Table 6.

How to improve adherence

What	Why
Engage	Take time to see situation through their eyes
Motivation	Search for factors that they actually care about (e.g. puberty or growing which will start once disease control is improved)
Assess the size of the problem and decriminalize	Ask: ‘most people have trouble taking their medication. How often do you remember yours?’
Involve	Plan the regimen with the adolescent
Take time to explore practicalities	If you put yourself in the adolescent's shoes with a mind for detail, you may find the problem – sometimes it is as simple as not having a bag big enough to carry the medicines around in
Think practically	Find an activity they do daily and attach the medication to it (e.g. brushing teeth); find the least chaotic time of day, often the morning
Visualize	It is easier to remember to do something if you can visualize yourself doing it (e.g. taking pills ‘with breakfast and dinner’ instead of ‘twice a day’)
Find out what they would agree to do	You then have a place to start working together from
Barriers	Ask about each drug in turn and explore barriers to taking, and what makes it hard
Contract	Make a contract that they agree to
Written instructions	Something to remind them – most of what is said has been shown to be forgotten once they leave the room
Take time to explain	It is a good idea to check out their level of knowledge on each occasion
Explore beliefs	You may be surprised to learn about their beliefs (e.g. that one drug works perfectly but they don't think the other does [or don't like the assumed side effects] so they only take the one)
Solution-focused approach	Find out what has been going well and why (e.g. ask ‘How have you managed to stay well for three weeks this month?’), and use this information
Check motivation	See where they are in the motivational cycle and if pre-contemplative you may want to refer to psychology to work on motivation