Six-step counselling framework · Developed in Malaysia

A practical guide to patient-centred medication counselling

CONNECT-6 turns Motivational Interviewing into a six-step conversation for busy pharmacy practice, moving from directive monologue to collaborative dialogue.

Published in Research in Social and Administrative Pharmacy, 2026

Take one tablet every morning. Don't skip. Avoid salty food. Any questions? No? Okay, next.
How have you been managing your medicines lately?
Honestly, I skip some mornings when I leave early.
Those early mornings are tricky. Shall we plan around them together?
Yes, that would help.
An example counselling exchange: a one-way list of instructions fades out and is replaced by a two-way conversation.

Six steps.
One conversation.

  1. 1
    CONNECTBuild trust and listen.
  2. 2
    CLARIFYExplore beliefs and practical barriers.
  3. 3
    COACHAsk. Share knowledge. Ask again.
  4. 4
    CHECKExplore importance and confidence.
  5. 5
    CREATEAgree on a practical plan together.
  6. 6
    COMMITConfirm the plan and follow up.
Based on Motivational Interviewing, adapted for time-constrained practice. View the infographic ↗
The framework

What each step sounds like

Use the sequence as a guide, then follow the patient's cues. CLARIFY, COACH and CHECK can be revisited when the conversation calls for it.

1
CONNECT
Build trust and listen.

Pharmacist: "How have you been managing your medicines lately?"

Patient: "Mostly fine, but this month has been busy at work."

2
CLARIFY
Explore beliefs and practical barriers.

Pharmacist: "What led to that decision?"

Patient: "I felt well, so I thought I didn't need them every day."

3
COACH
Ask. Share knowledge. Ask again.

Pharmacist: "May I add one thing to that?"

Patient: "Sure, go ahead."

4
CHECK
Explore importance and confidence.

Pharmacist: "On a scale of 0 to 10, how important is this to you?"

Patient: "Maybe a seven. I don't want to end up in hospital again."

5
CREATE
Agree on a practical plan together.

Pharmacist: "Which option would fit your day best?"

Patient: "Keeping them next to my toothbrush, I think."

6
COMMIT
Confirm the plan and follow up.

Pharmacist: "Can you tell me the plan we agreed?"

Patient: "Tablets by the toothbrush every morning, and I'll bring my box to the next visit."

Resources

Free training materials

For workshops, medication counselling practice and skills assessment. No registration is required.

For trainers

CONNECT-6 Training Deck

Workshop slides introducing the framework, with counselling techniques, worked examples and practice activities.

PDF · 79 pages · 1.4 MB · Added
For everyday practice

Quick Reference Counselling Card

A printable A4 guide to the six steps, with practical prompts and a worked patient conversation.

PDF · 4 A4 pages · 245 KB · Added
For assessors

Competency Assessment Checklist

A 27-item checklist for observing and scoring counselling skills before and after training, with space for feedback.

PDF · 3 A4 pages · 167 KB · Added

Free for non-commercial education and research with attribution. Commercial use needs prior permission from the team.

Using CONNECT-6 in your practice?

Tell us where the materials are helping. It takes two minutes, and email updates are a separate opt-in.

Share how you use it

Registration is optional. Responses are saved privately with the CONNECT-6 team through Google Forms.

Having trouble with the form? Open it in a new tab ↗

Explainer video

Watch the explainer

What CONNECT-6 is, why it was developed, and how it works in practice.

Research

Research behind CONNECT-6

A pre–post study with 27 pharmacists across hospital and health clinic settings in Selangor, Malaysia.

Read the published study
Roleplay counselling score, mean total
Before9.71
After17.00
p = 0.002
13/13self-assessment domains improved significantly after training (p ≤ 0.003)
Study details

Roleplay performance: mean total scores increased from 9.71 to 17.00 (p = 0.002).

Self-assessment: all 13 measured domains improved significantly (p ≤ 0.003).

Settings: improvements in both hospital and health clinic groups, with no statistically significant difference between them (p > 0.05).

Participant views: 100% agreed the framework improved their patient-centred counselling knowledge and skills, and 93% said they would apply it in daily practice. Read what they said ↓

Participant reflection · Ethical approval: NMRR ID-25-01263-PYJ, Ministry of Health Malaysia.

In their words

How pharmacists described the change

In the debrief straight after training, pharmacists reflected on how they counselled before CONNECT-6 and how it felt after. These are their own words.

Before training

Counselling was described as directive and pharmacist-centred:

  • “one-way communication”
  • “parent-to-child instructions”
  • “directives”
  • “superficial”
  • “generic”
  • “not personalised”

Patients were left feeling:

  • “merely [a] receiver”
  • “brushed off”
  • “defensive”

After CONNECT-6

Pharmacists described a different way of working:

  • “structured way of giving information”
  • “focused on patient”
  • “offered options”
  • “personalised plan”
  • “together tackling the issue”
  • “willing to listen”
  • “more caring”
  • “in a nicer way”

And patients began to:

  • “open up more”
  • feel “understood”
  • feel “valued”

Verbatim phrases from the post-training debrief with 27 pharmacists (Hassan et al., 2026). Quotes are shown in the original English.

100%agreed the framework improved their knowledge and skills in patient-centred counselling
96%agreed it gives a practical structure for patient-centred conversations
93%said they will apply CONNECT-6 in their daily practice

What they found hard: some worried that dialogue can be “more time-consuming” in busy outpatient clinics, that the order of COACH and CHECK could be confusing, and that patient choice must still “balance freedom with optimal therapy”. The FAQ below covers each of these.

CONNECT-6 in practice

Bring CONNECT-6 to your organisation

Training reach in 2026

4training sessions
126pharmacists involved

Training for your team

Available for hospitals, health clinics, pharmacy schools and professional societies.

Enquire about training

Research and implementation partnerships

Community, rural, specialist and international settings, curriculum integration and patient-outcome research.

Discuss a collaboration
In development

AI-assisted practice platform

Independent roleplay practice with competency feedback.

Register your interest
The team

The CONNECT-6 team

A multidisciplinary Malaysian team in clinical pharmacy, pharmacy education and health psychology developed and evaluated CONNECT-6.

Fahmi Hassan
Fahmi Hassan, PhD
Lead developer and principal contact · Pharmacist, HTAR Klang

Clinical pharmacy researcher based at Hospital Tengku Ampuan Rahimah, Klang.

  • Assoc. Prof. Ernieda Hatah, PhDPharmacy Lecturer, Universiti Kebangsaan Malaysia
  • Hariyati Sharima Abdul Majid, PhDConsultant Psychologist, IJN College
  • Shamala Balan, PhDPharmacist, HTAR Klang
  • Nirmala Jagan, PhDPharmacist, HSIS Serdang
  • Afizah ArsadPharmacist, HSIS Serdang
  • Wan Utma Sapini Wan Abdul SamadPharmacist, Hospital Selayang
FAQ

Common questions

Do I need Motivational Interviewing training before using CONNECT-6?

No. CONNECT-6 turns core Motivational Interviewing skills into a step-by-step workflow, so you learn them as you use it. In the validation study, 44% of pharmacists had no prior communication training, and skills improved across experience levels.

How long is the training?

The study used a single face-to-face session: a 60-minute structured briefing with case examples, a 30-minute Q&A, then roleplay practice. Each pharmacist also received a printed copy of the framework to use as a guide during counselling.

Won't this make my counselling sessions longer?

It can, and pharmacists in the study raised this, especially for busy outpatient clinics. Two things help. Not every step needs to be long: in a short encounter, a single open question and a quick plan still follow the framework. And because the conversation targets the patient's actual barrier, less time can go on information they do not need.

All participants expected the framework to make their sessions more efficient. Its effect on real consultation time has not been measured yet.

Do I have to follow the six steps in order?

No. CONNECT opens the conversation, and CREATE and COMMIT close it with a plan. In between, CLARIFY, COACH and CHECK can be reordered or revisited as the patient's cues demand. If the patient raises a new concern while you are coaching, go back to clarify it.

What if the patient wants a plan that goes against clinical guidelines?

Supporting autonomy does not mean giving up clinical responsibility. As study participants put it, the aim is to “balance freedom with optimal therapy”. Offer options that are all clinically safe, explain your concerns honestly using Elicit–Provide–Elicit, and let the patient choose among them.

Can I use it in Bahasa Melayu or other languages?

Yes. The study roleplays were carried out in a mix of English and Malay, the way most Malaysian consultations happen. Pharmacists found switching languages challenging, and the six steps act as a mental map that keeps the conversation on track while you switch.

Where does CONNECT-6 work best?

It was validated with hospital and health clinic pharmacists, and both groups improved to a similar degree. Participants felt it fits especially well in Medication Therapy Adherence Clinics (MTAC) and bedside counselling. Community pharmacy, rural and telepharmacy settings have not been studied yet.

Has CONNECT-6 been shown to improve patient outcomes?

Not yet. The published study measured pharmacists' counselling skills in simulated consultations, where scores rose from 9.71 to 17.00 out of 27. Studies of patient adherence, clinical outcomes and long-term skill retention are the next step. If you would like to collaborate on this, please get in touch.

How is it different from WWHAM or the Indian Health Service three prime questions?

Those tools are designed mainly to gather information or check recall. CONNECT-6 is designed for behaviour change: it explores why a patient is not taking their medicine, builds motivation and ends with a plan the patient owns. It can sit alongside those tools rather than replace them.

Can I use or adapt the materials?

Yes, for non-commercial education and research, under a CC BY-NC-SA 4.0 licence. Credit Hassan et al. (2026) and share any adaptations under the same licence. Commercial use needs prior permission from the team.

How to cite CONNECT-6

Hassan F, Hatah E, Balan S, Jagan N, Abdul Majid HS, Wan Abdul Samad WUS, Arsad A. Shifting pharmacist medication counselling from directive monologue to collaborative dialogue using the CONNECT-6 framework: A mixed-methods pre–post interventional validation study. Res Social Adm Pharm. 2026;22(7):764–774. doi:10.1016/j.sapharm.2026.03.008