Table 3 Post-intervention qualitative feedback provided by participants with diabetes (n = 9)

Approach to solving problems

“I liked the way the health professional was able to help me break down issues and simplify strategies and steps to work to a solution”.

“My problems or issues that are most concerning to me are more emotional - For example, I can’t use this problem-solving process to not be so lonely”.

• Provide diabetes HPs with more strategies and practical application of linking emotional problems to behaviors (given that behavioral problems are amenable to PST) through vignettes, demonstrations, group reflections

• Upskill HPs in referring participants on to other support (e.g., mental health professional for more complex emotional problems)

• Provide further guidance to HPs on when and where to refer

Structured intervention

“I liked the step-by-step approach. I could grasp each part before progressing to the next step”.

“The proposed problem-solving process did seem overly ornate, perhaps a little too inflexible and maybe a tad too much like a typical medical model”.

• To avoid LISTEN being delivered in a ‘scripted’ and ‘formulaic’ manner, HPs to develop their own template for facilitating sessions, with cues and prompts that fit with their communication style. While the key components of the PST model need to be included for the fidelity of the intervention, the facilitation of sessions needs to feel natural and ‘conversational’ to the participant.

• Ensure LISTEN is person-centered and focused on problems and goals important for the participant

• Increase fluidity and flexibility with the PST steps (less prescriptive)

• Focus on building therapeutic relationships (e.g., providing empathy)

• Participants to set overarching goals for what they would like to get out of LISTEN (start of session 1)

• Set expectations about LISTEN for the participant early on:

 - Revise recruitment flyer/promotional materials

 - Develop recruitment video (e.g., person with diabetes’ experience with LISTEN)

 - Develop information leaflet (i.e., what is LISTEN, participant involvement, potential benefits, testimonials

Role of health professional

“I learnt more about myself. Someone was there to discuss, prompt and listen”.

“I would have liked a bit more discussion and input/ideas [from the HP] instead of just questions”.

• Set expectations about LISTEN for the participant early on, i.e., problems, goals, and solutions should come from the participant (see above)

• Fluidity and increased flexibility with the PST steps (less prescriptive)

Online format of the program

“[It was helpful that…] I didn’t have to travel”.

The online format (although unavoidable these days) is impersonal.

• Evaluate the feasibility and cost (effectiveness) of alternative modes of delivery (e.g., in-person sessions). For example, online self-paced modules + e-mail/phone support

Therapeutic relationship with HP

“[The HP was a…] sympathetic listener… [and] was adaptable”.

“Maybe training for all parties involved on how to actually listen”.

• Include additional training around micro-counseling skills, specifically focused on reflective listening and responding with empathy, to assist with rapport building and strengthening the therapeutic relationship. This needs to include the opportunity to view demonstrations and practical application of skills through role play and supervised delivery with training cases.

Not enough resources provided

-

“Additional resources to help embed problem solving method, links to potential solutions”.

• Upskill HPs in referring participants on to other support (e.g., mental health professional for more complex emotional problems or a Diabetes Educator for self-management concerns)

• Provide guidance on when and where to refer