is the use of evaluation concepts, techniques, and findings to foster improvement and self-determination [36]. The advantage of the model is that it suggests a clear step-by-step empowering guide. Its limitation is that it does not suggest how to measure changes in empowerment [35].

The ‘parallel tracks’ program planning model elaborated by Laverack [37] integrates an empowerment approach within an issue-specific approach ensuring focus on both empowerment process goals and issue-specific goals. The advantage of this model is that by clarifying and distinguishing empowerment domains, participants are able to easily assess changes in empowerment during an intervention course and measure empowerment domains. The limitation of this model is that it does not clearly demonstrate the precise steps involved in the empowerment approach.

The empowerment expansion framework creates an opportunity to simultaneously expand empowerment in a community, achieve expected outcomes related to community needs and evaluate changes in both tracks. The framework of the empowerment expansion comprised four stages:

Stage I—assessment of ICRE (undertaken by an external evaluator among the participants in the three community programs) and evaluation of the organisational domains of community empowerment (ODCE). The latter process is beyond the scope of the current study and is not reported here.

Stage II—planning of community empowerment. This included the formulation and statement of the empowerment expansion (undertaken by workgroups in each of the three community programs, where goals and objectives for the empowerment expansion were defined; measurable indicators and measurement processes were identified; and action plans were agreed upon).

Stage III—consisted of two parallel implementation processes:

Empowerment expansion processes: included numerous activities targeted at the development of the four ODCE domains (Table 2). These processes were debated, formulated and planned by the community while being supported, facilitated and mediated by a health promotion practitioner and an internal evaluator; and

Stage IV—evaluation of changes in community members’ ICRE (and assessment of the ODCE, which is not in the scope of the current paper).

Two sets of data were collected. Ethical committee approval was not sought because in Estonia, studies that involve the voluntary participation of adults and have informed consent are exempt from further ethical approval.

The first dataset was used to investigate the multidimensional nature of the ICRE construct in the Estonian context and to assess the content validity and reliability of its dimensions. Questionnaires to be self-completed were mailed by regular post during April–May 2003 to a cross-sectional random sample of 1,000 inhabitants from Rapla County (selected from the National Population Register). Two reminders were subsequently mailed to those individuals who did not respond. The response rate was 67.1%. Respondents’ (n = 671) ages ranged from 17 to 71 years (Mean = 42; SD = 14.18). 392 (58.42%) female and 279 (41.58%) male respondents were included.

The second dataset was employed to assess changes in participants’ ratings of the dimensions of the ICRE. This sample consisted of all 120 voluntary participants from the three community programs who were involved in at least two program activities during the first intervention year of any of the three programs before the implementation of the empowerment expansion model. Two waves of the same self-administered questionnaire that was utilised for the first dataset were sent electronically: the first wave was sent one month before the first workshop related to application of the empowerment expansion framework in each community program separately (pre-test, 2003); and the second wave was sent after the last (third) workshop of the programs (post-test, January 2005). Additionally, two electronic reminders were sent to non-respondents, and phone interviews were undertaken with three individuals who did not respond electronically.

The pre-test was undertaken in 2003 (response rate 100%). Respondents’ (n = 120) ages ranged from 24 to 65 years (Mean = 43; SD = 10.9), and the sample comprised 78 (65%) women and 42 (35%) of men (Table 4). Of these participants, 22% had attained a primary level of education, 61% a secondary level, and 37% of the participants had a university education. With respect to the employment and affiliation of these individuals 19,16% were retired community members; 14,6% were people from the non-governmental sector; 10,83 worked in agriculture; 9,16% worked in the preschools and the same percentage in social work; 7,5% in the education system; 6,6% worked in the service and the same percentage in recreation sector; 3,33% were civil servants and students; 5% worked in the health care system; 2,50% were unemployed during the first measurement. In 2005, the post-test was undertaken. A total of 115 completed questionnaires were received during the post-test, which represented 95.8% of the pre-test participants. Five of the respondents who completed the pre-test had subsequently moved away from the community or were not available and, hence, were excluded from the current analysis. The mean age was 45 (SD = 10.51), and the sample consisted of 73 (63.48%) women and 42 (36.52%) of men.

There are few instruments that measure ICRE. For instance, Israel et al. [22] developed a 12-item perceived control scale to assess empowerment at individual, organisational and community levels (internal consistency α = 0.63). Similarly, Oman et al. [38] proposed a 6-item community involvement scale, and Reinigen et al. [12] suggested a youth empowerment scale (both with α = 0.78). Likewise, Spreitzer [9] developed a tool to evaluate IE in the workplace environment (12 items) that had a reliability coefficient 0.72. The present study utilised the mobilization scale–individual [39]. This scale was selected because most of the scale’s items emphasised participants’ perceptions of having the requisite abilities and motivations to make a difference in their communities. The original scale consists of nine subscales and 49 propositions. Five subscales (self-efficacy, participation, motivation, social assets and human capital) consisting 30 questions were selected as most appropriate for study context. The questionnaire was translated from English into Estonian language by two translators independently. Thereafter, the method of back-translation [40] was employed to determine the equivalence between the primary and secondary language tools. After the back-translation, the original and back-translated questionnaires were compared, and points of divergence were noted. The scale components were modified during a workshop in which Rapla community members were invited to respond to the items and discuss their cultural understanding and relevance to their community.

The content validity of the translated questionnaire was assessed by an expert panel of six health promotion experts. Each item in the questionnaire was discussed and rated as ‘essential’ (1) or ‘not necessary’ (0), and the content validity ratio (CVR) was calculated using the formula developed by Lawshe [41].

The final questionnaire consisted of 20 items rated on a Likert-type five-point scale (1 = ‘strongly agree’, the most favourable perception, to 5 = ‘strongly disagree’, the most unfavourable perception). The questionnaire considered the multidimensional nature of empowerment and allowed the assessment of the five dimensions of ICRE: self-efficacy related to an individual′s attitude toward social change in the community (7 items, e.g., “I have confidence in my capabilities to make the changes needed in my community”); participation in community activities (3 items, e.g., “I participate in community activities”); intention to become involved in community change (4 items, e.g., “I intend to take action in my community”); motivation to be involved (3 items, e.g., “I am motivated to get involved in my community”); and critical awareness that community issues are serious (one item, “I think that the problems in my community are serious”). Collectively, these dimensions provided a broad picture of ICRE.

The software package SPSS 12.0 was used for the statistical analysis of the data. For the first objective of the study, to assess the construct validity of the ICRE scale, we employed Lawshe’s [41] formula: CVR = (n < item > e + n < item > e)/(N × n), where ne = number of experts rating essential, and N = number of items. To investigate the multidimensional nature of the ICRE construct within the Estonian context, the first dataset was used, for which factor analysis was employed to extract the factors by applying principal components analysis (varimax rotation) (Table 5). To assess the reliability of the ICRE scale, we used internal consistency coefficients measured by Cronbach’s alpha, which were undertaken twice: collectively for the total empowerment scale and individually for each of the five empowerment dimensions. To assess the changes in the participants’ ratings of the dimensions of the ICRE before and after the application of the empowerment expansion framework, we compared the pre-test and post-test results using an independent sample t test (one way ANOVA). Significance level was set at p < 0.5.

Employing the formula suggested by Lawshe [41], the content validity ratio of the ICRE scale was 0.98, which is acceptable according to Davis [42] and Lawshe [41].

The dimensionality of the scale was evaluated by factor analysis (Table 5) using Kaiser’s criterion (eigenvalue > 1) [43]. The Kaiser-Meyer scale was .93, which is defined as very good [43]. Table 5 shows that five ICRE dimensions (factors) (i.e., self-efficacy, intention, participation, motivation and critical awareness) emerged relatively clearly. However, two items (intention—“I pitch in when there is work to be done”, and critical awareness—“I feel that community issues are important”) exhibited fairy low loadings on their associated factors and relatively high loadings on other components. All remaining factors presented relatively strong loadings on their individual components. The factors consisted of three to seven items each (though only one item for the factor critical awareness). Collectively, the five dimensions explained 62.91% of the variance in ICRE. With respect to each of the individual dimensions, self-efficacy explained 20.37% of the variance, intention 16.96%, participation 11.97%, and motivation 7.22%. Their corresponding Eigen values (a common criterion for a dimension to be useful) were 8.52, 1.91, 1.25 and 1.02 [44].

Cronbach alpha coefficients were used to assess the reliability of the scale (Table 5). The internal consistency (Cronbach’s α) of the total scale was 0.859, which is very good [45]. Likewise, the internal consistencies of the three sub-scales comprising three dimensions (Self-efficacy 0.883; Intention 0.834; Participation 0.808) were very good. The Motivation dimension had a lower α (0.69), which is considered satisfactory. Critical awareness comprised only one item, and hence, α was not applicable.

Table 6 presents the means and standard deviations of the empowerment scale at the beginning of the application of the empowerment expansion framework and two years after its application. Generally, the means of the post-test (2005) for the five dimensions of empowerment and for total empowerment were more favourable than their pre-test means (2003). These changes were statistically significant for four of the five dimensions (self-efficacy, participation, intention, and motivation).

These findings suggested that respondents’ perceptions of their self-efficacy related to community problem-solving had increased in 2005 in comparison with the 2003 data. Participants’ confidence in their capabilities to undertake the required changes in their communities had increased, as respondents felt they could influence their communities to take action on important issues. Furthermore, respondents’ motivation to participate, intention to participate and actual participation in community activities had all increased. Similarly, respondents’ critical awareness of the seriousness of the community issues also exhibited a moderate increase, although the increase was not significant. Nevertheless, the 2003 data indicated that the critical awareness component of empowerment already presented a high value during the pre-test period, suggesting that for these three programs, respondents’ baseline awareness of community problem seriousness was already high before the initiation of the programs.