Determinants of self-management behavior in gout: a scoping review.

Objective: This study aimed to identify modifiable determinants of self-management behavior in gout.

Methods: Four databases (MEDLINE, Embase, PsycINFO and CINAHL) were searched using terms related to gout, self-management and determinants of behavior as described in the Theoretical Domains Framework (TDF). Two reviewers independently selected relevant studies via screening of title/abstract and full text. Thematic synthesis was performed for qualitative data; quantitative data was summarized using cross-tabulation displaying the investigated associations of determinants with self-management behavior. The TDF facilitated identification and grouping of determinants.

Results: From 2087 unique articles found, 56 studies were included in this review, of which 27 qualitative and 29 quantitative studies. Eight themes were identified: knowledge and skills for self-management, acceptance of disease, beliefs about necessity of self-management to improve gout-related health, resistance and reluctance for medication adherence and dietary alteration/changes, negative emotions influencing self-management, social support and interactions, environmental context, and self-regulation of behavior. Quantitative determinants associated with self-management behavior, predominantly medication adherence, were mapped to 12 of the 14 domains of the TDF. No determinants regarding skills and goals have been identified in quantitative research.

Conclusion: Intervention targets for self-management behavior in gout mainly included determinants related to knowledge, implicit and explicit beliefs and attitudes, the environmental context and resources, (social) support and reinforcement.