A Self-Management Programme To Empower Adults Suffering From Gout And Their Caregivers In The Omaheke Region, Namibia

Abstract

The prevalence of gout has increased over the last few decades. Of the 291

conditions studied in the Global Burden of Disease (GBD) (2010), gout ranked 138th

for disability and 173rd for the overall burden of disability-adjusted life years.

Statistics assume that in a population of 71,233 there are 200 people in the Omaheke

region suffering from gout (Extrapolation of Prevalence Rate of Gout to Countries

and Regions, 2015). This is evidence for a need to optimize management of the

disease.

This study explores the experience of adults suffering from gout and of their

caregivers in the Omaheke region, with the aim of developing a self-management

programme to provide participants with education for diet and lifestyle changes for

better management of their ill-health.

The researcher adopted a qualitative, phenomenological, exploratory, and descriptive

approach. Two groups of participants (fourteen adults suffering from gout; and seven

caregivers) were interviewed to learn their responses. Those suffering from gout

were asked to report their experience of suffering from gout, and the caregivers were

asked about their experiences of caring for their relatives. The research questions for

those with gout and two caregivers were answered in unstructured individual indepth

interviews; five caregivers took part in a focus group discussion. Observations

of the participants’ reactions were also noted.

During Phase 1 of the research—a situation analysis—the phenomenological

approach for collecting data from selected participants was used. The resultant

inductive data analysis was used to develop a self-management programme.

During Phase 2, the conceptualization framework guided the development of a selfmanagement

programme, using the Practice Oriented Theory of Dickoff et al.

(1968).

During Phase 3—the development of a self-management programme —an adapted

version of three theories was used. The most prominent of these was the framework

of the Chronic Disease Self-management Programme (CDSMP) which has shown

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improvements in several areas. The Person-centered Care Theory—based on Carl

Rogers’s belief that the person is the expert concerning their needs, and Knowles’s

Adult Learner Theory in which the adult learner is seen as self-directed to learn,

were theories used to inform the educational process.

In Phase 4, in a two-day training workshop the self-management programme was

implemented and evaluated. Evaluation occurred immediately after every session

and a summative evaluation at the end of the programme, to verify whether its

interventions were likely to bring about the desired change among the participants. A

programme outcomes evaluation was carried out three months after implementation

of the programme.

Responses revealed great physical and psychological discomfort from gout,

accompanied by disrupted sleep, decreased self-efficacy and social

disconnectedness. Information was also seen as important for reducing predisposing

factors and managing the illness, and recommendations were made for extending the

impacts of the programme.