title: Knowledge, illness perceptions and stated clinical practice behaviour in management of gout: a mixed methods study in general practice.
abstract: The objective of the present study is to explore knowledge, illness perceptions and stated practice behaviour in relation to gout in primary care. This is a mixed methods study among 32 general practitioners (GPs). The quantitative assessment included the Gout Knowledge Questionnaire (GKQ; range 0-10; better) and Brief Illness Perceptions Questionnaire (BIPQ; nine items, range 0-10; stronger). Structured individual interviews obtained further qualitative insight into knowledge and perceptions, in the context of daily practice. Among 32 GPs, 18 (56.3 %) were male, mean age 44.4 years (SD 9.6) and mean working experience 17.1 years (SD 9.7). Median score [interquartile ranges (IQR)] on the GKQ was 7.8 [6.7-8.9] and 9.0 [8.0-10.0], when presented as open or multiple-choice questions, respectively. The BIPQ (median; [IQR]) revealed that gout was seen as a chronic disease (8.0; [7.0-9.0]), affecting life and emotions moderately (6.5; [5.0-7.0]), having many severe symptoms (8.0; [7.0-9.0]) and in which treatment could be very helpful (8.0; [7.0-9.0]). Further interviews revealed large variation in specific aspects of knowledge and about gaps concerning indications for uric acid-lowering therapy (UALT), duration of UALT, target serum uric acid (sUA) level or duration of prophylactic treatment. Finally, patients' adherence was not checked systematically. Specific knowledge gaps and discrepancies between perceptions and stated practice behaviour were identified, which might hamper effective management of this well-treatable disease. Improving evidence on the rationale and effectiveness of treatment targets and adherence interventions, tailoring guidelines to general practice and intensification of implementation of guidelines in primary health care seem to be needed.
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands. bartholomeus.spaetgens@mumc.nl.|CAPHRI Research Institute, University Maastricht, Maastricht, The Netherlands. bartholomeus.spaetgens@mumc.nl.
authors.forename: Bart
authors.initials: B
authors.lastname: Spaetgens
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
authors.forename: Tobias
authors.initials: T
authors.lastname: Pustjens
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.|CAPHRI Research Institute, University Maastricht, Maastricht, The Netherlands.
authors.forename: Lieke E J M
authors.initials: LEJM
authors.lastname: Scheepers
authors.affiliation: Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands.|Primary Health Care Centre Lobede, Lobith-Tolkamer, The Netherlands.
authors.forename: Hein J E M
authors.initials: HJEM
authors.lastname: Janssens
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.|CAPHRI Research Institute, University Maastricht, Maastricht, The Netherlands.
authors.forename: Sjef
authors.initials: S
authors.lastname: van der Linden
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.|CAPHRI Research Institute, University Maastricht, Maastricht, The Netherlands.
authors.forename: Annelies
authors.initials: A
authors.lastname: Boonen
mesh_terms: D000328:Adult; D019468:Disease Management; D005260:Female; D058006:General Practice / Q000592:standards*; D058005:General Practitioners; D006073:Gout / Q000175:diagnosis* / Q000188:drug therapy*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000592:standards*; D011795:Surveys and Questionnaires; D014527:Uric Acid / Q000097:blood
chemical_list: D014527:Uric Acid
keywords: Attitudes; Gout Knowledge Questionnaire; Health beliefs; Illness perceptions; Primary care