'It's just a great muddle when it comes to food': a qualitative exploration of patient decision-making around diet and gout.

Hider; Watson; Mallen; Roddy

Abstract

Objective: Our aim was to understand whether, why and how patients choose to modify their diets after developing gout.

Methods: We conducted an inductive thematic secondary analysis of qualitative data from 43 interviews and four focus groups with UK participants with gout (n?=?61).

Results: Participants commonly initiated dietary changes as part of a self-management strategy for gout. Reasons for making such dietary changes included: desperation; a desire for control; and belief that it would be possible to achieve successful management through diet alone; but not weight loss. Participants who did not make changes or who reverted to previous dietary patterns did so because: they believed urate-lowering therapy was successfully managing their gout; medication allowed normal eating; they did not find 'proof' that diet would be an effective treatment; or the dietary advice they found was unrealistic, unmanageable or irrelevant. Dietary modification was patient led, but patients would have preferred the support of a health-care professional. Beliefs that diet could potentially explain and modify the timing of flares gave patients a sense of control over the condition. However, the belief that gout could be controlled through dietary modification appeared to be a barrier to acceptance of management with urate-lowering therapy.

Conclusions: Perceptions about gout and diet play a large role in the way patients make decisions about how to manage gout in their everyday lives. Addressing the reasons why patients explore dietary solutions, promoting the value of urate-lowering therapy and weight loss and drawing on strong evidence to communicate clearly will be crucial in improving long-term clinical management and patient experience.

Citation

Hider, Watson, Mallen, & Roddy. (2021). 'It's just a great muddle when it comes to food': a qualitative exploration of patient decision-making around diet and gout. Rheumatology Advances in Practice, https://doi.org/10.1093/rap/rkab055

• Acceptance Date: Aug 5, 2021
• Publication Date: Aug 31, 2021
• Journal: Rheumatology Advances in Practice
• Print ISSN: 2514-1775
• Publisher: Oxford University Press
• DOI: https://doi.org/10.1093/rap/rkab055
• Keywords: gout; inflammatory arthritis; diet; qualitative; patient experience; self-management; long-term condition
• Publisher URL: https://academic.oup.com/rheumap/article/5/3/rkab055/6350495