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]