Chronic disease self-management in young people — formative SAQs

SAQ 1 — Assessing adherence and readiness in a young person with type 1 diabetes (10 marks)

A 16-year-old with type 1 diabetes has been admitted twice in six months with diabetic ketoacidosis. His HbA1c has climbed. He and his mother both insist he takes all his insulin. [2] [7]

Questions

1. Outline how you would assess his adherence objectively rather than relying on self-report. (4 marks) [2] [6]
2. Describe how you would use a transition-readiness tool such as the TRAQ, and state its limits. (3 marks) [3]
3. Explain why self-reported adherence overestimates true adherence and the operational implication. (3 marks) [2] [6]

Model answer

Objective adherence assessment (4). Pair self-report with an objective marker every time: insulin pump or pen download history, continuous-glucose monitoring time-in-range, and pharmacy refill or prescription-fill data. Where the picture is confusing, re-assess the diagnosis and exclude mimics such as an absorption problem or a drug interaction. A multimethod approach catches more non-adherence than any single measure. [6] [2]

Transition-readiness tool and its limits (3). Administer the TRAQ, whose domains cover managing medications and keeping appointments, to map the specific gaps in his self-care skills. Interpret it to find what to teach, not to generate a single number. State the limit explicitly: no readiness score alone justifies or blocks transfer, which remains a clinical judgement integrating skills, supports and circumstance. [3]

Self-report overestimates (3). Across chronic disease, self-report and parent-report substantially overstate true adherence because respondents give the answer they think is wanted. The operational implication is that self-report must never be the sole basis for decisions to escalate therapy; an objective marker accompanies every assessment. [2] [6]

SAQ 2 — Building a self-management plan and managing a non-adherence crisis (10 marks)

A 17-year-old renal transplant recipient presents with a falling tacrolimus trough and rising creatinine. Refill data show he has collected only half his immunosuppression. He discloses he has been overwhelmed since starting university. [5] [8]

Questions

1. Describe the stepwise approach to building his self-management plan. (5 marks) [4] [5]
2. Explain how motivational interviewing would be used in this encounter, naming the core skills. (3 marks) [4]
3. State the immediate safety-net after a non-adherence-related deterioration and why a punitive stance fails. (2 marks) [2] [8]

Model answer

Stepwise self-management plan (5). Engage and build trust in a confidential, non-judgemental space. Assess where he is — the real adherence (confirmed objectively), the barriers (transition stress, cost, routine disruption), and his strengths. Agree shared SMART goals anchored to his priorities. Build skills with a co-created action plan, simplified regimen and problem-solving for missed doses. Equip with tools — reminders, telehealth, university support. Plan the transition with a handover summary and a warm link to adult services. [5] [4]

Motivational interviewing (3). Use the OARS frame — Open questions, Affirmations, Reflective listening, Summaries — to draw out his own reasons to change (change talk) and to roll with resistance rather than argue. A systematic review found motivational interviewing improves adherence and symptom severity in adolescents and young adults with chronic illness. [4]

Safety-net and the punitive trap (2). Build a tighter safety-net: closer follow-up within days, objective graft-function monitoring, a written flare plan, and wrap-around supports. A punitive or shaming response destroys the relationship and worsens future engagement; the stance is curious, supportive and non-blaming, with the conversation held in the recovery phase rather than punitively. [2] [8]