The Active-Empathic Listening Scale (AELS): Conceptualization and evidence of validity within the healthcare context

Listening is a central component of patient-clinician communication and shapes how patients interpret empathy, support, and care quality. Active empathic listening (AEL)-the active and emotional involvement of a listener-is particularly relevant for healthcare. The Active Empathic Listening Scale (AELS) offers a theoretically grounded framework for assessing the dimensions of listening (sensing, processing, responding), yet its psychometric performance in healthcare remains unexamined. This study evaluated the structural and convergent validity and reliability of the 11-item AELS adapted for patient-clinician interactions.

A nationally representative sample of U.S. adults (N = 1257) completed an online survey describing a recent clinician interaction, with follow-up measures referring to that interaction, including the AELS, as well as supportive message quality (SMQ) and satisfaction with the interaction. Exploratory factor analysis (EFA) was performed and the EFA factor structure was confirmed via confirmatory factor analysis (CFA). Structural equation modeling (SEM) was used to assess convergent validity with SMQ and satisfaction.

EFA supported the three-factor structure of the AELS. CFA revealed a weak loading for Item 2 (λ =.495) and was removed. CFA of the 10-item AELS confirmed an excellent fit for a first-order and second-order model. A chi-square difference test indicated the refined 10-item model fit significantly better than the 11-item model. In the interest of parsimony, we retained the second-order model to assess convergent validity. SEM yielded a significant overall model, with significant paths to SMQ and satisfaction. The 10-item AELS demonstrated strong internal consistency across sensing (α =.86), processing (α =.93), and responding (α =.96).

The refined 10-item AELS demonstrated excellent calibration, strong factorial stability, and meaningful associations with SMQ and satisfaction. These findings support the AELS as a practical patient-reported instrument for evaluating listening quality in clinical interactions.