Results
diabetes
DIABETES
We interviewed 11 doctors, 2 nurses and 3 PACE-D coordinators. 7 doctors and 1 nurse were interviewed twice and 2 PACE-D coordinators asked to be interviewed together, so there were 23 interviews in total. 14 interviews (all in the second wave) were conducted online.Our sample includes all but 2 of the health professionals trained to conduct CSP conversations within the PACE-D trial: 2 eligible nurses declined interviews because they conducted very few CSP conversations. 11 participants were from one polyclinic and 5 from the other, reflecting different staffing arrangements.The interviews and huddle observations confirmed reports from PACE-D leaders that both polyclinics managed to establish a CSP system for people with diabetes, and to sustain this through the substantial disruptions of COVID-19 and introduction of a Next Generation Electronic Medical Record system. (At the time of writing CSP has been provided in these polyclinics for over three years – continuing beyond the trial). They also highlighted that the PACE-D coordinators came to play key roles in keeping key CSP processes going (not just supporting research components).We report our findings in three main sections. First, we outline the understandings of CSP evident in doctors’ and nurses’ accounts, including the key contrasts they saw between CSP and their previous ways of working, and the range of benefits they attributed to CSP. Important variations in health professionals’ enactments of CSP are introduced within this section.Second, we consider the challenges to CSP that participants reported as arising from (a) the situated characteristics of local patients and (b) organisational factors and policy pressures. This section also notes variations in health professionals’ interpretations of and enacted responses to these challenges. It indicates how both the external challenges and variations in health professionals’ enactments can impact the achievement and recognition of potential benefits of CSP.Third, we examine health professionals’ overall evaluations of CSP and their inclination to extend its use beyond PACE-D. We show that these evaluations are somewhat contingent on health professionals’ interpretive emphases, experiences of challenges, and awareness of variations in their collective enactments.In the Discussion, we develop our analysis of how variations in health professionals’ interpretive emphases and skill repertoires impact their enactments of CSP, scope to improve these with experience, evaluative judgements of CSP and motivation to continue with the approach.The findings and analysis were endorsed by participants when presented to their team huddle. Health professionals particularly appreciated recognition of the challenges they faced and the recommendations for future organisational support for CSP.