The English version of the Verona medical interview classification system (VR-MICS): An assessment of its reliability and a comparative cross-cultural test of its validity

Abstract

Objective: This study aimed to assess the inter-rater and intra-rater reliability of the English translation of the original Italian version of the VR-MICS and to evaluate its sensitivity by comparing the coding of English and Italian general practice consultations with emotionally distressed and non-distressed patients, as defined by the 12-item General Health Questionnaire (GHQ-12). Method: Six male GPs from Manchester (UK) and six from Verona (Italy) each contributed five consultations, which were coded using the VR-MICS. Intra-rater and inter-rater reliability were assessed both for the division of interviews into speech units and the speech unit coding. Interaction and main effects of GHQ-12 status and nationality on patient and GP expressions were assessed by two-way ANOVA. Results: Agreement indices for the division of speech units varied between 88–96 and 87–93% for GP and patient speech, respectively; those for coding categories between 88–91 and 82–86%, with Cohen's Kappa values between 0.86–0.91 and 0.80–0.85 for GP and patient speech, respectively. Cross-cultural comparisons of patient and GP speech showed no interaction effects between GHQ-12 status and nationality. The Italian GPs were more ‘doctor-centred’, while the UK GPs tended to use a more ‘sharing’ consulting style. Independent of nationality, distressed patients talked more, gave more psychosocial cues and increased amounts of positive talk compared to non-distressed patients. GPs in both settings, when interviewing distressed patients, reduced social conversation and increased psychosocial information-giving, checking questions and reassurance. Conclusion: The English translation of the VR-MICS showed satisfactory reliability indices and similar sensitivity to patients’ verbal behaviours in relation to their emotional state in the two settings. Practice implications: The VR-MICS may be an useful coding instrument to support collaborative research on doctor–patient communication between the two countries.