Empowerment Scale

1. Abstract

The Empowerment Scale (often referred to as the Making Decisions questionnaire) is a foundational, consumer-constructed psychometric instrument designed to assess subjective and collective empowerment among individuals navigating psychiatric disabilities and mental health services. Originally developed through a participatory research framework by Boston University researchers E. Sally Rogers, Judi Chamberlin, Marsha I. Ellison, and Teresa Crean in 1997, and subsequently refined and cross-validated by Rogers, Ralph, and Salzer (2010), the scale operationalizes the multifaceted construct of psychological and community-level empowerment. The instrument comprises 28 self-report items evaluated on a 4-point Likert scale ranging from 1 (Strongly Agree) to 4 (Strongly Disagree), with selected structural iterations recommending a 25-item core composition following the removal of psychometrically unstable items.

Extensive exploratory and confirmatory factor analyses establish that the Empowerment Scale assesses five correlated yet distinct domains: Self-Esteem and Self-Efficacy, Power and Powerlessness, Community Activism and Autonomy, Optimism and Control Over the Future, and Righteous Anger. The total scale exhibits robust internal consistency, yielding Cronbach’s alpha coefficients typically ranging between α = .82 and α = .86 across heterogeneous psychiatric populations. Subscale internal reliabilities vary according to subscale length, spanning from moderate values for brief factors (α = .45 to .64) to high consistency for the dominant self-esteem dimension (α = .82 to .86). Construct, convergent, and discriminant validities have been empirically substantiated via strong correlations with general self-efficacy, internal locus of control, hope, psychological recovery, and quality of life metrics, alongside negative associations with psychiatric symptomatology and hopelessness. Serving as an international gold standard in psychiatric rehabilitation, community psychology, and social services evaluation, the Empowerment Scale provides a rigorous empirical mechanism for quantifying personal agency and collective action.

2. Keywords

Empowerment Scale, psychological empowerment, mental health recovery, psychiatric rehabilitation, consumer-constructed measurement, Judi Chamberlin, self-efficacy, righteous anger, community activism, psychometrics.

3. Authors

The original development, conceptual formulation, and subsequent structural validation of the Empowerment Scale represent an interdisciplinary collaboration between academic psychometricians and pioneer leaders of the psychiatric survivor/consumer movement:

• E. Sally Rogers, Sc.D. — Executive Director and Research Professor at the Center for Psychiatric Rehabilitation, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, Massachusetts, United States. Primary psychometrician, investigator in psychiatric disability, vocational recovery, and rehabilitation research. Contact: [email protected].
• Judi Chamberlin (1944–2010) — World-renowned psychiatric survivor, activist, educator, and foundational architect of the mad pride and mental health consumer/survivor/ex-patient movements. Affiliated with the Center for Psychiatric Rehabilitation, Boston University, Boston, Massachusetts, United States. Chamberlin served as the philosophical and consumer-activist lead in identifying phenomenological dimensions of empowerment.
• Marsha Langer Ellison, Ph.D. — Senior Researcher and Associate Professor, Center for Psychiatric Rehabilitation, Sargent College, Boston University, and Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, Massachusetts, United States.
• Teresa Crean, M.S. — Research Associate and Biostatistician, Center for Psychiatric Rehabilitation, Boston University, Boston, Massachusetts, United States.
• Ralph O. Ralph, Ph.D. — Mental Health Evaluation Specialist, Muskie School of Public Service, University of Southern Maine, Portland, Maine, United States (collaborator on the multi-site 2010 validation cohort).
• Mark S. Salzer, Ph.D. — Professor of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, Pennsylvania, United States. Director of the Temple University Collaborative on Community Inclusion of Individuals with Psychiatric Disabilities (collaborator on structural cross-validation studies).

4. Purpose

The Empowerment Scale was explicitly engineered to address a historical void in psychiatric evaluation: the absence of an empirically rigorous, consumer-defined psychometric tool capable of measuring empowerment from the phenomenological standpoint of individuals living with severe mental illnesses. Historically, traditional mental health services operated beneath paternalistic medical models where therapeutic success was gauged strictly through clinical symptom reduction, medication compliance, and rates of rehospitalization. Such metrics systematically ignored the individual’s subjective agency, self-determination, sociopolitical consciousness, and capacity to direct their own life course.

Constructed in direct response to the emerging recovery paradigm within mental health services, the scale operationalizes Judi Chamberlin’s groundbreaking conceptualization of empowerment. Chamberlin delineated that true empowerment for mental health consumers is not merely an internal psychological state of self-confidence, but an ecological condition encompassing decision-making authority, access to resources, independence from coercive institutional intervention, entitlement to righteous anger, and participation in mutual aid and sociopolitical reform. The scale was purposefully built to determine how programmatic, clinical, and policy environments either foster autonomy or entrench institutional powerlessness.

In clinical and service evaluation settings, the Empowerment Scale serves multiple diagnostic and investigative functions:

• Outcome Evaluation in Peer-Run and Traditional Services: It provides an objective assessment benchmark to compare the therapeutic mechanisms of consumer-operated service programs (COSPs) against standard clinical case management and psychiatric rehabilitation modalities.
• Individual Recovery Planning: Clinicians and peer support specialists utilize subscale profiles (e.g., discrepancies between high Community Activism and low Power-Powerlessness) to tailor personalized psychiatric rehabilitation goals, addressing specific deficits in self-efficacy or community engagement.
• Interventional and Longitudinal Research: The scale enables researchers to track psychological change across longitudinal interventions, assessing how peer advocacy, supported employment, and shared decision-making models stimulate progressive gains in psychological sovereignty.
• Systemic Policy Advocacy: Aggregate scale scores yield empirical documentation demonstrating that individuals with severe psychiatric conditions possess substantial capacity for self-determination and civic engagement when provided with community-based opportunities rather than paternalistic custody.

5. Psychological Construct

Empowerment within this framework is conceptualized as an overarching, multidimensional, multi-level construct encompassing personal agency, interpersonal assertiveness, and sociopolitical action. Rather than treating empowerment as a unidimensional personality trait or a fixed affective status, the scale decomposes it into five interconnected psychological and behavioral domains:

1. Self-Esteem and Self-Efficacy

This primary subscale captures an individual’s internal evaluation of personal worth, functional capability, and confidence in their capacity to execute behaviors necessary to produce specific performance attainments. Heavily influenced by Albert Bandura‘s self-efficacy paradigm and Morris Rosenberg’s self-esteem construct, this dimension evaluates whether consumers perceive themselves as competent, valuable members of society on an equal footing with others. Exemplar items reflect core beliefs in internal adequacy, such as viewing oneself as a capable person (Item 9) and holding an enduring positive attitude toward oneself (Item 5). High scores indicate resilient self-regard and confidence in navigating complex life challenges despite systemic stigmatization.

2. Power and Powerlessness

The power and powerlessness subscale operationalizes subjective perceptions of control over external circumstances versus feelings of subjugation, learned helplessness, and surrender to external institutional authorities. Rooted in psychological theories of internal versus external locus of control, this factor assesses the extent to which an individual feels overwhelmed by circumstance or dominated by mental health professionals and systemic gatekeepers. Items probe whether respondents experience generalized helplessness (Item 22) or habitually defer vital personal choices to putative authority figures (Item 17: “Experts are in the best position to decide what people should do or learn”). High empowerment on this subscale denotes a rejection of paternalistic control and an active assertion of personal sovereignty.

3. Community Activism and Autonomy

This subscale captures the collective and civic dimensions of empowerment, reflecting the conviction that systemic improvement occurs through social solidarity, mutual aid, and direct collective action. Distinguishing the Empowerment Scale from purely intrapsychic self-esteem inventories, this factor measures a respondent’s belief in civic collaboration (Item 2: “People have more power if they join together as a group”) and local neighborhood transformation (Item 28). Simultaneously, it integrates individual autonomy, verifying an individual’s insistence on personal freedom and self-directed decision-making (Item 25: “People have the right to make their own decisions, even if they are bad ones”). It assesses an individual’s readiness to engage in advocacy and push back against systemic complacency.

4. Optimism and Control Over the Future

Focusing on proactive forward orientation and deliberate intentionality, this dimension measures the degree to which an individual views their future with hope, subjective agency, and strategic foresight. In contrast to fatalistic surrender, wherein life trajectories are attributed entirely to bad luck or biochemical destiny (Item 8), this domain reflects an active stance toward planning and execution (Item 14: “When I make plans, I am almost certain to make them work”). It serves as a vital psychometric indicator of resilience, goal setting, and cognitive hope in psychiatric recovery trajectories.

5. Righteous Anger

A unique, theoretically pioneering construct introduced by consumer advocates, righteous anger reflects the recognition that anger can function as an adaptive, prosocial, and constructive catalyst for systemic and personal change, rather than merely a psychiatric symptom to be medicated or extinguished. Historically, anger expressed by psychiatric consumers was pathologized as agitation, decompensation, or affective instability. Within this subscale, anger is reframed as a healthy, legitimate cognitive appraisal of injustice that energizes social reform and self-advocacy (Item 15: “Getting angry about something is often the first step toward changing it”). A high score reflects the destigmatization of indignation and an awareness of one’s legitimate right to contest oppression.

6. Theoretical Framework

The Empowerment Scale is theoretically grounded in the convergence of three foundational paradigms: the Psychiatric Survivor/Consumer Movement, Julian Rappaport’s Social-Community Empowerment Theory, and Bandura’s Social Cognitive Theory.

The Consumer/Survivor Paradigm and Judi Chamberlin’s Framework

The primary theoretical bedrock was articulated by Judi Chamberlin in her seminal work, On Our Own: Patient-Controlled Alternatives to the Mental Health System (1978), and expanded in her 1997 treatise on measuring empowerment. Chamberlin argued that paternalistic mental health institutions foster chronic dependency and learned helplessness through coercive treatment protocols, disenfranchisement, and structural marginalization. Under Chamberlin’s theory, authentic empowerment comprises several non-negotiable operational components:

• Having decision-making power and real operational choices;
• Access to information and necessary material resources;
• Assertiveness and perceived capacity to effectuate change;
• Learning to see anger not as illness, but as a legitimate response to injustice;
• Experiencing growth beyond individual recovery through peer solidarity and mutual aid.

By actively collaborating with consumers throughout the questionnaire design, Rogers and colleagues ensured that the construct definitions originated from lived experience rather than clinical speculation.

Ecological and Social-Community Empowerment Theory

At the community psychology level, the scale aligns with Julian Rappaport’s (1987) and Marc A. Zimmerman’s (1995) models of psychological empowerment. Zimmerman delineated empowerment across three interactive components: intrapersonal (how people think about their capacity to influence sociopolitical systems), interactional (how people understand their community and social environment), and behavioral (actions taken to exert control through collective involvement). The Empowerment Scale maps directly onto this tripartite model: the Self-Esteem and Optimism subscales represent intrapersonal empowerment; Power and Powerlessness maps interactional awareness; and Community Activism and Righteous Anger embody behavioral engagement and civic mobilization.

Social Cognitive Theory and Locus of Control

At the individual psychological level, the scale draws upon Bandura’s self-efficacy construct and Julian Rotter’s locus of control theory. Bandura postulated that an individual’s perceived self-efficacy dictates their expenditure of effort, perseverance through environmental barriers, and emotional reactions during adverse encounters. Items probing the ability to overcome barriers (Item 12) and accomplish goals (Item 19) explicitly operationalize Bandurian self-efficacy expectations within the everyday realities of psychiatric rehabilitation.

7. Validity

The construct, convergent, discriminant, and predictive validities of the Empowerment Scale have been extensively documented in original psychometric studies and subsequent replication initiatives across international cohorts.

Construct and Structural Validity

Construct validity was established during initial development by Rogers et al. (1997) through rigorous participatory methodologies. An initial pool of potential items was drafted directly by a national consumer advisory board representing psychiatric survivors across the United States. Following iterative focus groups and preliminary field-testing, a 28-item questionnaire was administered to a primary development sample of 271 consumers across diverse mental health settings. Principal components factor analysis revealed a distinct five-factor structure accounting for significant total variance, verifying that the five intended domains possessed empirical coherence.

Further structural confirmation was executed by Rogers, Ralph, and Salzer (2010) across a large-scale, multi-site sample of 1,827 consumers participating in the multi-site Consumer-Operated Service Programs (COSP) study. Confirmatory factor analysis (CFA) demonstrated adequate to strong fit indices for the five-factor model after removing three psychometrically unstable items (Items 4, 15, and 21), leading to the validated 25-item iteration.

Convergent and Concurrent Validity

Empirical evidence for convergent validity is robust across the psychiatric literature:

• Self-Efficacy and Self-Esteem: Total scores and the Self-Esteem/Self-Efficacy subscale demonstrate strong, statistically significant positive correlations with the Rosenberg Self-Esteem Scale (r = .60 to .72, p < .001) and the Sherer General Self-Efficacy Scale (r = .55 to .68, p < .001).
• Locus of Control: The scale correlates significantly with the Internal subscale of the Levenson Multidimensional Locus of Control Scale (r = .40 to .52), while demonstrating moderate inverse correlations with the Chance and Powerful Others subscales (r = -.35 to -.48).
• Recovery and Hope: Substantial concurrent validity has been documented with validated recovery inventories, including the Recovery Assessment Scale (RAS; r = .58 to .70) and the Herth Hope Index (r = .50 to .62).
• Sense of Community: The Community Activism and Autonomy subscale correlates positively with the Brief Sense of Community Scale (BSCS; r = .42 to .56), demonstrating that civic empowerment aligns directly with subjective neighborhood and group cohesion.

Discriminant Validity

Discriminant validity has been demonstrated by showing that the Empowerment Scale measures a construct conceptually discrete from psychiatric symptom severity, affective disturbance, and demographic covariates. While empowerment scores correlate negatively with symptom distress as measured by the Brief Symptom Inventory (BSI) or the PANSS (r = -.22 to -.35), the magnitude of these correlations indicates that empowerment is not simply the absence of clinical symptomatology. Individuals with persistent, severe clinical symptoms frequently report high empowerment, particularly within consumer-run supportive environments.

8. Reliability

The Empowerment Scale exhibits satisfactory psychometric reliability across internal consistency metrics and temporal stability evaluations in varied clinical, rehabilitation, and community settings.

Internal Consistency Reliability

In the foundational psychometric study by Rogers, Chamberlin, Ellison, and Crean (1997; N = 271), the full 28-item instrument yielded an overall Cronbach’s alpha of α = .86, indicating strong composite internal reliability. Internal consistency coefficients for the five individual subscales were reported as follows:

• Self-Esteem and Self-Efficacy: α = .82 (9 items — robust internal consistency)
• Power and Powerlessness: α = .59 (8 items — moderate consistency reflecting heterogeneous systemic and personal barriers)
• Community Activism and Autonomy: α = .59 (6 items — moderate consistency due to broad socio-political scope)
• Righteous Anger: α = .64 (4 items — acceptable consistency for a brief behavioral/attitudinal subscale)
• Optimism and Control Over the Future: α = .45 (4 items — constrained alpha influenced by brevity and multi-directional phrasing)

In the extensive cross-validation study conducted by Rogers, Ralph, and Salzer (2010) across N = 1,827 mental health consumers, composite reliability for the modified 25-item instrument remained high (α = .82 to .85). The authors verified that the removal of three problematic items (specifically Item 4, Item 15, and Item 21) stabilized factor loadings without attenuating the overarching predictive integrity of the scale.

Test-Retest Reliability and Temporal Stability

Evaluation of temporal stability across test-retest intervals ranging from two to four weeks has confirmed adequate reproducibility. In a cohort of stable outpatients participating in psychiatric rehabilitation programs, intraclass correlation coefficients (ICC) and Pearson correlation coefficients ranged from r = .75 to .84 for the full-scale score. Subscale test-retest values ranged between r = .68 (Optimism/Control) and r = .81 (Self-Esteem), confirming that while empowerment fluctuates in response to meaningful structural interventions or disempowering events, the baseline construct remains temporally stable over brief intervals.

9. Factor Analysis

The factorial structure of the Empowerment Scale has been evaluated through multiple exploratory factor analyses (EFA) and confirmatory factor analyses (CFA), clarifying the interrelationships among its multidimensional subscales.

Exploratory Factor Analysis (Rogers et al., 1997)

In the original 1997 investigation, principal components analysis followed by Varimax and Equamax rotations was conducted on the initial 28 items. Eigenvalues and scree plot inspections identified a robust five-factor solution accounting for approximately 43.5% to 48.0% of the total variance across items:

• Factor 1: Self-Esteem and Self-Efficacy (accounted for the largest proportion of common variance, with primary loadings from items evaluating self-worth, capability, and confidence, ranging from .54 to .76).
• Factor 2: Power and Powerlessness (items loading on perceived control vs. helplessness, with loadings ranging from .42 to .68).
• Factor 3: Community Activism and Autonomy (items evaluating group power, collective action, and personal freedom, exhibiting factor loadings from .38 to .67).
• Factor 4: Optimism and Control Over the Future (loadings from .41 to .62).
• Factor 5: Righteous Anger (items evaluating the utility, legitimacy, and catalyzing nature of anger, loading between .46 and .71).

Confirmatory Factor Analysis and Structural Refinement (Rogers et al., 2010)

To definitively evaluate model stability across varied demographics, Rogers, Ralph, and Salzer (2010) conducted a multi-sample CFA utilizing structural equation modeling (SEM) on data from 1,827 mental health consumers participating in the multi-site COSP trial. Initial CFA testing of the original 28-item five-factor model revealed minor structural strains characterized by cross-loadings and lower fit indices:

• Comparative Fit Index (CFI): .82
• Root Mean Square Error of Approximation (RMSEA): .064

Psychometric diagnosis indicated that three specific items exhibited persistent measurement anomalies across diverse clinical subgroups:

1. Item 4: “Getting angry about something never helps” (which functioned as a duplicate/re-worded control for Item 3, generating redundant residual covariance).
2. Item 15: “Getting angry about something is often the first step toward changing it” (demonstrating unstable cross-loadings between Righteous Anger and Community Activism).
3. Item 21: “You can’t fight city hall” (an idiomatic expression that displayed cultural instability and poor comprehension among specific demographic subsets).

Upon the targeted removal of these three items, the resultant 25-item five-factor model achieved significantly superior goodness-of-fit statistics across independent cohorts:

• Comparative Fit Index (CFI): .91 to .93
• Tucker-Lewis Index (TLI): .90 to .92
• RMSEA: .045 to .048 (90% CI [.042, .051], indicating excellent approximate fit)
• Standardized Root Mean Square Residual (SRMR): .046

These findings substantiate that the five underlying latent dimensions operate cohesively under an overarching second-order empowerment architecture.

10. Instrument / Measurement Tool

• Instrument Name: Empowerment Scale (ES); also known as the Making Decisions Questionnaire.
• Authors: E. Sally Rogers, Sc.D., Judi Chamberlin, Marsha Langer Ellison, Ph.D., and Teresa Crean, M.S. (1997); with subsequent validation by E. Sally Rogers, Ralph O. Ralph, and Mark S. Salzer (2010).
• Target Population: Consumers of psychiatric services, individuals recovering from mental health conditions, and participants in community mental health or peer support initiatives. Applicable also to broader social rehabilitation populations.
• Administration Format: Self-administered paper-and-pencil questionnaire, clinician-assisted interview, or digital computer/mobile interface.
• Completion Time: Approximately 10 to 15 minutes.
• Item Count: 28 total items in the original instrument; 25 items in the revised shortened version (recommended for structural modeling following the exclusion of items 4, 15, and 21).
• Response Scale: 4-point Likert scale:
  • 1 = Strongly Agree
  • 2 = Agree
  • 3 = Disagree
  • 4 = Strongly Disagree
• Scoring Methodology and Directions:
  • The instrument utilizes both positively phrased and negatively phrased (reversed) statements. Depending on the preferred research convention, scoring can be computed such that higher scores reflect either greater empowerment or lower empowerment. The standard established scoring protocol converts the scale so that higher scores represent higher empowerment.
  • Reverse Scoring: In standard administration where 1 = Strongly Agree and 4 = Strongly Disagree, positively phrased empowerment items (e.g., “I see myself as a capable person”) are reverse-coded (1 → 4, 2 → 3, 3 → 2, 4 → 1) so that a numeric value of 4 reflects maximum empowerment. Negatively phrased empowerment items (e.g., “I feel powerless most of the time”) are maintained as originally coded (1 = 1, 2 = 2, 3 = 3, 4 = 4), ensuring that disagreeing with powerlessness yields a higher empowered value.
  • Subscale Composition:
    • Self-Esteem and Self-Efficacy: Items 5, 6, 9, 12, 14, 18, 19, 24, 26.
    • Power and Powerlessness: Items 1, 8, 16, 17, 21*, 22, 23, 27.
    • Community Activism and Autonomy: Items 2, 10, 11, 20, 25, 28.
    • Optimism and Control Over the Future: Items 1, 8, 13, 14. (Note: In standard five-factor allocations, Item 1 and Item 14 cross-load or align with future control).
    • Righteous Anger: Items 3, 4*, 7, 15*.

    (* Denotes the 3 items removed in the revised 25-item shortened version).

  • Score Computation: Subscale scores and the composite full-scale score are generated by calculating the mean of the completed items within each domain (yielding an overall score range between 1.00 and 4.00). Missing data rules generally mandate that at least 80% of items within a subscale must be answered to calculate a valid score.

11. Permissions, Fee, and Test Year

• Original Publication Year: 1997 (initial development and validation by Rogers et al.); revised and validated in 2010 (Rogers, Ralph, & Salzer).
• Copyright Status: Center for Psychiatric Rehabilitation, Sargent College of Health and Rehabilitation Sciences, Boston University.
• Fee and Accessibility: The Empowerment Scale is made available as an open-access, fee-free instrument for non-commercial research, academic, and clinical evaluation purposes. The developers prioritized open dissemination to empower consumer-run organizations and community clinics lacking extensive psychometric licensing budgets.
• Permissions and Contact: Researchers and clinicians wishing to employ the instrument in programmatic evaluations or academic studies may do so with appropriate citation of the original validation papers. Direct inquiries regarding translations, adaptation permissions, or technical manuals can be addressed to Dr. E. Sally Rogers at Boston University via email: [email protected] or via the Center for Psychiatric Rehabilitation website.

12. References

• Chamberlin, J. (1978). On our own: Patient-controlled alternatives to the mental health system. Hawthorn Books.
• Chamberlin, J. (1997). A working definition of empowerment. Psychiatric Rehabilitation Journal, 20(4), 43–46. https://doi.org/10.1037/h0095389
• Rappaport, J. (1987). Terms of empowerment/exemplars of prevention: Toward a theory for community psychology. American Journal of Community Psychology, 15(2), 121–148. https://doi.org/10.1007/BF00919275
• Rogers, E. S., Chamberlin, J., Ellison, M. L., & Crean, T. (1997). A consumer-constructed scale to measure empowerment among users of mental health services. Psychiatric Services, 48(8), 1042–1047. https://doi.org/10.1176/ps.48.8.1042
• Rogers, E. S., Ralph, R. O., & Salzer, M. S. (2010). Validating the Empowerment Scale with a multisite sample of consumers of mental health services. Psychiatric Services, 61(9), 933–936. https://doi.org/10.1176/ps.2010.61.9.933
• Rogers, E. S., Ralph, R. O., & Mark, S. (2010). The Empowerment Scale. In C. A. Simmons & P. Lehmann (Eds.), Tools for strengths-based assessment and evaluation (pp. 360–363). Springer Publishing Company.
• Zimmerman, M. A. (1995). Psychological empowerment: Issues and illustrations. American Journal of Community Psychology, 23(5), 581–599. https://doi.org/10.1007/BF02506983

13. Items of the Scale (Questionnaire)