The Client Empowerment in Community Health Systems Scale

Development and validation in three countries

Bibliographic Data

ID19552300
AuthorsTracy L McClair (0000-0002-5045-7514, Population Council, corresponding author), Pooja Sripad (0000-0002-1166-5564, Population Council), Alain Casseus (0000-0002-0406-5499, Zanmi Lasante, Mirebalais, Haiti), Sharif Hossain (0000-0003-2569-0741, Population Council, Dhaka, Bangladesh), Timothy Abuya (0000-0001-8815-8299, British Council), Ann Gottert (0000-0001-6422-9478, Population Council)
Year2021
Volume11
Pages07010-07010
Publication date2021-03-10
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueJournal of Global Health (JOURNAL)
Journal identifiersISSN: 2047-2978 • E-ISSN: 2047-2986
PublisherInternational Society of Global Health (PUBLISHER • GB)
DOI10.7189/jogh.11.07010
PMID33763224
OpenAlexW3138810870
LanguageEN
Citations received5
References cited37

BACKGROUND: Effectively measuring client empowerment is critical for monitoring and supporting empowerment through interventions, including via community health workers (CHWs) on the front line. Yet a comprehensive measure capturing the multidimensional aspects of client empowerment is not currently available. We aimed to develop and validate the Client Empowerment in Community Health Systems (CE-CHS) Scale in three countries. METHODS: We used data from cross-sectional surveys from 2019-2020 with clients of CHWs in Bangladesh (n = 1384), Haiti (n = 616), and Kenya (n = 306). Nineteen candidate CE-CHS Scale items were adapted from existing health empowerment and sociopolitical control scales. Items spanned three hypothesized sub-domains: personal agency around health (eg, "I feel in control of my health"), agency in sharing health information with others (eg, "I feel confident sharing health information with my family/friends"), and empowerment in community health systems (eg, "Most facility/managers would listen to any concerns I raise"). Face and content validity of items were assessed via two focus group discussions in Haiti. For each country, we conducted split-sample exploratory/confirmatory factor analyses (EFA/CFA) and assessed internal consistency reliability. We assessed convergent validity by comparing final full-scale and sub-dimension scores to theoretically related variables. RESULTS: All participants in Bangladesh and Kenya were female, as were 85% in Haiti. Mean age in Bangladesh and Kenya was around 25 years; 40 in Haiti. EFA/CFA resulted in a final 16-item CE-CHS Scale representing the three hypothesized sub-scales. Three items were dropped in EFA due to poor performance. CFA fit statistics were good for the full-scale and each sub-scale. The mean CE-CHS score (range 1 to 4) was 2.4 in in Bangladesh, 2.8 in Haiti, and 3.0 in Kenya. Cronbach's alpha and ordinal theta of the full and sub-scales were greater than 0.7. Increased empowerment was associated with increased trust in CHWs, influence of CHWs on empowerment, satisfaction with CHW services, number of CHW interactions, civic engagement, and education, with slight variations in magnitude and significance by country. CONCLUSIONS: Findings suggest that the 16-item CE-CHS Scale is valid and reliable. This scale can be used to assess levels and determinants of, and changes in, client empowerment in future implementation research and monitoring of community health systems

Business · Community health · Economic growth · Empowerment · Focus group · Geography · Psychological intervention · Public health · Community Health and Development · Diabetes Management and Education · Global Maternal and Child Health · Medicine · Nursing · Psychology · Marketing