TITLE: How to measure empowerment in sexual health? Definitions and measurement indicators. A scoping review protocol
AUTHORS: Karna Coulibaly, Anne Gosselin, Annabel Desgrées du Loû

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?. Title and authors identificationHow to measure empowerment in sexual health? Definitions and measurement indicators. A scoping review protocolKarna  Coulibaly1,2, Anne Gosselin1,2,3, Annabel Desgrées du Loû1,21CEPED, Institute for Research on Sustainable Development, IRD-Université de Paris, ERL INSERM U1244 SAGESUD, Paris, France;2French Collaborative Institute on Migrations, CNRS, Aubervilliers, France;3ERES, Social Epidemiology Unit, IPLESP, INSERM S1136, Faculté de Médecine de Saint Antoine, Paris, France
?. RationaleThe notion of empowerment has been increasingly used since its appearance in the 1970s [1]. It has long been mobilized in the field of health by community psychology [2, 3] before being used as a basic notion in health promotion [4-7]. However, what this notion covers is sometimes unclear: "the popularity and apparent sustainability of empowerment has not, however, led to a broad consensus on its meaning, its measurement or its implementation" [8].In addition, the mobilization of empowerment theory in the field of sexual health has led to the use of notions such as "sexual empowerment", "sexual autonomy" or "sexual health empowerment" or "empowerment in sexual health" without providing more details on the definition and measurement of these concepts [9-11]. Thus, in view of the increasing use of all this notions, it seems important to shed light on their definition and evaluation.
?. Search strategyData selection:We will conduct a literature search on PubMed, Sage Journals, PsycInfo and Web of science. The searches will be conducted in French and English. The search strategies for each database will be designed in consultation with a librarian from the French National Research Institute for Sustainable Development (IRD). We will follow the PRISIMA extension for scoping review [12].
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?. Data extractionAll articles will be registered in Zotero and Excel. Duplicates will be removed. KC will assess the relevance of all titles and abstracts based on the inclusion and exclusion criteria. The full texts of included articles will be assessed against the eligibility criteria by reviewer KC and any question will be discussed with the second and third reviewer. Other reviewers may be included if necessary for assessing the article selection quality. Some articles may be included by snowball, from the bibliographic references of the first articles found. 
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							Two types of information will be collected: article characteristics and data on the measurement of sexual health empowerment. 
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							- The characteristics of the articles will include the names of the authors and the date of publication of the article; the country in which the research was conducted; the objectives of the study; the study design; the nature of the data; the year of the intervention or completion of the study; the target population; the sample size; and the results.
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							- Information on the measurement of empowerment will cover the research question or hypotheses of the authors; the definition of empowerment in sexual health; the role of empowerment in sexual health; the assessed dimensions of empowerment; the indicators of empowerment in sexual health; the validation of indicators; empowerment score variables; the validity of scores; the other variables included in the analyses (dependent variable and control variables) as well as study limitations and suggestions.
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?. AcknowledgementsWe would like to thank Lola Traverson for her helpful comments on the first draft of this protocol.
?. Presentation of data synthesis
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							We will present the results of the search in a diagram that allows to trace the process of selecting items. The different definitions of sexual health empowerment will be presented and summarized in a table. The characteristics of the articles will be presented in a table. The dimensions and indicators of empowerment and sexual health empowerment will be grouped in a table and described. The scores used to evaluate sexual health empowerment and their validation will also be presented.
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?. References[1] Solomon BB. Black Empowerment: Social Work in Oppressed Communities. New York: Columbia University Press, 1976.[2] Rappaport J. Studies in Empowerment: Introduction to the Issue. Prevention in Human Services 1984; 3: 1–7.[3] Le Bossé Y, Lavallée M. Empowerment et Psychologie communautaire. Aperçu historique et perspectives d’avenir. 1993; 14.[4] Augoyard P, Renaud L. Le concept d’« empowerment » et son application dans quelques programmes de promotion de la santé. Promotion & Education 1998; 5: 28–35.[5] Ridde V. Réduire les inégalités sociales de santé : santé publique, santé communautaire ou promotion de la santé ? Promotion & Education 2007; 14: 111–114.[6] Ridde V. A quoi sert la promotion de la santé?: essai introductif sur la réduction des inégalités sociales de santé. Harmattan Burkina, 2012.[7] Rissel C. Empowerment: the holy grail of health promotion? Health Promot Int 1994; 9: 39–47.[8] Beeker C, Guenther-Grey C, Raj A. Community empowerment paradigm drift and the primary prevention of HIV/AIDS. Soc Sci Med 1998; 46: 831–842.[9] Diallo Niang S. L’Empowerment comme moyen de contrôle de la sexualité et de la reproduction. In: La recherche féministe francophone. Editions Karthala, p. 375.[10] Peterson ZD. What Is Sexual Empowerment? A Multidimensional and Process-Oriented Approach to Adolescent Girls’ Sexual Empowerment. Sex Roles 2010; 62: 307–313.[11] Alimoradi Z, Kariman N, Simbar M, et al. Empowerment of Adolescent Girls for Sexual and Reproductive Health Care: A Qualitative Study. Afr J Reprod Health 2017; 21: 80–92.[12] Tricco AC, Lillie E, Zarin W, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Annals of Internal Medicine 2018; 169: 467–473.
?. Inclusion and exclusion criteriaWe will include articles that meet these criteria: - explore the link between empowerment and sexual health indicators;- use quantitative data methods;- are published in English or French;- are published between 1996 and 2020.We will exclude following articles:- Non-scientific or grey literature and non-peer-reviewed articles
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							Research will not be limited to a specific population or geographic area.
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?. Search terms  ABC1Search for Empowerment
  and sexual health in EnglishSearch for Empowerment
  and sexual health in French2Keywords  "empowerment"
  AND "sexual health";
  "empowerment"
  AND "sexually transmitted infection";
  "agency"
  AND "sexually transmitted infection";
  "empowerment"
  AND "contraceptive use»;
  "empowerment"
  AND "HIV prevention";
  "empowerment" ET "santé sexuelle" ;
  "empowerment" ET "infection sexuellement
  transmissible" ; "agency" ET "infection sexuellement
  transmissible" ; "empowerment" ET "contraception" ;
  "empowerment" ET "prévention VIH"
ABC1Search for Empowerment
  and sexual health in EnglishSearch for Empowerment
  and sexual health in French2Keywords  "empowerment"
  AND "sexual health";
  "empowerment"
  AND "sexually transmitted infection";
  "agency"
  AND "sexually transmitted infection";
  "empowerment"
  AND "contraceptive use»;
  "empowerment"
  AND "HIV prevention";
  "empowerment" ET "santé sexuelle" ;
  "empowerment" ET "infection sexuellement
  transmissible" ; "agency" ET "infection sexuellement
  transmissible" ; "empowerment" ET "contraception" ;
  "empowerment" ET "prévention VIH"
?. Review objectiveThis scoping review aims to identify definitions of empowerment and empowerment in sexual health, and to describe dimensions and indicators used to measure them.
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