Empowerment in primary care and psychiatric settings: a psychometric evaluation of the Swedish version of the empowerment scale

Abstract

Background: 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. Objectives: 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. Method: 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). Results: There was limited support for the one-factor solution in both samples, challenging the scale’s assumed unidimensionality (primary care sample: x2(350) = 1074, 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: (x2(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: (x2(270) = 622, p