**Background:** Poverty is closely linked to poor health outcomes, creating a vicious cycle. Health empowerment (HE) interventions have shown benefits for health literacy, self-efficacy, and psychological health, but most studies have been short-term, highly controlled, and delivered to either parents or children separately. Evidence on long-term, complex, family-based HE interventions for low-income families in high-income regions is limited. Hong Kong has one of the highest Gini coefficients globally (0.54), with over one-fifth of its population living in poverty. This study evaluated the 5-year effectiveness of a community-based health empowerment program (HEP) for low-income families in Tung Chung, a district where approximately 40% of residents live in poverty.
**Methods:** This prospective, comparative cohort study recruited low-income families with children in grades 1–3 (aged 7–11) between July 2012 and September 2015. Intervention families participated in the Trekkers Family Enhancement Scheme (TFES) and received the HEP, which included annual health assessments, health talks, self-care enablement courses, and health ambassador training. Comparison families were recruited from Tung Chung and Kwai Chung districts. Of 357 adults who provided consent and completed baseline assessment, 289 (162 intervention, 127 comparison) completed the 5-year follow-up (19% dropout rate). The primary outcome was self-care enablement measured by the Chinese Patient Enablement Instrument version 2 (PEI-2). Secondary outcomes included negative emotional states (DASS-21) and health-related quality of life (SF-12v2). Inverse probability weighting based on propensity scores was used to adjust for baseline differences. Linear regressions weighted by inverse probability weighting were applied to assess the independent effects of the HEP on changes in outcomes from baseline to 5-year follow-up.
**Key Results:** After propensity score weighting, baseline characteristics were balanced between groups. The HEP intervention group showed significantly greater increases in all PEI-2 items and total score compared to the comparison group (total PEI-2 score B = 5.22, 95% CI 3.81–6.63, p < 0.001, post hoc power = 1.00). The HEP was significantly associated with a greater decrease in DASS depression score (B = −1.98, 95% CI −3.48 to −0.47, p = 0.001, post hoc power = 0.66). There was a significant positive association between HEP participation and increases in SF-12v2 MCS scores (B = 2.99, 95% CI 0.34–5.64, p = 0.027, post hoc power = 0.55). No significant differences were found for DASS anxiety (B = −0.96, p = 0.193), DASS stress (B = −1.44, p = 0.129), or SF-12v2 PCS (B = −1.34, p = 0.290). Sensitivity analyses adjusting for baseline covariates without inverse probability weighting showed consistent results.
**Clinical Implications:** This study provides evidence that a long-term, multi-component health empowerment program can improve self-care enablement and mental health among adults from low-income families in a real-world community setting. The findings suggest that regular health assessments, health literacy education, self-care enablement courses, and peer health ambassador training can empower individuals to take greater control over their health. The lack of significant improvement in physical health-related quality of life may be attributable to the COVID-19 pandemic, which limited physical activity and changed intervention delivery to hybrid formats. The study's limitations include non-randomization, potential self-selection bias, reliance on self-reported data, and geographic restriction to one district in Hong Kong. Nevertheless, the low dropout rate (19%) and consistent findings across sensitivity analyses support the reliability of the results. Given widening income inequality globally, similar family-based HEPs may help break the cycle of poverty and poor health by enhancing health equity.