Dear participant:IF YOU HAD COMPLETED THIS QUESTIONNAIRE BEFORE,PLEASE DON'T COMPLETE IT AGAIN. I am a doctoral nursing student at the University of Connecticut conducting a research study entitled “Development of the Client Empowerment Scale”. The intent of my study is to test the reliability and validity of the Client Empowerment Scale, which measures the degree to which patients with chronic health conditions are empowered. The results of this study will be used to improve the care provided to clients with chronic conditions. Participation in this study is voluntary. You don not have to be in this study if you do not want to. If you agree to be in the study, but later change your mind, you may drop out at any time. You have the right to decline or withdraw from participation in the study at any time you feel uncomfortable.

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There are no risks associated with participation in this study. You will be asked to complete the demographic data sheet, and a questionnaire called “The Client Empowerment Scale”. The approximate time required to complete the questionnaires is 25-30 minutes. All information will be kept confidential and stored in secured servers at FormSite.com. The data collected will be coded and will be destroyed upon completion of the study. The UCONN Institutional Review Board (IRB) and the Office of Research Compliance may inspect study records. Your contribution in this study will help build the limited body of knowledge regarding empowerment of patients with chronic health conditions. Completing the questionnaire and the demographic sheet is a valid consent of your participation. Take as long as you like before you make a decision.

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Should you have any questions or concerns regarding this study, please contact the Principal Investigator of this project Dr.Carolyn D’Avanzo who can be reached at phone # (860) 486-0540 or via E-mail Address: Carolyn.Davanzo@uconn.edu. If you have any questions concerning your rights as a research participant, you may contact the University of Connecticut Institutional Review Board (IRB) at (860) 486-8802. An IRB is a group of people that reviews research studies and protects the rights of people involved in research. Thank you for your participation. Project Director Ismat Mikky, BSN, MSN, PhDc, RN Doctoral nursing student University of Connecticut School of Nursing

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Directions: Please read each item carefully then circle the number that corresponds to your level of agreement (how much you agree or disagree) with each of the given below statements. Click on the circle next to the ONE response that best describes your CURRENT feelings and perceptions of being empowered while living with a chronic illness (chronic health condition). Note: “Provider” in the statements refers to your health care provider includes physicians and nurses

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1=Strongly Disagree 2=Disagree 3=Unsure 4=Agree 5=Strongly Agree








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1=Strongly Disagree, 2=Disagree, 3=Unsure, 4=Agree, 5=Strongly Agree








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1=Strongly Disagree, 2=Disagree, 3=Unsure, 4=Agree, 5=Strongly Agree








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1=Strongly Disagree, 2=Disagree, 3=Unsure, 4=Agree, 5=Strongly Agree








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1=Strongly Disagree, 2=Disagree, 3=Unsure, 4=Agree, 5=Strongly Agree








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1=Strongly Disagree, 2=Disagree, 3=Unsure, 4=Agree, 5=Strongly Agree








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1=Strongly Disagree, 2=Disagree, 3=Unsure, 4=Agree, 5=Strongly Agree






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1=Strongly Disagree, 2=Disagree, 3=Unsure, 4=Agree, 5=Strongly Agree






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Thank you very much for your participation in this study

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