JMIR Publications

ABSTRACT

Background:

The role of online health communities (OHCs) in patient empowerment is growing and has been increasingly studied in recent years. Research has focused primarily on patients’ individual empowerment, with less attention paid to the role of OHCs in the development of patients’ collective empowerment. The concept and scale of individual empowerment has been validated and thoroughly empirically tested, but the measurement instruments to assess collective empowerment in OHCs have not been yet developed nor validated.

Objective:

This study’s aim was to develop an instrument for measuring collective empowerment in OHCs (CE-OHC) and to test its quality by investigating its factorial structure, reliability, construct and predictive validity.

Methods:

The CE-OHC scale was developed according to a strict methodology for developing valid and reliable scales. An initial set of 20 items was first tested in the pilot study conducted in 2016, using a sample of 280 registered users of Slovenia’s largest OHC. A refined version with 11 items was tested in the main study conducted in 2018 on a random sample of 30,000 registered users of the same OHC. The final sample comprised 784 users. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to investigate the factorial structure, discriminant and convergent validity of the scale. Cronbach’s alpha coefficient was used to determine the CE-OHC scale’s internal consistency. To establish the predictive validity, OLS regression was performed to test the role of CE-OHC in users’ civic participation.

Results:

The EFA resulted in a two-factor solution and the two factors—knowledge of resources and resource mobilization for collective action—that together explain 63.8% of the variance. The second-order CFA demonstrated a good fit to the data (RMSEA=.07) and the scale had a good internal consistency (α=.86). While evidence of the scale’s convergent validity was partially provided, discriminant validity of the scale remained unconfirmed. Overall, CE-OHC was confirmed to be a predictor of users’ civic participation, but the influence was somewhat weak and inconsistent across two subscales.

Conclusions:

The proposed CE-OHC scale is a reliable and relatively valid instrument and serves as a good baseline to advance the measurement of collective empowerment in OHC contexts. This is the first scale developed for this purpose, and future research should focus on the development of a clear nomological network of the collective empowerment construct in relation to the OHC settings.