Measuring Participation Enfranchisement

Heinemann AW, Lai J-S, Magasi S, Hammel J, Corrigan JD, Bogner JA, Whiteneck GG. Measuring participation enfranchisement. Arch Phys Med Rehabil 2011;92:564-71. Objective: To reflect the perspectives of rehabilitation stakeholders in a measure of participation enfranchisement that can be used by people with and without disabilities. Design: Survey. Setting: Community settings. Participants: We pilot-tested a draft instrument with 326 adults who had sustained stroke, spinal cord injury, traumatic brain injury, or other disabling condition, as well as a general population sample. We administered a revised version of the instrument to a statewide sample drawn from the 2006 Colorado Behavioral Risk Factors Surveillance System that included persons with (N=461) and without (N=451) self-identified activity limitations. Interventions: None. Main Outcome Measure: Participation enfranchisement. Results: We used multidimensional scaling, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), followed by rating scale analysis to evaluate the psychometric properties of the instrument. EFA identified 3 participation enfranchisement factors that describe perceived choice and control, contributing to one's community, and feeling valued; the factors were supported marginally by CFA. Rating scale analysis revealed marginal person separation and no misfitting items. Conclusions: Participation enfranchisement constitutes a new, previously unmeasured aspect of participation one that addresses subjective perceptions rather than objective performance with items that are clearly distinct from more generalized satisfaction with participation. The 19 enfranchisement items describe aspects of participation that may prove useful in characterizing longer-term rehabilitation outcomes.