How can learning effects be measured in Balint groups? Validation of a Balint group questionnaire in China

Kurt Fritzsche; Lili Shi; Johanna Löhlein; Jing Wei; Yue Sha; Yongbiao Xie; Yanling He; Volker Tschuschke; Guido Flatten; Yibo Wang; Chen Jin; Rainer Leonhart

doi:10.1186/s12909-021-03030-x

How can learning effects be measured in Balint groups? Validation of a Balint group questionnaire in China

BMC Med Educ. 2021 Dec 9;21(1):608. doi: 10.1186/s12909-021-03030-x.

Authors

Kurt Fritzsche^#¹, Lili Shi^#², Johanna Löhlein³, Jing Wei², Yue Sha², Yongbiao Xie⁴, Yanling He⁵, Volker Tschuschke⁶, Guido Flatten⁶, Yibo Wang⁷, Chen Jin⁸, Rainer Leonhart⁹

Affiliations

¹ Center for Mental Health, Department of Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, Hauptstr. 8, D 79104, Freiburg im Breisgau, Germany. kurt.fritzsche@uniklinik-freiburg.de.
² Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
³ Center for Mental Health, Department of Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, Hauptstr. 8, D 79104, Freiburg im Breisgau, Germany.
⁴ Guangdong General Hospital, Guangzhou, China.
⁵ Shanghai Mental Health Center, Shanghai, China.
⁶ Department of Medical Psychology, University Hospital, University of Cologne, Cologne, Germany.
⁷ Shanghai Ninth People's Hospital, Huangpu Branch Hospital, Shanghai, China.
⁸ Department of Psychiatry, Zhongguancun Hospital, Beijing, China.
⁹ Institute of Psychology, University of Freiburg, Freiburg, Germany.

^# Contributed equally.

Abstract

Background: Balint groups aim to reflect doctor-patient relationships on the basis of personal cases. This study reports the validation of a questionnaire aimed at the identification of learning processes among Balint group participants in China.

Methods: This multicenter cross-sectional study was conducted during Balint group sessions in Beijing, Guangzhou and Shanghai. A heterogeneous sample of different professional groups was intended to adequately capture the reality of Balint work in China. After a Balint group session, the participants were asked to complete the Mandarin version of the Balint group session questionnaire (BGQ-C) and the group questionnaire (GQ), an internationally validated instrument to assess central dimensions of therapeutic relationships during group processes.

Results: Questionnaires from n = 806 participants from 55 Chinese Balint groups, predominantly comprising individuals with a medical background, were analyzed. Most participants were female (74.6%), and the average age was 34.2 years old (SD = 9.4). The results indicated good to very good reliability (Cronbach's α = .70 to .86; retest r_s = .430 to .697). The verification of the construct validity of the BGQ-C showed satisfying convergent (r_s = .465 to .574) and discriminant validity (r_s = -.117 to -.209). The model was tested with a confirmatory factor analysis of a three-factor model (standardized root mean square residual = .025; comparative fit index = .977; Tucker-Lewis index = .971). The 3 empirically identified scales resulted in good model fit with the theoretical dimensions of Balint work postulated in the literature: "reflection of transference dynamics in the doctor-patient relationship", "emotional and cognitive learning" and "case mirroring in the dynamic of the group". Due to the high correlations between the factors, a single-factor model was possible. A group comparison between the German and Chinese samples showed different loadings across cultures.

Conclusions: The BGQ-C is a quick-to-complete, item-based measuring instrument that allows the relevant dimensions of Balint group work to be recorded. This study suggests good psychometric properties of the Chinese version. Nevertheless, it must be assumed that the composition of constructs in the two countries is different.

Keywords: Balint group; China; group process; learning effects; questionnaire; validation.

Publication types

Multicenter Study

MeSH terms

Adult
China
Cross-Sectional Studies
Female
Humans
Physician-Patient Relations*
Psychometrics
Reproducibility of Results
Surveys and Questionnaires