Future Developments

The principles underlying change counselling are widely cited in the research. They have received empirical support in other applications, and have high face validity. However, they remain largely untested in diabetes care. Evaluation is now needed, especially to ascertain the health benefits and costs. One of the main difficulties remains to be maintenance of the intervention throughout the period of the study. As recent research indicates, only 19% of the staff initially trained were employing the intervention at 2 year follow-up118. Therefore, there is a need for us to addressing our own behaviours, attitudes and clinic structures.

It is unlikely that the underlying theory in change counselling will change considerably in the next 10 years. The challenge is to isolate and refine the most useful components, and then translate these into useful clinical procedures. Clinicians ultimately need procedures which are either largely patient-determined or can be easily acquired and administered in 'noisy clinics'.

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