Measuring Empowerment Counselling in Routine Primary Health Care: Psychometric Properties of a Portuguese Adaptation of the Empowering Speech Practices Scale


      • Assessment of empowering counselling in well-child visits is critical.
      • The Portuguese Empowering Speech Practices Scale version shows good initial validity and reliability.
      • The Portuguese version of ESPS is similar to original version with two components.
      • The Portuguese ESPS can give unique insight relating family and nurse perspectives.
      • The Portuguese ESPS can be adapted for use in other countries given its universal items.



      Empowerment is a widely accepted approach to health promotion in which primary care nurses play an important role. Despite its clinical importance, empirical knowledge is low, mainly due to the lack of instruments to measure this construct. The Empowering Speech Practices Scale (ESPS) is a Finnish measure used to assess the empowerment process in counselling sessions. We designed this study to assess the psychometric properties of a Portuguese adaptation of the ESPS for families of 5-year-old children and nurses in well-child visits.

      Design and methods

      We used a cross-sectional survey design. The ESPS was translated and adapted to the context of children and family health promotion. We administered a sociodemographic questionnaire and the Portuguese ESPS to a sample of 82 families attending a 5-year-old well-child visit and 25 primary care nurses in Portugal. We evaluated the Portuguese ESPS for construct validity and internal consistency.


      Exploratory factor analysis supported a 44-item scale, two-component model, which is similar to the original version, explaining 73.79% of the total variance. Each subscale presented excellent internal consistency and distinguished consultations conducted by nurses with academic training in empowerment patient education.

      Conclusions and implications

      The Portuguese ESPS is a valid and reliable instrument for assessing empowerment in health counselling with families in well-child visits. It looks at the process from two perspectives: the nurses' and the families' perspectives. It can be useful to evaluate quality of care, to identify areas of improvement, and to delve deeper into relationships between empowerment and health outcomes.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


        • Barr P.J.
        • Scholl I.
        • Bravo P.
        • Faber M.J.
        • Elwyn G.
        • McAllister M.
        Assessment of patient empowerment - a systematic review of measures.
        PLoS One. 2015; 10e0126553
        • Beaton D.E.
        • Bombardier C.
        • Guillemin F.
        • Ferraz M.B.
        Guidelines for the process of cross-cultural adaptation of self-report measures.
        Spine. 2000; 25: 3186-3191
        • Cohen J.
        Statistical power analysis for the behavioral sciences.
        Lawrence Erlbaum Associates, Publishers, 1988
        • Cyril S.
        • Smith B.J.
        • Renzaho A.M.
        Systematic review of empowerment measures in health promotion.
        Health Promotion International. 2016; 31: 809-826
        • Direção-Geral da Saúde
        Programa nacional de saúde infantil e juvenil [child and youth national health program] [PDF file].
        (Direção-Geral da Saúde)
        • Dunst C.J.
        • Espe-Sherwindt M.
        Family-centered practices in early childhood intervention.
        in: Reichow B. Boyd B.A. Barton E.E. Odom S.L. Handbook of early childhood special education (pp. 37–55). 2016 (Springer International)
        • Dunst C.J.
        • Hamby D.W.
        • Raab M.
        Modeling the relationships between practitioner capacity-building practices and the behavior and development of young children with disabilities and delays.
        Educational Research Review. 2019; 14: 309-319
        • Dunst C.J.
        • Trivette C.M.
        • Hamby D.W.
        Meta-analysis of family-centered helpgiving practices research.
        Mental Retardation and Developmental Disabilities Research Reviews. 2007; 13: 370-378
        • Dunst C.J.
        • Trivette C.M.
        • Hamby D.W.
        Influences of family-systems intervention practices on parent-child interactions and child development.
        Topics in Early Childhood Special Education. 2010; 30: 3-19
        • Dunst C.J.
        • Trivette C.M.
        • LaPointe N.
        Toward clarification of the meaning and key elements of empowerment.
        Family Science Review. 1992; 5: 11-130
        • von Elm E.
        • Altman D.G.
        • Egger M.
        • Pocock S.J.
        • Gøtzsche P.C.
        • Vandenbroucke J.P.
        • STROBE Initiative
        The strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies.
        International Journal of Surgery. 2014; 12: 1495-1499
        • Gorsuch R.L.
        Factor analysis.
        Lawrence Erlbaum, 1983
        • Green L.W.
        • Kreuter M.W.
        Health promotion planning: An educational and environmental approach.
        Mayfield Publishing, 1991
        • Herbet R.J.
        • Gagnon A.J.
        • Rennick J.E.
        • O’Loughlin J.L.
        A systematic review of questionnaires measuring health-related empowerment.
        Research and Theory for Nursing Practice. 2009; 23: 107-132
        • IBM Corp
        IBM SPSS statistics for windows (version 26.0.).
        IBM Corp, 2019
        • Kayser L.
        • Kamoe A.
        • Duminski E.
        • Somekh D.
        • Vera-Munoz C.
        A new understanding of health related empowerment in the context of an active and healthy ageing.
        BMC Health Services Research. 2019; 19: 242
        • Kettunen T.
        • Liimatainen L.
        • Villberg J.
        • Perko U.
        Developing empowering counseling measurement. Preliminary results.
        Patient Education and Counseling. 2006; 64: 159-166
        • Kettunen T.
        • Poskiparta M.
        • Karhila P.
        Speech practices that facilitate patient participation in health counseling–a way to empowerment?.
        Health Education Journal. 2003; 62: 326-340
        • Kettunen T.
        • Poskiparta M.
        • Liimatainen L.
        Empowering counseling - a case study: Nurse–patient encounter in a hospital.
        Health Education Research. 2001; 16: 227-238
        • Kumpfer K.L.
        • Magalhães C.
        • Kanse S.A.
        Impact of family structure, functioning culture and family-based interventions on children’s health.
        in: Korin M.R. Health promotion for children and adolescents (p.57–81). Springer, 2016
        • Mas J.M.
        • Dunst C.J.
        • Balcells-Balcells A.
        • Garcia-Ventura S.
        • Giné C.
        • Cañadas M.
        Family-centered practices and the parental well-being of young children with disabilities and developmental delay.
        Research in Developmental Disabilities. 2019; 94: 103495
        • Ministério da Saúde
        Bilhete de identidade dos cuidados de saúde primários [Primary health care identity card].
        (Serviço Nacional de Saúde)
        • Ministério da Saúde
        • Direção-Geral da Saúde
        Plano de ação para a literacia em saúde 2019–2021 – Portugal. [Health literacy action plan 2029-2021 - Portugal]. Direção-Geral da Saúde.
        • Mokkink L.B.
        • Terwee C.B.
        • Patrick D.L.
        • Alonso J.
        • Stratford P.W.
        • Knol D.L.
        • de Vet H.C.
        The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: An international Delphi study.
        Quality of Life Research. 2010; 19: 539-549
        • Ordem dos Enfermeiros
        Regulamento do perfil de competências do enfermeiro de cuidados gerais. [PDF file]. Ordem dos Enfermeiros.
        • Perrin E.M.
        • Skinner A.C.
        The importance of screening for healthy weight and recommending healthy lifestyles in pediatric patients.
        North Carolina Medical Journal. 2013; 74: 34-38
        • Poskiparta M.
        • Kettunen T.
        • Liimatainen L.
        Questioning and advising in health counselling: Results from a study of Finnish nurse counsellors.
        Health Education Journal. 2000; 59: 69-89
        • Preston C.C.
        • Colman A.M.
        Optimal number of response categories in rating scales: Reliability, validity, discriminatory power and respondent preferences.
        Acta Psychologica. 2000; 104: 1-15
        • van Ryn M.
        • Heaney C.A.
        Developing effective helping relationships in health education practice.
        Health Education & Behavior. 1997; 24: 683-702
        • Schafer J.L.
        • Graham J.W.
        Missing data: Our view of the state of the art.
        Psychological Methods. 2002; 7: 147-177
        • Tabachnick B.G.
        • Fidell L.S.
        Using multivariate statistics.
        2013 (Pearson)
        • Taylor R.W.
        • Grant A.M.
        • Goulding A.
        • Williams S.M.
        Early adiposity rebound: Review of papers linking this to subsequent obesity in children and adults.
        Current Opinion in Clinical Nutrition and Metabolic Care. 2005; 8: 607-612
        • Tengland P.A.
        Empowerment: A conceptual discussion.
        Health Care Analysis. 2008; 16: 77-96
        • Walton N.
        Participation in paediatric research studies.
        in: Zlotnik Shaul R. Paediatric patient and family-centred care: Ethical and legal issues (pp. 187–207). Springer, 2014
        • Weisberg H.F.
        The total survey error approach: A guide to the new science of survey research.
        The University of Chicago Press, 2005
        • Wong N.T.
        • Zimmerman M.A.
        • Parker E.
        A tipology of youth participation and empowerment for children and adolescent health promotion.
        American Journal of Community Psychology. 2010; 46: 100-114
        • World Health Organization
        Global action plan for the prevention and control of noncommunicable diseases 2013–2020. [PDF file].
        World Health Organization, 2013
        • World Health Organization
        Framework on integrated people-centred health services. [PDF file].
        World Health Organization, 2016
        • World Health Organization
        Integrating diet, physical activity and weight management services into primary care. [PDF file].
        World Health Organization, 2016
        • World Health Organization
        Noncommunicable diseases.
        World Health Organization, 2018 (June)
        • World Health Organization & United Nations Children's Fund
        Global conference on primary health care [PDF file].
        World Health Organization, 2018
        • World Medical Association
        Ethical principles for medical research involving human subjects.
        (World Medical Association)