Table 2 Interpretation of the themes from field notes before and after training

More authoritarian

More collaborative

They reported that patients do not listen to what nurses and doctors, as the experts, tell them to do. They felt that trying to change a patients mind to change a risky behaviour, was a difficult task.

They reported that they needed to listen more to hear what patients had to say, rather than telling them what to do. They reported that they recognised the need to change the way that they look at patients, and that incorporating a patient’s circumstances into a conversation about changing behaviour, was an important aspect of counselling.

More directing and ‘telling’ the patient what to do

More eliciting and strengthening the patient’s own reasons for change

They reported that patient’s don’t understand the importance of changing risky behaviour, and therefore needed to be educated about the importance of change.

They recognised that previously they were trying to change their patients by persuasion and argumentation, rather than simply helping patients to change for themselves according to their own reasons and in their own time.

Patients do not have control and choices about their behaviour

Respect patients control and choices

They felt responsible for their patient’s unhealthy behaviours, and reported that they found it challenging to counter a patient’s beliefs about not changing.

They reported feeling relieved when they understood why patients often do not change when they expected them to, and that they are not expected to argue about it, or feel frustrated, but rather to respect the patient’s choices.