Abstract
Personal agency is a variable which potentially facilitates personal recovery in people with serious mental illness. This study aimed to develop a new brief measure for subjective personal agency that can be completed by people with serious mental illness. Two focus group interviews were first conducted with 11 people with schizophrenia to understand the fundamental components of subjective personal agency for people with serious mental illness living in the community. One group comprised six people with schizophrenia living in the community, while the other consisted of five people with schizophrenia working as peer-support workers. We then developed scale items through collaboration with people with schizophrenia and qualitative analysis (stage 1). A cross-sectional survey was then conducted to test the psychometric properties of the new scale among service users with schizophrenia in 18 assertive community treatment teams (stage 2). Factor validity was tested via exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). We evaluated convergent validity with the Boston University Empowerment Scale (BUES), divergent validity with the global assessment of functioning (GAF), internal consistency, and test-retest reliability. Seven items were included in the scale at stage 1. In stage 2, 195 participants completed this scale. EFA revealed a one-factor model with five items. CFA indicated good model fit (χ2 statistics [CMIN] = 8.445, df = 5 (CMIN/df = 1.689), p = 0.133, comparative fit index = 0.974, Tucker-Lewis fit index = 0.949, root mean square error of approximation = 0.077 and standardised root mean squared residual = 0.042). The new scale was significantly correlated with total BUES score (r = 0.526, p < 0.001), but not with GAF score. Cronbach's α for internal consistency was 0.79, and intra-class correlation coefficient for test-retest reliability was 0.70. We developed a new, five-item Subjective Personal Agency scale (SPA-5) that can be completed by people with serious mental illness. Further studies are needed to confirm the results outside Japan.
Highlights
Personal agency has come to be seen as an important concept that encompasses the broad range of activities through which people with severe mental illness, such as schizophrenia, take an active role in making meaning of their lives (Lysaker and Leonhardt, 2012)
The second stage was a crosssectional survey of assertive community treatment (ACT) service users with schizophrenia to test the scale’s psychometric properties
Based on the categories that were generated by the qualitative analysis, and after considering other relevant studies (Sen, 1985; Alkire, 2005; Ibrahim and Alkire, 2007; Samman and Santos, 2009; Ito and Akimoto, 2015; Tapal et al, 2017; Wood and Alsawy, 2018; van Weeghel et al, 2019), we developed an initial seven-item version of the Subjective Personal Agency scale (SPA)
Summary
Personal agency has come to be seen as an important concept that encompasses the broad range of activities through which people with severe mental illness, such as schizophrenia, take an active role in making meaning of their lives (Lysaker and Leonhardt, 2012). Studies have suggested relevant constructs of agency, including subjective freedom and ownership of one’s own life, and have identified agency as being proximate to empowerment and well-being (Sen, 1985; Alkire, 2005; Ibrahim and Alkire, 2007; Samman and Santos, 2009). These constructs, which were initially found in studies conducted in Western countries, have been observed in Japan (Ito and Akimoto, 2015)
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