Table 6. Primary studies reporting on the development or cross-cultural adaptation of the 4-Habit Coding Scheme.
| Author, year | Krupat, 2006 | Fossli Jensen, 2010 | Clayton, 2011 | Scholl, 2014 | Present study |
|---|---|---|---|---|---|
| Country | USA | Norway | USA | Germany | France |
| Setting | Hospital | Hospital | Family practice clinics | Primary and specialty consultations | School of medicine |
| Recruitment period | 1994 | 2007–2008 | - | 2009–2010 | 2017–2018 |
| Experience | Resident and senior staff | Resident and senior staff | Resident and senior staff | Senior staff | Medical students |
| No. physicians | 50 | 71 | 21 | 22 | 200 |
| Simulated consultations | No | No | No | No | Yes |
| Recording | Video-recorded | Video-recorded | Video-recorded | Audio-taped | Video-recorded |
| No. consultations | 100 | 497 | 174 | 54 | 200 |
| Mean score | |||||
| 1. Invest in the beginning | 17.7 | - | 24.1 | 12.1 | 18.8 |
| 2. Elicit the patient’s perspective | 7.6 | - | 11.5 | 4.5 | 10.0 |
| 3. Demonstrate empathy | 11.3 | - | 14.5 | - | 13.7 |
| 4. Invest in the end | 31.5 | - | 33.0 | 26.5 | 33.9 |
| Overall | 68.0 | 60.1 | 83.1 | - | 76.4 |
| Exploratory factor analysis | Not performed | Not performed | Not performed | Not performed | 4 principal components (66.8% of overall variance) |
| Cronbach’s alpha | |||||
| 1. Invest in the beginning | .71 | - | - | .41 | .80 |
| 2. Elicit the patient’s perspective | .51 | - | - | .46 | .72 |
| 3. Demonstrate empathy | .81 | - | - | .38 | .87 |
| 4. Invest in the end | .61 | - | - | .31 | .88 |
| Overall | - | .85 | - | - | .94 |
| Inter-rater reliability* | |||||
| 1. Invest in the beginning | .70 | - | .48 | .83 | .45 |
| 2. Elicit the patient’s perspective | .80 | - | .57 | .79 | .42 |
| 3. Demonstrate empathy | .71 | - | .39 | .85 | .53 |
| 4. Invest in the end | .69 | - | .65 | .78 | .64 |
| Overall | .72 | .78 | .72 | - | .60 |
| Intra-rater reliability* | |||||
| 1. Invest in the beginning | - | - | - | .87 | .59 |
| Author, year | Krupat, 2006 | Fossli Jensen, 2010 | Clayton, 2011 | Scholl, 2014 | Present study |
| 2. Elicit the patient’s perspective | - | - | - | .72 | .45 |
| 3. Demonstrate empathy | - | - | - | .84 | .58 |
| 4. Invest in the end | - | - | - | .83 | .71 |
| Overall | - | - | - | - | .72 |
* Inter-rater reliability was quantified by the Pearson correlation coefficient in the studies by Krupat et al. and Clayton et al., and by the intra-class correlation coefficient in the study by Fossli Jensen et al.
‡ Inter- and intra-rater reliability scores were quantified by computing absolute agreement intra-class correlation coefficient in the study by Scholl et al. In the present study, individual absolute agreement intra-class correlation coefficient was used for assessing inter- and intra-rater reliability.