Developing principles of social change as a result of a Pasifika Youth Empowerment Program: A qualitative study

Abstract Issue Empowerment is a concept over‐used in health promotion, yet it is an important process that can used in developing the capacity and capability of young people for creating social change to improve healthier lives. Methods The Youth Empowerment Program (YEP), a pilot study aimed at empowering 15 youth (18‐24 years) to lead healthier lives. We present secondary outcomes of the original YEP study, using focus groups and mobile‐mentary approaches to capture the impact of the YEP through the youths’ understanding of the program. Thematic analyses to examine the pragmatic usefulness of the empowerment program. Results We identified three major themes: (aa) Knowledge: education and awareness of healthy living and understanding of the wider social health issues, compound the health complexities of obesity; (b) Youth as catalysts for change: the youth viewed themselves as agents of social change; and (c) Transformation: the youth recognised themselves as catalysts for change that can positively transform communities into action. Conclusion This study contributes new insights and depth of understanding about how the empowerment program can strengthen the process of individual capacity in an effort to mobilise social change for the betterment of the whole community, particularly among indigenous Pasifika population groups. So what? Developing empowerment principles will enable others to consider “how apply” empowerment more practically when working with young people and not use it flippantly with no real action‐oriented outcome.


| INTRODUC TI ON
New Zealand (NZ) has a large proportion of Pacific peoples residing here, with over 8% of the total population self-identifying as being Pacific and Samoans make up almost half of the total Pacific population. 1 Regarding health, NZ has one of the highest rates of obesity internationally. 2 Nationally, obesity disproportionately affects Pacific peoples (67%), compared to the general population (31.3%). 3 There are significant health and social inequities in accessing care and outcomes for Pasifika peoples. 4 Communitybased participatory research has enormous potential to draw on the innovative potential of Pasifika youth, their knowledge, resources and motivation to address their experienced inequities. A novel approach to obesity prevention would be through tailored empowerment programs for youth. Previous work has utilised youth as agents of change as part of a social movement, which have shown to be powerful approach if given the adequate resources. [5][6][7] Such programs are needed for health promotion programs and it is a good fit with Pasifika peoples-a valid approach to empower youth in the efforts to reduce health inequities and reshape community health.
There have been several community-based participatory studies [8][9][10][11][12][13][14] that highlight the successes of working with population groups to tackle obesity and other related NCDs (eg, T2DM) including the effectiveness of culturally adapted intervention approaches to manage obesity health-related diseases. 15 A similar study by Townsend et al (2016) described the community-based participatory research approach (CBPR) and data collection process that incorporated active decision making and leadership by community partners, and from the participants themselves. CBPR was considered a positive research approach to establish trust and integrate community expertise, particularly when it comes to integrating and understanding other scientific components such as behavioural and biological sciences. 16 A movement involving an ecological social-change approach 17 including key partners within a community setting such as youth, other community constituents (eg, staff and agencies) and relevant sector (health and non-health) stakeholders may offer another way forward in terms of addressing NCDs.
There are many youth empowerment programs available, however, more often than not, these programs tend to be located or carried out within a school setting, with a focus on "teaching" the young adolescents. [18][19][20] Empowerment programs should be more than extending providing new knowledge and understanding, it should also provide a social space for young people to transform knowledge into action; identify and learn to overcome barriers; and develop leadership and confidence in social action activities. 21 This should be the crux of empowerment programs. Building "capacity" to improve health equity and tackling the social-health disparities experienced by, often, marginalised communities, is becoming increasingly necessary. Addressing the needs of a community by investigating the health issues through the perspectives and lived experiences of the community and its constituents using a bottom-up approach requires time, effort, resources and funding. 22 Mobilising the community into collective action is viewed as a pragmatic re-distribution of resources and it is an indicator of community empowerment. 23,24 The over-use of the term empowerment can lead to a diminished meaning, mainly because the term has been borrowed from many disciplines, whilst others confuse "power" with "empowerment." 24 From a health promotion perspective, empowerment is the "process of enabling people to increase control over, and to improve their health." 25 Historically, empowerment has shown to be rooted in the civil right and women's movement, derived from social action ideology in the 1960s. 26 Furthermore, when individuals living in oppressed societies, re-construct their personal and social realities, this can lead to citizen empowerment, where they become assertive and committed grassroots activists. 26 Based on the literature, personal development, participation, raising social consciousness and social action are the key features of empowerment programs. 18,19,21,26 This paper aims to describe through the youth empowerment, 21 the perspectives of youth, their learned view of the empowerment process and the practical implications of the program, particularly as community members who are capable of taking ownership of obesity as a complex health problem affecting Pasifika peoples.

| ME THODS
At the completion of the YEP program, we conducted: (a) two focus groups (n=15 youth, per group) and; (b) piloted the use of individual mobile-mentaries 27 (with the same 15 youth), as a form of digital narrative to further understand the impact of the YEP at an individual level, using Pacific talanoa 28 methodology. Talanoa as a sharing concept is widely accepted by different Pacific ethnicities. The facilitator ensures the environment is welcoming and respectful.
The participants are open to share their perspectives and ideas, and this is often based on a trusting relationship. The key questions used in the focus groups and mobile-mentaries are listed in Table 1. The data from the focus groups and individual mobile-mentaries were used for this paper, to triangulate the knowledge obtained at a group (focus groups) and individual (mobile-mentaries) levels. The aim of the focus groups and digital narratives were to capture the impact of the YEP through the youths' understanding of the program. The empowerment approach enabled youth to investigate the social world through their lived experiences and perspectives. Thus, for this study, we used a CBPR approach aligned with Pasifika methodological processes to understand the impact of the YEP program through the perspective of Pasifika youth.
The methodology and initial findings for the current project has been published earlier, 21 where we described the overall study context including the empowerment process. Focus groups are a well-established form of social research, and they were facilitated and digitally recorded by the first named author. Digital narratives have also been used widely in different formats and under different paradigms. 27 Specifically, using their own smart-phones, the youth were trained by MS utilising story-boarding and the set of questions outlined in Table 1 to document their independent narratives about the health-related issues of obesity.
The initial focus group set out to establish how the YEP had an impact on the youths' knowledge and awareness of obesity and its related health problems. In the second focus group, we identified and utilised the key themes (from the first focus group), as discussion points, to identify aspects of social change, from a youth perspective. The approach aligns with aspects of the theory of social justice leadership approach. 31 This theoretical approach was deemed appropriate, because the empowerment process sought to identify leadership qualities in young people as a process to express their views of the social justice issues concerning their communities.
The focus groups and individual mobile-mentaries were transcribed verbatim and entered into an NVivo 11 software program and then, thematically analysed independently by the author and again by an independent research assistant, using a general inductive reasoning approach. This approach allowed for iterative coding, until meaningful thematic categories were attained (saturation), as well as it being determined by the aim of the project and by the participants. The transcripts and a summary of themes were presented to the youth and community leaders as a process of authentication, which aligns with the CBPR and Pasifika methodological processes.
No further modifications were made and the participants corroborated that the transcripts and summary reflected a true and accurate record.

| Focus groups
Two major themes were identified from the focus group discussions.
The first, being that; "knowledge is a powerful tool for social change." The youth reported that "knowing and understanding" obesity and its related issues was valuable for recognising the consequences of this condition on personal health and the impact on family members.
Although the youth still identified with body size and over-weight as the main reasons for obesity, they also expressed a deeper understanding of the social-economic and cultural factors that impact health behaviours, recognising that these were less well understood, as often knowledge was "handed-down" from less informed [older] family members.

Focus group 1 Mobile-mentaries
How as the YEP changed you and why is it important to you? How did you find the YEP program?
What were your inspirations from the YEP? How has it impacted you?
What were your fears from the YEP? What was your highlight?
What do you perceive as your strengths? What did you find challenging?
What do you perceive as your passions? What did you expect to gain from it?
What are the most common stereotypes? Favourite module and why?
Focus group 2 How are you going to apply and implement what you've learnt from YEP in your life?
After hearing about the key themes developed from our first meeting, how do you relate these themes to the pillars of social change?
How did you find the action planning process?
What are the ways in which we can inform other youth or groups who may go through this same or similar program?
What does the intervention mean to you?
What cultural and social norms do we need to consider when we are thinking about building or running a similar program like the YEP?
What do you hope to achieve with the intervention?
What are the challenges and how will you overcome them?
What's the ultimate goal for the intervention?
How will you drive the intervention message? Raise awareness?
How are you going to drive this change?
"We get stuck in our own familial ways, often handed down by families and cultural ways." "YEP is a massive eye-opener, forces us to think about how to change our foods and re-educate the family and community." Through the program, the youth achieved a clearer understanding that their personal experiences of chronic diseases, such as obesity and diabetes, differ greatly to that of their older family members.
The module on the historical factors 21   Rather than taking the typical Pasifika cultural viewpoint, that; "being big is a sign of good health," the youth stated that culture is the difference between the Pasifika and Westernised viewpoints of health.
That is, the cultural values, principles and way of life influence the family and community's perspective on and practice of health. Neither is views were considered wrongful, just different. However, if we observe the health of Pasifika people through Pasifika-lens only, it would most certainly be culturally relevant and fundamentally holistic. 34,35 Healthy transformation (theme 2), also included "Education" be- … I really hope to achieve positive change however it may be measured I just hope that it brings about awareness to people, that people start taking it seriously that they see how it's affecting not only them but, the generation to come.
The message that we are hoping to deliver is for anyone and everyone, but mainly our Pacific community. This is where the problem is like crazy, and so we really wanna target the at-risk community, which is our Pacific people." The overall common goal for this program was for the participants to recognise that youth leadership is necessary for the younger and older generational cohorts and an important barrier was overcoming stereotypes and changing or improving their lifestyle habits.
Participants also acknowledged that culture, religious and traditional beliefs and values may impede the change needed to integrate healthy habits into life.

| D ISCUSS I ON
Our study has shown that youth, when given the opportunity to Given the focus on the NZ Pasifika population, who have the highest rate of obesity in NZ, 36 arguably the youth participants in this study have also had the highest exposure to the obesogenic environment. 37 Therefore, it is reasonable that their perspectives and understanding of the disease will differ from that of academics who have struggled to reduce the health inequalities associated with this growing epidemic, in Pasifika peoples. Furthermore, the youth perspective tends to overlook being marginalised, or do not consider themselves to be a socially excluded group, rather, their narratives strongly evoke empowerment, advocacy, collective promotion and activism to respond to the growing needs of their community.
The primary aim of this study was to investigate the youth per-

| Knowledge a tool for social change
The youth from this study perceived education and knowledge as an important motivational factor that can influence healthier lives. 21 It was clear from the study participants, that the knowledge handed-down from older family members was due to different environmental exposures (education, lifestyle experiences, family and church environment) and that the indigenous-related knowledge was not always accurate, particularly that relating to body-size and health. In the present day, with the abundance of knowledge being shared in different forms (eg, social media platforms), youth have a greater exposure to information, as well as, to the obesogenic context and they are more aware of the diversity of food and how to access food in their local environment. 10 The YEP combined knowledge and skills as essential components to make informed behavioural changes and mind-set and this was the single most important theme in the current research.
Whilst some studies do not report on how much knowledge and skills are needed to change behaviours, there is often an imbalance between the two and the difference may contribute to unsuccessful obesity intervention. 38 Other researchers have reported that while having the knowledge is important, it is insufficient to effect behavioural change (fruit and vegetable consumption). 39 Therefore, there is a discrepancy between advocating for population-based interventions that aim to target greater overall benefit in risk reduction in many people, than by large reductions in just a few people. 40 The YEP participants con-  and socio-environmental conditions," and it is inherent as a result of their interactions. It is also a function of the resource opportunities or economic, political and environmental conditions in which people live. 45 For the youth in this study, the transforming the health of their community links to the first and second key findings, however, it should be Pasifika-relevant, focused and community-driven (not from a top-down approach). The limitations of this study can be evident in the exploratory nature of this work and that a scaled-up approach of the YEP is necessary to fully comprehend the impact of empowerment.

| CON CLUS IONS
This study has highlighted three key findings that we propose equating as principles that can facilitate social change in behaviours, culture and mind-set. They are: Knowledge-a tool for social change; Youth catalysts for change; and Transformation of the community, by empowering the community. The key findings are inter-linked and are necessary for community organisations to include as part of any form of capacity development programming. The YEP provides the knowledge capacity development for the youth generation. It also provides a medium for which youth can learn to facilitate ways to address social-health issues through the program opportunities. With youth at the vanguard of collective action for the community, knowledge and education about the key issues of health will be important to Pasifika people to enable better healthier living. The establishment and sustainability of any prevention or intervention program, through network collaboration and capacity development of youth is necessary to ensure that our culture and communities are aligned to healthy living. Youth may be better at identifying different approaches that are fitting for our diverse cultures and communities, which will be important for sustainability and long-term support at an organisational level.