Study of Acceptance and Application of Calgary Cambridge Communication Guideline for Doctor-Patient Communication in Primary Health Care

Widyastuti Widyastuti(1*), Mora Claramita(2), Retna Siwi Padmawati(3)

(1) Puskesmas Tegalrejo; Yogykarta; Indonesia
(2) Departement of Family and Community Medicine; Faculty Medicine, Public Health and Nursing; Universitas Gadjah Mada; Indonesia
(3) Department of Public Health; Faculty Medicine, Public Health and Nursing; Universitas Gadjah Mada; Indonesia
(*) Corresponding Author


Background: Communication is a basic skill that must be acquired by every doctor just like all other clinical skills. One of communication guidelines for doctor-patient that is the most widely used in many countries is the Calgary-Cambridge Communication Guideline (CCCG). However, since CCCG is based on the Western style of communications, a further study is necessary to determine whether CCCG is acceptable and applicable in Indonesia. Methods:  This research was an analytic descriptive study with a cross-sectional design. The research was conducted from December 2016 until January 2017 in Yogyakarta with 58 primary care doctors. The data was collected using the CCCG-based questionnaire method with a cross-cultural adaptation. Results: The CCCG is well accepted although its application is not optimum. The acceptance rate was 4.03 (indicating highly acceptable), while the application rate was 3.74 (indicating occasionally implemented). There was a significant difference between the acceptance and application rates (p<0.01). There were no significant differences between the acceptance rates of Puskesmas (Community and Primary Health Care Center) and non-Puskesmas (p = 0.115) facilities while the application was significantly different (p = 0.001). The application levels of the Puskesmas were lower than those in non-Puskesmas. Additionally, there was no difference in the acceptance or application of CCCG for doctors who have and who have not attended communication training. Conclusion: There was no difference in the acceptance of CCCG, but there was a difference in its application. The application rate at Puskesmas was lower than non-Puskesmas facilities. The experience in communication training did not affect the acceptance and the application rates of CCCG.


Acceptance; application; Calgary-Cambridge communication guidelines; Puskesmas; non-Puskesmas communication training

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1. Kurtz S, Silverman J, and Drapper J. Teaching and learning communication skills in medicine. Abingdon, Oxon: Radcliffe Medical Press. 1998.

2. Claramita M, Nugraheni MDF, van Dalen J, van der Vleuten C. Advance in Health Science Education. 2012. doi: 10.1007/s10459-012-9352-5.

3. Kurtz S, Draper J, Silverman J. Skills for communicating with patients. CRC Press. 2016 Mar 9.

4. Tongue JR, Epps HR, Forese LL. Communication skills for patient-centered care: research-based, easily learned techniques for medical interviews that benefit orthopaedic surgeons and their patients. JBJS 9 The Journal Of Bone & Joint Surgery). 2005 Mar 1;87(3):652-8.

5. Makoul G. The SEGUE Framework for teaching and assessing communication skills. Patient education and counseling. 2001 Oct 1;45(1):23-34.

6. Frankel RM, Stein T. Getting the most out of the clinical encounter: The four habits model. Perm J. 1999;3(3):79-88.

7. Edwards A, Elwyn G, Hood K, Robling M, Atwell C, Holmes-Rovner M, Kinnersley P, Houston H, Russell I. The development of COMRADE—a patient-based outcome measure to evaluate the effectiveness of risk communication and treatment decision making in consultations. Patient education and counseling. 2003 Jul 1;50(3):311-22.

8. Kirkpatrick DL. Evaluating training programs: The four levels. San Francisco: Berret-Koehler Publisher. 1998.

9. Hall JA, Roter DL, Katz NR. Meta-analysis of correlates of provider behavior in medical encounters. Medical care. 1988 Jul 1:657-75.

10. Claramita M, Prabandari YS, Van der Vleuten CP. Developing and validating a guideline on doctor-patient communication for Southeast Asian context. South‑East Asian J Med Educ. 2010;4:23-30.

11. Claramita M, Susilo AP, Kharismayekti M, van Dalen J, van der Vleuten C. Introducing a partnership doctor-patient communication guide for teachers in the culturally hierarchical context of Indonesia. Education for Health. 2013 Sep 1;26(3):147.

12. Claramita M, Van Dalen J, Van der Vleuten CP. South East Asian doctors and patients are not approaching their perceived ideal partnership style of consultation. Patient Education and Counseling. 2011;85(3):169-174.

13. Claramita M. Doctor-patient communication in a culturally hierarchical context of Southeast Asia: A partnership approach. Maastricht University; 2012 Jan 1.

14. Claramita M, Utarini A, Soebono H, Van Dalen J, Van der Vleuten C. Doctor–patient communication in a Southeast Asian setting: The conflict between ideal and reality. Advances in health sciences education. 2011 Mar 1;16(1):69-80.

15. Gatot S and Oktarina. Primary care service oriented national health service system. Jakarta: Executive Board of the Indonesian Doctors Association. 2014.

16. Hofstede G. Culture's consequences: Comparing values, behaviors, institutions and organizations across nations. Sage Publications. 2003.

17. Geertz C. The religion of Java. Chicago and London: University of Chicago Press. 1976 Feb 15.

18. Geertz C. The Java Family. Jakarta: Grafiti Press. 1983.

19. Moore M. What does patient-centered communication mean in Nepal?. Medical Education. 2008;42:18-26.

20. Moore M. What do Nepales medical students and doctors think about patient centered communication?. Patient Education and Counseling. 2009;76:38-43.

21. Ohtaki S, Ohtaki T, Fetters MD. Doctor–patient communication: A comparison of the USA and Japan. Family Practice. 2003 Jun 1;20(3):276-82.

22. Regulation of the Mayor of Yogyakarta. Implementation of working days, working hours, work ceremony and electronic presence in Yogyakarta City Government. Yogyakarta: Yogyakarta City Civil Service, Education and Training Agency. 2016.


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