Self-Determination Theory to observe healthcare professionals' counselling in chronic care encounters: Development of the COUNSEL-CCE tool

Objective: To develop and psychometrically evaluate an observation tool to rate healthcare professionals' engagement in need-supportive and need-thwarting counselling in chronic care encounters.

Methods: The observation tool was developed through three stages (January 2018 - June 2019). First, a set of items was developed according to essential components of need-supportive and need-thwarting counselling as identified in Self-Determination Theory. Second, content validation by five experts. Third, ecological validation using video-recorded real-life consultations. For the psychometric evaluation (June - October 2019), the tool was used by three observers to code 55 units of real-life encounters.

Results: The Coding and Observing Need-Supportive Counselling in Chronic Care Encounters (COUNSEL-CCE) consists of 44 items clustered into nine theoretically underpinned behavioural approaches. Psychometric testing indicated acceptable to good consistency in scoring between observers and strong consistency within observers.

Conclusion: The COUNSEL-CCE captures person-oriented alongside process-oriented aspects during chronic care encounters. A person-oriented approach expresses counselling that is responsive to individual preferences and needs, whereas a process-oriented approach indicates the necessity to support competency building within patients, and is more instrumental of nature.

Practice implications: COUNSEL-CCE is a valuable observation tool to assess (graduate) healthcare professionals' counselling style and address if, and how, counselling evolves as a result of professional training.