Four Habits coding scheme (4HCS)
4-habits-coding-scheme-Krupat-et-al.-2006.pdf
4 habits coding scheme - codebook-rev 603
4 habits coding scheme - Norwegian validation 2008
Bellier et al., 2020 French validation 4HCS
Developers: Edward Krupat, Richard Frenkel, Terry Stein, Julie Irish
Year of publication: 2006
Date of last revision: 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
Tool topics:
Empathy
General communication behavior / Overall communication behavior
Information giving / providing information / explanation and planning
Patient perspective – considering, eliciting
Relationship building
Shared decision making
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).
Types of data required to use the tool: Video recordings, Audio recordings
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.
Tool/manual available: Yes. (Tool displayed in validation paper)
Access: Public
Contact: Edward Krupat