(2003; 211 pages)
Nonadherence to regimens for asthma treatment may have several causes including inadequate knowledge and skill on the part of the patient, and inadequate awareness of the problem, or lack of skill to address it, on the part of the health professional. Patients must have a basic understanding of their illness and its treatment if we are to expect even minimal adherence. Achievement of adherence requires considerable effort from both the patient and caregiver. To perform the daily tasks necessary for successful control of their asthma, patients must be well motivated and convinced that their own behaviour will result in improved health, a concept referred to as self-efficacy. Simply giving information to patients is unlikely to change behaviour; health care providers must understand the psychological principles that underlie self-management training and comprehend that motivating patients requires more than informing them briefly about the prescription that has just been written. At the core of these principles is the need to establish treatment goals that can be embraced both by health professionals and patients in a partnership that requires regular and reciprocal communication. Patients will not perform the work necessary to achieve goals they do not understand or do not view as necessary and important. Once appropriate goals have been established, most patients require assistance in determining how to evaluate their changing symptoms and how to use their written action plan to make effective decisions about daily self-management behaviour.