Evaluation of Women’s Empowerment in a Community-Based Human Papillomavirus Self-Sampling Social Entrepreneurship Program (Hope Project) in Peru: Mixed-Method Study

Abstract Background: Understanding the community women’s sense of relational and financial empowerment in the social entrepreneurship context could be the key to developing a sustainable pathway to scale-up community-based human papillomavirus (HPV) self-sampling programs in low-resource settings. The Hope Project, social entrepreneurship from Peru, trains women (Hope Ladies) to promote HPV self-sampling among other women in their communities. This study aims to evaluate the Hope Ladies’ relational/financial empowerment after participating in the program. Methods: We used a parallel mixed-method design. The Hope Ladies participated in semi-structured in-depth interviews (n= 20) and an eight-questions five-point Likert scale survey that evaluated their relational (n=19)/financial (n=17) empowerment after participating in the social entrepreneurship. The interview and the survey questions were developed using validated empowerment frameworks, indicators, and theory: 1) Kabeer’s conceptual framework, 2) International Center for Research on Women (ICRW)’s economic empowerment indicators, and 3) the Relational Leadership Theory (RLT), respectively. Deductive content analysis was used to evaluate the interviews with pre-determined codes and categories of empowerment. Descriptive statistics were used to analyze the survey results. Results: All Hope Ladies reported experiencing empowerment in the social entrepreneurship. Interviews: The women reported challenges and improvement in three categories of empowerment: 1) resources (balancing the roles between the household and working as a Hope Lady, camaraderie with other Hope Ladies, recognition from the community as a resource); 2) agency (improved ability to express themselves, increased knowledge about reproductive health, ability to speak out against male-dominant culture and fear of cervical cancer-related stigma); and 3) achievement (increased economic assets, improved ability to make financial decisions from increased supplemental income, widened social network and capital, and technology skills development). Survey : All (100%) agreed/totally agreed an increase in social contacts, increased unaccompanied visits to a healthcare provider (86%), improved confidence in discussing reproductive topics (100%), improved ability to make household decisions about money (57% pre-intervention vs. 92% post-intervention). Conclusions: The Hope Ladies’ reported improved relational/financial empowerment through participating in community-based social entrepreneurship. More studies are needed to elucidate the relationship between empowerment and worker retention/performance to inform the scale-up of HPV self-sampling social entrepreneurship.