Patient communication competence: development of a German questionnaire and correlates of competent patient behavior

The aim of our study was to design and psychometrically test a patient questionnaire to capture patient communication competence in the context of patient-provider interaction (CoCo questionnaire). We also aimed to determine patient characteristics associated with competent patient behavior.

To assure content validity, we initially conducted 17 focus groups (n=97) made up of patients and providers. In the main study n=1.264 patients with chronic back pain, chronic-ischemic heart disease or breast cancer who underwent inpatient rehabilitation were surveyed at the end of rehabilitation.

The CoCo questionnaire contains four scales (patient adherence in communication, critical and participative communication, communication about personal circumstances, active disease-related communication) and 28 items addressing competent patient behavior. We provide evidence of unidimensionality, local independence, reliability, a Rasch-Model fit, the absence of differential item functioning, and signs of construct validity. The most important correlates of communication competence are health literacy and communication self-efficacy.

The CoCo questionnaire has good psychometric properties in German. Future research should examine CoCo's responsiveness and analyze criterion validity by means of observation data.

The CoCo questionnaire can be recommended for use in evaluating patient communication training programs.