Rethinking Empowerment in Healthcare: A Dynamic Continuum.

Empowerment is a widely used term in healthcare literature, policy and practice, but its meaning is often inconsistent and increasingly framed as an individual outcome linked to self-management, responsibility and compliance. However, such framings risk oversimplifying empowerment and reinforcing neoliberal and paternalistic assumptions that place responsibility on individuals while overlooking wider relational, systemic and contextual influences. Drawing on findings from constructivist grounded theory research with people affected by advanced liver disease, carers and healthcare professionals, I propose that empowerment is not a fixed state or something that can be delivered by professionals, but rather a dynamic, relational process that exists on a continuum and frequently co-exists with disempowerment. Rather than being an outcome to be achieved, empowerment is enacted through everyday actions, relationships, resistance and navigation of constraint across patients, carers and professionals. The paper proposes a reconceptualisation of empowerment as relational, contextual and co-produced, with implications for moving away from notions of empowerment as professional intervention or individual achievement.