Self-Advocacy Scale for Patients with Stroke

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Abstract

In the realm of chronic disease management, Patient empowerment has emerged as a critical determinant of long-term health outcomes. For individuals recovering from a Stroke, navigating the complex healthcare system and managing Secondary prevention strategies requires a high degree of Self-advocacy. This involves the patient's willingness and ability to actively represent their own interests, acquire necessary medical information, and communicate their care preferences effectively to healthcare providers. Recognizing the unique challenges faced by this demographic, researchers developed the Self-advocacy Scale for Patients with Stroke to provide a standardized, psychometrically sound method for quantifying these behaviors.

The development of this instrument represents a significant advancement in health psychology and rehabilitative care. Prior to its creation, Self-advocacy measures were largely restricted to other clinical populations, such as oncology or psychiatric patients, leaving a notable gap in Stroke care. By operationalizing the concept of Self-advocacy specifically for Stroke survivors, this scale allows clinicians and researchers to objectively assess a patient's level of proactive engagement.

Ultimately, this tool serves a dual purpose: it facilitates empirical research into the mechanisms of patient-centered care and provides a practical clinical utility. By identifying patients with lower Self-advocacy skills, healthcare teams can implement targeted educational interventions, thereby fostering better medication adherence, lifestyle modifications, and overall quality of life during the critical Secondary prevention phase.

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Keywords
Self-advocacy
Stroke
psychometrics
Health management
Patient empowerment
scale development
Secondary prevention

📊 Psychometric Scorecard

Items Count
24
Structure
Multidimensional
Cronbach's α
0.94
Validation Country
📍 China

Authors

👤 Zhixin Zhao
🏛 Zhengzhou University

👤 Jing Chen
🏛 Zhengzhou University

👤 Beilei Lin
🏛 Zhengzhou University

👤 Chunhui Zhang
🏛 Zhengzhou University

👤 Shanshan Wang
🏛 Zhengzhou University

👤 Yongxia Mei
🏛 Zhengzhou University

👤 Yunjing Qiu
🏛 Zhengzhou University

👤 Hu Jiang
✉ [email protected]
🏛 Zhengzhou University

👤 Xiaoxuan Wang
🏛 Zhengzhou University

👤 Zhenxiang Zhang
✉ [email protected]
🏛 Zhengzhou University

Purpose

Historically, psychometric instruments measuring Self-advocacy have been tailored to specific clinical populations, such as individuals with cancer, HIV, or psychiatric disorders. Because the rehabilitative journey, cognitive demands, and physical limitations of Stroke survivors differ vastly from these other groups, existing tools lacked the specificity required for accurate measurement in Stroke care. This scale was developed to bridge that critical gap, providing a culturally and clinically relevant tool for assessing how Stroke patients advocate for their own health needs.

For researchers and clinicians, this instrument is highly valuable because it shifts the focus from passive patient compliance to active Patient empowerment. In regions like China, where Stroke is a leading cause of mortality and disability, Secondary prevention relies heavily on the patient's ability to manage complex lifestyle and medical regimens. By quantifying Self-advocacy, healthcare providers can identify individuals who may struggle to communicate their needs or make informed decisions, allowing for the delivery of personalized, patient-centered nursing interventions.

Construct

The psychological construct of Self-advocacy in this context is conceptualized as a multidimensional trait reflecting a patient's proactive engagement in their healthcare journey. Grounded in patient-centered care models, the construct moves beyond mere health literacy to encompass the behavioral and communicative actions a patient takes to ensure their needs are met. It captures the transition from being a passive recipient of medical directives to an active partner in the therapeutic alliance.

The scale operationalizes this construct through five distinct but interrelated dimensions: awareness of rights and interests, self-cognition, effective communication, seeking support, and self-decision making. 'Awareness of rights' and 'self-cognition' form the internal, cognitive foundation, representing the patient's understanding of their condition and their entitlement to quality care. 'Effective communication' and 'seeking support' represent the interpersonal behavioral manifestations, while 'self-decision making' reflects the ultimate executive action of participating in care planning. Together, these dimensions provide a holistic view of a patient's capacity to navigate the healthcare system.

Validity

The validation process for this instrument was rigorous and multifaceted, ensuring that the scale accurately captures the intended construct. Content validity was initially established through a two-round Delphi expert consultation involving 18 specialists from diverse fields including medicine, nursing, and psychology. This process yielded an excellent scale-level content validity index (S-CVI) of 0.967, with individual item indices (I-CVI) ranging from 0.833 to 1.000, well above the standard threshold of 0.78. This indicates strong consensus among experts that the items are highly relevant to Stroke Self-advocacy.

Beyond expert consensus, the researchers evaluated structural validity to ensure the items grouped together logically. The data confirmed the theoretical five-dimension model. Furthermore, the researchers established convergent and discriminant validity by examining the average variance extracted (AVE) and composite reliability (CR). The findings demonstrated that the items within each subscale correlated strongly with one another, while the subscales remained distinct enough to measure different facets of the overarching construct, aligning perfectly with modern psychometric standards.

Reliability

Reliability testing demonstrated exceptional internal consistency and temporal stability, confirming that the scale is a dependable measurement tool. The overall internal consistency was excellent, with a total Cronbach's alpha of 0.936. When broken down by its five dimensions, the alpha coefficients remained robust, ranging from 0.816 to 0.898. These values easily surpass the generally accepted threshold of 0.80 for clinical instruments, indicating that the items within the scale and its subscales are highly correlated and measure the same underlying concepts without excessive redundancy.

To ensure the scale produces consistent results over time, the researchers also evaluated test-retest reliability. A subset of 30 Stroke patients completed the assessment again after a two-week interval. The resulting test-retest reliability coefficient for the total scale was 0.885, with dimensional scores ranging from 0.755 to 0.853. Additionally, a split-half reliability coefficient of 0.874 was observed. Together, these metrics provide strong evidence that the scale is stable and not overly susceptible to random daily fluctuations, making it highly suitable for longitudinal tracking in clinical settings.

Factor Analysis

The dimensionality of the scale was rigorously evaluated using both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). During the EFA phase, researchers utilized maximum variance rotation to uncover the underlying factor structure of the initial item pool. After two rounds of analysis, a clear five-factor solution emerged, which successfully explained 68.285% of the cumulative variance. Importantly, all retained items demonstrated strong factor loadings exceeding the standard 0.40 threshold, ensuring that each item contributed meaningfully to its respective factor.

Following the EFA, a CFA was conducted using maximum likelihood estimation to verify the stability of this five-factor model in a broader context. The structural equation modeling confirmed that the empirical data fit the theoretical dimensions perfectly. The alignment between the hypothesized conceptual framework (derived from qualitative interviews and concept analysis) and the statistical factor structure provides robust evidence that the scale accurately maps the complex, multidimensional nature of Self-advocacy in Stroke survivors.

Subscales

Subscale Items Description
Awareness of rights and interests Measures the patient's understanding of their entitlement to quality care, information, and respect within the healthcare system.
Self-cognition Assesses the patient's internal understanding of their own health status, personal needs, and the impact of the Stroke on their life.
Effective communication Evaluates the patient's ability and willingness to articulate their symptoms, concerns, and preferences clearly to healthcare providers.
Seeking support Measures the proactive behaviors a patient takes to acquire medical, emotional, or informational assistance from their network or medical team.
Self-decision making Captures the patient's active participation in formulating care plans and making informed choices regarding their treatment and recovery.

Instrument

Test Type Self-report questionnaire
Format 24 items, 5-point Likert scale
Scoring Items are scored from 1 (Strongly disagree) to 5 (Strongly agree). Total scores are calculated by summing the item responses.
Language Chinese
Population Medical patients
Age Group Adults
Administration Self-administered or researcher-administered
Completion Time 11 minutes

Self-Advocacy Scale for Patients with Stroke Items

📋 Items are currently not available

The individual items of this scale are not publicly available. Researchers interested in using this instrument should contact the original authors directly to request the scale materials.

Sample

The study included a total of 565 valid responses from Stroke survivors recruited from two hospitals in Henan, China, between August 2024 and November 2024. An initial pilot survey was also conducted with 20 Stroke survivors, and test-retest reliability was established using a subsample of 30 participants.

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Cite This Paper

Zhixin Zhao, Jing Chen, Beilei Lin, Chunhui Zhang, Shanshan Wang, Yongxia Mei, Yunjing Qiu, Hu Jiang, Xiaoxuan Wang, Zhenxiang Zhang (2025). Self-advocacy Scale for Patients with Stroke. Scientific reports. https://doi.org/10.1038/s41598-025-08109-9

📄 Download Full-Text PDF

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References
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Cite this article

Mohammed looti (2026). Self-Advocacy Scale for Patients with Stroke. PSYCHOLOGICAL SCALES. Retrieved from https://scales.arabpsychology.com/s/self-advocacy-scale-for-patients-with-stroke/

Mohammed looti. "Self-Advocacy Scale for Patients with Stroke." PSYCHOLOGICAL SCALES, 13 Aug. 2026, https://scales.arabpsychology.com/s/self-advocacy-scale-for-patients-with-stroke/.

Mohammed looti. "Self-Advocacy Scale for Patients with Stroke." PSYCHOLOGICAL SCALES, 2026. https://scales.arabpsychology.com/s/self-advocacy-scale-for-patients-with-stroke/.

Mohammed looti (2026) 'Self-Advocacy Scale for Patients with Stroke', PSYCHOLOGICAL SCALES. Available at: https://scales.arabpsychology.com/s/self-advocacy-scale-for-patients-with-stroke/.

[1] Mohammed looti, "Self-Advocacy Scale for Patients with Stroke," PSYCHOLOGICAL SCALES, vol. X, no. Y, ص Z-Z, August, 2026.

Mohammed looti. Self-Advocacy Scale for Patients with Stroke. PSYCHOLOGICAL SCALES. 2026;vol(issue):pages.

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