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

Abstract : BACKGROUND: 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. OBJECTIVE: To perform the cross-cultural adaptation of the 4-HCS into French and to assess its psychometric properties. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
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Submitted on : Monday, April 27, 2020 - 3:55:32 PM
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Alexandre Bellier, Philippe Chaffanjon, Edward Krupat, Patrice François, José Labarère. Cross-cultural adaptation of the 4-Habits Coding Scheme into French to assess physician communication skills. PLoS ONE, Public Library of Science, 2020, 15 (4), pp.e0230672. ⟨10.1371/journal.pone.0230672⟩. ⟨inserm-02555785⟩

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