Table 4 Interpretations and skill repertoires that impact enactments and evaluations of CSP

View of purpose of CSP

Improve HbA1c and other biomedical markers or risk factors for diabetes, supporting patient to work on these.

Improve health and broader wellbeing, working with person’s own perspective on these.

(This can include, but is not limited to, biomedical markers and risk factors).

View of CSP conversation as ‘causal’; expected timeframe of success

As a discrete intervention, with an expectation that it will impact directly and relatively quickly on relevant behaviours and (biomedical) health outcomes.

As an intervention that is part of a long-term process in a complex social environment. It may have various benefits, but impacts on health may take a long time to become evident.

Understanding of how motivation features in CSP

Patient should come in prepared and motivated to improve their health; practitioner works with a motivated patient to set goals and action plans to improve their diabetes.

Patient ideally comes in prepared and motivated to improve their health, but practitioner role includes working to identify and develop patient’s motivation and support them, when appropriate, to set goals and action plans to improve some aspect of their health and wellbeing that matters to them.

Why listen to patients and find out about their lives?

Attend to patient’s views about their test results and elicit practical details of their life in order to identify scope for them to act to improve their diabetes.

Attend to patient’s views about their diabetes, perspectives on what matters and key features of their life in order to understand them better and to find appropriate ways to support them to address their own priorities for diabetes or broader health and wellbeing.

Emphases in professional interest

Strong interest in disease, bioscience and/or epidemiology; less drawn to psychosocial aspects of healthcare

Strong interest in people and the psychosocial aspects of healthcare as vital for good use of biomedicine

Relevant prior training

No or little prior training with motivational interviewing or similar.

Some (perhaps extensive) prior training and experience in motivational interviewing or similar.

How CSP relates to previous practice

CSP perhaps involves a significant change, but the difference is seen mainly in terms of allocated consultation time, consultation stages, the kind of questions the health professional asks and the balance of who talks.

CSP allows space for and perhaps gives a formal structure to approaches to working with patients that were already of interest or being tried.

Or

CSP involves a significant change in approach involving a shift in values towards more sharing and a greater appreciation of working with what matters to the patient.

Presumptive comparator in evaluative judgements of CSP generally

‘Ideal’ account of CSP

Or

The most positive examples of substantial improvements in patients’ biomedical markers following CSP.

Pre-CSP arrangements, including ‘usual’ consultations.