EMPOWER-UP – a tool for measuring empowerment in relational decision-making and problem-solving: detailing the link between questionnaire items and the theoretical and empirical foundation

EMPOWER-UP – a tool for measuring empowerment in relational decision-making and problem-solving: detailing the link between questionnaire items and the theoretical and empirical foundation | 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 – a tool for measuring empowerment in relational decision-making and problem-solving: detailing the link between questionnaire items and the theoretical and empirical foundation Emilie Haarslev Schröder Marqvorsen, Line Lund, Morten Aagaard Petersen, and 9 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7805471/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background Fostering empowerment is an important goal in the medical care of individuals living with long-term health conditions. Documented difficulties in realising empowerment encouraged us to develop the EMPOWER-UP questionnaire to measure healthcare users’ perceptions of empowerment in relational decision-making and problem-solving across healthcare settings. Preliminary studies among Danish- and English-speaking adult healthcare users with diabetes, cancer, and severe mental illness supported content- and face validity and demonstrated strong psychometric properties of the final 24-item questionnaire. This study explores how daily life-level theories, in the form of four grounded theories, contributed to the final questionnaire. This involved detailing the link between EMPOWER-UP’s content and its theoretical and empirical foundation. Methods We conducted a theory-driven and empirical revisit of EMPOWER-UP’s theoretical and empirical foundation. During this revisit, we explored how each of the four grounded theories constituting the foundation contributed to the items across the questionnaire’s three subscales. Accordingly, we detailed how the content of EMPOWER-UP is linked to concepts related to empowering and disempowering relational patterns and empowering insight, demonstrated by exemplary participant quotes or observations. Results Concepts from all four grounded theories contributed to EMPOWER-UP’s items and subscales. The findings provided transparency about how individual items are linked to theoretical concepts and experiences of healthcare users and providers engaging in decision-making and problem-solving activities. The findings clarify EMPOWER-UP’s capacity to measure otherwise hidden empowering and disempowering relational patterns related to life-versus-disease conflicts, user-provider relationship types, and communication and reflection styles. The findings also provided a deeper understanding of EMPOWER-UP’s value for measuring the ability of interventions and clinicians to overcome relational barriers and provide an empowering insight with the ability to mobilise relational capacities. Conclusion Demonstrating how each of EMPOWER-UP’s 24 items is linked to concepts, quotes, or observations from its conceptual foundation may improve transparency for clinicians and researchers considering its use in clinical practice and research settings. Empowerment questionnaire validity psychometrics patient-reported outcome measure user-provider relationships long-term health conditions grounded theory decision-making problem-solving Full Text Additional Declarations Competing interest reported. EHSM and VZ developed the EMPOWER-UP questionnaire. All other authors declare that they have no competing interests. Supplementary Files SupplementaryFile1.pptx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 30 Nov, 2025 Reviewers agreed at journal 20 Nov, 2025 Reviewers invited by journal 20 Nov, 2025 Editor assigned by journal 18 Nov, 2025 Editor invited by journal 24 Oct, 2025 Submission checks completed at journal 23 Oct, 2025 First submitted to journal 23 Oct, 2025 You are reading this latest preprint version 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-7805471","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":556453780,"identity":"e6fb9589-8ba0-4de7-ad76-86e25dd596bf","order_by":0,"name":"Emilie Haarslev Schröder 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EHSM and VZ developed the EMPOWER-UP questionnaire. All other authors declare that they have no competing interests.","formattedTitle":"EMPOWER-UP – a tool for measuring empowerment in relational decision-making and problem-solving: detailing the link between questionnaire items and the theoretical and empirical foundation","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":true,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"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":"bmc-medical-informatics-and-decision-making","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"midm","sideBox":"Learn more about [BMC Medical Informatics and Decision Making](http://bmcmedinformdecismak.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/midm/default.aspx","title":"BMC Medical Informatics and Decision Making","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Empowerment, questionnaire, validity, psychometrics, patient-reported outcome measure, user-provider relationships, long-term health conditions, grounded theory, decision-making, problem-solving","lastPublishedDoi":"10.21203/rs.3.rs-7805471/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7805471/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eFostering empowerment is an important goal in the medical care of individuals living with long-term health conditions. Documented difficulties in realising empowerment encouraged us to develop the EMPOWER-UP questionnaire to measure healthcare users\u0026rsquo; perceptions of empowerment in relational decision-making and problem-solving across healthcare settings. Preliminary studies among Danish- and English-speaking adult healthcare users with diabetes, cancer, and severe mental illness supported content- and face validity and demonstrated strong psychometric properties of the final 24-item questionnaire. This study explores how daily life-level theories, in the form of four grounded theories, contributed to the final questionnaire. This involved detailing the link between EMPOWER-UP\u0026rsquo;s content and its theoretical and empirical foundation.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eWe conducted a theory-driven and empirical revisit of EMPOWER-UP\u0026rsquo;s theoretical and empirical foundation. During this revisit, we explored how each of the four grounded theories constituting the foundation contributed to the items across the questionnaire\u0026rsquo;s three subscales. Accordingly, we detailed how the content of EMPOWER-UP is linked to concepts related to empowering and disempowering relational patterns and empowering insight, demonstrated by exemplary participant quotes or observations.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eConcepts from all four grounded theories contributed to EMPOWER-UP\u0026rsquo;s items and subscales. The findings provided transparency about how individual items are linked to theoretical concepts and experiences of healthcare users and providers engaging in decision-making and problem-solving activities. The findings clarify EMPOWER-UP\u0026rsquo;s capacity to measure otherwise hidden empowering and disempowering relational patterns related to life-versus-disease conflicts, user-provider relationship types, and communication and reflection styles. The findings also provided a deeper understanding of EMPOWER-UP\u0026rsquo;s value for measuring the ability of interventions and clinicians to overcome relational barriers and provide an empowering insight with the ability to mobilise relational capacities.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eDemonstrating how each of EMPOWER-UP\u0026rsquo;s 24 items is linked to concepts, quotes, or observations from its conceptual foundation may improve transparency for clinicians and researchers considering its use in clinical practice and research settings.\u003c/p\u003e","manuscriptTitle":"EMPOWER-UP – a tool for measuring empowerment in relational decision-making and problem-solving: detailing the link between questionnaire items and the theoretical and empirical foundation","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-12 12:43:46","doi":"10.21203/rs.3.rs-7805471/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-11-30T19:50:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"240470414029217679510389829656279815190","date":"2025-11-20T12:18:49+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-20T07:54:15+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-18T09:19:18+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-24T15:45:09+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-23T09:34:34+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Informatics and Decision Making","date":"2025-10-23T09:30:39+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-informatics-and-decision-making","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"midm","sideBox":"Learn more about [BMC Medical Informatics and Decision Making](http://bmcmedinformdecismak.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/midm/default.aspx","title":"BMC Medical Informatics and Decision Making","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c01e826a-34b8-4d71-9808-9a32bf125b58","owner":[],"postedDate":"December 12th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-12-15T07:20:17+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-12 12:43:46","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7805471","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7805471","identity":"rs-7805471","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}