EMPOWER-UP – a tool for measuring empowerment in relational decision-making and problem-solving: detailing the link between questionnaire items and the theoretical and empirical foundation

Background Fostering empowerment is an important goal in the medical care of individuals living with long-term health conditions. Documented difficulties in realising empowerment encouraged us to develop the EMPOWER-UP questionnaire to measure healthcare users’ perceptions of empowerment in relational decision-making and problem-solving across healthcare settings. Preliminary studies among Danish- and English-speaking adult healthcare users with diabetes, cancer, and severe mental illness supported content- and face validity and demonstrated strong psychometric properties of the final 24-item questionnaire. This study explores how daily life-level theories, in the form of four grounded theories, contributed to the final questionnaire. This involved detailing the link between EMPOWER-UP’s content and its theoretical and empirical foundation. Methods We conducted a theory-driven and empirical revisit of EMPOWER-UP’s theoretical and empirical foundation. During this revisit, we explored how each of the four grounded theories constituting the foundation contributed to the items across the questionnaire’s three subscales. Accordingly, we detailed how the content of EMPOWER-UP is linked to concepts related to empowering and disempowering relational patterns and empowering insight, demonstrated by exemplary participant quotes or observations. Results Concepts from all four grounded theories contributed to EMPOWER-UP’s items and subscales. The findings provided transparency about how individual items are linked to theoretical concepts and experiences of healthcare users and providers engaging in decision-making and problem-solving activities. The findings clarify EMPOWER-UP’s capacity to measure otherwise hidden empowering and disempowering relational patterns related to life-versus-disease conflicts, user-provider relationship types, and communication and reflection styles. The findings also provided a deeper understanding of EMPOWER-UP’s value for measuring the ability of interventions and clinicians to overcome relational barriers and provide an empowering insight with the ability to mobilise relational capacities. Conclusion Demonstrating how each of EMPOWER-UP’s 24 items is linked to concepts, quotes, or observations from its conceptual foundation may improve transparency for clinicians and researchers considering its use in clinical practice and research settings.