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Gout Self‐Management in African American Veterans: A Qualitative Exploration of Challenges and Solutions From Patients' Perspectives
Author(s) -
Singh Jasvinder A.,
Herbey Ivan,
Bharat Aseem,
Dinnella Janet E.,
PullmanMooar Sally,
Eisen Seth,
Ivankova Nataliya
Publication year - 2017
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.23202
Subject(s) - gout , medicine , veterans affairs , allopurinol , health care , family medicine , gerontology , physical therapy , economics , economic growth
Objective To explore gout self‐management and associated challenges and solutions in African Americans. Methods We conducted semistructured interviews with 35 African American veterans with gout, who received health care at Birmingham or Philadelphia Veterans Affairs ( VA ) medical centers, had filled urate‐lowering therapy ( ULT ; most commonly allopurinol) for at least 6 months, and had a ULT medication possession ratio ≥80%. The interview protocol was constructed to explore key concepts related to gout self‐management, including initial diagnosis of gout, beginning medical care for gout, the course of the gout, ULT medication adherence, dietary strategies, comorbidity and side effects, and social support. Results Thirty‐five African American male veterans with gout who had ≥80% ULT adherence (most commonly, allopurinol) were interviewed at Birmingham (n = 18) or Philadelphia (n = 17) VA medical centers. Mean age was 65 years, mean body mass index was 31.9 kg/m 2 , 97% had hypertension, 23% had coronary artery disease, and 31% had renal failure. The main themes motivating African American veterans to better gout self‐management were fear of pain, adherence to medications, self‐discipline, lifestyle changes, information gathering, and developing a positive outlook. Birmingham participants more frequently revealed skipping gout medications. More Philadelphia participants discussed lifestyle/diet changes to prevent gout flares, indicated limiting social activities that involved drinking, and sought more information about gout self‐management from health care providers and internet sources. Conclusion Identified themes, including cultural differences by site, led to the development of a patient‐centered intervention to improve gout self‐management in African American men with gout.