Primary care intervention development research; developing a lifestyle intervention for people living with gout

Conference:

SAPC ASM 2023 - Brighton

Talk Code:

7B.6

Presenter:

Lorraine Watson

Twitter:

@lwatsonRD

Co-authors:

Watson L [1,2], Cornwall N [1], Jinks C [1], Bradbury K [3], Goff L [4], Little P [5], Mallen C [1,6], & Roddy E [1,6]

Author institutions:

1.School of Medicine, Keele University, 2.Specialist Adult Dietetic Service, Midlands Partnership NHS Foundation Trust, 3.Dept of Psychology, University of Southampton, 4.Dept of Nutritional Sciences, King’s College London, 5.Dept of Medicine, University of Southampton, 6.Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust

Problem

Gout is a common inflammatory arthritis predominantly managed in primary care. Lifestyle, particularly diet and alcohol, has been associated with gout for centuries and the dietary factors which may trigger flares remain of great interest to people living with gout and their families. However, there is a lack of robust clinical trial evidence about the effectiveness of lifestyle change in people living with gout. A scoping review and semi-structured interviews aimed to identify barriers and facilitators to behaviours relating to lifestyle (diet, alcohol, physical activity) change in people living with gout and to explore stakeholder views on lifestyle interventions for gout respectively. This intervention development research is to develop a new lifestyle intervention for people living with gout.

Approach

In a scoping review, following Arksey & O’Malley’s scoping studies methodological framework, databases Embase, MEDLINE, CINAHL, PsycINFO and AMED were searched from January 2000 to October 2021 to identify qualitative studies in gout. Thematic synthesis identified themes and barriers and facilitators to behaviours relating to lifestyle within the results of included qualitative studies.Semi-structured interviews with people with gout and healthcare professionals are being undertaken. Analysis of the semi-structured interview data will involve inductive reflexive thematic analysis using NVivo v12 software. Involvement of a stakeholder community of practice (COP) and a Patient & Public Involvement and Engagement (PPIE) group has informed the research process and aided the interpretation of results.

Findings

1871 title/abstracts and 158 full papers were screened and 38 qualitative studies in gout were identified. The themes identified in the thematic synthesis and corroborated by COP and PPIE group members were: Impact of gout, Current information, Knowledge, Current treatment plans or strategies, Patient/healthcare professional relationship, Motivation to treat/manage gout, Social influence. Examples of potential facilitators for lifestyle change in people with gout include the desire to prevent flares and pain, the provision of information, and that people with gout already search for information and avoid or consume certain foods. Potential barriers include poor knowledge, confusing or inadequate information, uncertainty about effectiveness of diet in gout management, stigma, and a reluctance to see healthcare professionals. Themes and subthemes from the semi-structured interviews, which have been discussed with PPIE and stakeholder COP members, will be presented. Semi-structured interviews will identify what makes a lifestyle intervention acceptable to stakeholders and identify barriers and facilitators to engagement with lifestyle interventions in gout.

Consequences

This intervention development research will inform the development of the new lifestyle intervention for people living with gout in primary care, to be tested in a future pilot and feasibility study. Such research is required due to the current paucity robust clinical trial evidence about the effectiveness of lifestyle change in people living with gout.

Submitted by:

Lorraine Watson

Funding acknowledgement:

Lorraine Watson is funded by the National Institute for Health and Care Research (NIHR) School for Primary Care Research (SPCR) [Post-doctoral Fellowship Grant reference PID-210149]. Clare Jinks and Christian Mallen are part funded by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) West Midlands. Christian Mallen is funded by the NIHR SPCR. Katherine Bradbury is funded by NIHR ARC Wessex. The School of Medicine has received funding from BMS for a non-pharmacological AF screening trial. This (abstract) presents independent research funded by the NIHR. The views expressed are those of the author(s) and not necessarily those of the (partner organisation), the NHS, the NIHR or the Department of Health and Social Care. Christian Mallen has received grant funding from Wellcome and the Medical Research Council.