Background/Purpose:   Recent research has suggested that renaming gout to a pathophysiological illness label (urate crystal arthritis) avoids inaccurate lay perceptions of gout and promotes more effective management strategies.  In Aotearoa/New Zealand, Māori (indigenous New Zealanders) have high prevalence of gout, with early onset and severe disease.  It is unknown how a change in illness label would impact on indigenous New Zealanders who are disproportionally affected by gout.  The aim of this study was to examine the effect of changing the illness label of gout on the perceptions of the disease and its management in Māori in Aotearoa/New Zealand.

Methods: Supermarket shoppers in rural and urban locations with large Māori communities were recruited into a study examining the perceptions of different types of arthritis. Participants were randomised 1:1 to complete a questionnaire examining the perception of the same disease description labelled as either ‘gout’ or ‘urate crystal arthritis’ (UCA).  Participants rated likely causal factors for the disease, illness perceptions and the usefulness of various management strategies using Likert scales. Differences between the two illness labels were tested using independent sample t-tests.

Results:  Completed questionnaires were available from 172 Māori participants.  The gout-labelled illness was most likely to be viewed as caused by diet (P=0.003), whereas the UCA-labelled illness was most likely to be viewed as caused by aging (P=0.001).  ‘UCA’ was seen as having a wider range of factors as responsible for the illness, with stress or worry, hereditary factors, chance and pollution more likely to be viewed as causes of ‘UCA’. ‘Gout’ was less likely to be viewed as having a chronic timeline than ‘UCA’ (mean (SD) for ‘Gout’ 6.9 (2.8) and for ‘UCA’ 7.9 (2.4), P=0.013).  ‘Gout’ was also viewed as better understood than ‘UCA’ (mean (SD) for ‘Gout’ 6.3 (3.1) and for ‘UCA’4.4 (3.3), P=0.001).  Other illness perceptions did not differ between the illness label groups. Changing to a healthier diet was perceived as more helpful for ‘Gout’ compared to ‘UCA’ (mean (SD) for ‘Gout’ 8.5 (2.3) and for ‘UCA’ 7.3 (2.7), P=0.003).  Participants also viewed stopping or restricting alcohol use as more helpful for ‘Gout’ than ‘UCA’ (mean (SD) for ‘Gout’ 8.1 (2.8) and for ‘UCA’ 7.0 (3.1), P=0.017). There were no differences between ‘Gout’ and ‘UCA’ in perceptions that adopting regular exercise, losing weight or taking long-term medications would be helpful for managing the illness (P>0.23 for all). 

Conclusion: In an indigenous population that is disproportionately affected by gout, causal beliefs and management strategies for a gout-labelled illness are consistent with widely-held lay beliefs that gout is a disease caused by self-inflicted dietary excess.  Renaming gout to urate crystal arthritis promotes more complex causal beliefs, a longer timeline for the disease, and is likely to avoid perceptions that dietary modification and alcohol restriction are the main strategies for effective management.