The Client Empowerment in Community Health Systems Scale: Development and validation in three countries

• DOI: 10.7189/jogh.11.07010
• Publication Date: 2021-03-19T18:14:02Z
• Authors: Tracy L McClair; Pooja Sripad; Alain Casseus; Sharif Hossain; Timothy Abuya; Ann Gottert
• Keywords: Community Health

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