Agency-Based Empowerment Interventions: Efforts to Enhance Decision-Making and Action in Health and Development


This paper outlines the critical role of personal agency in influencing health and development outcomes and presents a framework for implementing non-therapeutic cognitive-behavioral interventions that foster agency, especially for women, in resource-poor settings. The United Nations’ Sustainable Development Goals (SDGs) has placed “empowerment” at the center of global targets, particularly to improve individuals’ health and development. Despite extensive research on individual and community empowerment, there is limited focus on the role of psychological and behavioral approaches directly fostering individual and collective agency in health programs. Fundamental to this process is the understanding that decision-making is an interaction between mental processes and one’s current context. Approaches that allow individuals to understand how their beliefs, values, emotions, and thoughts impact their behaviors and can be modulated to increase their personal agency are needed. This model is illustrated through a pilot behavioral intervention with women engaged in sex work in Pune, India, demonstrating substantive benefits.

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We would like to thank Tejaswi Sevakari, Director of Saheli Sangh in Pune, India and a Certified Master Trainer in the Empowerment Workshop methodology (Empowerment Institute, USA) for her dedication and efforts on this work. Ms. Sevakari, who conducted the trainings, has generously provided information for the case study. We would also like to thank Mandakini Desale, program manager; Deepa Dandvate, social worker; Shakuntala Pawar, Ffounder and board member of Saheli Sangh; Mahadevi Madar, president of Saheli Sangh; and Meena Koil, secretary of Saheli Sangh for their dedication and untiring efforts for the women living and working in the red light district in Pune.

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Correspondence to Anita Shankar PhD.

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Shankar, A., Sundar, S. & Smith, G. Agency-Based Empowerment Interventions: Efforts to Enhance Decision-Making and Action in Health and Development. J Behav Health Serv Res 46, 164–176 (2019).

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  • Women’s health
  • Cognitive behavioral approaches
  • Empowerment
  • Development
  • Personal agency