title: Assessment of patient empowerment--a systematic review of measures.
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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Dartmouth College, Lebanon, United States of America.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Barr
authors.affiliation: University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Scholl
authors.affiliation: Cardiff University, Cardiff, United Kingdom; Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Paulina
authors.initials: P
authors.lastname: Bravo
authors.affiliation: Radboud University Medical Center, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands.
authors.forename: Marjan J
authors.initials: MJ
authors.lastname: Faber
authors.affiliation: Dartmouth College, Lebanon, United States of America.
authors.forename: Glyn
authors.initials: G
authors.lastname: Elwyn
authors.affiliation: Cardiff University, Cardiff, United Kingdom.
authors.forename: Marion
authors.initials: M
authors.lastname: McAllister
mesh_terms: D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D010358:Patient Participation; D017060:Patient Satisfaction; D011594:Psychometrics; D058996:Quality Improvement; D011795:Surveys and Questionnaires