"Four Habits" goes abroad: Report from a pilot study in Norway

Pål Gulbrandsen, Ed Krupat, Jurate Saltyte Benth, Andrew Garratt, Dana Gelb Safran, Arnstein Finset, Richard Frankel

Research output: Contribution to journalArticle

30 Scopus citations


Objective: "Four Habits" is the first larger generic clinical communication program to have a documented effect. It has not been evaluated outside USA. In a pilot study, Norwegian hospital physicians assessed its usefulness, and we developed a questionnaire where patients reported "Four Habits"-specific physician behaviour. Methods: We ran a 3-day course with 16 participants and three US facilitators. The questionnaire mapping "Four Habits" with 23 items was distributed by participating physicians to 210 patients. Participating physicians met in evaluative focus groups 3 months after the course. Results: The questionnaire was condensed to 10 items after factorial analysis. The resulting scale performed well. A large amount of missing data on some items suggested that patients found it difficult to evaluate details of "Four Habits"-specific physician behaviour. Participants found that the "Four Habits" short course led to improvement of their encounters. Some elements of the method were not perceived as relevant for all types of encounters (habits II and III). Conclusion: "Four Habits" is applicable outside US with some adjustments. A shortened version of the questionnaire will be used in a planned randomized controlled trial.

Original languageEnglish (US)
Pages (from-to)388-393
Number of pages6
JournalPatient Education and Counseling
Issue number3
StatePublished - Sep 1 2008


  • Communication
  • Counseling
  • Focus groups
  • Hospital physicians
  • Norway
  • Outpatient clinics
  • Questionnaire

ASJC Scopus subject areas

  • Medicine(all)

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    Gulbrandsen, P., Krupat, E., Benth, J. S., Garratt, A., Safran, D. G., Finset, A., & Frankel, R. (2008). "Four Habits" goes abroad: Report from a pilot study in Norway. Patient Education and Counseling, 72(3), 388-393. https://doi.org/10.1016/j.pec.2008.05.012