Optimising self-management (Table 3)
Empowering AYA with self-management skills can help them become autonomous, expert patients, minimising their dependency on parents and HCP. It is therefore essential that AYA have the knowledge and skills to ensure they can self-manage their allergies and/or asthma effectively and confidently. Focusing consultations on areas where AYA say they are not confident may be recommended to improve self-management including adherence (Grade C).28-33 Barriers to successful self-management such as poor symptom perception and failure to take responsibility need to be addressed.7 Facilitators to self-management which could be employed are the use of routines, simple treatment regimes, better understanding, a positive attitude and support from family, friends and school/college.7
To facilitate self-management, a personal action plan may be recommended to assist AYA in self-managing their allergy and/or asthma (Grade C).29,31,45,46 Plans should be developed with the AYA and parents/carers which could be smartphone-based.46
Peer-led interventions are recommended to improve asthma-related quality of life, asthma knowledge, and to reduce asthma-related doctor visits and school absence (Grade A).47-51 Adolescents are likely to mirror the behaviour of their peers. To date, these peer-led interventions have been demonstrated in randomised controlled trials for AYA with asthma; they may also be useful for other allergic conditions.
AYA with allergy and/or asthma are frequently excluded from activities, which may have an impact on their developing social skills. Consideration may be given to supporting the AYA, family and the wider community to allow AYA to be included in social events (Grade D).52-55 This may involve encouraging them to focus on sports that are less likely to exacerbate asthma (e.g. swimming) or undertake sport at times when symptoms are less likely to be triggered (e.g. avoiding cold mornings or pollen peaks). Ensuring that the menu for school trips or parties does not contain relevant food allergens will be helpful for some AYA; it is therefore important that AYA develop the necessary self-advocacy communication skills to inform organisers about their allergy. Additionally, educating teachers, club staff, and other parents about allergy/or and asthma is important as mistaken beliefs can present a barrier to effective communication and integration in social contexts.52,55
Motivational interviewing (MI) can be recommended to improve understanding and perception of the disease and adherence, thereby reducing asthma symptoms and improving quality of life (Grade B).56 MI has been widely used in medicine and other settings in this age group. The approach seeks to increase motivation to change behaviours and then encourages the AYA to set goals for themselves. Training is required for HCP to effectively utilise MI.