Individual interviews
VAE, confusion, diabetes
DIABETES
All doctors and nurses who conducted CSP conversations for PACE-D were invited to take part, as were PACE-D coordinators (a new teamlet role introduced to help recruit patients, arrange appointments, and collect data for the trial). Eligible staff were identified and approached by a PACE-D administrator and subsequently a PACE-D coordinator who also helped arrange interviews. Informed consent was documented before interviews commenced.Participants were told that the study aimed to learn from their perspectives, including to identify any concerns or difficulties with CSP, to complement and inform the interpretation of the PACE-D trial data when it became available, and to inform decisions about whether and how CSP would continue beyond the trial. The interviewer (VAE) was introduced to health professionals during their CSP training and first huddles as a non-clinical Professor, new to Singapore, with an interest in person-centred care and self-management support.We planned to conduct two face-to-face interviews with each health professional: one relatively soon after CSP conversations were initiated and a second at least 9 months later once they had more experience with the approach and had seen some patients for follow-up appointments. This reflected recognition that skills can develop with practice and that experience and perspectives can change with time. We were mindful that when interventions such as CSP are introduced, the health professionals who are expected to adopt new practices might benefit from some kind of support as they get used to them, and we thought that conducting two interviews rather than just one, when practices had become more settled, could be useful. In practice, first interviews started later than originally envisaged due to an initial delay in recruiting patients to the study and not all were completed before COVID-19 resulted in access restrictions. Further delays arose when VAE relocated, necessitating a revision to the study protocol and the securing of ethics committee approval to conduct interviews online and from overseas. Some health professionals’ first interviews thus did not take place until at least 12 months after CSP conversations were commenced, and in these circumstances, we judged a second interview unnecessary. To avoid confusion, we refer to the interviews as ‘wave 1’ (conducted relatively soon after CSP was implemented) and ‘wave 2’ (conducted at least 9 months after CSP was implemented). These are indicated as w1 or w2 after quotations. For health professionals who were interviewed twice, the minimum time between first and second interviews was 9 months (average 11 months). We note that the CSP experience levels of health professionals at the time of each wave varied because of a combination of leave and secondment arrangements and, to some extent, preferences for conducting CSP conversations.The interviews were conversational in style, supported by a topic guide that (for doctors and nurses) prompted coverage of: their role in relation to PACE-D, how they had been introduced to CSP and what they had first thought of it; examples of occasions when they thought CSP conversations had gone more and less well; how CSP conversations went compared with previous consultations for diabetes; perceived advantages and disadvantages for patients and for health professionals; any challenges in delivering CSP well; and whether and why they would or would not be inclined to continue with CSP beyond the PACE-D study, or to recommend it to other polyclinics. The topic guide was modified for interviews with PACE-D coordinators and developed over time to reflect questions of interest identified from previous interviews (for example, whether and how CSP works differently for different patient groups). It was annotated for second interviews to pick up points raised previously by each participant, including to check whether and how experiences or views had changed.Interview recordings were a mean of 48 minutes long (range 36 to 74 minutes).Audio-recordings of the interviews were transcribed by medical students on a student work scheme. VAE checked and corrected the transcripts against the audio recordings.