Journal of Education and Health Promotion

Exploring the educational opportunity and implementation of CARE among dental students in India

Document Type : Original Article

Authors

. Soni Rajput
. Amit Kumar 1
. Manjunath P. Puranik 2
. Namita Shanbhag 2

1 Oral Health Sciences Centre, PGIMER, Chandigarh

2 Department of Public Health Dentistry, Government Dental College and Research Institute, Bengaluru, Karnataka, India

Abstract
CONTEXT: Empathy is considered to be backbone of the patient–physician relationship. The
consultation and relational empathy (CARE) measure is widely used internationally to measure
empathy. However, no validated tool is available to gather patient feedback on dentists’ empathy
in India.
OBJECTIVE: The objective of this study was to explore the reliability and validity of a CARE measure
and to assess the factors influencing CARE score and to determine if there was an association
between their CARE score and satisfaction of the patient.
SETTING AND DESIGN: A cross‑sectional study was done in dental colleges.
SUBJECTS AND METHODS: A questionnaire study was carried out among 100 patients from 6
dental colleges in Bangalore using validated CARE measure.
STATISTICAL ANALYSIS: Internal consistency of items was evaluated by the Cronbach’s alpha,
and construct validity was assessed by confirmatory factor analysis. Satisfaction was assessed by
a question response on 5‑point Likert scale. Descriptive and inferential statistics were performed
with significance set at 5%.
RESULTS: The mean CARE score was 43.80 ± 5.36. Internal reliability was high (Cronbach’s
alpha: 0.859) and was reduced by the removal of any of 10 items. High corrected item‑total correlations
ranged from 0.752 to 0.847. Factor analysis showed a single solution with high item loadings (>0.80).
Self‑perception of overall health (odds ratio [OR] = 3.78), relationship with family (OR = 4.61) and
friends (OR = 3.78), and previous dental experience (OR = 16.00) were more likely, whereas
dentist‑provided treatment (OR = 0.20), number (OR = 0.07) and dental treatment taken (OR = 0.13),
presence of anxiety (OR = 0.03), and fear (OR = 0.05) were less likely to have CARE score. The
satisfaction of the patient regressed significantly with the relationship with family members (ß = 0.77)
and CARE score (ß = 0.21).
CONCLUSION: This study confirms the educational opportunity and implementation of CARE in
dental students. CARE scores among patients varied depending on personal factors and dental
treatment‑related factors. The satisfaction of the patient was influenced by the relationship with
family members and CARE scores.

Keywords

CARE measure
dentist
empathy
factor analysis
India
students
1. Mercer SW, Reilly D, Watt GC. The importance of empathy in
the enablement of patients attending the Glasgow Homoeopathic
Hospital. Br J Gen Pract 2002;52:901‑5.
2. Roter DL, Stewart M, Putnam SM, Lipkin M Jr, Stiles W, Inui TS.
Communication patterns of primary care physicians. JAMA
1997;277:350‑6.
3. Halpern J. What is clinical empathy? J Gen Intern Med
2003;18:670‑4.
4. Sherman JJ, Cramer A. Measurement of changes in empathy
during dental school. J Dent Educ 2005;69:338‑45.
5. Mercer SW, Maxwell M, Heaney D, Watt GC. The consultation
and relational empathy (CARE) measure: Development and
preliminary validation and reliability of an empathy‑based
consultation process measure. Fam Pract 2004;21:699‑705.
6. Derksen F, Bensing J, Lagro‑Janssen A. Effectiveness of
empathy in general practice: A systematic review. Br J Gen Pract
2013;63:e76‑84.
7. Mercer SW, McConnachie A, Maxwell M, Heaney D, Watt GC.
Relevance and practical use of the consultation and relational
empathy (CARE) measure in general practice. Fam Pract
2005;22:328‑34.
8. Neumann M, Wirtz M, Bollschweiler E, Mercer SW, Warm M,
Wolf J, et al. Determinants and patient‑reported long‑term
outcomes of physician empathy in oncology: A structural equation
modelling approach. Patient Educ Couns 2007;69:63‑75.
9. Fung CS, Hua A, Tam L, Mercer SW. Reliability and validity of the
Chinese version of the CARE measure in a primary care setting
in Hong Kong. Fam Pract 2009;26:398‑406.
10. Hanževački M, Jakovina T, Bajić Ž, Tomac A, Mercer S. Reliability
and validity of the croatian version of consultation and relational
empathy (CARE) measure in primary care setting. Croat Med J
2015;56:50‑6.
11. Aomatsu M, Abe H, Abe K, Yasui H, Suzuki T, Sato J, et al. Validity
and reliability of the Japanese version of the CARE measure in a
general medicine outpatient setting. Fam Pract 2014;31:118‑26.
12. Bikker AP, Fitzpatrick B, Murphy D, Mercer SW. Measuring empathic, person‑centred communication in primary care
nurses: Validity and reliability of the consultation and relational
empathy (CARE) measure. BMC Fam Pract 2015;16:149.
13. Babar MG, Hasan SS, Yong WM, Mitha S, Al‑Waeli HA. Patients’
perceptions of dental students’ empathic, person‑centered care
in a dental school clinic in Malaysia. J Dent Educ 2017;81:404‑12.
14. Kersten P, White PJ, Tennant A. The consultation and relational
empathy measure: An investigation of its scaling structure. Disabil
Rehabil 2012;34:503‑9.
15. Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for
the process of cross‑cultural adaptation of self‑report measures.
Spine (Phila Pa 1976) 2000;25:3186‑91.
16. Lwanga SK, Lemeshow S. Sample Size Determination in Health
Studies: A Practical Manual. Geneva: World Health Organization;
1991. 25p.
17. List of Dental Colleges in Karnataka. Available from: http://
www.rguhs.ac.in/institutions_rguhs.html. [Last accessed on
2017 Aug 06].
18. Frankel RM. Empathy research: A complex challenge. Patient
Educ Couns 2009;75:1‑2.
19. Shanafelt TD, West C, Zhao X, Novotny P, Kolars J, Habermann T,
et al. Relationship between increased personal well‑being and
enhanced empathy among internal medicine residents. J Gen
Intern Med 2005;20:559‑64.
20. Neumann M, Bensing J, Mercer SW, Ernstmann N, Pfaff H.
Analyzing the “nature” and “specific effectiveness” of clinician
empathy: A theoretical overviewand contribution towards a
theory‑based research agenda. Patient Educ Couns 2009;74:339‑46.
21. Neumann M, Edelhäuser F, Tauschel D, Fischer MR, Wirtz M,
Woopen C, et al. Empathy decline and its reasons: A systematic
review of studies with medical students and residents. Acad Med
2011;86:996‑1009.
22. Hojat M, Mangione S, Nasca TJ, Cohen MJ, Gonnella JS,
Erdmann JB, Veloski J. The Jefferson scale of empathy:
Development and preliminary psychometric data. Educ Psychol
Meas 2001;61:349‑65.
23. Hojat M, Mangione S, Nasca TJ, Rattner S, Erdmann JB,
Gonnella JS, et al. An empirical study of decline in empathy in
medical school. Med Educ 2004;38:934‑41.
24. Newton BW, Barber L, Clardy J, Cleveland E, O’Sullivan P. Is
there hardening of the heart during medical school? Acad Med
2008;83:244‑9.
25. Chen D, Lew R, Hershman W, Orlander J. A cross‑sectional
measurement of medical student empathy. J Gen Intern Med
2007;22:1434‑8.
Journal of Education and Health Promotion
Volume 10, Issue 9
September 2020
Pages 1-7

Home

Guide for Authors

Submit Manuscript

Reviewers

Contact Us