title: Gout Self-Management in African American Veterans: A Qualitative Exploration of Challenges and Solutions From Patients' Perspectives.
abstract: To explore gout self-management and associated challenges and solutions in African Americans.
  
  
  
  We conducted semistructured interviews with 35 African American veterans with gout, who received health care at Birmingham or Philadelphia Veterans Affairs (VA) medical centers, had filled urate-lowering therapy (ULT; most commonly allopurinol) for at least 6 months, and had a ULT medication possession ratio ≥80%. The interview protocol was constructed to explore key concepts related to gout self-management, including initial diagnosis of gout, beginning medical care for gout, the course of the gout, ULT medication adherence, dietary strategies, comorbidity and side effects, and social support.
  
  
  
  Thirty-five African American male veterans with gout who had ≥80% ULT adherence (most commonly, allopurinol) were interviewed at Birmingham (n = 18) or Philadelphia (n = 17) VA medical centers. Mean age was 65 years, mean body mass index was 31.9 kg/m2, 97% had hypertension, 23% had coronary artery disease, and 31% had renal failure. The main themes motivating African American veterans to better gout self-management were fear of pain, adherence to medications, self-discipline, lifestyle changes, information gathering, and developing a positive outlook. Birmingham participants more frequently revealed skipping gout medications. More Philadelphia participants discussed lifestyle/diet changes to prevent gout flares, indicated limiting social activities that involved drinking, and sought more information about gout self-management from health care providers and internet sources.
  
  
  
  Identified themes, including cultural differences by site, led to the development of a patient-centered intervention to improve gout self-management in African American men with gout.
authors.affiliation: VA Medical Center and University of Alabama at Birmingham, and Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Jasvinder A
authors.initials: JA
authors.lastname: Singh
authors.affiliation: University of Alabama at Birmingham.
authors.forename: Ivan
authors.initials: I
authors.lastname: Herbey
authors.affiliation: University of Alabama at Birmingham.
authors.forename: Aseem
authors.initials: A
authors.lastname: Bharat
authors.affiliation: Philadelphia VA Medical Center and University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Janet E
authors.initials: JE
authors.lastname: Dinnella
authors.affiliation: Philadelphia VA Medical Center and University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Sally
authors.initials: S
authors.lastname: Pullman-Mooar
authors.affiliation: Washington University School of Medicine and St. Louis VA Medical Center, St. Louis, Missouri.
authors.forename: Seth
authors.initials: S
authors.lastname: Eisen
authors.affiliation: University of Alabama at Birmingham.
authors.forename: Nataliya
authors.initials: N
authors.lastname: Ivankova
mesh_terms: D001741:Black or African American / Q000208:ethnology* / Q000523:psychology; D000368:Aged; D019468:Disease Management; D006073:Gout / Q000208:ethnology* / Q000523:psychology / Q000628:therapy*; D006074:Gout Suppressants / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D012648:Self Care / Q000379:methods* / Q000523:psychology; D014728:Veterans / Q000523:psychology
chemical_list: D006074:Gout Suppressants