The Psychometrics of Developing the Patient Empowerment Scale

Assessing enablement in clinical practice: a systematic review of available instruments

RATIONALE, AIMS AND OBJECTIVES

Enablement is an intervention by which the health care provider recognizes, promotes and enhances patients' ability to control their health and life. An abundant health literature suggests that enablement is associated with good outcomes. In this review, we aimed at identifying and comparing instruments that assess enablement in the health care context.

METHOD

We conducted a systematic literature review using Medline, Embase, Cochrane, Cinahl and PsycINFO databases, 1980 through March 2009, with specific search strategy for each database. Citations were included if they reported: (1) development and/or validation of an instrument; (2) evaluation of enablement in a health care context; and (3) quantitative results following administration of the instrument. The quality of each main retained citation was assessed using a modified version of the Standards for Reporting of Diagnostic Accuracy.

RESULTS

Of 3135 citations identified, 53 were retrieved for detailed evaluation. Four articles were included. Two instruments were found: the Patient Empowerment Scale (PES) and the Empowering Speech Practices Scale (ESPS). Both instruments assessed enablement in hospital setting, one from the inpatient's perspective (PES) and the other from both perspectives (ESPS).

CONCLUSION

Two instruments assess enablement in hospital setting. No instrument is currently available to assess enablement in an ambulatory care context.

Diabetes Empowerment Process Scale: development and psychometric testing of the Chinese version

AIM

This paper is a report of the development and psychometric testing of the Chinese version of the Diabetes Empowerment Process Scale.

BACKGROUND

In people living with diabetes, empowerment can improve metabolic and psychosocial outcomes. A scale for measuring empowerment processes can also help healthcare professionals to optimize their empowering actions and would improve their interactions with people living with diabetes.

METHOD

Based on literature reviews and interviews with people living with diabetes, a 27-item Chinese Diabetes Empowerment Process Scale was developed. Fifteen items were produced after item analysis and content validity testing. To test construct validity, concurrent validity and internal consistency, 211 outpatients living with diabetes completed the Chinese Diabetes Empowerment Process Scale, a Self-care Behaviour Scale and a Diabetes Empowerment Scale. Test-retest reliability was also analysed with 30 patients. The study was conducted in 2008 and 2009 in Taiwan.

RESULTS

Confirmatory factor analysis indicated that a second-order factorial model with four subscales and 15 items best fitted the data. The four subscales were Mutual participation, Raising awareness, Providing necessary information and Open communication. Scores on the Chinese Diabetes Empowerment Process Scale correlated statistically significantly with those on the Self-care Behaviour Scale (r=0.21-0.40; P<0.01) and Diabetes Empowerment Scale (r=0.35-0.65; P<0.01). Reliability was supported by acceptable Cronbach's α (range: 0.73-0.91) and test-retest reliability scores (range: 0.75-0.83).

CONCLUSION

The Chinese Diabetes Empowerment Process Scale has satisfactory validity and reliability for measuring the empowerment process of health professionals. Further studies are needed to test the applicability of the scale to other populations.

Developing a self-rating measure of patient competence in the context of oncology: a multi-center study

OBJECTIVE

Concepts of patient competence (PC) are being increasingly used, but seldom clearly defined in the context of shared medical treatment decision making and coping with cancer. The meaning of such concepts should therefore be clarified, and measures developed that permit the assessment of different facets of this patient characteristic. Consequently, this study attempted to contribute to the definition and measurement of PC.

METHODS

Employing literature reviews and qualitative interviews, we developed a working definition of PC in the context of cancer from which we designed a self-rating measure of this patient characteristic that was then tested for validity and reliability in a sample of N=536 patients with cancer.

RESULTS

Using factor analyses, we developed five problem- and three emotion-focused subscales that measure distinct facets of PC with satisfactory reliability. Additional analyses provide preliminary evidence of the instruments' validity.

CONCLUSIONS

This study represents an essential first step in developing a reliable self-rating measure of PC in the context of cancer. Although further refinement of this measure is clearly required, it provides a preliminary methodological basis for empirically investigating the determinants and potential health effects of PC.

Subjective dimensions of patient competence: relationships with selected healthcare usage behaviors and general features of self-rated competence

OBJECTIVE

To introduce the concept of patient competence and provide additional information on the concurrent validity of a new self-rating measure of patient competence in the context of cancer employing healthcare usage behaviors and more general self-rated features of patient competence as criteria.

METHODS

Based on a multi-center sample of n=536 patients with cancer, bivariate correlations and multiple regressions were computed.

RESULTS

The competence subscale of striving for autonomous decisions emerged as significant, albeit weak predictor of having used professional psycho-social support (r=.31, beta=.28) and employing other complementary medicines (r=.28; B=.65) in relation to one's cancer. Problem-focused and emotion-focused competencies relate differently to different general features of self-rated competence like feeling informed and assertive or adapting well.

CONCLUSION

Additional support for the concurrent validity of the new self-rating measure of patient competence in the context of cancer has been found. Viewed in perspective, this measure may therefore provide a methodological basis to examine determinants and health effects of patient competence empirically. Nevertheless, further research on the conceptualization and measurement of patient competence appears necessary.

PRACTICE IMPLICATIONS

Having available measures of patients' specific competencies in the context of cancer will help identify their strength and weaknesses in dealing with life-threatening disease and enhance their coping resources.