Skip to main content

Advertisement

SpringerLink
Log in

A qualitative and quantitative analysis of the characteristics of gout patient education resources

  • Original Article
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

Patient education is an important aspect of gout management, but there is evidence that many patients lack adequate knowledge of their condition. Our aim was to examine the characteristics of gout patient education resources. Ten gout patient information resources were examined for readability (Flesch–Kincaid reading level, the Simple Measure of Gobbledygook measure and the Flesch Reading Ease Score), qualitative characteristics such as figure and jargon use and whether they included information on the major points of gout. The median readability grade level of the examined resources was 8.5. The difference in readability grade level between the highest and the lowest education resource was 6.3 grade levels. The information content of the resources was high with an average of only 3.9 proposed criteria of 19 (19 %) absent from the resources. Jargon use was low and concepts were usually explained. However, important information regarding acute flare prophylaxis during urate-lowering therapy initiation and titration and treating serum uric acid to target was absent from 60 % of the patient education resources. There was poor use of key messages at the start. Gout patient resources have a wide range of readability. Thirty percent of resources were above the average reading level of rheumatology outpatients reported in previous studies. Sixty percent of gout patient resources omit education items that could impact on patient adherence and in turn patient outcomes. Further research is needed into the literacy levels and education requirements of patients with gout.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Choi HK, Curhan G (2007) Independent impact of gout on mortality and risk for coronary heart disease. Circulation 116(8):894–900

    Article  PubMed  Google Scholar 

  2. Robinson PC, Merriman TR, Herbison P, Highton J (2013) Hospital admissions associated with gout and their co-morbidities in New Zealand and England 1999–2009. Rheumatology (Oxford) 52(1):118–126

    Article  Google Scholar 

  3. Becker MA, Chohan S (2008) We can make gout management more successful now. Curr Opin Rheumatol 20(2):167–172

    Article  PubMed  Google Scholar 

  4. Sarawate CA, Brewer KK, Yang W et al (2006) Gout medication treatment patterns and adherence to standards of care from a managed care perspective. Mayo Clin Proc 81(7):925–934

    Article  PubMed  Google Scholar 

  5. Ogdie AR, Hoch S, Dunham J, Von Feldt JM (2010) A roadmap for education to improve the quality of care in gout. Curr Opin Rheumatol 22(2):173–180

    Article  PubMed  Google Scholar 

  6. Reach G (2011) Treatment adherence in patients with gout. Joint Bone Spine 78(5):456–459

    Article  PubMed  Google Scholar 

  7. Zhang W, Doherty M, Bardin T et al (2006) EULAR evidence based recommendations for gout. Part II: Management. Report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis 65(10):1312–1324

    Article  PubMed  CAS  Google Scholar 

  8. Lindsay K, Gow P, Vanderpyl J, Logo P, Dalbeth N (2011) The experience and impact of living with gout: a study of men with chronic gout using a qualitative grounded theory approach. J Clin Rheumatol 17(1):1–6

    Article  PubMed  Google Scholar 

  9. Parker RM, Baker DW, Williams MV, Nurss JR (1995) The test of functional health literacy in adults: a new instrument for measuring patients' literacy skills. J Gen Intern Med 10(10):537–541

    Article  PubMed  CAS  Google Scholar 

  10. Doak LG, Doak CC (1980) Patient comprehension profiles: recent findings and strategies. Patient Couns Health Educ 2(3):101–106

    Article  PubMed  CAS  Google Scholar 

  11. Williams MV, Parker RM, Baker DW et al (1995) Inadequate functional health literacy among patients at two public hospitals. JAMA 274(21):1677–1682

    Article  PubMed  CAS  Google Scholar 

  12. Larson I, Schumacher HR (1992) Comparison of literacy level of patients in a VA arthritis center with the reading level required by educational materials. Arthritis Care Res 5(1):13–16

    Article  PubMed  CAS  Google Scholar 

  13. Swearingen CJ, McCollum L, Daltroy LH, Pincus T, Dewalt DA, Davis TC (2010) Screening for low literacy in a rheumatology setting: more than 10% of patients cannot read “cartilage,” “diagnosis,” “rheumatologist,” or “symptom”. J Clin Rheumatol 16(8):359–364

    PubMed  Google Scholar 

  14. Zhang LY, Schumacher HR, Su HH et al (2011) Development and evaluation of a survey of gout patients concerning their knowledge about gout. J Clin Rheumatol 17(5):242–248

    Article  PubMed  CAS  Google Scholar 

  15. Makaryus AN, Friedman EA (2005) Patients' understanding of their treatment plans and diagnosis at discharge. Mayo Clin Proc 80(8):991–994

    Article  PubMed  Google Scholar 

  16. Williams MV, Baker DW, Parker RM, Nurss JR (1998) Relationship of functional health literacy to patients’ knowledge of their chronic disease. A study of patients with hypertension and diabetes. Arch Intern Med 158(2):166–172

    Article  PubMed  CAS  Google Scholar 

  17. Wilson E, Chen AH, Grumbach K, Wang F, Fernandez A (2005) Effects of limited English proficiency and physician language on health care comprehension. J Gen Intern Med 20(9):800–806

    Article  PubMed  Google Scholar 

  18. Gazmararian JA, Kripalani S, Miller MJ, Echt KV, Ren J, Rask K (2006) Factors associated with medication refill adherence in cardiovascular-related diseases: a focus on health literacy. J Gen Intern Med 21(12):1215–1221

    Article  PubMed  Google Scholar 

  19. Macabasco-O’Connell A, DeWalt DA, Broucksou KA et al (2011) Relationship between literacy, knowledge, self-care behaviors, and heart failure-related quality of life among patients with heart failure. J Gen Intern Med 26(9):979–986

    Article  PubMed  Google Scholar 

  20. Baker DW, Parker RM, Williams MV, Clark WS, Nurss J (1997) The relationship of patient reading ability to self-reported health and use of health services. Am J Public Health 87(6):1027–1030

    Article  PubMed  CAS  Google Scholar 

  21. Dewalt DA, Berkman ND, Sheridan S, Lohr KN, Pignone MP (2004) Literacy and health outcomes: a systematic review of the literature. J Gen Intern Med 19(12):1228–1239

    Article  PubMed  Google Scholar 

  22. Schillinger D, Piette J, Grumbach K et al (2003) Closing the loop: physician communication with diabetic patients who have low health literacy. Arch Intern Med 163(1):83–90

    Article  PubMed  Google Scholar 

  23. Paasche-Orlow MK, Wolf MS (2007) The causal pathways linking health literacy to health outcomes. Am J Health Behav 31(Suppl 1):S19–S26

    Article  PubMed  Google Scholar 

  24. DuBay W (2004) The principles of readability. Impact information, Costa Mesa, California

  25. Ley P, Florio T (1996) The use of readability formulas in healthcare. Psychol, Health Med 1:7–28

    Article  Google Scholar 

  26. Diaz JA, Griffith RA, Ng JJ, Reinert SE, Friedmann PD, Moulton AW (2002) Patients' use of the Internet for medical information. J Gen Intern Med 17(3):180–185

    Article  PubMed  Google Scholar 

  27. Bernier MJ, Yasko J (1991) Designing and evaluating printed education materials: model and instrument development. Patient Educ Couns 18:253–263

  28. Houts PS, Doak CC, Doak LG, Loscalzo MJ (2006) The role of pictures in improving health communication: a review of research on attention, comprehension, recall, and adherence. Patient Educ Couns 61(2):173–190

    Article  PubMed  Google Scholar 

  29. Australian Rheumatology Association (2011) Gout. Available from: http://www.rheumatology.org.au/downloads/Gout_001.pdf. Accessed 8 Sep 2011

  30. American College of Rheumatology. Gout. Available from: http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/gout.asp. 8 Sep 2011

  31. Annals of Internal Medicine (2011) Things you should know about gout. Available from: http://www.annals.org/site/intheclinic/itc-gout-patient-information.pdf. Accessed 8 Sep 2011

  32. The Gout and Uric Acid Society (2011) About gout. Available from: http://gouteducation.org/wp-content/uploads/2010/05/Gout_Brochure.pdf. Accessed 8 Sep 2011

  33. The UK Gout Society (2011) All about gout. Available from: http://www.ukgoutsociety.org/docs/2009FinalGoutBooklet.pdf. Accessed 8 Sep 2011

  34. The Arthritis Society of Canada (2011) Gout. Available from: http://www.arthritis.ca/local/files/pdf%20documents/2011/Gout_FINAL%20ENGLISH.pdf. Accessed 8 Sep 2011

  35. Mayo Clinic (2011) Gout. Available from: http://www.mayoclinic.com/health/gout/DS00090. Accessed 8 Sep 2011

  36. UpToDate (2011) Patient information: gout. Available from: http://www.uptodate.com/contents/patient-information-gout. Accessed 8 Sep 2011

  37. Pharmaceutical Management Agency of New Zealand (PHARMAC) (2011) Out with gout. Available from: http://www.pharmac.govt.nz/2008/06/10/Out%20with%20Gout%20-%20English.pdf. Accessed 17 Nov 2011

  38. Writemark Limited (2011). Available from: http://www.writemark.co.nz/Why+invest+in+the+WriteMark.html. Accessed 21 Nov 2011

  39. Fitzsimmons PR, Michael BD, Hulley JL, Scott GO (2010) A readability assessment of online Parkinson's disease information. J R Coll Physicians Edinb 40(4):292–296

    Article  PubMed  CAS  Google Scholar 

  40. Perez-Ruiz F, Liote F (2007) Lowering serum uric acid levels: what is the optimal target for improving clinical outcomes in gout? Arthritis Rheum 57(7):1324–1328

    Article  PubMed  Google Scholar 

  41. Riedel AA, Nelson M, Joseph-Ridge N, Wallace K, MacDonald P, Becker M (2004) Compliance with allopurinol therapy among managed care enrollees with gout: a retrospective analysis of administrative claims. J Rheumatol 31(8):1575–1581

    PubMed  Google Scholar 

  42. Maxwell M (1978) Readability—have we gone too far. J Read 21(6):525–530

    Google Scholar 

  43. Falvo D (2011) Effective patient education - a guide to increased compliance. Jones and Bartlett, Sudbury

  44. Hirsh JM, Boyle DJ, Collier DH et al (2011) Limited health literacy is a common finding in a public health hospital's rheumatology clinic and is predictive of disease severity. J Clin Rheumatol 17(5):236–241

    Google Scholar 

  45. Montori VM, Rothman RL (2005) Weakness in numbers. The challenge of numeracy in health care. J Gen Intern Med 20(11):1071–1072

    Article  PubMed  Google Scholar 

  46. Apter AJ, Cheng J, Small D et al (2006) Asthma numeracy skill and health literacy. J Asthma 43(9):705–710

    Article  PubMed  Google Scholar 

  47. Murphy-Bielicki B, Schumacher H (1984) How does patient education affect gout? Clin Rheumatol Pract 2:77–80

    Google Scholar 

  48. Schumacher HR, Taylor W, Edwards L et al (2009) Outcome domains for studies of acute and chronic gout. J Rheumatol 36(10):2342–2345

    Article  PubMed  Google Scholar 

  49. Lorig K, Konkol L, Gonzalez V (1987) Arthritis patient education: a review of the literature. Patient Educ Couns 10(3):207–252

    Article  PubMed  CAS  Google Scholar 

  50. Schumacher H (2011) Patient education. How can we improve it and evaluate the effects? J Clin Rheumatol 17(5):229–230

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We would like to thank Susan Reid for advice regarding readability assessments and the construction of patient education material. PR is supported by the National Health and Medical Research Council Australia, Arthritis Australia and the University of Queensland Diamantina Institute.

Disclosures

None.

Author information

Authors and Affiliations

  1. Department of Rheumatology, Princess Alexandra Hospital, Ipswich Road, Brisbane, Australia

    Philip C. Robinson

  2. University of Pennsylvania and VA Medical Center, Philadelphia, PA, USA

    H. Ralph Schumacher Jr.

  3. University of Queensland Diamantina Institute, Translational Research Building, 37 Kent Street, Woolloongabba, Brisbane, Queensland, 4102, Australia

    Philip C. Robinson

Authors
  1. Philip C. Robinson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H. Ralph Schumacher Jr.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Philip C. Robinson.

Additional information

We have full control of the primary data and we agree to allow the journal to review the data if requested.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Robinson, P.C., Schumacher, H.R. A qualitative and quantitative analysis of the characteristics of gout patient education resources. Clin Rheumatol 32, 771–778 (2013). https://doi.org/10.1007/s10067-013-2168-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-013-2168-8

Keywords

Search

Navigation