Background/Purpose: The World Health Organization describes empowerment in health promotion work as a process in which the person receives more control over decisions and actions that affect their own life and health (1998). Empowerment (E) is an important concept in rheumatoid arthritis (RA), where it has been associated to favorable outcomes. Currently, there is no validated E instrument for use with Spanish speaking RA patients. Objective of the study were to adapt the Spanish version of the Health Empowerment Scale (S-HES) (1) for RA (S-ERA) and to perform its psychometric validation.

Methods: The S-ERA instrument was adapted from the already existing S-HES (1). Adaption was performed by 3 researchers who at first, substitute the word “health” with “rheumatoid arthritis” in each item from the S-HES. A first proposal of the S-ERA included 2 alternatives sentences per item. Then, an external Committee integrated by 6 rheumatologists and 2 psychiatrists rated each sentence according to 3 categories: Unnecessary, important but not necessary or essential. One sentence per item was retained when ≥80% of the validators agree that the sentence/item was essential. A first version was obtained and it was pilot tested in a convenience sample of 50 RA outpatients (Cronbach’s α=0.84). After that, minor modifications were adopted and a final version of the S-ERA integrated by 8 items scored on a 5 point Likert scale, was applied to 109 additional consecutive RA patients from the outpatient Clinic of a tertiary care level Center (Table 1). Test-retest exercise was performed in a sample of 50 patients. All the patients gave written informed consent.

Results: The 109 RA outpatients were primarily females (89%) and 99 (91%) had low-medium socioeconomic status; their (mean±SD) age was 50.6±13.3 years and their formal education was 9.7±3 years. Ninety-four (86.2%) patients had rheumatoid factor and 56 (51.4%) were in remission according to their attending rheumatologist, meanwhile 27 patients (25%) had a major comorbidity. 

The (mean±SD) score of the S-ERA was 34.4±3.8 (8-40, where 40 indicates the strongest level of RA related E). S-ERA instrument had a good internal consistency (Cronbach’s α=0.82); construct validity was examined by factor analysis that showed a single factor explaining 46.2% of the variance. The intra-class coefficient correlation in the test-retest was 0.79, p≤0.0001. Table 2 summarizes additional psychometric properties.

Conclusion: The S-ERA instrument is easy to apply and had adequate validity and reliability to evaluate E in Hispanic RA patients.

Reference: 1. Serrani ADJL. Colombia Médica 2014; 45