Improving gout education from patients’ perspectives: a focus group study of Māori and Pākehā people with gout
Cassandra J. Rolston 1 8 , Tamlin S. Conner 1 8 , Lisa K. Stamp 2 , Tia Neha 3 , Suzanne Pitama 4 , Niamh Fanning 2 , Ron Janes 5 , Andrea Judd 6 , Ben Hudson 7 , Roisin M. Hegarty 1 , Gareth J. Treharne 11 Department of Psychology, University of Otago, Dunedin, New Zealand
2 Department of Medicine, University of Otago, Christchurch, New Zealand
3 School of Psychology, Victoria University, Wellington, New Zealand
4 Māori/Indigenous Health Institute, University of Otago, Christchurch, New Zealand
5 Wairoa Medical Centre, Wairoa, Hawkes Bay, New Zealand
6 Kaikoura Medical Centre, Kaikoura, New Zealand
7 Department of General Practice, University of Otago, Christchurch, New Zealand
8 These two authors contributed equally to this paper
Correspondence to: Gareth J. Treharne, Department of Psychology, University of Otago, PO Box 56, Dunedin 9054, New Zealand. Email: gareth.treharne@otago.ac.nz
Journal of Primary Health Care 10(3) 194-200 https://doi.org/10.1071/HC18010
Published: 4 October 2018
Journal Compilation © Royal New Zealand College of General Practitioners 2018.
This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Abstract
INTRODUCTION: Gout is a common form of arthritis that is typically managed in primary care. Gout management guidelines emphasise patient education for successful treatment outcomes, but there is limited literature about the educational experiences of people living with gout in New Zealand, particularly for Māori, who have higher gout prevalence and worse gout outcomes than Pākehā.
AIM: To explore gout patient education in primary care from the perspectives of Māori and Pākehā people with gout.
METHODS: In total, 69 people with gout were recruited through primary care providers in three locations across New Zealand. Nine semi-structured focus groups were run with Māori and Pākehā participants in separate groups.
RESULTS: Thematic analysis yielded two themes in relation to gout education: (i) ‘Multiple sources of gout education’; and (ii) ‘Gaps in gout knowledge’. Participants received education from general practitioners, educational resources, family and friends, and their own experiences. Māori participants preferred information to be kanohi-ki-te-kanohi (face-to-face) and with significant others present where necessary. Participants disclosed gaps in gout’s epidemiology and management. Pākehā and Māori participants reported limited understanding of the genetic basis of gout or the biological underpinnings of the condition and its treatments, but learned treatment adherence through experience.
DISCUSSION: Despite improved gout patient education, knowledge gaps remain and may contribute to poor medication adherence. Gout patient education interventions need to be tailored to culture and incorporate suitable methods of disseminating information about gout management.
KEYWORDS: gout; health-care education; communication; Māori health services; qualitative trials
References
[1] Neogi T. Gout. Ann Intern Med. 2016; 165 1–16.| Gout.Crossref | GoogleScholarGoogle Scholar |
[2] Winnard D, Wright C, Taylor WJ, et al. National prevalence of gout derived from administrative health data in Aotearoa New Zealand. Rheumatology. 2012; 51 901–9.
| National prevalence of gout derived from administrative health data in Aotearoa New Zealand.Crossref | GoogleScholarGoogle Scholar |
[3] Dalbeth N, House ME, Horne A, et al. The experience and impact of gout in Māori and Pacific people: a prospective observational study. Clin Rheumatol. 2013; 32 247–51.
| The experience and impact of gout in Māori and Pacific people: a prospective observational study.Crossref | GoogleScholarGoogle Scholar |
[4] Jackson G, Dalbeth N, Te Karu L, et al. Variation in gout care in Aotearoa New Zealand: a national analysis of quality markers. N Z Med J. 2014; 127 37–47.
[5] Horsburgh S, Norris P, Becket G, et al. Allopurinol use in a New Zealand population: prevalence and adherence. Rheumatol Int. 2014; 34 963–70.
| Allopurinol use in a New Zealand population: prevalence and adherence.Crossref | GoogleScholarGoogle Scholar |
[6] Morris C, Macdonald L, Stubbe M, Dowell A. “It’s complicated” - talking about gout medicines in primary care consultations: a qualitative study. BMC Fam Pract. 2016; 17 114
| “It’s complicated” - talking about gout medicines in primary care consultations: a qualitative study.Crossref | GoogleScholarGoogle Scholar |
[7] Khanna D, Fitzgerald JD, Khanna PP, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care Res. 2012; 64 1431–46.
| 2012 American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia.Crossref | GoogleScholarGoogle Scholar |
[8] Hamburger M, Baraf HS, Adamson TC, et al. 2011 Recommendations for the diagnosis and management of gout and hyperuricemia. Postgrad Med. 2011; 123(Suppl 1) 3–36.
| 2011 Recommendations for the diagnosis and management of gout and hyperuricemia.Crossref | GoogleScholarGoogle Scholar |
[9] Richette P, Doherty M, Pascual E, et al. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis. 2017; 76 29–42.
| 2016 updated EULAR evidence-based recommendations for the management of gout.Crossref | GoogleScholarGoogle Scholar |
[10] Sivera F, Andres M, Carmona L, et al. Multinational evidence-based recommendations for the diagnosis and management of gout: integrating systematic literature review and expert opinion of a broad panel of rheumatologists in the 3e initiative. Ann Rheum Dis. 2014; 73 328–35.
| Multinational evidence-based recommendations for the diagnosis and management of gout: integrating systematic literature review and expert opinion of a broad panel of rheumatologists in the 3e initiative.Crossref | GoogleScholarGoogle Scholar |
[11] Becker MA, Chohan S. We can make gout management more successful now. Curr Opin Rheumatol. 2008; 20 167–72.
| We can make gout management more successful now.Crossref | GoogleScholarGoogle Scholar |
[12] Lioté F, Terkeltaub R. Overview of gout therapy strategy and targets, and the management of refractory disease. In: Gout and Other Crystal Arthropathies. Terkeltaub R, editor. Philadelphia: Elsevier Saunders; 2012. p. 194–208.
[13] Dalbeth N. Management of gout in primary care: challenges and potential solutions. Rheumatology. 2013; 52 1549–50.
| Management of gout in primary care: challenges and potential solutions.Crossref | GoogleScholarGoogle Scholar |
[14] Von Korff M, Glasgow RE, Sharpe S. ABC of psychological medicine organising care for chronic illness. BMJ. 2002; 325 92–4.
| ABC of psychological medicine organising care for chronic illness.Crossref | GoogleScholarGoogle Scholar |
[15] Fields TR, Rifaat A, Yee AMF, et al. Pilot study of a multidisciplinary gout patient education and monitoring program. Semin Arthritis Rheum. 2017; 46 601–8.
[16] Schumacher HR. Patient education: How can we improve it and evaluate the effects? J Clin Rheumatol. 2011; 17 229–30.
| Patient education: How can we improve it and evaluate the effects?Crossref | GoogleScholarGoogle Scholar |
[17] Robinson PC, Schumacher HR. A qualitative and quantitative analysis of the characteristics of gout patient education resources. Clin Rheumatol. 2013; 32 771–8.
| A qualitative and quantitative analysis of the characteristics of gout patient education resources.Crossref | GoogleScholarGoogle Scholar |
[18] Te Karu L, Bryant L, Elley CR. Maori experiences and perceptions of gout and its treatment: a kaupapa Maori qualitative study. J Prim Health Care. 2013; 5 214–22.
[19] Treharne GJ, Richardson AC, Neha T, et al. Education preferences of people with gout: Exploring differences between indigenous and non-indigenous peoples from rural and urban locations. Arthritis Care Res (Hoboken). 2018; 70 260–7.
| Education preferences of people with gout: Exploring differences between indigenous and non-indigenous peoples from rural and urban locations.Crossref | GoogleScholarGoogle Scholar |
[20] Potter M, Gordon S, Hamer P. The nominal group technique: A useful consensus methodology in physiotherapy research. NZ J Physiotherapy. 2004; 32 126–30.
[21] Varga-Atkins T, McIsaac J, Willis I. Focus group meets nominal group technique: An effective combination for student evaluation? Innov Educ Teach Int. 2017; 54 289–300.
| Focus group meets nominal group technique: An effective combination for student evaluation?Crossref | GoogleScholarGoogle Scholar |
[22] Workbase Education Trust. To stop gout you need to bring your uric acid levels down. Wellington: Ministry of Health; 2015. [cited 2018 August 6]. Available from: http://www.health.govt.nz/system/files/documents/topic_sheets/stop_gout_booklet-dec2015.pdf
[23] Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006; 3 77–101.
| Using thematic analysis in psychology.Crossref | GoogleScholarGoogle Scholar |
[24] Boyatzis RE. Transforming Qualitative Information: Thematic Analysis and Code Development. Thousand Oaks, CA: Sage; 1998.
[25] Johnston ME, Treharne GJ, Chapman PT, Stamp LK. Patient information about gout: an international review of existing educational resources. J Rheumatol. 2015; 42 975–8.
| Patient information about gout: an international review of existing educational resources.Crossref | GoogleScholarGoogle Scholar |
[26] Rewi P. Whaikorero the world of Māori oratory. Auckland: Auckland University Press; 2010.
[27] Jackson G, Wright C, Thornley S, et al. Potential unmet need for gout diagnosis and treatment: capture-recapture analysis of a national administrative dataset. Rheumatol (Oxford). 2012; 51 1820–4.
| Potential unmet need for gout diagnosis and treatment: capture-recapture analysis of a national administrative dataset.Crossref | GoogleScholarGoogle Scholar |
[28] Kreuter MW, Lukwago SN, Bucholtz RD, et al. Achieving cultural appropriateness in health promotion programs: targeted and tailored approaches. Health Educ Behav. 2003; 30 133–46.
| Achieving cultural appropriateness in health promotion programs: targeted and tailored approaches.Crossref | GoogleScholarGoogle Scholar |
