The Adolescent Asthma Self-Efficacy Questionnaire may flag up several different area where your teenage patient may need additional support to facilitate the self-management of their asthma. Others may come up during the consultation.
Given the constraints of clinic time, it may only be possible to address one or two of these at a particular consultation. So, a decision must be made as to where to focus. This must be a joint decision as your patient is unlikely to actively participate in making behavioural changes unless they really share the same agenda as you.
When negotiating the current focus with your adolescent patient, their priority may not coincide with your one. For example, their chief concern may be symptoms that are preventing them from playing football. However, tackling this issue might automatically put the focus on improving adherence which might be the healthcare professional’s chief concern. In other situations, it might be necessary to tackle one or two of the teenager’s concerns before getting to what is concerning the HCP at a future consultation. The experience of successfully making changes in other areas will improve an adolescent’s motivation and confidence.
Is your patient at least ambivalent about the need to improve an aspect of asthma self-management?
If you are to have a chance of succeeding during the next evoking stage, it is important that your teenage patient at least feels ambivalent about the need to have a change in the specific area. So, it is important to establish where the adolescent is on the no reason for change > ambivalence > altered behaviour spectrum. You can listen out for change talk, like the examples below:
You could also check how patient’s level of ambivalence. For example, ‘You have been talking about xyz…Thinking about how much you currently want to do that, on a scale from 0 to 10 where ‘0’ is ‘not at all’ and ‘10’ is ‘very much’, where would you place yourself now?. This will help you decide where the focus of your consultation should lie.