Psychometric validation of the urdu version of the gothenburg empowerment scale among adults with congenital heart disease in Pakistan

Abstract Background This study aims to assess the psychometric properties of the Urdu translated version of the Gothenburg Empowerment Scale (GES) among adults with congenital heart disease (CHD) in Pakistan, focusing on factorial validity, internal consistency, and measurement invariance across gender and age groups. Methodology A cross-sectional study was conducted at a tertiary care hospital Karachi, Pakistan as part of the international APPROACH IS II project. Participants were adults (aged 18 years or above) with confirmed CHD and completed the GES (Urdu translated version) by structured telephone interviews. Psychometrics included confirmatory factor analysis (CFA) of first- and second-order models, assessment of internal consistency (Cronbach’s alpha) and measurement invariance (configural, metric, scalar and strict) across different categories of gender and age. Model fit was calculated by using comparative fit index (CFI), root mean square error of approximation (RMSEA), and standardized root mean residual (SRMR). Results A total of 245 adults with CHD were included (79.2% < 40 years; 50.6% males). CFA supported the original five factor structure of the scale. The final model showed adequate fit (CFI = 0.962; RMSEA = 0.072; SRMR = 0.050). Overall internal consistency was evaluated (alpha = 0.803), the highest reliability being found for the “Enabling Others” and “Decision Making” subscales. A significant ceiling effect (35%) and a minimal floor effect (0.4%) were found. Measurement invariance testing supported the presence of configural and metric invariance between gender and age, and partial scalar invariance was supported for gender. Conclusions The Urdu version of the Gothenburg Empowerment Scale is a valid and reliable tool for measuring empowerment in adults with congenital heart disease in Pakistan. The robust factorial validity of the instrument, good internal consistency and demonstrated measurement invariance support its usefulness in clinical practice as well as research to assess empowerment-focused interventions and patient-reported outcomes.