Table 1 Questions from the semi-structured interview schedules

Think about the relationship between stress and your ability to make a lifestyle change. How easy is it to make a change when you are stressed?

Do you think stress impacts on some patients’ ability to make lifestyle changes? How?

Prompt- Some people who are stressed, are not able to think about making any changes to their lifestyle- what do you think about this? Can you give me some examples from your experience?

Prompt- some patients are unable to change their lifestyle when they are stressed- can you give me any examples of this?

Prompt- Others become stressed when they try to make a change. Have you had this experience? What do you think about this?

Prompt- What do think is the effect of lifestyle change on patients’ level of stress- do they become more or less distressed if they make a change; why do you think that happens?

Prompt- some people feel better in themselves if they make a lifestyle change (e.g. stop smoking). Have you had this experience? Tell me about it.

Tell me about your recent health check with your doctor -what happened during the consultation; did the doctor suggest any changes to your lifestyle or medications:

Thinking about one of the patients who visited you for a health check, can you describe the consultation to me? What were the main factors that influenced your decisions about managing the patient?

Prompt- Discuss each issue brought up by the patient- e.g. If advised to increase physical activity then ask- what role does your general well being play in your ability to become more active; does being stressed make a difference to your activity levels?

Prompt- Would you give me some examples of how the consultation or your management might by influenced by a patient’s stress or distress?

Did the doctor make you aware of any risk factors for poor health that you were not already aware of? How did this make you feel- prompts: stressed/ concerned/very anxious/down or depressed; not any different. Has your response changed over time since the health check- e.g. Become more or less stressed/anxious?

Do you think that some patients become stressed as a result of being told they are at risk of cardiovascular disease- if yes can you give me an example from your practice?

Did your doctor refer you to any services to help you tackle your risk factors? If yes, then explore the patient’s perspectives about the effectiveness of the services if they attended and the role of stress in this process; e.g. Did attending the group program help relieve any anxiety you had about your risk factors. Did it help you with other aspects of your life?

How have you found conducting the health checks for the HIPs study? Have you referred any high risk patients to the Change program (individual and group visits)? What influenced you to refer some patients and not others? What role did psychological factors such as patient distress or stress play in your decision whether to refer to the Change program or other services?

If the doctor suggested referral to other services but patient did not take these up- explore reasons why.

What are your thoughts about stress and its impact on diabetes, heart attacks and strokes? Do you think there is a relationship- if yes in what way; if not why not; Is long term stress more or less important than short term stress?

Based on your experience - what do you think about the relationship between mental health and diabetes or cardiovascular disease?