Nissling Linnea, Lindwall Magnus, Kaldo Viktor, Larsman Pernilla, Hansson Lars, Frööjd Sandra, Bendix Marie, Weineland Sandra
Department of Psychology, Faculty of Social Sciences, University of Gothenburg, Gothenburg, Sweden.
Research, Development, Education and Innovation, Primary Health Care, Region Västra Götaland, Sweden.
BMC Psychol. 2025 Aug 13;13(1):909. doi: 10.1186/s40359-025-03123-y.
There has recently been an increased emphasis on patient empowerment and collaboration within their healthcare. However, there is widely a lack of clarity to the concept of empowerment and existing measurement tools lack uniformity, covering diverse domains and related concepts.
This study aims to conduct a psychometric evaluation of the Swedish version of the Empowerment Scale- Making Decisions, focusing on its structural validity and reliability in assessing patient empowerment. This includes a detailed examination of the factor structure across two different contexts, psychiatric care (n = 211) and primary care (n = 210). We will compare several confirmatory factor analysis (CFA) models proposed in previous research to identify the best fit. If no models provide a good fit, we intend to suggest a new scale for further evaluation.
The dimensionality of the scale was tested by comparing four CFA models, together with a one-factor solution, to identify the best fit for the two samples. Reliability measures were determined by coefficient Omega (ω) as well as Cronbach's alpha (α).
There was limited support for the one-factor solution in both samples, challenging the scale's assumed unidimensionality (primary care sample: x(350) = 1074, p <.001, CFI = 0.58, TLI = 0.54, RMSEA = 0.10 (90% CI: 0.09 - 0.11), SRMR = 0.11; psychiatric care sample: (x(350) = 1307, p = < 0.001, CFI = 0.66, TLI = 0.63, RMSEA = 0.11 (90% CI:0.11;0.12), SRMR = 0.10). None of the previously suggested factor solutions demonstrated satisfactory fit. However, a three factor-solution entailed the less complexity and best model fit (primary care sample: (x(270) = 503, p = < 0.001),CFI = 0.85, TLI = 0.84, RMSEA = 0.06 (90% CI 0.06;0.07), SRMR = 0.07; psychiatric care sample: (x(270) = 622, p <.001), CFI = 0.87, TLI = 0.86, RMSEA = 0.08 (90% CI 0.07;0.09), SRMR = 0.07). Based on this, we continued with exploratory refinements of this solution and arrived at two adjusted three-factor models based on each sample. These two adjusted models displayed only slight differences, and in a last step we removed the items that differed between the samples to arrive at one solution appropriate for use in health care settings in general. As a result, an improved and shortened adaptation of the scale was put forward that included 18 items targeting the subscales Self-Esteem, Powerlessness and Activism. This solution remained relatively clear to the previously proposed solutions (primary care sample:(x(131) = 240, p <.001), CFI = 0.91, TLI = 0.90, RMSEA = 0.06 (90% CI 0.05;0.08), SRMR = 0.07; psychiatric care sample: (x(131) = 379, p <.001), CFI = 0.88, TLI = 0.86, RMSEA = 0.09 (90% CI 0.08;0.10), SRMR = 0.07; combined sample: (x(131) = 432, p <.001), CFI = 0.91, TLI = 0.90, RMSEA = 0.07 (90% CI 0.07;0.08), SRMR = 0.06).
The results reinforce the difficulties in measuring empowerment given the complexity of this concept. The improved and shortened adaptation of the scale could potentially be used within health care settings to measure empowerment, but further research is needed to conceptualize and measure empowerment in patients with mental health problems. Given scarce support for the scale's unidimensionallity, future research should explore using multiple instruments targeting different constructs to measure patient empowerment more comprehensively.
最近，医疗保健领域越来越强调患者赋权及患者参与协作。然而，对于赋权概念的界定普遍缺乏清晰度，现有的测量工具缺乏统一性，涵盖了不同领域及相关概念。
本研究旨在对瑞典语版的“赋权量表——做出决策”进行心理测量评估，重点关注其在评估患者赋权方面的结构效度和信度。这包括对两个不同背景下（精神科护理，n = 211；初级护理，n = 210）的因素结构进行详细考察。我们将比较先前研究中提出的几种验证性因素分析（CFA）模型，以确定最佳拟合模型。如果没有模型能提供良好拟合，我们打算提出一个新量表以供进一步评估。
通过比较四个CFA模型以及单因素模型，来测试量表的维度，以确定两个样本的最佳拟合模型。通过欧米茄系数（ω）以及克朗巴哈系数（α）来确定信度指标。
两个样本对单因素模型的支持有限，这对量表假定的单维度性提出了挑战（初级护理样本：χ²(350) = 1074，p <.001，CFI = 0.58，TLI = 0.54，RMSEA = 0.10（90%CI：0.09 - 0.11），SRMR = 0.11；精神科护理样本：χ²(350) = 1307，p < 0.001，CFI = 0.66，TLI = 0.63，RMSEA = 0.11（90%CI：0.11；0.12），SRMR = 0.10）。先前提出的因素模型均未显示出令人满意的拟合。然而，一个三因素模型的复杂性较低且拟合最佳（初级护理样本：χ²(270) = 503，p < 0.001），CFI = 0.85，TLI = 0.84，RMSEA = 0.06（90%CI 0.06；0.07），SRMR = 0.07；精神科护理样本：χ²(270) = 622，p <.001），CFI = 0.87，TLI = 0.86，RMSEA = 0.08（90%CI 0.07；0.09），SRMR = 0.07）。基于此，我们继续对该模型进行探索性优化，基于每个样本得出了两个调整后的三因素模型。这两个调整后的模型仅显示出细微差异，最后一步，我们去除了样本间不同的项目，得出一个适用于一般医疗保健环境的单一模型。结果，提出了一个改进并简化后的量表版本，其中包括针对自尊、无助感和行动主义子量表的18个项目。该模型与先前提出的模型相比拟合度仍然相对较好（初级护理样本：χ²(131) = 240，p <.001），CFI = 0.91，TLI = 0.90，RMSEA = 0.06（90%CI 0.05；0.08），SRMR = 0.07；精神科护理样本：χ²(131) = 379，p <.001），CFI = 0.88，TLI = 0.86，RMSEA = 0.09（90%CI 0.08；0.10），SRMR = 0.07；合并样本：χ²(131) = 432，p <.001），CFI = 0.91，TLI = 0.90，RMSEA = 0.07（90%CI 0.07；0.08），SRMR = 0.06）。
鉴于赋权概念的复杂性，这些结果凸显了测量赋权的困难。改进并简化后的量表版本可能在医疗保健环境中用于测量赋权，但仍需进一步研究以对心理健康问题患者的赋权进行概念化和测量。鉴于对量表单维度性的支持不足，未来研究应探索使用针对不同结构的多种工具，以更全面地测量患者赋权。
