Title: Improving the engagement of teenagers with asthma with their healthcare
Funder: Asthma UK

Abstract: Background Asthma is one of the most common long-term conditions affecting adolescents. Many have poor control and impaired quality of life despite the availability of modern pharmacotherapy. Our previous research has demonstrated that adolescent with asthma communicate poorly with healthcare professionals and are often not engaged in self-managing their condition. This is likely to underlie their poor asthma control and suggests that healthcare professionals need to take a different approach to this group. Previous research suggests that a self-efficacy (ability to self-manage specific tasks) focused approach might be more effective than current approaches. Although other asthma self-efficacy questionnaires exist, we do not have one for adolescents. Aim To develop a new adolescent approach for young people with asthma and evaluate whether it improves their symptom control in clinical practice and their engagement with their asthma. Part of the evaluation will focus on asthma related self-efficacy; we will develop and validated a tool to assess this outcome both within the project and more widely. Methodology PHASE I: Guided by our previous data, we will develop a new adolescent approach with the key stakeholders (adolescent patients, their parents or carers, their healthcare professionals, and patient organisations) to overcome their poor engagement with their healthcare. We will use focus groups plus 1:1 interviews in younger adolescents to explore areas for inclusion in the adolescent approach and self-efficacy outcome measure using a qualitative content approach. Our previous work would suggest that our adolescent approach is likely to include seeing the adolescent initially on their own, taking an adolescent rather than a disease-centred approach and ensuring that the adolescent is an active participant in the consultation. The prototype approach and self-efficacy questions will be reviewed by the stakeholders in a second round of focus groups and 1:1 interviews to generate a refined adolescent approach (Obj. 1a) and appropriate self-efficacy outcome questions (Obj. 2a). PHASE II: We will undertake a randomised controlled trial of the adolescent approach usinga cluster design with adolescents with asthma. Clinics will be randomised to the new intervention or their current practice with 100 adolescents recruited into the study. The study is powered to assess the impact of the adolescent approach on asthma control. They will be assessed before and 10 weeks after their clinic visit: asthma control test plus asthma related self-efficacy, symptoms and medications use. In parallel with this, we will recruit 250 new adolescents with asthma from primary care, secondary care and patient groups to formally validate the asthma self-efficacy scale using psychometric principles. Cross-sectional validity and repeatability will be assessed using other related validated instruments (eg children's health locus of control, general self-efficacy scale). Benefit to patients with asthma We have previously demonstrated that adolescents with asthma are not engaged with their healthcare and have poor self-management skills. Improving healthcare professionals' approach to these patients might result in better engagement, greater ownership of their healthcare and improved self-management skills. This ought to result in improved asthma control and less morbidity and mortality.


Research activity codes: 7.1 INDIVIDUAL CARE NEEDS;7.3 MANAGEMENT AND DECISION MAKING
Health categories: RESPIRATORY