RESEARCH ARTICLE: Pharmacist-patient communication in Indonesia: The Roter Interaction Analysis System (RIAS) in a socio- hierarchical context



counseling, health communication, patient-centered care, pharmacist-patient communication, RIAS


Background: Patient-centred communication skills are required for good counselling practice of a pharmacist. Little is known about the communication skill of pharmacists in the Indonesian setting, where socio-hierarchical gaps between health care provider - patient exist.

Objective: To assess the communication between pharmacist and patient in an outpatient clinical counselling setting in Indonesia.

Method: Data were analysed from 54 outpatient clinical counselling sessions conducted by pharmacists with their patients at a private hospital. Utterances in each session were coded and analysed using the Roter Interaction Analysis System (RIAS). The differences between the pharmacists’ and patients’ types of communication were analysed using Mann-Whitney tests.

Results: According to RIAS, ‘biomedical communication’ was dominated by the pharmacists and ‘socio-emotional communication’ was dominated by the patients. Statistical analysis showed there was a significant difference between the ‘biomedical’ and ‘socio-emotional communication’ between the patients and pharmacists (p<0.001).

Conclusion: Pharmacist-patient communication in this study was directed mostly towards a pharmacist-centred communication. Further investigation is needed to explain the reasons behind this phenomenon and to identify whether the same result also occurred in different settings.

Author Biographies

Ika Mulyono, Faculty of Pharmacy University of Surabaya, Kalirungkut Surabaya

Centre for Medicines Information and Pharmaceutical Care

Sylvi Irawati, Faculty of Pharmacy University of Surabaya, Kalirungkut Surabaya

Centre for Medicines Information and Pharmaceutical Care

Astrid Pratidina Susilo, Indonesian Skills Laboratory Network and Development


Mora Claramita, Universitas Gadjah Mada (UGM), Yogyakarta

Department of Medical, Health Professions Education, and Bioethics, Faculty of Medicine, Public Health and Nursing


Allinson, M. & Chaar, B. (2016). How to build and maintain trust with patients. The Pharmaceutical Journal, 297 (7895), 1-8

American Association of Hospital Pharmacists. (1993). ASHP statement on pharmaceutical care. AJHP: American Journal of Health-System Pharmacy, 50, 1720–1723

Aslam, M., Tan, C.K. & Prayitno, A. (2003). Farmasi klinis (clinical pharmacy): menuju pengobatan rasional dan penghargaan pilihan pasien. Jakarta: PT Gramedia.

Barnett, N. (2017). Patient-centered care in pharmacy practice (online). Available at: wp-content/uploads/2017/08/Patient-centred-care-in- pharmacy-practice-for-OPnet-7-Nov-2017-Nina- Barnett.pdf. 25th August, 2018

Blom, L., Jonkers, R., Kok, G. & Bakker, A. (1998). Patient education in 20 Dutch community pharmacies; analysis of audiotaped patient contacts. International Journal of Pharmacy Practices, 6(2), 72-76. doi: 10.1111/j.2042-7174.1998.tb00919.x

Bosma, L., Jansman, F.G.A., Franken, A.M., Harting, J.W. & Van den Bemt, P. (2008). Evaluation of pharmacist clinical interventions in a Dutch hospital setting. Pharmacy World and Science, 30(1), 31-38. doi: 10.1007/s11096-007-9136-9

Cavaco, A.N. & Romano, J.P. (2010). Exploring pharmacist–customer communication: the established blood pressure measurement episode. Pharmacy World and Science, 32(5), 601–609. doi:10.1007/ s11096-010-9413-x

Cavaco, A. & Roter, D. (2010). Pharmaceutical consultations on community pharmacies: utility of the Roter Interaction Analysis System to study pharmacist- patient communication. International Journal of Pharmacy Practice, 18, 141-148. doi:/10.1211/ijpp/ 18.03.0003

Chong, W.W., Aslani, P. & Chen, T.F. (2014). Pharmacist–patient communication on use of antidepressants: a simulated patient study in community pharmacy. Research in Social and Administrative Pharmacy, 10(2), 419–437. doi:10.1016/j.sapharm. 2013.05.006

Claramita, M., van Dalen, J. & van der Vleuten, C.P.M. (2011). Doctors in a Southeast Asian country communicate sub-optimally regardless of patients’ educational background. Patient Education and Counseling, 85(3), e169–e174. doi:10.1016/j.pec. 2011.02.002

Claramita, M., Nugraheni, M.D.F, van Dalen, J. & van der Vleuten, C. (2013). Doctor-patient communication in Southeast Asia: a different culture? Advance in Health Sciences Education, 18(1), 15-31. doi:10.1007/ s10459-012-9352-5

Claramita, M. & Susilo, A.P. (2014). Improving communication skills in the Southeast Asian health care context. Perspectives on Medical Education, 3(6), 474-479. doi:10.1007/s40037-014-0121-4

Ellington, L., Matwin, S., Jasti, S., Williamson, J., Crouch, B., Caravati, M. & Dudley, W. (2008). Poison control center communication and impact on patient adherence. Clinical Toxicology, 46, 105-109

Ernawati, D., Lee, Y.P., Sunderland, B. & Hughes, J. (2016). Are Pharmacy Graduates from an Indonesian University Prepared to Deliver Patient Care? Preprints 2016, 2016120146. doi:10.20944/preprints201612. 0146.v1.

Epner, D.E. & Baile, W.F. (2012). Patient-centered care: the key to cultural competence. Annals of Oncology, 23(3), 33-42. doi: 10.1093/annonc/mds086

Hawes, E.M. (2018). Patient education on oral anticoagulation. Pharmacy, 6(2), 34. doi:10.3390/ pharmacy6020034

Herman, M.J. & Susyanty, A.L. (2012). Analysis of Pharmacy Services By Pharmacist In Community Pharmacy (Kajian Praktek Kefarmasian oleh Apoteker di Apotek Komunitas. Buletin Penelitian Sistem Kesehatan, 15(3), 271–81

Hofstede, G., Hosfstede, G.J. & Minkov, M. (2010). Cultures and Organizations: Software of the Mind: Intercultural Cooperation and its Importance for Survival. New York: McGraw Hill.

Jennings, D.L., Ragucci, K.L., Chumney, E.C.G. & Wessell, A.M. (2007). Impact of clinical pharmacist intervention on diabetes related quality-of-life in an ambulatory care clinic. Pharmacy Practice, 5(4), 169-173

Kaboli, P.J., Hoth, A.B., McClimon, B.J. & Schnipper, J.L. (2006). Clinical pharmacists and inpatient medical care a systematic review. Archive of Internal Medicine, 166(9), 955-964. doi: 10.1001/archinte.166.9.955

Kansanaho, H., Cordina, M., Puumalainen, I. & Airaksinen, M. (2005). Practicing pharmacists’ patient counseling skills in the context of reflectivity. Pharmacy Education, 5(1), 19-26. doi:10.1080/156022105000750 77

Kim, Y.M., Kols, A., Bonnin, C., Richardson, P. & Roter, D. (2001). Client communication behaviors with health care providers in Indonesia. Patient Education and Counseling, 5, 59-68

Kuntz, J.L., Safford, M.M., Singh, J.A., Phansalkar, S., Slight, S.P., Her, Q.L., Lapointe, N.A., Mathews, R., O'Brien, E., Brinkman, W.B., Hommel, K., Farmer,

K.C., Klinger, E., Maniam, N., Sobko, H.J., Bailey, S.C., Cho, I., Rumptz, M.H., Vandermeer, M.L. & Hornbrook, M.C. (2014). Patient-centered interventions to improve medication management and adherence: a qualitative review of research findings. Patient Education and Counseling, 97, 310-326. doi:10.1016/j.pec.2014.08.021

McKinn, S., Linh, D.T., Foster, K. & McCaffery, K. (2017). Communication between health workers and ethnic minorities in Vietnam. Health Literacy Research and Practice, 1(4), e163-e172. doi:10.3928/24748307- 20170629-01

Meeuwesen, L., van den Brink-Muinen, A. & Hofstede, G. (2009). Can dimensions of national culture predict cross- national differences in medical communication? Patient Education and Counseling, 75(1), 58–66. doi:10.1016/ j.pec.2008.09.015

Montgomery, A.T., Lindbland, A.K., Eddby, P., Soderlund, E., Tully, M.P. & Sporrong, S.K. (2010). Counselling behavior and content in a pharmaceutical care service in Swedish community pharmacies. Pharmacy World Science, 32, 455-463

Morrison, A. & Wertheimer, A. I. (2001). Evaluation of studies investigating the effectiveness of pharmacists’ clinical services. AJHP: American Journal of Health- System Pharmacy, 58(7), 569-577

Murad, M.S., Chatterley, T. & Guirguis, L.M. (2013). A meta-narrative review of recorded patient- pharmacist interaction: Exploring biomedical or patient-centered communication. Research in Social Administrative Pharmacy, 10(1), 1-20. doi:10.1016/ j.sapharm.2013.03.002

Nakayama, C., Kimata, S., Oshima, T., Kato, A. & Nitta, A. (2016). Analysis of pharmacist-patient communication using the Roter Method of Interaction Process Analysis System. Research in Social and Administrative Pharmacy, 12(2), 319-326. doi: 10.1016/j.sapharm.2015.05.007

Ngoh, L.N. (2009). Health literacy: a barrier to pharmacist-patient communication and medication adherence. Pharmacy Today, 15, 45-57

Naughton, C.A. (2018). Patient-centered communication. Pharmacy, 6(18). doi:10.3390/ pharmacy6010018

O’Connell, M.B., Korner, E J., Rickles, N.M. & Sias, J.J. (2007). Cultural Competence in Health Care and Its Implications for Pharmacy Part 1. Overview of Key Concepts in Multicultural Health Care. Pharmacotherapy, 27(7), 1062–1079. doi:10.1592/ phco.27.7.1062

Okumura, L.M., Rotta, I. & Correr, C.J. (2014). Assessment of pharmacist-led patient counseling in randomized controlled trials: a systematic review. International Journal of Clinical Pharmacy, 36, 882-891. doi:10.1007/s11096-014-9982-1

Pires, C.M. & Cavaco, A.M. (2014). Communication between health

professionals and patients: review of studies using the RIAS (Roter Interaction Analysis System) methods. Revista da Associação Médica Brasileira, 60(2), 156-172. doi:10.1590/1806-9282. 60.02.014

Roter, D. (2006). The Roter method of interaction process analysis. Baltimore: Bloomberg School of Public Health, Department of Health Policy and Management, The John Hopkins University

Roter, D. & Larson, S. (2002). The Roter Interaction Analysis System (RIAS): utility and flexibility for analysis of medical interactions. Patient Education and Counseling, 46(4), 243–251

Schottenfeld, L., Petersen, D., Peikes, D., Ricciardi, R., Burak, H., McNellis, R. & Genevro, J. (2016). Creating Patient-Centered Team-Based Primary Care. AHRQ Pub. No. 16-0002-EF. Rockville, MD: Agency for Healthcare Research and Quality

Sporrong, S.K. & Kaae, S. (2018). Trends in pharmacy practice communication research. Pharmacy, 6(127)

Stevenson, F.A., Cox, K, Britten, N & Dunbar, Y. (2004). A systematic review of the research on communication between patients and health care professionals about medicines: the consequences for concordance. Health Expect, 7, 235-245

Susilo, A.P., Marjadi, B., van Dalen, J. & Scherpbier A. (2019). Patient decision-making in the informed consent process in a hierarchical and communal culture. The Asia Pacific Scholar, 4(3), 57-66. doi:10.290.60/TAPS. 2019-4-3/OA2085

Susilo, A.P., van Dalen, J., Scherpbier, A., Tanto, S., Yuhanti, P. & Ekawati, N. (2013). Nurses’ roles in informed consent in a hierarchical and communal context. Nursing Ethics, 20(4), 413-425. doi:10.1177/ 0969733012468467

Talasaz, A.H. (2012). The potential role of clinical pharmacy services in patients with cardiovascular diseases. Journal of Tehran Heart Center, 7(2), 41-46

Tindall, W.N., Beardsley, R.S. & Kimberlin, C.L. (2003). Communication Skill in Pharmacy Practice 4th ed.: A Practical Guide for Students and Practitioners. Philadelphia: Lippincott Williams & Wilkin.

van Hulten, R., Blom, L., Mattheusens, J., Wolters, M. & Bouvy, M. (2011). Communication with patients who are dispensed a first prescription of chronic medication in the community pharmacy. Patient Education and Counseling, 83, 417-422

Watermeyer, J. & Penn, C. (2009). The organization of pharmacist-patient interactions in an HIV/AIDS clinic. Journal of Pragmatics, 41(10), 2053-2071. doi:10.1016/ j.pragma.2009.02.010

NEJM Catalyst. (2017). What is patient-centred care? (online). Available at: patient-centered-care/. Accessed 3rd August , 2018

Zhao, P.X., Wang, C., Qin L., Yuan, M., Xiao, Q., Guo, Y.H. & Wen, A.D. (2012). Effect of clinical pharmacist’s pharmaceutical care intervention to control hypertensive outpatients in China. AJJP: African Journal of Pharmacy and Pharmacology, 6(1), 48-56. doi:10. 5897/ajpp11.633

Zweber, A. (2002). Cultural competence in pharmacy practice. American Journal of Pharmaceutical Education, 66, 172–176




How to Cite

Mulyono, I., Irawati, S., Susilo, A. P., & Claramita, M. (2019). RESEARCH ARTICLE: Pharmacist-patient communication in Indonesia: The Roter Interaction Analysis System (RIAS) in a socio- hierarchical context. Pharmacy Education, 19(1), p 359–369. Retrieved from



Research Article