ArticleBMC medical education2026
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.
Article in BMC medical education, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors.
Funding
Abstract
backgroundEffective 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.
methodsFollowing 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).
resultsThe 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).
conclusionsThe 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.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.