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

• Published in: PloS one 2020-04, Vol.15 (4), p.e0230672-e0230672
• Main Authors: Bellier, Alexandre, Chaffanjon, Philippe, Krupat, Edward, Francois, Patrice, Labarère, José
• Format: Article
• Language: English
• Subjects: Adaptation; Biology and Life Sciences; Coding; Communication; Communication skills; Consistency; Correlation coefficient; Correlation coefficients; Curricula; Engineering and Technology; Factor analysis; Goodness of fit; Habits; Hospitals; Interpreters; Life Sciences; Median (statistics); Medical students; Medicine; Medicine and Health Sciences; Neurons and Cognition; Patient satisfaction; People and Places; Personality; Physical Sciences; Physicians; Psychology and behavior; Quality; Quantitative psychology; Reliability aspects; Reliability engineering; Research and Analysis Methods; Semantics; Skills; Social Sciences; Statistical analysis; Statistical tests; Structural reliability; Students; Translations; Translators; Two dimensional analysis; Validity; Video equipment
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0230672

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.