Consulting with young people’s about their health needs

Dr Linda Milnes,

Associate Professor in Children and Young People’s Nursing,IMG_8979

School of Healthcare, University of Leeds

http://medhealth.leeds.ac.uk/profile/1100/1403/linda_milnes

Twitter @LindaMilnes

As the 2015 update of Key Data for Adolescence (Association for Young People’s Health) was published, last September, once again we are alerted to the fact that one fifth of the UK’s population are 10-24 years old, which is 11.7 million young people.   One in seven of this population have a diagnosis of a long-term condition or disability. Many of these young people will be cared for by specialist services in paediatric centres but will also access primary care services. An example of this is young people with asthma, reported as 800,000 in the UK.  Young people talk of experiencing daily symptoms, restrictions on activities, having good days and bad days and feeling different to their peers (Callery et al., 2003). Health care for this group should be patient-centred and focus on skilling young people to self-care effectively as they move towards adulthood a transition we know can bring many challenges for them.

Consultations between health professionals and young people are an opportunity to develop and build therapeutic relationships, gain young people’s perspectives on their condition and understand their priorities for effective self-care. However, research tells us that young people’s participation in consultations can be limited (Lyte et al., 2007; Cahill and Papageorgiou, 2007). Using asthma as an exemplar, young people report a lack of confidence in asking questions (Dixon-Woods et al., 2002), feeling intimidated (Milnes et al., 2014) and uncomfortable about attending asthma appointments alone (Edgecombe et al., 2010).

It is here that my research interests lie, supporting the development of young people’s communication skills and promoting their participation in consultations. Participating in consultations, communicating health needs and concerns, taking part in complex decisions about disease management all require high level communication and interpersonal skills. Doctors and nurses receive high level training in communicating with young people and can learn from experiences, but there is still a problem. In response to a call by young people for health professionals to improve their communication skills further training is now available (http://www.mefirst.org.uk/). I would argue that this is an excellent way forward but we know that communicating with health professionals requires confidence and practice in a, sometimes, paternalistic environment so why not train patients to participate? Alongside young people and experts in the field of respiratory care and health psychology, I developed an intervention to promote young people’s participation in primary care consultations. It was well received and validated the need for interventions to help young people build confidence in communicating with health professionals (Milnes et al., 2014; Milnes et al., 2012). Supported by the young people’s patient and public involvement group at Asthma UK Centre For Applied Research – SPEAK Asthma – we are aiming towards developing further research projects in this field. We are currently doing a survey (including interviews with health professionals) regarding current practice to promote participation in asthma consultations in outpatient departments.

Applied health research involving young people as a distinct group is rare. The older age range is often included in ‘adult’ samples or the younger in ‘child’ samples where data analysis is not separated by age. The recent recommendation to expand the definition of young people to 12 – 25 years old could support the increase of research in this group. Widening the age range helps to strengthen the argument that effective health care is needed for this larger proportion of the population and hopefully this will lead to research that is more meaningful.

Association for Young People’s Health (2015) Key Data for Adolescence. Available online. http://www.youngpeopleshealth.org.uk/key-data-on-adolescence (Accessed 24/01/15)

Cahill, P. and Papageorgiou, A. 2007. Video analysis of communication in paediatric consultations in primary care. British Journal of General Practice. 57, p866.

Callery, P., Milnes, L.J., Verduyn, C. and Couriel, J. 2003. Qualitative study of young people’s and parents’ beliefs about childhood asthma. British Journal of General Practice. 53, pp.186-190.

Dixon-Woods, M., Anwar, Z., Young, B. and Brooke., B. 2002. Lay evaluation of services for childhood asthma. Health & Social Care in the Community. 10(6), pp.503-511.

Edgecombe, K., Latter, S., Peters, S. and Roberts, G. 2010. Health experiences of adolescents with uncontrolled severe asthma. Archives of Disease in Childhood.

Lyte, G., Milnes, L., Keating, P. and Finke, A. 2007. Review management for children with asthma in primary care: a qualitative case study. Journal of Clinical Nursing. 16(7b), pp.123-132.

Milnes, L.J., McGowan, L., Campbell, M. and Callery, P. 2012. Developing an intervention to promote young people’s participation in asthma review consultations with practice nurses. Journal of Advanced Nursing. 69(1), pp.91-101.

Milnes, L.J., McGowan, L., Campbell, M. and Callery, P. 2014. A qualitative evaluation of a pre-consultation guide intended to promote the participation of young people in asthma review consultations. Patient Education and Counseling. 91(1), pp.91-96.

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