The English version of the Verona medical interview classification system (VR-MICS). An assessment of its reliability and a comparative cross-cultural test of its validity.
OBJECTIVE
This study aimed to assess the inter-rater and intra-rater reliability of the English translation of the original Italian version of the VR-MICS and to evaluate its sensitivity by comparing the coding of English and Italian general practice consultations with emotionally distressed and non-distressed patients, as defined by the 12-item General Health Questionnaire (GHQ-12).


METHODS
Six male GPs from Manchester (UK) and six from Verona (Italy) each contributed five consultations, which were coded using the VR-MICS. Intra-rater and inter-rater reliability were assessed both for the division of interviews into speech units and the speech unit coding. Interaction and main effects of GHQ-12 status and nationality on patient and GP expressions were assessed by two-way ANOVA.


RESULTS
Agreement indices for the division of speech units varied between 88-96 and 87-93% for GP and patient speech, respectively; those for coding categories between 88-91 and 82-86%, with Cohen's Kappa values between 0.86-0.91 and 0.80-0.85 for GP and patient speech, respectively. Cross-cultural comparisons of patient and GP speech showed no interaction effects between GHQ-12 status and nationality. The Italian GPs were more 'doctor-centred', while the UK GPs tended to use a more 'sharing' consulting style. Independent of nationality, distressed patients talked more, gave more psychosocial cues and increased amounts of positive talk compared to non-distressed patients. GPs in both settings, when interviewing distressed patients, reduced social conversation and increased psychosocial information-giving, checking questions and reassurance.


CONCLUSIONS
The English translation of the VR-MICS showed satisfactory reliability indices and similar sensitivity to patients' verbal behaviours in relation to their emotional state in the two settings.


CONCLUSIONS
The VR-MICS may be an useful coding instrument to support collaborative research on doctor-patient communication between the two countries.
Del Piccolo
Lidia
L
Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Italy. lidia.delpiccolo@univr.it
Mead
Nicola
N
Gask
Linda
L
Mazzi
Maria Angela
MA
Goss
Claudia
C
Rimondini
Michela
M
Zimmermann
Christa
C
D000328:Adult; D000704:Analysis of Variance; D003431:Cross-Cultural Comparison; D019937:Diagnostic Techniques and Procedures / Q000145:classification; D005194:Family Practice; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D018802:Patient-Centered Care / Q000145:classification*; D010817:Physician-Patient Relations; D015203:Reproducibility of Results; D013315:Stress, Psychological / Q000175:diagnosis*; D006113:United Kingdom