Development, Reliability and Validity of the Five Habits Coding Scale

doi:10.12114/j.issn.1007-9572.2022.0135

Chinese General Practice ›› 2022, Vol. 25 ›› Issue (16): 1990-1994.DOI: 10.12114/j.issn.1007-9572.2022.0135

• Original Research·Quality Improvement • Previous Articles Next Articles

Development, Reliability and Validity of the Five Habits Coding Scale

1.International Cooperation & Exchange Office, the Third Xiangya Hospital of Central South University, Changsha 410013, China
2.Department of General Practice, the Third Xiangya Hospital of Central South University, Changsha 410013, China
3.Department of Gastroenterology, the Third Xiangya Hospital of Central South University, Changsha 410013, China
4.Post-graduation Medical Education Office, the Third Xiangya Hospital of Central South University, Changsha 410013, China

Received:2021-11-29 Revised:2022-04-26 Published:2022-06-05 Online:2022-05-05
Contact: Xinchun LIU
About author:
WANG Q Y, YIN L Y, YAN Y X, et al. Development, reliability and validity of the Five Habits Coding Scale[J]. Chinese General Practice, 2022, 25 (16) : 1990-1994, 2002.

"五习惯"医患沟通评价量表的构建及信效度研究

1.410013　湖南省长沙市，中南大学湘雅三医院国际合作与交流办
2.410013　湖南省长沙市，中南大学湘雅三医院全科医学科
3.410013　湖南省长沙市，中南大学湘雅三医院消化内科
4.410013　湖南省长沙市，中南大学湘雅三医院毕业后医学教育办

通讯作者: 刘新春
作者简介:
王清燕，尹兰义，闫雅鑫，等."五习惯"医患沟通评价量表的构建及信效度研究[J].中国全科医学，2022，25（16）：1990-1994，2002. [www.chinagp.net] 作者贡献：王清燕、刘新春进行文章的构思与研究的设计；王清燕、尹兰义负责研究的实施；王清燕、尹兰义、闫雅鑫、彭艳负责数据收集；王清燕进行数据分析与结果解释，撰写论文；姚晨姣、唐秋萍负责相关行政、技术或材料支持；刘新春负责研究经费的获取、论文写作指导、质量控制及审校，并对文章整体负责。
基金资助:
美国中华医学会基金资助项目(CMB OC 14-200)

Abstract

Abstract:

Background

Doctor-patient communication barrier is one of the major causes leading to medical disputes. Still, there are limited studies and rare instruments with good reliability and validity regarding doctors' ability to communicate with patients in China.

Objective

To construct the Five Habits Coding Scale (5HCS) and verify its reliability and validity.

Methods

The first draft of the Five Habits Coding Scale (5HCS) was formulated based on the Chinese version of the Four Habits Coding Scheme (4HCS) developed using Brislin's translation model in March 2014. Then from April to June 2014, the items of the first draft of 5HCS were revised in accordance with the expert consensuses obtained from two rounds of Delphi consultations, and after that, the final version of the 5HCS was developed, and utilized to evaluate 127 residents' abilities to communicate with patients in March 2018 for testing its internal consistency, inter-rater reliability, content validity and criterion-related validity.

Results

The final version of 5HCS consists of 21 items fell under 5 dimensions, namely "Show respect and kindness, harmonize doctor-patient relationship" "Provide information, guide patients' views" "Demonstrate empathy, build up trust" "Risk disclosure, informed consent", and "Provide diagnostic information, shared-decision making". The Cronbach's α of the scale was 0.716. The dimension-total correlation coefficients (Pearson correlation coefficients) ranged from 0.524 to 0.692, and the content validity index of each item (I-CVI) ≥0.81. The inter-rater reliability was calculated by intraclass correlation (ICC) (Pearson coefficient=0.912, ICC=0.912, P<0.01) . And the criterion-related validity was testified by comparing to the Chinese version of SEGUE (r=0.377, P<0.01) .

Conclusion

The 5HCS has been proved to be highly reliable and valid, so it could be applied and promoted as a tool to evaluate the doctor-patient communication ability of residents in China.

Key words: Physician-patient relations, Doctor-patient communication, Five Habits Coding Scale, Reliability, Validity

摘要：

背景

医患沟通障碍是导致医疗纠纷发生的主要原因之一。目前，我国对医务人员医患沟通能力的评价研究较少，缺乏信效度良好的评估工具。

目的

构建"五习惯"医患沟通评价量表（5HCS），检验其信度和效度。

方法

2014年3月，采用Brislin翻译法在"四习惯"医患沟通评价体系（4HCS）的基础上，形成5HCS初稿；2014年4—6月，采用德尔菲法，使用问卷分两轮征求专家意见，根据专家意见修订条目后形成5HCS定稿；2018年3月，使用新构建的5HCS对127名住院医师的医患沟通能力进行评估，通过分析其评价数据，检验量表的内部一致性、评价者间信度、内容效度和标准关联效度。

结果

正式版5HCS包含5个维度（"尊重示善，融洽关系""采集信息，引导观点""表达共情，建立信任""风险告知，知情同意""提供诊断，协商决策"），21个条目。量表的Cronbach's α系数为0.716，各维度与量表总分的r值为0.524~0.692，各条目的内容效度指数（I-CVI）≥0.81，量表总分的评价者间信度r值为0.912，组内相关系数（ICC）=0.912，标准关联效度以中文版医患沟通技能评价量表（SEGUE）为标准，两个量表总分之间的r值为0.377（P<0.01）。

结论

5HCS具有良好的信度和效度，可将其作为我国住院医师医患沟通能力测评工具加以推广应用。

关键词: 医生病人关系, 医患沟通, "五习惯"医患沟通评价量表, 信度, 效度

Qingyan WANG,Lanyi YIN,Yaxin YAN, et al. Development, Reliability and Validity of the Five Habits Coding Scale[J]. Chinese General Practice, 2022, 25(16): 1990-1994. DOI: 10.12114/j.issn.1007-9572.2022.0135.
王清燕,尹兰义,闫雅鑫等. "五习惯"医患沟通评价量表的构建及信效度研究[J]. 中国全科医学, 2022, 25(16): 1990-1994. DOI: 10.12114/j.issn.1007-9572.2022.0135.

Figures/Tables 4

References 25

[1]	张振玲，朱保群.我国医患关系现状研究综述[J].卫生职业教育，2021，39(5)：155-157.
[2]	袁锋，龙勇，罗海文. 急诊科医生医疗纠纷发生的原因分析与管理对策分析[J]. 中国社区医师，2021，37(15)：190-191. DOI：10.3969/j.issn.1007-614x.2021.15.092.
[3]	肖瑶，常晓波，胡丹，等. 医患沟通技能测评工具国内外研究进展[J]. 医学与哲学，2021，42(8)：64-67. DOI：10.12014/j.issn.1002-0772.2021.08.13.
[4]	FRANKEL R M, STEIN T. Getting the most out of the clinical encounter：the four habits model[J]. J Med Pract Manage，2001，16(4)：184-191.
[5]	STEIN T, FRANKEL R M, KRUPAT E. Enhancing clinician communication skills in a large healthcare organization：a longitudinal case study[J]. Patient Educ Couns，2005，58(1)：4-12. DOI：10.1016/j.pec.2005.01.014.
[6]	邓黎黎，廖晓阳，伍佳，等. 国外医患沟通模式对我国全科医生沟通技能培训的启示[J]. 中国全科医学，2021，24(13)：1684-1689. DOI：10.12114/j.issn.1007-9572.2021.00.185.
[7]	KRUPAT E, FRANKEL R, STEIN T，et al. The Four Habits Coding Scheme：validation of an instrument to assess clinicians' communication behavior[J]. Patient Educ Couns，2006，62(1)：38-45. DOI：10.1016/j.pec.2005.04.015.
[8]	BRISLIN R W. Back-translation for cross-cultural research[J]. J Cross Cult Psychol，1970，1(3)：185-216. DOI：10.1177/135910457000100301.
[9]	YU D S F, LEE D T F, WOO J. Translation of the Chronic Heart Failure Questionnaire[J]. Appl Nurs Res，2003，16(4)：278-283. DOI：10.1053/S0897-1897(03)00079-X.
[10]	周丹丹.论患者知情权[D]. 烟台：烟台大学，2016.
[11]	孙佳，夏云，黄雪飞，等. 临床医师胜任力评价指标体系的构建[J]. 中国卫生资源，2014，17(6)：433-435，476. DOI：10.3969/j.issn.1007-953X.2014.06.017.
[12]	吴明隆. 问卷统计分析实务——SPSS操作与应用[M]. 重庆：重庆大学出版社，2009：207-208.
[13]	MAKOUL G. The SEGUE framework for teaching and assessing communication skills[J]. Patient Educ Couns，2001，45(1)：23-34. DOI：10.1016/S0738-3991(01)00136-7.
[14]	李娟. 用SEGUE量表对医学生医患沟通技能评价的研究[D]. 沈阳：中国医科大学，2008.
[15]	郭峰，王煜. SEGUE量表在急诊住培医患沟通教学形成性评价中的应用研究[J].中华医学教育探索杂志，2020，19(10)：1197-1201. DOI：10.3760/cma.j.cn116021-20190922-00278.
[16]	朱慧，张丹妮，金孔军，等.恐动症成因分析量表的汉化及信效度检验[J].解放军护理杂志，2020，37(1)：1-4. DOI：10.3969/j.issn.1008-9993.2020.01.001.
[17]	DANCEY C, REIDY J. Statistics without maths for psychology：using SPSS for windows[J]. Prentice Hall，2007，26(2)：353-355.
[18]	李灿，辛玲. 调查问卷的信度与效度的评价方法研究[J]. 中国卫生统计，2008，25(5)：541-544. DOI：10.3969/j.issn.1002-3674.2008.05.034.
[19]	赵海红，张学敏，张嗣敏，等.连续性评估记录和评价（CARE）量表中文版在脑卒中评定中的信度研究[J].中国康复医学杂志，2020，35(10)：1225-1227，1254. DOI：10.3969/j.issn.1001-1242.2020.10.013.
[20]	JENSEN B F, GULBRANDSEN P, BENTH J S，et al. Interrater reliability for the Four Habits Coding Scheme as part of a randomized controlled trial[J]. Patient Educ Couns，2010，80(3)：405-409. DOI：10.1016/j.pec.2010.06.032.
[21]	余红梅，罗艳虹，萨建，等. 组内相关系数及其软件实现[J]. 中国卫生统计，2011，28(5)：497-500. DOI：10.3969/j.issn.1002-3674.2011.05.006.
[22]	SCHOLL I, NICOLAI J, PAHLKE S，et al. The German version of the Four Habits Coding Scheme：association between physicians' communication and shared decision making skills in the medical encounter[J]. Patient Educ Couns，2014，94(2)：224-229. DOI：10.1016/j.pec.2013.10.006.
[23]	孙振球，徐勇勇. 医学统计学[M]. 4版. 北京：人民卫生出版社，2014：491.
[24]	史静琤，莫显昆，孙振球. 量表编制中内容效度指数的应用[J]. 中南大学学报（医学版），2012，37(2)：152-155. DOI：10.3969/j.issn.1672-7347.2012.02.007.
[25]	曹茹，张玥，王锦帆. 多主体视角下我国医患信息沟通评价指标体系的构建与验证[J]. 医学与社会，2021，34(7)：31-35. DOI：10.13723/j.yxysh.2021.07.007.

条目内容	最小值	最大值	均值（±s）
1.称呼患者	1.00	4.00	2.17±0.55
2.与患者寒暄	1.00	3.00	2.09±0.62
3.对患者病史的熟悉程度	1.00	3.00	1.99±0.99
4.请患者描述病情	2.00	3.00	2.99±0.09
5.了解患者其他不适	1.00	4.00	2.82±0.66
6.引导患者观点	1.00	4.00	2.58±0.82
7.探寻患者因疾病对生活产生的影响	1.00	4.00	1.31±0.71
8.接受患者流露自己的情绪	2.00	3.00	2.98±0.12
9.鼓励患者表达	1.00	3.00	2.91±0.31
10.识别患者的感受	1.00	4.00	1.39±0.78
11.非语言行为	2.00	4.00	3.02±0.20
12.解释检查和治疗的原理	1.00	4.00	2.64±0.87
13.告知检查和治疗的风险	1.00	4.00	2.06±1.03
14.征得患者的同意	3.00	4.00	3.02±0.12
15.使用专业术语的情况	3.00	4.00	3.02±0.12
16.评估患者对信息的理解程度	2.00	4.00	3.00±0.18
17.提供诊断，给予患者空间理解信息	1.00	4.00	3.01±0.43
18.邀请患者参与决策	1.00	5.00	2.99±0.34
19.探寻患者执行治疗计划的障碍	1.00	3.00	1.29±0.69
20.询问患者是否还有其他问题	3.00	5.00	3.07±0.29
21.计划随访	1.00	4.00	2.98±0.37
总分	45.00	67.00	53.33±4.16

条目内容	最小值	最大值	均值（±s）
1.称呼患者	1.00	4.00	2.17±0.55
2.与患者寒暄	1.00	3.00	2.09±0.62
3.对患者病史的熟悉程度	1.00	3.00	1.99±0.99
4.请患者描述病情	2.00	3.00	2.99±0.09
5.了解患者其他不适	1.00	4.00	2.82±0.66
6.引导患者观点	1.00	4.00	2.58±0.82
7.探寻患者因疾病对生活产生的影响	1.00	4.00	1.31±0.71
8.接受患者流露自己的情绪	2.00	3.00	2.98±0.12
9.鼓励患者表达	1.00	3.00	2.91±0.31
10.识别患者的感受	1.00	4.00	1.39±0.78
11.非语言行为	2.00	4.00	3.02±0.20
12.解释检查和治疗的原理	1.00	4.00	2.64±0.87
13.告知检查和治疗的风险	1.00	4.00	2.06±1.03
14.征得患者的同意	3.00	4.00	3.02±0.12
15.使用专业术语的情况	3.00	4.00	3.02±0.12
16.评估患者对信息的理解程度	2.00	4.00	3.00±0.18
17.提供诊断，给予患者空间理解信息	1.00	4.00	3.01±0.43
18.邀请患者参与决策	1.00	5.00	2.99±0.34
19.探寻患者执行治疗计划的障碍	1.00	3.00	1.29±0.69
20.询问患者是否还有其他问题	3.00	5.00	3.07±0.29
21.计划随访	1.00	4.00	2.98±0.37
总分	45.00	67.00	53.33±4.16

维度	尊重示善，融洽关系	采集信息，引导观点	表达共情，建立信任	风险告知，知情同意	提供诊断，协商决策
尊重示善，融洽关系	-	-	-	-	-
采集信息，引导观点	0.229^a	-	-	-	-
表达共情，建立信任	0.336^a	0.244^a	-	-	-
风险告知，知情同意	0.291^a	0.188^a	0.317^a	-	-
提供诊断，协商决策	0.089	0.179^a	0.274^a	0.282^a	-
总量表	0.524^a	0.692^a	0.616^a	0.684^a	0.570^a

维度	尊重示善，融洽关系	采集信息，引导观点	表达共情，建立信任	风险告知，知情同意	提供诊断，协商决策
尊重示善，融洽关系	-	-	-	-	-
采集信息，引导观点	0.229^a	-	-	-	-
表达共情，建立信任	0.336^a	0.244^a	-	-	-
风险告知，知情同意	0.291^a	0.188^a	0.317^a	-	-
提供诊断，协商决策	0.089	0.179^a	0.274^a	0.282^a	-
总量表	0.524^a	0.692^a	0.616^a	0.684^a	0.570^a

维度	Pearson相关系数	评价者间信度系数
尊重示善，融洽关系	0.821^a	0.814^a
采集信息，引导观点	0.907^a	0.907^a
表达共情，建立信任	0.629^a	0.621^a
风险告知，知情同意	0.828^a	0.827^a
提供诊断，协商决策	0.852^a	0.850^a
总量表	0.912^a	0.912^a

Development, Reliability and Validity of the Five Habits Coding Scale

"五习惯"医患沟通评价量表的构建及信效度研究

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维度	尊重示善，融洽关系	采集信息，引导观点	表达共情，建立信任	风险告知，知情同意	提供诊断，协商决策	5HCS总分
准备	0.411^a	0.055	0.207^a	0.074	-0.086	0.160
信息收集	0.170	0.377^a	0.166	0.253^a	0.025	0.351^a
信息给予	0.037	0.014	0.179^a	-0.091	0.091	0.048
理解患者	0.149	-0.229^a	0.000	0.119	0.101	<0.001
结束问诊	-0.059	-0.019	0.070	0.115	0.206^a	0.100
SEGUE总分	0.287^a	0.324^a	0.276^a	0.229^a	0.059	0.377^a

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