title: 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.
abstract: 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.
authors.affiliation: 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
authors.forename: Lidia
authors.initials: L
authors.lastname: Del Piccolo
authors.forename: Nicola
authors.initials: N
authors.lastname: Mead
authors.forename: Linda
authors.initials: L
authors.lastname: Gask
authors.forename: Maria Angela
authors.initials: MA
authors.lastname: Mazzi
authors.forename: Claudia
authors.initials: C
authors.lastname: Goss
authors.forename: Michela
authors.initials: M
authors.lastname: Rimondini
authors.forename: Christa
authors.initials: C
authors.lastname: Zimmermann
mesh_terms: 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