Certainly no major conclusions or generalizations can be made from a pilot study of this size. However, as is the nature of pilot studies, needed modifications in methodology have been discovered. Also, it is obvious that rapport development may be evaluated with the MISS, and the use of a camera has proven to be a worthwhile assessment and intervention tool. The results of this pilot study would certainly warrant continuation with a larger study. Rapport development has not been studied in diabetes. Perhaps rapport may be at risk because of the lengthy provider-patient relationship and the need for repeated physician reinforcement of required medical regimens and some associated life-style changes. In this study, rapport appeared to increase slightly in the experimental (camera) group and decrease in the control (non-camera) group. From the patients' perspective, use of photography communicates that the health care provider cares about them as individuals, is interested in their life-styles, and is seeking methods to best integrate the treatment regimen into their individual life patterns. However, rapport development may deteriorate over time with individuals who have a chronic illness (as indicated by some decrease in pretest/posttest mean differences in both groups), thus emphasizing the responsibility of health care providers to actively work to preserve rapport. The camera may be one method to accomplish this goal. When treating an individual with a chronic illness, health care providers tend to view the patient and problem as one entity rather than as two separate components. The camera may help to enhance this separation and promote understanding of the individual by means of rapport development.