The Patient-Oriented Four Habits Model (POFHM) to Enhance Doctor–Patient Relationships in Community Health Care: A Stepped Wedge Cluster Randomized Trial

Backgrounds Doctor-patient communication requires the efforts of both doctors and patients, but there is a lack of empirical research demonstrating how to intervene to enhance communication between doctors and patients. Therefore, the aim of this study was to evaluate the effects of three intervention strategies on promoting the quality of doctor-patient communication. Methods A pragmatic, stepped-wedge, cluster-randomized, single-blind clinical trial was conducted from 2022 to 2023 across community health care institutions in China that provide outpatient clinics. The intervention, which is based on core mindfulness theory and the four habits model (FHM), involves three strategies: FHM for patients only, FHM for doctors only, and patient-oriented FHM (POFHM) for both doctors and patients. We used generalized linear mixed models to evaluate the effects of the interventions on the treatment outcomes. Results Among 1866 patients (34.37% males, median age 44 years), the FHM for doctors did not differ from that of the control group. The FHM for patients was associated with a significant mean increase of 0.15 points (95% CI, 0.060–0.250). The POFHM for patients and doctors was associated with a significant mean increase of 0.23 points in patient literacy (95% CI, 0.100–0.360) and 0.29 points in the sense of control (95% CI, 0.120–0.460). Conclusions FHM only for doctors had no effect, whereas FHM only for patients increased patient literacy. In contrast, the POFHM for doctors and patients, which is designed to prioritize patients while involving doctors in a supportive role, effectively enhances patient literacy and a sense of control. Practice implications Improving the doctor-patient relationship and promoting doctor‒patient communication require the joint efforts of both doctors and patients, with a focus on cultivating good habits among patients. Trial registration This study was pre-registered on AsPredicted (registration number: #107,282) on September 18, 2022.