Assessment of patient empowerment--a systematic review of measures

Paul J Barr, Isabelle Scholl, Paulina Bravo, Marjan J Faber, Glyn Elwyn, Marion McAllister, Paul J Barr, Isabelle Scholl, Paulina Bravo, Marjan J Faber, Glyn Elwyn, Marion McAllister

Abstract

Background: Patient empowerment has gained considerable importance but uncertainty remains about the best way to define and measure it. The validity of empirical findings depends on the quality of measures used. This systematic review aims to provide an overview of studies assessing psychometric properties of questionnaires purporting to capture patient empowerment, evaluate the methodological quality of these studies and assess the psychometric properties of measures identified.

Methods: Electronic searches in five databases were combined with reference tracking of included articles. Peer-reviewed articles reporting psychometric testing of empowerment measures for adult patients in French, German, English, Portuguese and Spanish were included. Study characteristics, constructs operationalised and psychometric properties were extracted. The quality of study design, methods and reporting was assessed using the COSMIN checklist. The quality of psychometric properties was assessed using Terwee's 2007 criteria.

Findings: 30 studies on 19 measures were included. Six measures are generic, while 13 were developed for a specific condition (N=4) or specialty (N=9). Most studies tested measures in English (N=17) or Swedish (N=6). Sample sizes of included studies varied from N=35 to N=8261. A range of patient empowerment constructs was operationalised in included measures. These were classified into four domains: patient states, experiences and capacities; patient actions and behaviours; patient self-determination within the healthcare relationship and patient skills development. Quality assessment revealed several flaws in methodological study quality with COSMIN scores mainly fair or poor. The overall quality of psychometric properties of included measures was intermediate to positive. Certain psychometric properties were not tested for most measures.

Discussion: Findings provide a basis from which to develop consensus on a core set of patient empowerment constructs and for further work to develop a (set of) appropriately validated measure(s) to capture this. The methodological quality of psychometric studies could be improved by adhering to published quality criteria.

Conflict of interest statement

Competing Interests: PJB, IS, PJB, MF and MMcA declare that they have no competing interests. GE provides ad hoc consulting to Emmi Solutions, a producer of patient decision support tools, and holds a number of research grants in the area of shared decision-making. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1. PRISMA flow chart of study…
Fig 1. PRISMA flow chart of study selection.

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