Soares et al.

BMC Public Health (2015) 15:775

DOI 10.1186/s12889-015-2113-7

RESEARCH ARTICLE Open Access

Individual and collective empowerment and

associated factors among Brazilian adults:
a cross-sectional study
Marcia Fatima Soares1,2*, Rachel Conceição Ferreira3,4, Camila Alessandra Pazzini5,6, Denise Vieira Travassos3,7,
Saul Martins Paiva8 and Efigênia Ferreira e Ferreira3*

Abstract
Background: The empowerment embedded in the health area is defined as a process that can facilitate control
over the determinants of health of individuals and population as a way to improve health. The aim of this study
was to verify the association between individual and collective empowerment with sociodemographic conditions,
lifestyle, health conditions and quality of life.
Method: A cross-sectional analytical study was conducted with 1150 individuals (aged 35 to 44 years). The
empowerment was determined by questions from the Integrated Questionnaire for the Measurement of Social
Capital (IQ-MSC). The quality of life was measured using the WHOQOL (World Health Organization Quality of
Life-Bref). Lifestyle and health conditions were obtained by adapted questions from the Fantastic Lifestyle
Questionnaire The DMFT Index was incorporated in the health conditions questions. Logistic regression or
multinomial regression was performed.
Results: The practice of physical activity was related to individual (OR: 2.70) and collective (OR: 1.57) empowerment.
Regarding individual empowerment, people with higher education level (5–11 years – OR: 3.46 and ≥12 years – OR: 4.41),
who felt more able to deal with stress (OR:3.76), who presented a high score on quality of life (psychological
domain) (OR:1.23) and that smoked (OR:1.49) were more likely to feel able to make decisions and participate in
community activities. The increase in the DMFT Index represented less chance of individuals to feel more able to
make decisions (OR: 0.96). Regarding the collective empowerment, being religious (catholic) (OR: 1.82), do not
drink or drink just a little (OR: 1.66 and 2.28, respectively), and increased score of overall quality of life (OR: 1.08)
were more likely to report that people cooperate to solve a problem in their community.
Conclusion: The two approaches to empowerment, the individual and collective are connected, and the physical
activity showed to be a good strategy for the empowerment construction.
Keywords: Empowerment, Social capital, Lifestyle, Health conditions, Quality of life, Adults

* Correspondence: [email protected]; [email protected]

1
Student in Public Health at Faculty of Dentistry, Universidade Federal de
Minas Gerais Belo Horizonte, Av. Presidente Antonio Carlos, 6627, Belo
Horizonte 31270-901 Minas Gerais, Brazil
3
Department of Social and Preventive Dentistry, Faculty of Dentistry,
Universidade Federal de Minas Gerais, Av. Presidente Antonio Carlos, 6627,
Belo Horizonte 31270-901 Minas Gerais, Brazil
Full list of author information is available at the end of the article

© 2015 Soares et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
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article, unless otherwise stated.
Soares et al. BMC Public Health (2015) 15:775 Page 2 of 11

Background ability was observed [12] on those who were classified

The Lalonde [1] report published in 1974 is considered with high social capital.
a starting point in the worldwide movement of Health Some authors observed an strong inverse association
Promotion. It brought a new understanding of the determi- between collective social capital and dental pain [13], dental
nants of health and the need for more health care actions. caries [14] or dental loss [15], all relating the results to the
In addition to clinical care, there is a need for interventions power of the community.
in the environment, risk moderation and better under- However, others observed an inverse association between
standing of the complexity of the individual and their high social capital and benefits to health, such as the small
social context. dental care usage of adults with high social capital [16].
After this report, the resulting actions regarding in- Few studies evaluated factors associated with em-
vestments in lifestyle and self-care brought changes in powerment, which facilitates or make in more difficult
the 80s. The better understanding of the social context its construction. In a study with young refugees who
in which human being live, and their influence on be- participated in an integration program to newcomer
havior change for health, exposes a certain weakness in youth in Canada [17], difficulties in the empowerment
expected results [2]. construction were observed. The authors identified that
Health promotion is seen as the main strategy for the sense of belonging, positive self-identity, emotional
reducing morbidity and early mortality. This strengthens well-being and the auto-determination could allow or re-
one guideline: the individual and collective empowerment strict the building of the individual empowerment. These
to participate actively in the health-building process. With factors can be found in population at different ages, but
the need to involve all segments of society, the concept of particularly among the marginalized.
empowerment is incorporated as a centerpiece of Health Therefore, this subject is relatively unexplored. To better
Promotion [3]. understand what contributes to the individual and
Historically, the term empowerment has its origin in community empowerment construction, the aim of this
movements for social justice in the 60s, such as the study was to verify the association between empowerment
mobilization of blacks, women and homosexuals, all in and sociodemographic characteristics, lifestyle health
defense of human rights and social justice [4]. The health conditions and quality of life.
empowerment is defined as a process that can facilitate
control over the determinants of health as a fundamental Methods
strategy for achieving health [3]. This study is part of a Project (The oral health of adults
Empowerment can occur at two levels: the psychological/ in the Metropolitan Region of Belo Horizonte (MRBH):
individual and the community/collective. The individ- objective and subjective aspects) started in 2010 and
ual level refers to the greater ability of individuals to developed in the Public Health Graduate Program, at
feel strong to make choices in their lives. The collective the Faculty of Dentistry of the Universidade Federal de
empowerment refers to the capacity of a community, Minas Gerais.
through the participation process, to achieve collect- It is a cross-sectional study among adults, male and
ively defined goals [5]. female, 35 to 44 years old, which is a standard age
An effective empowerment process requires the involve- group for oral health conditions surveillance in adults
ment of individual and collective levels. The community [18], living in MRBH (32 municipalities).
with established social values can influence the lifestyles of Belo Horizonte is the capital of the Minas Gerais state,
its individuals, even among the empowered [6]. The life- located in the southeast of Brazil and is the 6th largest
style is one of the four determinants of health groups [1]. city and the third largest metropolitan area in Brazil [19].
If worked isolated, it does not include social and cultural The MRBH is a political, financial, educational and cul-
determinants. tural center of Minas Gerais representing around 25 %
While the empowerment processes is been significantly of the population and 40 % of the economy of Minas
associated with health outcomes, including self-care Gerais state.
behaviors [7, 8], especially if the modifications include The method used for sample size calculation was to
a supportive social environment [9, 10], it must not be estimate proportions with a correction for the finite
considered a solution itself and may present positive or population. The methodology and data collection
negative results [7, 10]. instruments were tested in a pilot study involving 98
Some studies were dedicated to the empowerment theme, participants with the same age group, randomly selected
most of them by means to measure social capital, since in one municipality in the region, not included in the
it is considered an empowerment domain [11]. Dimensions study.
evaluated in these instruments could determinate the The pilot study allowed to verify the distribution of
capacity to act in own benefit or for the community. This adults in the parameters to be investigated and the issues
Soares et al. BMC Public Health (2015) 15:775 Page 3 of 11

related to empowerment [20]. The frequency of individuals community activities and feel able to make a decision;
who responded positively to the items was used in the cal- 4. did participate in community activities and feel able
culation of the sample size. It was assumed an 80 % power, to make a decision. Thirty-seven (3.6 %) individuals who
5 % significance level and a design effect equal to 2.0, to were in category two were excluded from data analyzes.
compensate the minor variation in the cluster sample. The Maintaining this category in bivariate and multivariate
sample was calculated from 758 individuals, with a 20 % analyzes, resulted in very imprecise estimates. Another
addition compensating possible losses, with a total of 934 design would need to include this group with sufficient
individuals. Although this is a cross-sectional study, losses sample of those individuals who participates in com-
could be the fact that individuals could not accept to take munity activities and feel unable to make a decision.
part of the study or could not be located at home after The collective empowerment was assessed through a
three attempts. question of scale collective action and cooperation “If there
For sample selection, it was considered the total of inhab- was a problem of water supply in this community, what is
itants in each municipality, grouped according quartiles of the probability that people cooperate to solve the problem?”
population size. Two municipalities in each quartile were This question was selected because it is a common problem
randomly selected. The cluster sampling was used to select in smaller municipalities and an uncomfortable issue to
blocks from municipalities with up to 50 thousand (Cluster the population. The answer options were grouped into
I) and census tracts and blocks from municipalities with two categories for the variable composition: 1-Unlikely/
over 50 thousand inhabitants (Cluster II). The number of neither likely nor unlikely; 2-likely.
adults examined was proportional to the population of the The intention was to be able to measure the empower-
municipality. All residences located in randomly selected ment of the community where the individuals live.
blocks were visited. The independent variables considered were: Sociode-
Data collection was performed by a structured ques- mographic characteristics: sex (male or female), age (35
tionnaire in the form of interviews and oral health eval- to 39 and 40 to 44 years old), total years of education
uations in the participant’s households between May (<4, 5 to 11 years), ethnicity (black/yellow/indigenous/
and December of 2010. The oral health evaluations brown or white), marital status (with or without com-
were conducted under natural light using mirrors, dental panion), religion (no religious, Catholic or otherwise -
plans and wooden spatulas. The condition of the tooth Protestant/evangelical/spiritualist/Jehovah witness), per
crown was recorded according to the WHO criteria [18], capita income, time residing at this location; Lifestyle:
excluding third molars. This was the only data that com- physical activity (very little or no); smoker (very little
posed the “health conditions” variable group. or no); drinking (very little or no); Health conditions:
For the oral health evaluations, an expert performed general health perception (very bad/poor, fair, very
the theoretical calibration of five researchers, presenting good/good); health problem that causes pain (yes or
photographs of clinical conditions to be study. The no), ability to handle the stress of everyday life (very
agreement on the clinical examination was tested with little or no), ability to relax and enjoy leisure (very, little or
12 volunteers at a dental clinic in a teaching institution, no), presence of toothache in the last three months (yes
yielding kappa values ranging from 0.81 to 0.92 interob- or no), the average DMFT Index (number of decayed,
server, and 0.80 and 1.00 intraobserver. missing and filled permanent teeth).
The dependent variables for analyzes were individual Besides these data, we measured the quality of life using
empowerment and collective empowerment, built on issues the WHOQOL (World Health Organization Quality of
of the Integrated Questionnaire for the Measurement of Life-Bref ) version with 26 items, validated in Brazil
Social Capital (SC -IQ) [20]. The individual empowerment [21]: two general questions and 24 questions assessing
variable was created from the combination of two ques- physical, psychological, social and environmental fields.
tions, components of empowerment dimension and polit- The quality of life scores were computed with range
ical action: “in the last 12 months, have you or someone in 4–24 points, and higher scores indicate better quality
your household participate in any community activity where of life. Fifty-two participants who answered less than
people gather to do some work for the benefit of the commu- 21 questions of the WHOQOL were excluded from
nity?” (Yes: No), and “you feel you have the power to make the analyzes, following the guidelines for implementa-
decisions that could change the course of your life?” (totally tion and analyzes of the instrument. Variables of life-
unable; able or unable; fully capable). style related to stress and ability to relax were obtained
From the combination of the answers to these two from questions adapted from the Fantastic Lifestyle Ques-
questions, four categories were established in this variable: tionnaire [22].
1. did not participate in community activities and unable to The variable per capita income, time living in the same
make a decision; 2. did participate in community activities place, and DMFT Index scores of quality of life were
and feel unable to make a decision; 3. did not participate in included in the statistical and quantitative analyzes.
Soares et al. BMC Public Health (2015) 15:775 Page 4 of 11

Statistical analyzes were conducted using Stata Statistical with a minor loss only to the relax and enjoy leisure time
Software (StataCorp LP version). Initially, was performed a variable (deff = 2.21).
descriptive analyzes to obtain mean, standard deviation and In the bivariate analyzes, variables associated with indi-
proportions. Univariate analyzes were performed to identify vidual empowerment with p < 0.25 were: sociodemographic
factors associated with individual empowerment and (years of schooling, time living in the same place, religion),
collective factors. Logistic regression and multinomial lifestyle (physical activity, smoking, alcohol consumption),
regression was the performed analyzes. For the final health (perceived health, ability to cope with stress, to relax
model, only variables associated to empowerment with and enjoy leisure), quality of life (physical, social, environ-
p < 0.25 were included. All analyzes were performed mental, psychological and overall) and DMFT Index.
with design effect correction. The svyset command in The multiple analyzes (Table 4), demonstrated that
Stata was used to analyze data of complex samples, individual empowerment was positively associated in the
considering the levels of sampling and sample weight two categories used (did not participate/feel capable) to
svyset sector [pweith pesoamostral =]| |block. All fur- higher education, plenty physical activity, tabagism, more
ther analyzes were conducted using the svy command. ability to handle the daily stress and quality of life (psychic
The Ethics Committee of the Universidade Federal de domain) and DMFT Index (only non set analyzes). The
Minas Gerais, approved this study with the Protocol more DMFT the less the chance to feel capable to make
number CAEE0096.0.203.000–09 on 26/03/2009, and all decisions to change the course of life.
participants signed an informed consent. The same factors, except the DMFT Index, were asso-
ciated with greater participation in community activities
and the increased feeling of being able to make decisions
Results that change the course of life. However, OR values are
The sample included 1150 adults, most females (66.63 %), higher indicating the additional association of the inde-
52.30 % had between 35 and 39 years old; 50.58 % pre- pendent variables on participation in community activities
sented five to 11 years of education; 72.72 % were Brown/ (Table 4).
Black/Yellow/Indigenous; 71.49 % were living with a part- The variables associated with collective empowerment
ner and 48.99 % were Catholic. The average per capita in- (p < 0.25) in the univariate analyzes were skin color, marital
come of the participants were $255 (SE = 49.76) and lived status, religion, physical activity, alcoholic consumption,
an average of 14.8(SE = 0.70) years in the same location. general health perception, overall quality of life, social and
Regarding the life style, physical activities were still re- environmental domains of the quality of life.
stricted (61.95 %; no), the alcoholic beverages consumption The multiple model remained significantly associated
(61.13 %; no) and smoking (79.1 %; no) were low. In the with collective empowerment: to be Catholic, do plenty
questions related to health conditions, the participants physical activity, do not ingest alcoholic beverage or just
considered themselves with very bad/poor, fair health a little, and higher overall quality of life (Table 5).
(68.49 %), with presence of health problems that caused
pain (40.46 %) and toothache in the last six months
(24.10 %). Almost fifity seven percent (56.65 %) of the par- Discussion
ticipants self-declared capable to relax and 62.97 % the Measuring empowerment of individuals and communi-
ability to handle the daily stress The average DMFT Index ties is challenging. The option to use a questionnaire as
was 16.91 (SE = 0.27) (Table 1). a tool was considered feasible and possible and was the
The median and interquartile range of quality of life choice in this study. The metropolitan region of Belo
scores were: physical domain (16.57, 3.43), psychological Horizonte was excluded from this study sample due of
(15.32, 2.80), social (16.0, 4.0), environment (13.0, 3.0), the size (approximately 2.5 million inhabitants) and the
total score of quality of life (16.0, 2.0). peculiarities of a large urban center, showing the highest
Regarding individual and collective empowerment, social indicators compared to other municipalities in the
most adults reported that even if they felt able to make a region [19].
decision to change their course of life and declared non- Since the sample selection was made according to
participation in community activities (59.82 %), 62.91 % population size (two municipalities in each quartile),
reported that the community probably would collaborate in the 32 municipalities of this study were included
on the water supply problem (Table 2). municipalities with less than nine thousand inhabitants
The results of descriptive analyzes among independent (quartile 1) and municipalities with more than seventy
variables and individual and collective empowerment, and thousand (quartile 4).
the deff associated with each estimate is shown in Table 3. The demographic characteristics of our study sample,
Regarding the choice for deff = 2, the sample representa- is representative of the Brazilian population standard
tiveness is confirmed once it was sufficient for all variables, [11, 23], not only in the range size of the population, but
Soares et al. BMC Public Health (2015) 15:775 Page 5 of 11

Table 1 Characterization of the sample according to the Table 1 Characterization of the sample according to the
independent variables investigated independent variables investigated (Continued)
Totala % (95 % IC) Ability to handle the stress of every day
Sociodemographic life (n = 1121)
Sex (n = 1150) No 8.52 (6.39–10.66)
Male 33.37 (18.90–47.84) Little 28.51 (25.11–31.91)
Female 66.63 (52.16–81.10) Much 62.97 (58.66–67.28)
Age (n = 1150) Relax and enjoy leisure time (n = 1129)
35 e 39 52.30 (48.06–56.54) No 13.46 (11.54–15.38)
40 e 44 47.70 (43.46–51.94) Little 29.89 (26.03–33.75)
Years of study (n = 1144) Much 56.65 (52.27–61.03)
≤4 41.15 (33.27–49.02) Toothache in the last three months (n = 1116)
5 a 11 50.58 (43.99–57.17) Yes 24.10 (20.95–27.63)
≥12 8.27 (5.10–11.45) No 75.90 (72.74–79.05)
Skin color (n = 1067)
Brown, Black, Asian, and Indigenous 72.75 (67.95–77.55) regarding aspects such as a high percentage of women
White 27.25 (22.45–32.05) in the study sample (66.63 %), lower education among
adults (91.73 %; <12 years old), minority of White people
Marital status (n = 1143)
(27.25 %), living with a partner (71.49 %) and average
No companion 28.51 (24.71–32.31)
per capita income of less than $250 (Table 1).
With companion 71.49 (67.69–75.29) The study population could be considered with residence
Religion (n = 1128) stability since it presents an average of 14.8 (SE = 0.70) years
No religion 9.20 (5.25–13.15) living in the same location [19]. This is a considerable time
Catholic 48.99 (38.31–59.68) that probably allowed the population to bond socially,
which has to be considered when analyzing empowerment,
Other Religions (Protestant/evangelicals/ 41.81 (34.31–49.30)
spiritualist/Jehovah’s witness) especially collective empowerment.
Lifestyle
The participants consider themselves with poor/very
poor health (68.49 %), and that could be explained by
Physical activity (n = 1095)
the higher presence of health problems that caused
No 61.95 (53.97–69.93) pain (40.46 %) and dental pain (24.10 %) in the last six
Little 20.02 (15.25–24.80) months. Signs and symptoms are significant in the self-
Much 18.08 (13.99–22.07) health evaluation.
Smoke cigarettes (n = 1096) The results related to the participation in community
Much 10.91 (7.9913.82)
activities and in the variable to be able to decide about
its own life, demonstrates that 77.83 % of the partici-
Little 9.38 (8.06–10.70)
pantes feelt empowered to solve their personal issues
No 79.71 (76.56–82.85) but only for 18.03 %, the empowerment helped them to
Consumption of alcoholic beverages (n = 1093) be involved with the community. However, when it was
Much 5.7 (4.19–7.28) discussed a practical issue (lack of water supply), which
Little 33.13 (26.38–39.89) is common to several Brazilian municipalities, the partic-
No 61.13 (55.09–67.17)
ipants revealed the possibility of a considerable commu-
nity participation (62.91 %).
Health Conditions
General Health Perception (n = 1148) Individual and collective Empowerment and its
Very bad/bad 68.49 (60.15–76.83) association
Regular 26.80 (20.44–33.15) Table 6 briefly shows the observed significant associations.
Very good/good 4.75 (2.23–7.19) Among the sociodemographic variables used in this
Have a health problem that causes pain
study, after multivariate analyzes, education was associ-
(n = 1090) ated with individual empowerment and religiosity with
Yes 40.46 (35.19–45.73) collective empowerment. Individuals with more years of
education compared to those with less education had a
No 59.54 (54.27–64.81)
higher chance (aged 5–11 years and >12 years) to feel able
Soares et al. BMC Public Health (2015) 15:775 Page 6 of 11

Table 2 Distribution of adults regarding the categories of individual and collective empowerment
Number Percent 95 % IC
Individual empowerment
Did not participate in community activities, feels unable to make decisions that change the course of life 241 22.15 17.80–26.50
Did not participate in community activities, feel able to make a decision that changes the course of life 633 59.82 56.44–63.21
Participated in community activities, feels able to make decisions that change the course of life 178 18.03 13.37–22.68.
Total 1052a
Collective empowerment
Unlikely collective cooperation + nor likely, nor unlikely 421 37.09 31.14–43.04
Likely collective cooperation 662 62.91 56.96–68.86
Total 1083b
a
Loss of 98 individuals: 52 excluded because they answered less than 21 questions of the WHOQOL + 37 who answered participate in community activities and
feel unable to make decisions that change the course of life + 9 adults did not answer the questions giving rise to individual empowerment variable. bLoss of 67
individuals: 52 excluded because they answered less than 21 questions of the WHOQOL + 15 adults did not answer the question giving rise to collective
empowerment variable

to make decisions. The education influence cognitive re- The smoking habit was associated with individual
sources, understanding of information and knowledge [24]. empowerment. No smokers (79.42 %) were less likely
The Catholic religion was associated with collective to participate in community activities and to felt able
empowerment. In the literature, studies have associated to make important decisions for their life or their com-
religion to individual empowerment. For the behaviour munity. The research PETab: Brazil Report, published
of prevention and cure of diseases, religion can influence in 2011 by the National Cancer Institute - INCA in
values, lifestyle, cognitions, emotions, and behaviours. partnership with the Pan American Health Organization
The power of faith has demonstrated an important facilita- -PAHO reported a significant decline of smokers in Brazil
tor of individual empowerment, however, for the collective (34.8 % in 1989 and 18.2 % in 2008) and a lower percent-
empowerment; limitations and potential negative influences age of smokers among women, prevalent gender in our
of religion in community settings are discussed. Beliefs and sample. Furthermore, there is a population awareness
values may negatively affect the decision-making power, about smoking in Brazil, with a decrease of social accept-
but religion has a good capacity to mobilize human and ability of smokers [30]. Tobacco control has provoked
institutional positively or negatively resources. The as- among smokers a concern about the degree of harm
sociation between empowerment and religion can be more that may be caused to passive smokers [31–33]. The
related with group involvement than with the choice of anti-smokers norms influence social relationships. Accord-
the religious belief [25–27]. ing to the Brazil report [30], the decrease of smoking is less
Regarding the lifestyle, physical activity was associated in population groups with lower income and schooling,
to individual and collective empowerment. Although there similar to this study population. The association observed
is a policy guideline of the Brazilian Ministry of Health in this study may be related to the psycho-emotional sensa-
from 2011, creating a Health Fitness Program (Programa tions caused by this habit. According to participants of
Academia da Saúde) [28], the practice of physical activity smoking cessation activities, smoking calms, divert, gives
among adults is not an installed habit. In this study, pleasure, relieves the sadness and decreases anxiety. It is
61.95 % reported no physical activity at work or as a sport; understandable the smoking habit association with the indi-
this is a common practice for only 18 % of this population. vidual empowerment and no association with the collective
The men reported more active with 54.2 % practicing empowerment [34].
physical activity. Among women, the percentage is 29.9 % The less or no consumption of alcoholic beverage
(p < 0.001). (94,26 %) was associated with collective empowerment.
The municipalities encourage physical activity installing Alcoholic beverage use was strongly associated with
the Health Fitness Program in organized public spaces. All disarrangement and violent behavior than sociability
the municipalities included in the study when data collec- or social support [35, 36].
tion occurred had one or more centers for physical activity Regarding the health conditions variable, only the item
(http://www.mg.gov.br). This is not a routine practice for ability to handle stress (62.97 %) was associated to indi-
the predominant gender in this sample (female) that could vidual empowerment, both for those who participated in
be explained by culture, poverty, social construction of community activities and for those who did not. Studies
gender or biological determinism [29]. have demonstrated an association between stress caused by
Soares et al. BMC Public Health (2015) 15:775 Page 7 of 11

Table 3 Distribution of adults regarding the individual and collective empowerment and independent variables
Independent variables Individual Empowerment (%) Collective Empowerment (%)
Did not participate/ Did not participate/ Participate/ Deff Unlikely + neither Likely Deff
Feels unable Feels able Feels able likely nor unlikely
Sociodemographic
Sex
Male 17.31 64.87 17.83 37.40 62.60
Female 24.58 57.30 18.12 1.20 36.47 63.53 1.25
Age
35 and 39 21.47 60.30 18.23 36.23 63.77
40 and 44 22.90 59.29 17.80 1.55 38.04 61.96 0.54
Years of study
≤4 29.86 58.15 11.99 36.63 63.37
5 a 11 17.29 60.78 21.93 37.48 62.52
≥12 13.60 62.46 23,93 1.77 36.65 63.35 1.06
Skin color
Brown, Black, Asian, and Indigenous 21.75 61.45 16.80 38.85 61.15
White 23.56 57.71 18.73 1.15 34.47 65.53 0.65
Marital status
No companion 22.42 57.34 20.24 35.63 64.37
With companion 22.07 60.64 17.29 1.95 40.92 59.08 1.41
Religion
No religion 32.09 55.08 12.83 46.79 53.21
Catholic 21.47 61.96 16.57 31.05 68.95
Other Religions (Protestant/evangelicals/ 20.70 58.38 20.92 2.01 41.33 58.67 1.27
spiritualist/ Jehovah’s witness)
Lifestyle
Physical activity
No 26.29 57.67 16.05 39.35 60.65
Little 20.08 61.49 18.43 38.31 61.69
Much 10.28 65.52 24.20 1.56 29.19 70.81 1.08
Smoke cigarettes
Much 17.13 59.39 23.48 40.02 59.98
Little 22.12 54.77 23.11 41.14 58.86
No 22.77 60.42 16.81 1.33 36.34 63.66 1.73
Consumption of alcoholic beverages
Much 32.51 46.68 20.81 52.55 47.45
Little 17.87 66.88 15.25 39.06 60.94
No 23.74 56.80 19.46 1.94 34.81 65.19 1.14
Health Conditions
General Health Perception
Very bad/bad 18.52 62.36 19.12 34.93 65.07
Regular 30.67 52.72 16.61 42.54 57.46
Very good/good 26.57 63.31 10.11 1.21 37.08 62.92 1.21
Have a health problem that causes pain
Yes 28.32 54.43 17.25 37.40 62.60
No 18.10 63.69 18.21 1.94 36.99 63.01 0.95
Soares et al. BMC Public Health (2015) 15:775 Page 8 of 11

Table 3 Distribution of adults regarding the individual and collective empowerment and independent variables (Continued)
Ability to handle the stress of every day life
No 42.95 47.23 9.82 44.34 55.66
Little 30.35 54.25 15.40 35.58 64.42
Much 15.56 63.79 20.65 2.25 37.04 62.96 1.92
Relax and enjoy leisure time
No 38.94 45.50 15.56 37.33 62.67
Little 25.63 57.84 16.53 34.80 65.20
Much 16.45 64.28 19.27 1.52 38.45 61.55 2.21
Toothache in the last three months
Yes 25.18 57.68 17.14 36.41 63.59
No 21.19 60.50 18.31 1.25 37.34 62.66 1.25
Per capita income (average,, EP) 404,79 (50,17) 421,89 (55,46) 432,74 (50,68) - 410,71 (58,75) 428,73 -
(48,2)
Time to live in the same location 14,91 (0,68) 13,84 (0,63) 15,19 (1,64) - 13,13 (0,90) 15,01 -
(Average, EP) (0,83)
DMFT (Average, EP) 18,36 (0,38) 16,54 (0,32) 16,77 (0,74) - 17,08 (0,66) 16,83 -
(0,31)

Table 4 Crude and Adjusted model of factors associated with individual empowerment (n = 1027)
Did not participate, feel capable Participated feel capable
OR gross (95 % IC) p-value OR adjusted (95 % IC) p-value OR gross (95 % IC) p-value OR adjusted (95 % IC) p-value
Socio demographic
Years of study
<4 1 1 1 1
5 a 11 1.80 (1.35–2.41) <0.001 1.91 (1.22–3.00) 0.007 3.16 (1.31–7.62) 0.012 3.46 (1.16–10.28) 0.027
>12 2.36 (1.40–3.98) 0.002 2.35 (1.03–5.36) 0.043 4.38 (2.10–9.16) <0.001 4.41 (1.47–13.21) 0.010
Life style
Physical activity
No 1 1
Little 1.40 (0.85–2.29) 0.177 1.08 (0.71–1.64) 0.703 1.50 (0.79–2.87) 0.207 1.20 (0.47–3.04) 0.696
Much 2.90 (1.57–5.36) 0.001 2.10 (1.24–3.56) 0.008 3.86 (1.90–7.79) 0.001 2.70 (1.37–5.31) 0.006
Smoke cigarettes
Much 1 1 1 1
Little 0.71 (0.31–1.65) 0.417 0.49 (0.17–1.42) 0.179 0.76 (0.31–1.90) 0.547 0.47 (0.20–1.14) 0.091
No 0.77 (0.50–1.18) 0.001 0.47 (0.28–0.78) 0.006 0.54 (0.32–0.91) 0.023 0.26 (0.16–0.43) <0.001
Health conditions
Ability to handle the stress of
every day life
No 1 1 1 1
Little 1.63 (0.90–2.93) 0.101 1.37 (0.69–2.69) 0.352 2.22 (1.60–8.13) 0.218 1.86 (0.48–7.27) 0.356
Much 3.73 (1.94–7.17) <0.001 2.49 (1.24–4.95) 0.012 5.81 (2.93–11.51) <0.001 3.76 (1.67–8.48) 0.002
Quality of life
Psychological domain 1.25 (1.10–1.43) <0.001 1.20 (1.08–1.33) 0.002 1.23 (1.06–1.43) 0.008 1.23 (1.10–1.43) 0.008
DMFT 0.96 (0.93–0.99) 0.042 0.96 (0.92–0.99) 0.042 0.96 (0.91–1.02) 0.187 0.96 (0.91–1.02) 0.221
a
Results of the multinomial logistic regression. Reference category: not participated/incapable. Final model adjusted for sex and per capita income. The results of
crude analyzes of the variables in the final model were presented
Soares et al. BMC Public Health (2015) 15:775 Page 9 of 11

Table 5 Crude and Adjusted model of factors associated with collective empowerment. (n = 1048)
OR Gross Value of p OR adjusteda Value of p
Socio demographic variables
Religion
No religion 1 1
Catholic 1.95 (1.06–3.6.1) 0.034 1.82 (1.15–2.90) 0.013
Protestant/evangelicals/spiritualist/ Jehovah’s witness (other religions) 1.25 (0.76–2.04) 0.361 1.04 (0.72–1.51) 0.820
Lifestyle
Physical activity
No 1 1
Little 1.05 (0.74–1.48) 0.796 1.06 (0.69–1.61) 0.795
Much 1.57 (1.09–2.28) 0.019 1.57 (1.12–2.20) 0.012
Consumption of alcoholic beverages
Much 1 1
Little 1.73 (1.11–2.69) 0.017 1.66 (1.08–2.54) 0.022
No 2.07 (1.24–3.46) 0.007 2.28 (1.24–4.19) 0.010
Quality of life
Social domain 1.06 (102–1.10) 0.003
Environmental domain 1.07 (1.00–1.16) 0.059
Quality of life (Total) 1.09 (1.04–1.16) 0.002 1.08 (1.02–1.52) 0.014
a
Results of binary logistic regression analyzes. Reference category is Improbable + Neither likely nor unlikely that people cooperate to solve the problem of water
supply in the community. The results of crude analyzes of the variables in the final model were presented

daily work [37, 38] and need to know how to deal with it, Conclusions
diminishing its negative effects on health and quality of life. This study pointed out several hypotheses about the em-
A measure of the quality of life was also common for powerment of the community. The data presented, and
individual and collective empowerment. For the individual, the observed associations lead us to some reflections dir-
there was a significant association only with the psycho- ectly related to training for the individual and collective
logical dimension related to aspects such as self-esteem, empowerment.
body/image appearance, feelings, and others. In the collect- The existence of an association between empowerment
ive level, a correlation to the total index Lifestyles (WHO- and physical activity, whether at an individual or collective
QOL) with all domains (physical, psychological social and level make us belive that such practice of health promotion
environmental) were observed. A study of institutionalized must be seen as a valuable ally in the construction of
elderly with nursing care demonstrated an association empowerment.
between quality of life and empowerment perceived by Behaviorist approach that demonize sedentary, blaming
this group [39]. the individual, showing the physical activity to reduce
The major limitation of this study is the cross-sectional the epidemiological condition, solely [6] can ward off
methodology measuring subjective questions with quanti- the individual from this habit with prejudice to the
tative methods. Since it is an underexplored theme, construction of health empowerment. Approaches that
identifying hypothesis could bring significant value to new consider the physical activity can bring benefits to in-
evaluations and empowerment guidance. dividuals and communities

Table 6 Individual and Collective Empowerment and associated factors: a conceptual framework
Independent variables associated Individual Empowerment Collective Empowerment
Sociodemographic Higher education Catholic
Lifestyle Much Physical Activity
Smoker Do not consume or consume little alcoholic beverage
Health Conditions Much ability to handle stress
Quality of life Domain psychological All areas
Soares et al. BMC Public Health (2015) 15:775 Page 10 of 11

Individual empowerment was also associated with the Bairro de Lourdes, Belo Horizonte, ZIP Code 30180160 Minas Gerais, Brazil.
8
higher educational level, to the capacity to handle stress Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry,
Universidade Federal de Minas Gerais, Avenida Bandeirantes, 2275/500 Bairro
and to the psychological domain of Quality of Life Index. Bandeirantes, 30.210-420 Belo Horizonte, Minas Gerais, Brazil.
These are plausible associations since it clarifies issues
such as self-esteem and well-being were the first condi- Received: 2 June 2014 Accepted: 30 July 2015

tions for individual action.

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