Measurement Properties of the Swedish Empowerment Audiology Questionnaire: A Rasch Analysis.

Abstract

Objectives: Hearing loss is among the most common chronic conditions worldwide, substantially affecting daily life. Its management typically involves person-centered rehabilitation focusing on hearing aid fitting and active client participation. The Empowerment Audiology Questionnaire (EmpAQ) is a self-report instrument assessing empowerment, available in 15- and five-item versions. The EmpAQ was recently translated into Swedish (EmpAQ SWE), with satisfactory content validity, convergent validity, and reliability. This study aimed to further evaluate the EmpAQ SWE by examining its construct validity.

Design: Adults with hearing loss (pure-tone average > 20 dB HL in the better ear) were invited to complete a digital survey (n = 1,176); 152 participants responded. The survey included demographic questions and both EmpAQ-15 and EmpAQ-5. Rasch analysis was applied to assess item targeting, threshold ordering, item fit, differential item functioning (DIF), local dependency (LD), unidimensionality, and reliability.

Results: The EmpAQ SWE demonstrated acceptable measurement properties with adequate item targeting, covering most individuals in the sample and distinguishing approximately three clinically meaningful empowerment levels. Unidimensionality was supported, confirming that the instrument measures a single underlying construct. DIF was identified for Item 1 of the EmpAQ-5 between working and nonworking participants, while Item 6 of the EmpAQ-15 showed misfit and weak discrimination. LD was observed within empowerment dimensions but without broader residual correlations. The person separation index (PSI) was 0.77 for the EmpAQ-15 and 0.55 for the EmpAQ-5. Mean person locations were 1.6 (SD = 1.1) and 1.1 (SD = 1.3), respectively.

Conclusions: The EmpAQ SWE demonstrated acceptable psychometric properties, supporting its validity for assessing self-reported empowerment among individuals with hearing loss in Sweden. Findings align with results from the original English version, reinforcing its clinical relevance. Future research should address item-level refinements to further enhance the instrument.