Cross-cultural adaptation of the 4-Habits Coding Scheme into French to assess physician communication skills.

Alexandre Bellier,Edward Krupat,José Labarère,Philippe Chaffanjon,Patrice Francois,Gian Mauro Manzoni

doi:10.1371/journal.pone.0230672

Abstract

The Four Habits Coding Scheme (4-HCS) is a standardized instrument designed to assess physicians' communication skills from an external rater's perspective, based on video-recorded consultations. To perform the cross-cultural adaptation of the 4-HCS into French and to assess its psychometric properties. The 4-HCS was cross-culturally adapted by conducting forward and backward translations with independent translators, following international guidelines. Four raters rated 200 video-recorded medical student consultations with standardized patients, using the French version of the 4-HCS. We examined the internal consistency, factor structure, construct validity, and reliability of the 4-HCS. The mean overall 4-HCS score was 76.44 (standard deviation, 12.34), with no floor or ceiling effects across subscales. The median rating duration of rating was 8 min (range, 4-19). Cronbach's alpha was 0.94 for the overall 4-HCS, ranging from 0.72 to 0.88 across subscales. In confirmatory factor analysis, goodness-of-fit statistics did not corroborate the hypothesized 4-habit structure. Exploratory factor analysis resulted in two dimensions, with the merging of three conceptually related habits into a single dimension and substantial cross-loading for 15 out of 23 items. Median average absolute-agreement intra-class correlation coefficient estimates were 0.74 (range, 0.68-0.84) and 0.85 (range, 0.76-0.91) for inter- and intra-rater reliability of habit subscales, respectively. The French version of the 4-HCS demonstrates satisfactory internal consistency but requires the use of two independent raters to achieve acceptable reliability. The underlying factor structure of the original US version and cross-cultural adaptations of the 4-HCS deserve further investigation.

Highlights

Physician communication skills are key components of effective medical consultations [1] and comprise core physician competences that are most desired by patients [2]
The 4-HCS is based on the conceptual framework of the “Four Habits Model,” a training program that was developed within the US Kaiser Permanente Health Maintenance Organization and implemented for teaching effective communication skills to thousands of clinicians in this organization over the two last decades [9]
The French version of the 4-HCS demonstrates satisfactory internal consistency but moderate reliability, requiring the use of two independent raters to assess communication skills of medical students based on video-recorded consultations with standardized patients

Summary

Introduction

Physician communication skills are key components of effective medical consultations [1] and comprise core physician competences that are most desired by patients [2]. Many organizations have implemented structured training programs and routinely assessed physicians’ communication skills [3, 7]. The Four Habits Coding Scheme (4-HCS) is a standardized instrument designed to assess 23 physician communication skills or behaviors from an external rater’s perspective, based on video-recorded consultations [8]. The 4-HCS is based on the conceptual framework of the “Four Habits Model,” a training program that was developed within the US Kaiser Permanente Health Maintenance Organization and implemented for teaching effective communication skills to thousands of clinicians in this organization over the two last decades [9]. The Four Habits Coding Scheme (4-HCS) is a standardized instrument designed to assess physicians’ communication skills from an external rater’s perspective, based on videorecorded consultations

Methods

Results

Discussion

Conclusion