Navigation:
Useful tools:
Change your life booklet:
Gout Worked Question Examples.pdf
Links to other websites:
[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 3: Let’s talk gout (part 1)
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)
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)
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.
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).
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. **
Watch this webinar by Carla White and Susan Reid (who developed the Three Steps approach) talking about using the approach.
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.
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 person talks about the impacts then discuss the key messages – gout is not the person’s fault, gout is caused by high levels of uric acid not food and by genes affecting their kidneys and so on.
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 person talks about the concerns of others then identify how gout is impacting them, in terms of their employment, family, sporting, social and community activities. Ask how their lives would be if they were not having any gout attacks.
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:
*That is okay I am/someone is going to call/text you again in 3 months to see how you are going in case you have changed your mind. And you can always contact me if you want to talk again.*
***(Adapted from questions developed by Dr John McMenamin, GP).***
Emphasise at all times that gout is not the person’s fault, but is due to high levels of urate/uric acid being held in their body by their kidneys. Incorporate conversations about gout into Cardiovascular Disease Risk Assessments and Diabetes Annual Reviews if appropriate and not overwhelming.
If the person is uncertain about taking long term medicine (uncertainty is perfectly normal) then get them to think about and answer these questions:
<aside> ❓ What worries you about making changes?
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<aside> ❓ What is good about making changes?
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<aside> ❓ What worries you about staying the same?
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<aside> ❓ What is good about staying the same?
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Uncertainty about taking daily medicines is perfectly understandable. Here is an example of how you can adapt the questions for this situation.
<aside> ❓ What worries you about taking uric acid medicine every day (and not having gout attacks)?
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<aside> ❓ What worries you about not taking a medicine every day (and still having gout attacks)?
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<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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