Gout Self-Management App: eHealth Tool for People with Gout

The intervention group will be provided with access to the Healthy.me app tailored for the self-management of gout. Healthy.me is a self-management eHealth app available on smartphones and tablets that contains features to help patients manage their chronic diseases. The app has been tailored to promote effective self-management of gout and long-term adherence to ULT. The app was developed, using dimensions of the Health Belief Model: perceived susceptibility, perceived severity, perceived benefits and perceived barriers. While education materials from the app raise awareness of consequences of uncontrolled gout, susceptibility to gout attacks when serum urate concentrations are high, and the importance of keeping a low serum urate level, the key feature of the app, “Uric Acid Tracker”, is designed to provide personalised feedback on susceptibility to and severity of gout by presenting individual patients’ serum urate levels and gout attack data on a graph. This personalised feedback will enable the patients to relate their high serum urate levels to the occurrence of gout attacks (perceived susceptibility and severity), and recognise attack-free benefits of ULT adherence behaviour when their serum urate is consistently low. Low medication adherence is a major barrier to keeping gout under control, and thus the app is designed to include educational content and pop-up alerts to remind the patients to take their ULTs. Specifically, the intervention app contains these features: • Uric Acid Tracker: Serum urate results will be recorded and graphed under the ‘Uric Acid Tracker’ function. Patients will be asked to obtain their serum urate results from their GP or pathologist after every test, and promptly enter the results into this feature of the app. Alerts within the app will be triggered if serum urate is not in the target range, recommending that patients discuss their gout management with their GP. The patient’s serum urate concentrations will be represented in a graph over time and in relationship to the target serum urate (which is 0.36 mmol/L or lower). • Gout Facts: Educational materials including written information and a video animation about gout and its management for people with gout will be available via the app. The following topics are covered: what is gout, why take ULT medication, the effects of ULT, what to do in a gout attack, and the importance of ULT adherence. • Electronic Gout Attacks Diary: This feature provides the ability to record gout attacks including pain intensity, location of attack(s) or joint(s) affected, and triggers. The gout attack data that patients enter will be presented in the graph next to serum urate levels. • Schedule: This feature can be used as an alternative to the calendar function of smart devices if patients prefer to use it for management of their gout. Patients can schedule their tasks, such as having blood tests and collecting results, seeing their GP or other members of their care team, and recording gout attacks. • Team: Contact details of GP, pathology service, researchers and others such as rheumatologist, physiotherapist etc. can be listed. • Diet Tips: An evidence-based list of foods that can raise or lower serum urate will be available. Patients in the intervention group will be provided with their personal login details to access and download the Healthy.me gout management app and installation guide. They will have access to a short introduction to the ‘Healthy.me app’ and its features via an email or in paper form. There will be an opportunity for patients to ask researchers any questions via the web-site, email, phone or face to face. Patients will have access to the app for 12 months. Patients’ GPs will also have access to the introductory material about the app, and the content of educational materials in the app.