Better conversations about gout

Talking about gout in a new way with whānau Māori and Pacific patients with gout is key to changing gout outcomes with these groups, and changing community beliefs about gout.

Whānau Māori and Pacific patients with gout develop knowledge and beliefs about gout based on their own experiences (I ate kaimoana and then I got gout) and information passed onto them by other people they trust and regard as knowledgeable – whānau and friends. These beliefs have sometimes been reinforced by the health sector.

At this stage it’s not enough to provide information alone as this will not counter beliefs about gout gained through experiences and passed on by trusted whānau and friends.

We recommend that your team use the ‘Three Steps to Meeting Health Literacy Needs’ in conversations with whānau Māori and Pacific patients with gout. (3)

The 3 steps:

Your team can use the 3-step process in every health discussion to identify people’s prior knowledge, thoughts and feelings. As a result, your team can work out what new information (if any) is required and how and why to provide this new information. And then your team can check their messages have been effective for the people you’re working with. This will give your team some assurance that people have what they need by the end of their discussion.

To address a person’s strongly held beliefs, your team first needs to identify what the person with gout already knows, thinks, does and believes (their schema – Step 1 of the 3-step process). This is the most important step.

Only once you understand the person’s world view can you start to connect new correct information to their schema about gout (Step 2 of the 3-step process).

Use the patient information booklet, Change your Life stop the pain of gout by bringing your uric acid levels down as part of Steps 1 and 2

<aside> <img src="/icons/delivery-truck_orange.svg" alt="/icons/delivery-truck_orange.svg" width="40px" /> Hard copies of Change your life are available in English, te reo Māori, Samoan and Tongan (order free copies here Gout Booklet (google.com)

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Link to PDF of booklet:

<aside> <img src="/icons/book_blue.svg" alt="/icons/book_blue.svg" width="40px" /> Click file to open in a new tab and view or download the Change your life booklet (PDF)

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Step 1

Use the book to tick off what the person already knows and record on page 4 the impact gout is having on that person’s life. You might also identify what pain medicine the person is taking on page 8.

Step 2

You can add more information to what the person already knows. Focus on pages 2 and 3, eg, gout is not the person’s fault, and the causes of gout and uric acid, if this is new to the person. You might want to talk about uric acid lowering medicines on page 6 and depending on the person’s age you might like to show them the stories of 2 young men on pages 10 and 11.

If you have a Point of Care meter get their permission to test their uric acid levels or look at their latest blood test results and show them where their result is in relation to the treatment goal (back page). You could also show them the picture of the uric acid crystals in the joint (page 4) so the person can visualise the uric acid crystals in their joints and how they are damaging their joints and bones. You could also talk to them about how to reduce uric acid levels (page 6) and then deciding to start taking uric acid lowering medicines (page 7).

Step 3

This step requires practice so your team gets used to asking it at the end of every conversation. At the end of the conversation your team needs to check they have been clear, and the person has the information they need to go away and think about starting uric acid lowering medicines which they will have to take every day. At Step 3 it’s not enough to ask Do you have any questions? or Do you understand? The person’s responses to these questions won’t tell you if you have been clear, or whether they have the information they need. **

[Video] Let’s Talk Gout | He Ako Hiringa

Watch this webinar by Carla White and Susan Reid (who developed the Three Steps approach) talking about using the approach.

[Webinar] Gout part 2: Having the conversation about gout with whānau

[Webpage] Health Literacy NZ | Health Coach Resources

[VIDEO] Using Ask, Build, Check with a person with high cholesterol

[PODCAST] Episode Three: Let’s talk about gout (part 1)

Consistent messages for your team to discuss with whānau Māori and Pacific peoples with gout

Using key messages consistently with all whānau Māori and Pacific peoples with gout will help address the persistent self-blame and stigma that exists around gout, build new community beliefs, and support decision making around taking daily uric acid lowering medicines.

Key messages

Gout is not your fault – you don’t bring it on yourself.
Gout is caused by high levels of urate/uric acid in your body.
90 percent of the urate/uric acid in your body is caused by your genes and your kidneys.
Most people get rid of extra urate/uric acid in their urine.
Whānau Māori and Pacific peoples have genes that tell their kidneys to hold onto extra urate/uric acid. You can’t change your genes.
When the level of urate/uric acid gets too high in your body you have a gout attack. The extra urate/uric acid turns into very sharp crystals like needles in your joints.
Your joint gets very painful and red and swollen.
After a few days the pain will go away but the crystals remain in your joint.
Every time you have a gout attack more and more crystals form in your joints. They damage your joints and bones.
There are medicines you can take every day that stop you having painful gout attacks.
Taking uric acid medicine every day will bring down your urate/uric acid levels and stop damage to your joints and bones.

Questions to ask when a person with gout comes into your practice and they’re not interested in doing anything about it

When a person with acute gout presents to your practice ask them: What concerns do you have about how your gout is affecting you, your job, your family and other parts of your life?
If the answer is none, then ask: What concerns do your family, friends, boss, sports coach, have about how your gout is affecting you and all parts of your life?
If the answer is none, ask: Is it okay if I talk to you about the GP’s/my concerns?

And if the answer is no say:

<aside> <img src="/icons/book_blue.svg" alt="/icons/book_blue.svg" width="40px" /> Click file to open in a new tab (PDF)

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References:

See all Gout Guide References