(22%); and provision of clear explanations, including the patient in decision making, and instilling trust (each 5%).The SPs in this study appear to be highly activated 'real' patients and attribute much of that to their experience as SPs. They believe that doctors are effective when they provide patient-centred care, but also view the doctor-patient interaction as truly collaborative. Further studies should explore how SPs can help us not only understand the central role of collaboration in patient activation, but also how best to use that insight to activate real patients.