Never say enough in psychiatric recovery: Translation and validation of a Chinese version of empowerment scale (ES-C) for enhancement of recovery services

Abstract Description

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Authors (including presenting author) :

Lam YL(1), Chow LP(1), Sin CK(1)

Affiliation :

(1)Kwai Chung Hospital

Introduction :

Commencement of the Integrated Day Recovery Service (IDRS) of Kwai Chung Hospital (KCH) in September, 2018 was a milestone in service enhancement of psychiatric rehabilitation. IDRS embeds and sustains recovery-oriented practice to promote family involvement and enhance social inclusion of Persons-in-recovery (PIRs). Given that empowerment is of great significance for determining recovery of PIRs, IDRS places special emphasis on providing PIRs with high standard empowerment services to enhance PIRs’ confidence, social skills, knowledge and access of resources, stabilization of psychiatric symptoms, power for making decision and influencing their lives. However, there is a lack of a psychometrically sound Chinese version of Empowerment Scale (ES-C) for mental health practice use and evaluating the efficacy of the service delivery. Also, there are limited researches to study on the factors influencing level of empowerment among Chinese people with severe mental illness (SMI). In light of the above, translation and validation of an ES-C was conducted in KCH.

Objectives :

To translate and test the psychometric properties of an ES-C in Hong Kong Chinese people with SMI. To investigate the relationships between level of empowerment and the demographic and clinical characteristics of participants.

Methodology :

PIRs with SMI aged 18 years or above under the care of inpatient wards and Rehabilitation and Outpatient Departments of KCH were recruited into the study to administer the original English version of Empowerment Scale (ES), the ES-C, the Chinese version of Recovery Assessment Scale (RAS-C), and a demographic and clinical data sheet. Through whice, item equivalence (Kappa coefficient), content validity (content validity index), factor structure (confirmatory factor analysis), internal consistency (Cronbach’s alphas), test-retest reliability (intra-class correlation), and concurrent validity between ES-C and RAS-24-C (Pearson’s correlation) were tested. The associations between ES-C and demographic characteristics (multiple regression test) were also examined.

Result & Outcome :

280 participants were approached on a voluntary basis using convenience sampling method with 257 usable questionnaires collected. A 20-item refined model of ES-C with good fit to the data was yielded (x²/df=1.830, CFI=0.903, GFI=0.902, and RMSEA=0.057). The mean ± SD score of the ES-C was 2.87±0.33; it was close to the findings of western studies. The refined ES-C demonstrated good content validity (Item-CVI between 0.90 and 1.00, Scale-level CVI=0.92), good concurrent validity (ES-C and RAS-C were strongly correlated; r=0.70, N=257, p=0.000), good internal reliability (Cronbach's α=0.85), good test-retest reliability (ICC=0.77) and a high level of item equivalence with ES (kappa value between 0.7 and 1.0). Education level and employment status emerged as significant factors of empowerment, explaining 10.3 percent of variance in empowerment score [F (9, 247) =4.25, adjusted R²=0.103, p=0.000)]. Despite the need to further evaluate its factor structure, the current ES-C is a reliable tool to measure empowerment level of Chinese PIRs with SMI for better understanding about empowerment-based mental health promotion and care services. Moreover, investigation of the relationships between level of empowerment and the demographic and clinical characteristics of participants reflected meaningful indications of personal factors in relation to empowerment of Chinese people with SMI.