Background/Purpose Inadequate patient self-management education resources may contribute to poor management and outcomes for gout. Patient education resources need to be easy to read and should provide clear and consistent messages regarding lifestyle, diet, and treatment recommendations for gout patients to implement. The aim of this project was to review existing educational resources for gout patients in order to identify strengths and weaknesses and to compare resources cross-nationally.

Methods Twenty-four patient education resources for gout were identified: 12 print items and 12 websites. The print items are those given to patients by health professionals in New Zealand or are provided by relevant health organizations in New Zealand, Australia, the United States, Canada, and the United Kingdom. The top ten websites based on a Google search using the keyword “gout” were included, as well as two interactive websites aimed at gout patient self-management. Resources were assessed for coverage of essential information, ease of reading, and dietary recommendations.

Results All identified resources provided some information about the nature of gout (e.g. caused by too much uric acid in the body) and lifestyle issues (e.g. body weight, nutrition). However, inconsistent messages were given regarding the relative influence of diet on gout, with some resources suggesting little impact of diet and others implicating diet as a major factor in gout management. There was also discordance in certain dietary recommendations, particularly regarding non-meat proteins such as legumes. 50.0% of the resources identified a target serum urate level but only 29.1% recommended checking serum urate levels. Co-morbidities associated with gout not universally discussed included: kidney problems (87.5%), heart disease (58.3%), and diabetes (41.7%). Resources were largely consistent cross-nationally although some differences were found (see Table 1). New Zealand resources were more likely to mention target serum urate levels and to advise patients to continue taking urate-lowering therapies during acute attacks than American or British resources. Certain dietary recommendations also differed within resources from different countries. 50.0% of the resources were written at a highly complex reading level.

Conclusion

A considerable amount of room for improvement exists in current self-management educational resources for gout patients. Inconsistent messages, lack of information on key topics, and inaccessible writing styles were the primary issues identified. Examining resources developed internationally may provide additional information useful for developing educational resources for gout patients. Further research with gout patients is required to determine the resources that patients perceive as most informative and actionable.

 Table 1. Content of Gout Patient Education Resources by Country

Content Category	New Zealand (n = 10)	United States (n = 7)	United Kingdom (n= 4)
Mean Scores
Readability†	62.6	65.7	61.4
Reading grade level‡	8.4	8.29	9.0
Percent of Resources Covering Each Category
Uric acid	100%	100%	100%
Crystal formation	90%	100%	100%
Long term treatment	100%	86%	50%
Acute treatment	100%	100%	50%
Uric acid < .36 mmol/L	70%	43%	25%
Check uric acid	40%	29%	25%
Non-drug treatments	70%	86%	50%
Not to stop medication	50%	14%	0%
Heart disease	70%	57%	25%
Diabetes	40%	43%	25%
Kidney problems	90%	100%	50%
Weight	100%	100%	100%
General diet	100%	100%	100%
Foods to avoid	100%	100%	100%
Alcohol	100%	100%	100%
Add low-fat dairy	70%	57%	50%
NOTE: Three resources are not included in the table: 1 from Australia, 1 from Canada, and 1 international resource †Higher Flesch-Kincaid readability scores indicate greater ease of reading (i.e. scores above 90 indicate easy to read, scores <30 indicate difficult to read) ‡Grade level indicates reading grade level based on the United States school system (the majority of American adults read at an eighth to ninth grade level)

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/self-management-education-for-patients-with-gout-a-review-of-existing-resources/