Conviction and Confidence

One of the most challenging roles of a diabetes educator is to help those who seem stuck - those unable to make a specific behaviour change, appointment after appointment.  Hopefully this page will help! You'll learn to:

  • Assess and build conviction in patients
  • Assess and build confidence in patients


Why study conviction & confidence?

Why study conviction & confidence (C & C)?

It's simple. We became health professionals to help people. By using techniques to address conviction and confidence we can better help patients and ourselves. 

Help patients:

  • make faster behaviour changes
  • make more meaningful changes
  • empower themselves
  • take responsibility for their decisions

Help ourselves:

  • increase rapport with patients 
  • save appointment time
  • decrease frustrations
  • increase work satisfaction
What are conviction & confidence?
The BIG SUMMARY is here!


1. Ask About Conviction

Ask About Conviction

Consider these questions when assessing how important a patient finds a specific behaviour change. Try not to interpret a patient's smiles, long-standing relationship with you or their lack of dissent as high conviction. Clarifying conviction levels with direct questions is respectful of the patient's preferences, time and efforts. Allowing time for the patient to think and reflect outloud can provide insight into a patient's beliefs about a behaviour, concerns, expectations and ideas about how that behaviour change may impact their life.

  • "How do you feel about ____(insert behaviour)?"
  • "How do you think ____(insert behaviour) will benefit you?"
  • "On a scale of 1 to 10 how important is ____(insert behaviour) to you?"  
    (...because quite often, the smile can mislead!)

ahs conviction scale vs smile 2018


You may need to assess conviction "Higher Up" by asking:

  • "How important is getting lower glucose levels to you?"
  • "How would a lower A1c impact your dreams for home, work, family?"
  • "How would you feel about making medication changes if it could reduce your risk for _____(e.g. kidney or eye damage. Insert the specific complication you feel best connects with the patient)?"
2. Assess Level of Conviction
3. Build Conviction


1. Ask About Confidence

Ask About Confidence

Remember, a patient's smiles don't necessarily mean high confidence. Also, don't assume a patient would tell you they aren't confident, even if you've had a trusting relationship with them for years. Clarify using questions like these when assessing confidence. 

  • "How confident do you feel about ____ (insert behaviour)?"
  • "On a scale of 1 – 10, how CONFIDENT are you that you could _____(insert behaviour)?"

Remember that high confidence does not mean the person has high conviction to change - they may feel confident they could change IF they wanted to. Assessing coinviction first, before assessing confidence, is often the best strategy.

2. Assess Level of Confidence
3. Build Confidence

Keep in Mind

The Order Matters!

The Order Matters!

Find the Target - Assess 1st: Is it conviction or confidence that needs increasing first? 

Aim at the Target - Coach 2nd

dcc conviction blind target 2018

 When we forget to assess conviction first and assume people are on board with change, maybe because of their smiles and humour, we put the therapeutic relationship at risk. We risk:

  • disrespecting patients' autonomy and time
  • losing patients' trust
  • losing rapport and honest answers; alienating patients
  • decreasing our ability to help patients


Other Client Centred Skills


Case 1: Marta

Case 1: Marta

The diabetes educator asks, “Marta, how do you feel doing some gluocose checks?”

Marta shrugs, then she sighs heavily with annoyance and says, “I used to do that. It will get in the way of my work. I know you need the numbers for the insulin doses but I have to take care of kids for a living. I run a daycare. It’s chaotic. Those kids keep me so busy! And, those kids are much more important than me!”

  1. Do you think Marta is ready to set a SMART goal to test once or twice daily? 
  2. If you answered 'no', what do you think she needs first?
    • An increase in conviction? If so, what option for building conviction do you think is best suited to her?
    • Or an increase in confidence. If so, what option for building confidence do you think is best suited to her?

If you aren't sure if glucose checking is important to her, or you want to clarify the level of conviction, what question could you ask her? 

Case 2: Kareem
Case 3: Ava