Illness perception and treatment experience in patients with gout: a descriptive qualitative study

Determinants of Self-Management Behavior in Gout: A Scoping Review

OBJECTIVE

This study aimed to identify modifiable determinants of self-management behavior in patients with gout.

METHODS

Four databases (Medline, Embase, PsycINFO, and CINAHL) were searched using terms related to gout, self-management, and determinants of behavior as described in the Theoretical Domains Framework (TDF). Two reviewers independently selected relevant studies via screening of title/abstract and full text. Thematic synthesis was performed for qualitative data; quantitative data were summarized using cross-tabulation displaying the investigated associations of determinants with self-management behavior. The TDF facilitated identification and grouping of determinants.

RESULTS

From 2,087 unique articles found, 56 studies were included in this review, of which there were 27 qualitative and 29 quantitative studies. Eight themes were identified: knowledge and skills for self-management, acceptance of disease, beliefs about necessity of self-management to improve gout-related health, resistance and reluctance for medication adherence and dietary alteration/changes, negative emotions influencing self-management, social support and interactions, environmental context, and self-regulation of behavior. Quantitative determinants associated with self-management behavior, predominantly medication adherence, were mapped to 12 of the 14 domains of the TDF. No determinants regarding skills and goals have been identified in quantitative research.

CONCLUSION

Intervention targets for self-management behavior in patients with gout mainly included determinants related to knowledge, implicit and explicit beliefs and attitudes, the environmental context and resources, and (social) support and reinforcement.

Self-management behavior preferences and influencing factors in Chinese patients with recurrent gout: A qualitative study

Objectives

This study aimed to explore the preferences and influencing factors of self-management behaviors in patients with recurrent gout and provide a theoretical basis for developing targeted strategies to improve self-management preferences.

Methods

A total of 10 patients with recurrent gout were recruited from the gout specialist outpatient clinic at a tertiary hospital in Shenyang, Liaoning Province, China. Semi-structured interviews were conducted with these patients, and the Kawakita Jiro (KJ) method was used to analyze the interview data.

Results

After four rounds of screening by five researchers, 35 codes were selected from an initial 132. After three rounds of discussion and induction, the KJ method identified seven domains of self-management behavior preferences in patients with recurrent gout: 1) extensive knowledge of gout, yet difficulty in distinguishing between accurate and inaccurate information; 2) a passive attitude of "no pain, no management"; 3) the challenge of changing entrenched daily habits; 4) the optimistic but unrealistic belief of "self-delusion"; 5) a tendency to seek medical attention late due to hopelessness of cure and familiarity with recurrences; 6) preference for analgesics for gout recurrences while neglecting long-term urate-lowering therapy (ULT); and 7) gout-related stigma.

Conclusion

The results of this study showed that the self-management behavior of patients with recurrent gout could be improved, especially in the aspects of medical seeking behavior, medication compliance, daily management and emotional management. At the same time, we found that gout stigma, difficulty in distinguishing true and false knowledge of gout and negative attitude of "ignoring pain" were significantly associated with self-management behavior.

Assessment of electronic health literacy and its association with self-management among gout patients: A cross-sectional study

Objectives

This study aimed to assess electronic health (eHealth) literacy and self-management ability among gout patients in China and analyze their correlation.

Patients and methods

A cross-sectional study was conducted on 168 male gout patients (mean age: 44.5±13.8 years, range, 22 to 76 years) using a gout patient self-management assessment scale and the Chinese version of eHealth Literacy Scale between August 2020 and February 2021. The correlation between eHealth literacy and gout self-management was examined. Multivariate regression analysis was conducted to identify the predictors of gout patients' self-management ability.

Results

The scores of eHealth literacy and self-management were 28.56±1.72 and 3.59±0.78, respectively, which were both in the medium level, with the lowest score in the lifestyle management dimension. Pearson's correlation analysis showed that eHealth literacy was significantly and positively associated with the total score of gout self-management and its four dimensions. Literacy in eHealth (β=0.399, p<0.001, 95% confidence interval [CI]: 0.023-0.069), living with family members (β=0.336, p=0.001, 95% CI: 0.313-1.234), living in an urban area (β=0.312, p=0.005, 95% CI: 0.191- 1.022), and having college or a higher level of education (β=0.268, p=0.016, 95% CI: 0.032-0.302) were the significant predictors of gout patients' self-management ability, explained 30.6% of the total variance.

Conclusion

Literacy in eHealth was the most significant predictor of gout self-management ability. Gout patients had the lowest score in the perceived ability of searching and applying online health-related information, indicating that both the quantity and quality of gout-specific information needs to be enlarged in electronic resources. Healthcare providers could design and implement eHealth literacy interventions to strengthen patients' gout self-management ability.

Health literacy in patients with gout: A latent profile analysis

OBJECTIVES

Understanding the health literacy status of patients with gout diagnosis is essential for improving the health of this population. Our study aimed to investigate the latent profiles of health literacy in patients with gout and to analyze differences in characteristics across potential profiles.

METHODS

This was a cross-sectional study. Eligible participants attended the Shandong Gout Medical Center, from March 2023 to May 2023 and self-reported gout diagnosis. We used the Health Literacy Scale for Patients with Gout designed and validated by our team. The scale had good reliability and validity among patients with gout. 243 patients completed the Demographic Information Questionnaire and the Health Literacy Scale for Patients with Gout. We used latent profile analysis to identify the latent profiles of gout patients' health literacy. We used Chi-square tests with Bonferroni correction to analyze differences in demographics and illness characteristics across identified profiles.

RESULTS

Three profiles of patients with gout emerged (prevalence): the low literacy-low critical group (21.81%), the moderate literacy group (42.79%), and the high literacy-stable group (35.39%). The three groups differed in age, education level, monthly income, disease duration, and place of residence (P<0.01).

CONCLUSIONS

The health literacy of patients with gout was heterogeneous. Healthcare professionals should adopt targeted interventions based on the characteristics of each latent health literacy profile to improve the health literacy level of patients with gout.

A content analysis of medication adherence material in patient educational resources about gout

Objective

This study aimed to investigate how medication adherence is addressed in online gout resources in six countries. We investigated how often adherence was referred to, the strategies suggested to improve patient adherence, and the types of nonadherence that were targeted. We also examined the readability of the adherence material.

Methods

A content analysis was conducted on 151 online gout resources from medical and health organisations in six predominantly English-speaking countries. Two reviewers coded the content of the websites into categories (kappa 0.80). The analysis involved coding the resources for reasons for nonadherence, and adherence-promoting strategies. Flesch-Kincaid Reading Ease scores and word count were also computed.

Results

Out of 151 websites examined, 77 websites discussed medication adherence (51%), with intentional nonadherence being more prevalent than unintentional nonadherence. 67 websites targeted different types of nonadherence, including drug-specific concerns (50%), misconceptions of gout curability and the necessity of medication (16%), forgetfulness (16%), and other practical challenges (5%). Strategies to promote adherence were found in one-third of the websites, with medication education being the most prevalent strategy (17%), followed by healthcare provider engagement (13%) and memory aid strategies (6%). On average, about 11% of the words (89.27, SD = 76.35) in the entire document were focused on adherence. Difficult reading comprehension was found in one-fifth of adherence-related websites.

Conclusion

Findings reveal limited medication adherence coverage and narrow strategies in online gout resources. Improved adherence portrayal is needed for effective gout management through comprehensive strategies and clear, understandable information.

Influence of Nurse-Led Health Education on Self-Management Ability, Satisfaction, and Compliance of Elderly Patients with Chronic Obstructive Pulmonary Disease Based on Knowledge, Belief, and Practice Model

Objective

Knowledge, belief, and behavior model (knowledge-attitude-practice (KAP)) is known as a cognitive model. Health education is important to the prognosis of patients, including chronic obstructive pulmonary disease (COPD) patients. However, the investigation regarding health education based on the KAP model is few. Thus, this work is aimed at analyzing the influence of nurse-led health education on self-management ability, satisfaction, and compliance of elderly patients with COPD based on knowledge, belief, and practice model.

Methods

60 elderly patients with COPD cured in our hospital from January 2019 to April 2021 were enrolled for the study. The patients were randomly assigned to control group (n = 30) and study group (n = 30). The former group received routine nursing, and the latter group accepted health education based on “knowledge, belief, and practice” model. Finally, the scores of nursing satisfaction, KAP score, compliance rate, self-management level, pulmonary function, and life quality were compared in the two groups.

Results

The nursing satisfaction of the study group (100.00%) was higher than that (83.33%) of the control group (P < 0.05). The scores of knowledge, attitude, and behavior were remarkably higher in the study group than in the control group after nursing (P < 0.05). Moreover, KAP scores also significantly increased in the study group after nursing. The compliance rate of the study group (93.33%) was higher than that of the control group (66.67%) (P < 0.05). After nursing, the scores of symptom management, daily life management, emotion management, information management, and management efficiency were higher in the study group than in the control group (P < 0.05). In addition, pulmonary functions were improved in the two groups following nursing. Compared with the control groups, the 6 min walking distance, FEV1%, and FEV1/FVC% were higher in the study group (P < 0.05). After nursing, the scores of life quality were reduced in the two groups. The scores of physiological function, psychological function, social function, and health self-cognition were lower in the study group than in the control group (P < 0.05).

Conclusion

Based on the model of knowledge, belief, and practice, nurse-led health education can successfully enhance the self-management ability, satisfaction, and compliance of elderly COPD patients.

Nursing Methods and Experience of Local Anesthesia Patients under Arthroscope

In order to solve the nursing problems of local anesthesia patients under arthroscopy, a nursing method and experience based on local anesthesia patients under arthroscopy was proposed. From June 2019 to May 2021, 478 patients who underwent knee arthroscopy under spinal anesthesia or local anesthesia were retrospectively investigated, including 186 cases (38.9%) under local anesthesia and 292 cases (61.1%) under spinal anesthesia. 2% lidocaine plus epinephrine was injected locally and intra-articular in patients with local anesthesia, and 0.75% bupivacaine in patients with spinal anesthesia. It was found that in the local anesthesia group and spinal anesthesia group, 94.1% (175/186) and 98.3% (287/292) patients did not feel pain during operation. 93.0% (173/186 cases) and 96.2% (281/292 cases) of patients in the two groups were satisfied or very satisfied with the effect of anesthesia, respectively. The experimental results showed that local anesthesia was a simple and effective anesthesia method for knee arthroscopy, which was more reliable and safer than spinal anesthesia. Local anesthesia could be used for knee arthroscopy or cleaning and rinsing, free body removal, or even common meniscinoplasty.