Study Highlights Deficiencies in Medication Adherence Information, Strategies for Gout

Yasaman Emad, PhD candidate

Credit: University of Auckland

Within studies examining gout, a limited percentage of words (11%) focused on treatment adherence, according to a study published in Rheumatology Advances in Practice.¹ These findings also showed limited medication adherence coverage coupled with narrow strategies in online gout resource.

Gout adherence is classified into 2 categories—unintentional and intentional—defined as the process by which patients choose not to take their medication based on beliefs and perceptions about their condition or treatment. For example, certain patients may not take their medications based on adverse side effects, while other patients may not adhere to medication due to forgetting to take the drug, challenges regarding refills, or encountering logistical barriers such as travel.²

“Recent studies have emphasized the significance of online health information seeking as a potential factor that can impact adherence to prescribed medications,” wrote a group of international investigators led by Yasaman Emad, PhD candidate associated with the Department of Psychological Medicine at the University of Auckland in New Zealand. “The way in which people with gout consume online health information can shape their beliefs surrounding their condition and medication use, ultimately impacting their behaviour and level of adherence to prescribed medications.”

Investigators believe improved adherence portrayal could help to effectively manage gout through comprehensive strategies and clear, easily understood information strategies.

An analysis of how medication adherence is addressed among online gout resources was performed using data from 6 countries. They evaluated how often adherence was referred to, the strategies to improve patient adherence, and the types of non-adherence that were targeted. The readability of adherence material was also assessed.

A total of 151 online gout resources from medical and health organizations were included from predominantly English-speaking countries. The analysis used coding for adherence-promoting strategies and non-adherence, and Flesch-Kinacid Reading Ease scores and word count were collected.

Of the websites included, 77 discussed medication adherence (51%), with results demonstrating intentional non-adherence was more prevalent than unintentional non-adherence. A total of 67 websites focused on different types of non-adherence, citing drug-specific concerns (50%), misconceptions regarding gout curability and medication necessity (16%), forgetfulness (16%), and other barriers (5%).

Strategies designed to promote medication adherence were found in only 1 out of 3 websites, with medication education being the most prevalent strategy (17%), followed by engagement from healthcare providers (13%), and memory aid strategies (6%).

Overall, about 11% of the words (89.27, standard deviation [SD] = 76.35) in the entire document were focused on medication adherence among this patient population. Difficult reading comprehension was reported in approximately one-fifth of adherence-related sites.

Investigators noted limitations including analyzing predominantly English-speaking countries, which may hinder generalizability to patient websites from other countries. Currently, there are no guidelines for what types of material on non-adherence should be focused on within patient websites, which could account for the variability in material. Future work should focus on this. Additionally, readability cannot indicate the quality or comprehensiveness of the information alone. Lastly, the study did not include an analysis of resources for healthcare providers including the management guidelines or reference texts. Future research should include an evaluation of gout management guidelines regarding adherence optimization recommendations.

“The study showed that around half of websites providing patient information on gout did not cover adherence or provide any strategies to help patients keep to their medication regimen,” investigators concluded. “Websites could also be improved with greater attention to unintentional factors such as forgetting and through improving readability to help patients with lower health literacy.”

References

1. ^{Emad Y, Derksen C, Petrie KJ, Dalbeth N. A content analysis of medication adherence material in patient educational resources about gout. Rheumatol Adv Pract. 2024;8(2):rkae042. Published 2024 Mar 19. doi:10.1093/rap/rkae042}
2. ^{Penner LS, Armitage CJ, Thornley T et al.Non-adherence to medicines: not solved but solvable. J Health Serv Res Policy 2009;14:1–61.}