EMPOWER-UP: psychometric evaluation of a generic questionnaire for assessing empowerment in relational decision-making and problem-solving among adults with long-term health conditions

EMPOWER-UP: psychometric evaluation of a generic questionnaire for assessing empowerment in relational decision-making and problem-solving among adults with long-term health conditions | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article EMPOWER-UP: psychometric evaluation of a generic questionnaire for assessing empowerment in relational decision-making and problem-solving among adults with long-term health conditions Emilie Haarslev Schröder Marqvorsen, Morten Aagaard Petersen, and 12 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3772053/v2 This work is licensed under a CC BY 4.0 License Status: Posted Version 2 posted You are reading this latest preprint version Show more versions Abstract Background Relational decision-making and problem-solving are powerful activities occurring daily across all healthcare contexts. Their empowering potential can be difficult to judge and is seldom fully exploited, and they can even be perceived as disempowering. This calls for assessment of the extent to which healthcare users perceive their interactions with healthcare providers as empowering. We developed a 36-item draft version of the generic EMPOWER-UP questionnaire deemed to have good face and content validity by healthcare users and researchers with expertise across multiple healthcare contexts. This article reports the psychometric properties of the Danish and English versions of the questionnaire. Methods A cross-sectional study was carried out among 526 adults diagnosed with diabetes, cancer, or severe mental illness in Denmark, United Kingdom, and Australia with recent (≤ 6 months) interaction with a healthcare provider. We evaluated structural validity, cross-cultural validity, and measurement invariance using confirmatory and exploratory factor analyses, item response theory modelling, and differential item functioning. Additionally, we evaluated empirical reliability and internal consistency. Results The final 24-item Danish and English versions of EMPOWER-UP has a three-factor second-order structure. The three factors of empowering mechanisms (14 items), disempowering mechanisms (6 items), and empowering insight (4 items) are connected through the second-order factor, realizing empowerment. Partial credit model calibration supported the use of summed subscale item scores, enhancing usability in clinical practice settings. Differential item functioning analysis demonstrated invariance across subgroups. Empirical reliability of the subscales was estimated at 0.85–0.95, and Cronbach’s alpha was 0.90–0.96. Conclusions The 24-item EMPOWER-UP questionnaire measuring empowerment in relational decision-making and problem-solving showed strong psychometric properties among adults with cancer, diabetes, and severe mental illness. Further evaluation in other contexts and populations is needed, including evaluation of construct validity, responsiveness to change, and test-retest reliability. Empowerment Decision making Problem solving Self-Determination Theory Life Skills User-provider relationships Questionnaire Design Patient Reported Outcome Measure Psychometrics Long-term health conditions Full Text Additional Declarations Competing interest reported. VZ and EHSM are the primary developers of EMPOWER-UP. The remaining authors have no competing interests to disclose. Supplementary Files AdditionalFile1.Flowchart.pptx Additionalfile2.Exploratoryfactoranalysis.docx Additionalfile3.IRTparameters.docx Additionalfile4.FinalDanishandEnglishEMPOWERUP.docx Cite Share Download PDF Status: Posted Version 2 posted You are reading this latest preprint version Show more versions Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3772053","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":560569400,"identity":"365a96c9-d9b4-11f0-907b-06cc9d20a69f","order_by":0,"name":"Emilie Haarslev Schröder 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VZ and EHSM are the primary developers of EMPOWER-UP. The remaining authors have no competing interests to disclose.","formattedTitle":"EMPOWER-UP: psychometric evaluation of a generic questionnaire for assessing empowerment in relational decision-making and problem-solving among adults with long-term health conditions","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Empowerment, Decision making, Problem solving, Self-Determination Theory, Life Skills, User-provider relationships, Questionnaire Design, Patient Reported Outcome Measure, Psychometrics, Long-term health conditions","lastPublishedDoi":"10.21203/rs.3.rs-3772053/v2","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3772053/v2","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eRelational decision-making and problem-solving are powerful activities occurring daily across all healthcare contexts. Their empowering potential can be difficult to judge and is seldom fully exploited, and they can even be perceived as disempowering. This calls for assessment of the extent to which healthcare users perceive their interactions with healthcare providers as empowering. We developed a 36-item draft version of the generic EMPOWER-UP questionnaire deemed to have good face and content validity by healthcare users and researchers with expertise across multiple healthcare contexts. This article reports the psychometric properties of the Danish and English versions of the questionnaire.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA cross-sectional study was carried out among 526 adults diagnosed with diabetes, cancer, or severe mental illness in Denmark, United Kingdom, and Australia with recent (\u0026le;\u0026thinsp;6 months) interaction with a healthcare provider. We evaluated structural validity, cross-cultural validity, and measurement invariance using confirmatory and exploratory factor analyses, item response theory modelling, and differential item functioning. Additionally, we evaluated empirical reliability and internal consistency.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe final 24-item Danish and English versions of EMPOWER-UP has a three-factor second-order structure. The three factors of empowering mechanisms (14 items), disempowering mechanisms (6 items), and empowering insight (4 items) are connected through the second-order factor, realizing empowerment. Partial credit model calibration supported the use of summed subscale item scores, enhancing usability in clinical practice settings. Differential item functioning analysis demonstrated invariance across subgroups. Empirical reliability of the subscales was estimated at 0.85\u0026ndash;0.95, and Cronbach\u0026rsquo;s alpha was 0.90\u0026ndash;0.96.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eThe 24-item EMPOWER-UP questionnaire measuring empowerment in relational decision-making and problem-solving showed strong psychometric properties among adults with cancer, diabetes, and severe mental illness. Further evaluation in other contexts and populations is needed, including evaluation of construct validity, responsiveness to change, and test-retest reliability.\u003c/p\u003e","manuscriptTitle":"EMPOWER-UP: psychometric evaluation of a generic questionnaire for assessing empowerment in relational decision-making and problem-solving among adults with long-term health conditions","msid":"","msnumber":"","nonDraftVersions":[{"code":2,"date":"2025-12-15 13:20:14","doi":"10.21203/rs.3.rs-3772053/v2","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}},{"code":1,"date":"2023-12-27 08:28:36","doi":"10.21203/rs.3.rs-3772053/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c01e826a-34b8-4d71-9808-9a32bf125b58","owner":[],"postedDate":"December 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-29T07:55:45+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-15 13:20:14","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v2","identity":"rs-3772053","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3772053","identity":"rs-3772053","version":["v2"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}