Four Habits coding scheme (4HCS)

Developers: Edward Krupat, Richard Frenkel, Terry Stein, Julie Irish

Year of publication: 2006

Date last updated: 21 October 2019

Setting in which the tool was originally developed/validated: primary care

Restriction to setting(s): None to our knowledge

Target group: Physicians (in training)

Language(s): English

Translations(s): Brazilian, French, German, Norwegian

Specific constructs/behaviours:

The 4HCS assesses 23 behaviors, each associated with one of the Four Habits. Habit 1, Invest in the Beginning, contains six items that focus on creating rapport quickly and planning the visit (e.g., demonstrating familiarity with the patient and greeting the patient warmly). Habit 2, Elicit the PatientНs Perspective, contains three items (eliciting the patient's understanding of the problem, understanding the patient's goals for the visit, determining the impact of the problem on the patientНs life). Habit 3, Demonstrate Empathy, contains four items that deal with encouraging, accepting, and responding to the patientНs expression of emotion (e.g., helping patients to identify their emotions; using appropriate nonverbal behavior). Habit 4, Invest in the End, contains 10 items that focus on effective decision making and information sharing (e.g., testing for comprehension and determining the acceptability of the treatment plan).

Tool topics:

Intended application: Education, Research

Reference(s) to development/validation paper(s):

Krupat, Edward, Richard Frankel, Terry Stein, and Julie Irish. "The Four Habits Coding Scheme: validation of an instrument to assess cliniciansН communication behavior." Patient education and counseling 62, no. 1 (2006): 38-45.

• Krupat et al. (2006)

Tool/manual available: Yes. (Tool displayed in validation paper)

Contact: Edward Krupat