ArticleJournal of global health2021
The Client Empowerment in Community Health Systems Scale: Development and validation in three countries.
Article in Journal of global health, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed, 12 citations in OpenAlex.
- Article
- Lessons From a Behavior Change Intervention to Improve Provider-Parent Partnerships and Care for Hospitalized Newborns and Young Children in Kenya.Global health, science and practice · 2023Article
- Development and Validation of the Trust in My Doctor, Trust in Doctors in General, and Trust in the Health Care Team Scales.Social science & medicine (1982) · 2022Article
- Development and validation of a multi-dimensional scale to assess community health worker motivation.Journal of global health · 2021Article
- Measuring client trust in community health workers: A multi-country validation study.Journal of global health · 2021Article
- Advancing community health measurement, policy, and practice.Journal of global health · 2021Article
- Measuring quality of care at the community level using the contraceptive method information index plus and client reported experience metrics in Bangladesh.Journal of global health · 2021Article
- Measuring Clients' Satisfaction and Trust in Community Health Workers: Results From a Cross-Sectional Survey.Journal of primary care & community healthArticle
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Authors and funding
6 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundEffectively 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.
methodsWe 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.
resultsAll 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.
conclusionsFindings 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.
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