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Background <p>Effective physician–patient communication is essential for high-quality care in general practice and can be systematically assessed using structured instruments such as the Four Habits Coding Scheme (4HCS). Although the 4HCS has been validated in English, no Danish version exists, limiting research, evaluation, and training opportunities in Denmark. This study aimed to translate and culturally adapt the 4HCS into Danish and evaluate its inter- and intra-rater reliability in both face-to-face and video consultations.</p> Methods <p>Following internationally accepted guidelines, the original 4HCS was translated into Danish using forward–backward translation with minor cultural adaptations. The instrument contains 23 items rated on a 1–5 scale, grouped into Four Habits with a total possible score range of 23–115. Ten general practitioners recorded 150 consultations (78 face-to-face, 72 video consultations), of which 138 were eligible for assessment. Three trained physician raters independently evaluated the consultations using the Danish 4HCS. Inter- and intra-rater reliability were calculated using intra-class correlation coefficients (ICC).</p> Results <p>The mean overall 4HCS total score was 79.80 (SD 14.30), with minimal differences between FTF and VC consultations. Inter-rater reliability for the total score was good (ICC = 0.75), with similar reliability for FTF (ICC = 0.74) and VCs (ICC = 0.77). Intra-rater reliability was good across all habits and modalities (ICC range = 0.67–0.75). Item-level reliability showed some variability (ICC range = 0.30–0.81).</p> Conclusions <p>The Danish 4HCS demonstrated good inter- and intra-rater reliability for assessing physician–patient communication in both FTF and VC consultations. It shows promise as a reliable tool for evaluating communication in Danish general practice across consultation modalities. Future studies may focus on enhanced rater calibration to further improve scoring consistency.</p>

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Cross-cultural adaptation of the Four Habits Coding Scheme into Danish: a study of inter- and intra-rater reliability in face-to-face and video consultations

  • 期刊论文

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  • 发表日期：

    2026年5月7日

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  • Christian Emil Brinck,
  • Ulrik Bak Kirk,
  • Henrik Schou Pedersen,
  • Maria Louise Køpfli,
  • Linda Huibers,
  • Morten Bondo Christensen,
  • Alexandre Bellier,
  • Edward Krupat,
  • Anette Fischer Pedersen

摘要

Background

Effective physician–patient communication is essential for high-quality care in general practice and can be systematically assessed using structured instruments such as the Four Habits Coding Scheme (4HCS). Although the 4HCS has been validated in English, no Danish version exists, limiting research, evaluation, and training opportunities in Denmark. This study aimed to translate and culturally adapt the 4HCS into Danish and evaluate its inter- and intra-rater reliability in both face-to-face and video consultations.

Methods

Following internationally accepted guidelines, the original 4HCS was translated into Danish using forward–backward translation with minor cultural adaptations. The instrument contains 23 items rated on a 1–5 scale, grouped into Four Habits with a total possible score range of 23–115. Ten general practitioners recorded 150 consultations (78 face-to-face, 72 video consultations), of which 138 were eligible for assessment. Three trained physician raters independently evaluated the consultations using the Danish 4HCS. Inter- and intra-rater reliability were calculated using intra-class correlation coefficients (ICC).

Results

The mean overall 4HCS total score was 79.80 (SD 14.30), with minimal differences between FTF and VC consultations. Inter-rater reliability for the total score was good (ICC = 0.75), with similar reliability for FTF (ICC = 0.74) and VCs (ICC = 0.77). Intra-rater reliability was good across all habits and modalities (ICC range = 0.67–0.75). Item-level reliability showed some variability (ICC range = 0.30–0.81).

Conclusions

The Danish 4HCS demonstrated good inter- and intra-rater reliability for assessing physician–patient communication in both FTF and VC consultations. It shows promise as a reliable tool for evaluating communication in Danish general practice across consultation modalities. Future studies may focus on enhanced rater calibration to further improve scoring consistency.