Empathic communication in outpatient clinics: validity and reliability of Consultation and Relational Empathy (CARE) Measure in Iran

Document Type : Research Paper


Department of Public Health, School of Public Health, Zanjan University of Medical Sciences, Zanjan, Iran.


Background and Objective: Physician empathy is an essential component in every primary health care consultation and has the pivotal role in patients- physician relationship. Physician with good empathic communication, will be able to find insight toward patients' experiences.  We investigated the psychometric properties of an Iranian version of the Consultation and Relational Empathy (CARE) Measure in outpatients' clinics of teaching hospitals.
Method: Thisresearchwas carried out as cross-sectional study at outpatient clinics of teaching hospitals in Zanjan city in 2018. The study population included 285 outpatients selected by systematic sampling. The Iranian version of CARE measure was used for the data collection. SPSS (version 16) for Windows was used to analyze the data. Statistical analyses included descriptive: mean, percentages and frequency and analytical statistics: Pearson’s correlation and factor analysis (construct validity), Cronbach’s alpha (internal consistency), factor analysis and Independent samples t-test and ANOVA. P values less than 0.05 were assumed statistically significant.
Results: The factor analysis on ten items of CARE measure leaded to one prominent factor with an eigenvalue of 6.04 that explained 61.04 percent of the variance. Correlations of Items-total CARE measure score ranged from 0.64 to 0.77.  Reliability of the Measure was 0.93 that higher than minimum accepted value (0.7). Overall mean of CARE Measure score was (28.5± 8.7). Difference in mean of CARE Measure score was statistically significant on the base of education characteristics (f = 2.89, p = 0.036). There were statistically positive and significant association between the CARE items scores and outpatients' overall satisfaction (r = 0.63, p <0.001) and recommending physician to their relatives (r = 0. 51, p <0.001). Majority of the outpatients (72percent) agreed with item" physicians really listen". In contrast, less than a half of the outpatients (40.9 percent) agreed with item" physicians fully understanding their patient concerns ".
Conclusion: The findings of present study showed that patients' perceived relational empathy from physicians was at average and high average level. Thus, there is room for improvement of empathic communication skills during consultation process for health care team (especially physicians).