Development of the Client Empowerment Scale (CES)

Date of Completion

January 2006


Health Sciences, Nursing




In a contemporary health care system, it is more crucial than ever that the health care provider empower clients who have a chronic health condition. Chronic conditions place a tremendous burden on clients and deplete the health resources on the national level. Empowerment tenets should supplant the medical model for an effective management of chronic health conditions. Despite the abundance of empowerment scholarship in the health care literature, there is paucity of valid and reliable measures of the construct 'client empowerment'. The purpose of this study was to report the developmental process of the Client Empowerment Scale (CES) and investigate its reliability and validity among clients with different chronic health conditions. The initial pool of 131 items was reviewed for content by a panel of five experts. The final 60-item instrument reported an inter-rater agreement of 0.71, and content validity index of 0.9. The dissertation committee and University of Connecticut IRB approved the study protocol for human subjects' protection. The questionnaire was posted on several online support groups designed for clients with various chronic health conditions. The study sample consisted of 318 participants who completed the CES, and data were stored on a secured server at www.formsite.com. Demographic data analysis revealed that 80.5% (n = 256) of study participants were white, 73% (n = 232) were females, 50% (n = 159) from the age group of 30-49, and 39% (n = 124) had some college education. The sample represented participants with different chronic health conditions including: comorbid (n = 104, 32.7%), neurological (n = 68, 21.4%), and diabetes mellitus (n = 35, 11%). Analysis of data reported that the CES scale is highly reliable with Alpha (α) of 0.97. Statistical techniques to assess the construct validity of the CES scale were executed using two methods of factor analysis: principal component analysis, and principal axis factoring. Principal component analysis with Varimax rotation revealed that the extracted 6-factor solution was the most conceptually meaningful and accounted for 58.64% of the total variance. Reliability of the extracted 6-subscales included: Informed Confidence (α = 0.94), Client-Provider Relationship (α = 0.95), Social Advocacy (α = 0.94), Awareness (α = 0.90), Control (α = 0.71), and Client-Client Support (α = 0.77). The reliable and valid CES instrument can be used to measure clients' empowerment, predict clients' self-management practices, and evaluate the effectiveness of empowering programs. Suggestions to enhance the validity and reliability of the CES instrument were discussed. Nursing implications and recommendations for future studies are included. ^