Advances in the conceptualization and measurement of Health Care Empowerment: development and validation of the Health Care Empowerment inventory

Mallory O Johnson, Carol Dawson Rose, Samantha E Dilworth, Torsten B Neilands, Mallory O Johnson, Carol Dawson Rose, Samantha E Dilworth, Torsten B Neilands

Abstract

The Health Care Empowerment Model offers direction for the investigation of patient-controlled engagement and involvement in health care. At the core of the model is the construct of Health Care Empowerment (HCE), for which there exist no validated measures. A set of 27 candidate self-report survey items was constructed to capture five hypothesized inter-related facets of HCE (informed, engaged, committed, collaborative, and tolerant of uncertainty). The full item set was administered to 644 HIV-infected persons enrolled in three ongoing research studies. Exploratory and confirmatory factor analyses resulted in a two factor solution comprising four items each on two subscales: (1) HCE: Informed, Committed, Collaborative, and Engaged HCE ICCE) and (2) HCE Tolerance of Uncertainty (HCE TU). Subscale scores were evaluated for relationships with relevant constructs measured in the three studies, including depression, provider relationships, medication adherence, and HIV-1 viral load. Findings suggest the utility of this 8-item Health Care Empowerment Inventory (HCEI) in efforts to measure, understand, and track changes in the ways in which individuals engage in health care.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

References

    1. Johnson MO (2011) The shifting landscape of health care: toward a model of health care empowerment. Am J Public Health 101: 265–270.
    1. D'Zurilla TJ, Goldfried MR (1971) Problem solving and behavior modification. Journal of Abnormal Psychology 78: 107–126.
    1. Lazarus RS, Folkman S (1984) Stress, appraisal, and coping. New York: Springer Pub. Co. xiii, 445 p.
    1. Ewart CK (2004) How integrative behavioral theory can improve health promotion and disease prevention. In: Boll TJ, editor. Handbook of Clinical Health Psychology. Washington, D.C.: American Psychological Association. 249–289.
    1. Hibbard JH, Stockard J, Mahoney ER, Tusler M (2004) Development of the Patient Activation Measure (PAM): conceptualizing and measuring activation in patients and consumers. Health Serv Res 39: 1005–1026.
    1. Johnson MO, Sevelius JM, Dilworth SE, Saberi P, Neilands TB (2012) Preliminary support for the construct of health care empowerment in the context of treatment for human immunodeficiency virus. Patient Prefer Adherence 6: 395–404.
    1. Gardner EM, McLees MP, Steiner JF, Del Rio C, Burman WJ (2011) The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection. Clin Infect Dis 52: 793–800.
    1. Giordano TP, Gifford AL, White AC Jr, Suarez-Almazor ME, Rabeneck L, et al. (2007) Retention in care: a challenge to survival with HIV infection. Clin Infect Dis 44: 1493–1499.
    1. Johnson MO, Catz SL, Remien RH, Rotheram-Borus MJ, Morin SF, et al. (2003) Theory guided, empirically supported avenues for intervention on HIV medication nonadherence: Findings from the Healthy Living Project. AIDS Patient Care STDS 17: 645–656.
    1. Turner CF, Ku L, Rogers SM, Lindberg LD, Pleck JH, et al. (1998) Adolescent sexual behavior, drug use, and violence: Increased reporting with computer survey technology. Science 280: 867–873.
    1. Sevelius JM, Carrico A, Johnson MO (2010) Antiretroviral therapy adherence among transgender women living with HIV. J Assoc Nurses AIDS Care 21: 256–264.
    1. Johnson MO, Neilands TB, Dilworth S, Morin SF, Remien RH, et al. (2007) The Role of Self-Efficacy in HIV Treatment Adherence: Validation of the HIV Treatment Adherence Self-Efficacy Scale (HIV-ASES). Journal of Behavioral Medicine 30: 359–370.
    1. Harvey RM, Kazis L, Lee AF (1999) Decision-making preference and opportunity in VA ambulatory care patients: association with patient satisfaction. Res Nurs Health 22: 39–48.
    1. Beach MC, Duggan PS, Moore RD (2007) Is patients’ preferred involvement in health decisions related to outcomes for patients with HIV? J Gen Intern Med 22: 1119–1124.
    1. Radloff LS (1977) The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement 1: 385–401.
    1. Chesney MA, Ickovics JR, Chambers DB, Gifford AL, Neidig J, et al. (2000) Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: the AACTG adherence instruments. Patient Care Committee & Adherence Working Group of the Outcomes Committee of the Adult AIDS Clinical Trials Group (AACTG). AIDS Care 12: 255–266.
    1. Chesney MA, Ickovics J. Adherence to combination therapy in AIDS clinical trials.; 1997; Washington, D.C.
    1. Walsh JC, Pozniak AL, Nelson MR, Mandalia S, Gazzard BG (2002) Virologic rebound on HAART in the context of low treatment adherence is associated with a low prevalence of antiretroviral drug resistance. Journal of Acquired Immune Deficiency Syndromes 30: 278–287.
    1. Walsh JC, Mandalia S, Gazzard BG (2002) Responses to a 1 month self-report on adherence to antiretroviral therapy are consistent with electronic data and virological treatment outcome. Aids 16: 269–277.
    1. Oyugi JH, Byakika-Tusiime J, Charlebois ED, Kityo C, Mugerwa R, et al. (2004) Multiple Validated Measures of Adherence Indicate High Levels of Adherence to Generic HIV Antiretroviral Therapy in a Resource-Limited Setting. Journal of Acquired Immune Deficiency Syndromes 36: 1100–1102.
    1. DHHS (2011) Guidelines for the use of antiretroviral agents in HIV-infected adults and adolescents. Department of Health and Human Services and the Henry J. Kaiser Family Foundation.
    1. Kalichman SC, Rompa D, Cage M (2000) Reliability and validity of self-reported CD4 lymphocyte count and viral load test results in people living with HIV/AIDS. International Journal of STD & AIDS 11: 579–585.
    1. McDonald RP (1985) Factor Analysis and Related Methods. Hillsdale, New Jersey: Lawrence Erlbaum and Associates.
    1. Gerbing DW, Hamilton JG (1996) Viability of exploratory factor analysis as a precursor to confirmatory factor analysis. Structural Equation Modeling 3: 62–72.
    1. Hu L-t, Bentler PM (1999) Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling 6: 1–55.
    1. Yu CY (2002) Evaluating cutoff criteria of model fit indices for latent variable models with binary and continuous outcomes. [Doctoral Dissertation]. Los Angles, CA: University of California, Los Angeles.
    1. Raykov T, Marcoulides GA (2011) Introduction to Psychometric Theory. New York: Routledge.
    1. Frosch DL, May SG, Rendle KAS, Tietbohl C, Elwyn G (2012) Authoritarian Physicians and Patients’ Fear of Being Labeled “Difficult” Among Key Obstacles to Shared Decision Making. Health Affairs 31: 1030–1038.

Source: PubMed

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