Evidence for Change

Evidence for Change provides a quick, evidence-based overview of key behavioral science research that Atlantis Health applies in supporting patients to achieve optimal health outcomes.

Professor Keith Petrie of the University of Auckland is known internationally for constructing new methods for measuring patients' perceptions of illness. As Behavioral Science Lead of the Southern Hemisphere at Atlantis Health, Keith works with the behavioral science team to bring the latest behavior change evidence and interventional approaches to improve patient understanding and optimize support solutions that empower people living with long-term conditions to Change for Good.

Research selected

"A Content Analysis of Medication Adherence Material in Patient Educational Resources on Gout." Emad, Y., Derksen, C., Petrie, K. J., & Dalbeth, N. (2024). Rheumatology Advances in Practice, 8(2), rkae042

Relevance today

Challenge: One of the key ways of managing gout is through urate lowering therapy but taking medication long-term is a significant and challenging behavior change, especially when symptoms come and go.

Many people living with gout discontinue treatment after their initial prescription, with less than half of people living with gout still taking their medication as prescribed at 12 months.

Online health information seeking is an important behavior that can impact medication adherence. Previous studies show that most people living with gout seek online information about their condition and medication. Previously, online patient education resources for this condition had not been robustly evaluated. 

Our paper is the first to comprehensively examine how medication adherence-related information is discussed in online patient resources for gout.

There are two types of nonadherence: intentional nonadherence, where patients decide not to take their medication based on their individual beliefs and perceptions about their condition or treatment, and unintentional nonadherence, where patients do not take their medication for unplanned reasons often beyond their control, such as forgetting, challenges in access to refills, and other logistical barriers.

In this 2024 study, we investigated how medication adherence is addressed in online patient resources for gout across six countries, specifically exploring how often adherence was referred to, the strategies that were suggested to improve adherence, the types of nonadherence that were targeted in the resources, and the readability of the materials from a health literacy perspective

What the research tells us

151 websites were examined across six English-speaking countries. Despite the critical role of medication adherence in optimizing gout management, only about half of the websites mentioned adherence to urate lowering medications.

The four barriers addressed by those websites that mentioned medication adherence were:

  1. Drug-specific concerns, such as flare-ups after treatment initiation, side effects, dosage, and anxiety about developing dependency
  2. Misconceptions about gout curability and medication necessity, such as perceived lack of need when asymptomatic and unhelpful beliefs about gout curability
  3. Forgetfulness / unintentional nonadherence
  4. Practical challenges, such as medication access difficulty, perceived lifestyle disruptions, and inconvenience associated with medication-taking behavior

Strategies to promote adherence were found in just one-third of the websites. From most common to least, these were:

Medication education, such as describing the mechanism of action, benefits of the medication, and the consequences of nonadherence

Encouraging patients to seek advice from healthcare professionals for medication adherence support

Memory aid strategies, such as establishing a medication-taking routine, recommendations for optimal medication taking, enhancing medication accessibility and visibility, using reminders and alarms, and using pill boxes

We also found that the websites varied in readability levels, with approximately one-fifth classified as having 'difficult' or 'very difficult' readability, indicating potential comprehension challenges for readers. 

Online resources need to provide clear and comprehensive information about medication adherence and offer a wider range of strategies to help patients manage this aspect of living with a long-term condition.

Applying the research

Addressing both the intentional and unintentional adherence challenges with helpful advice and strategies is a fundamental aspect of designing a support solution that will help patients start and stay on treatment.

We identify the relevant content and resources and co-design multichannel support solutions to address key patient beliefs and barriers related to their medication. We develop the content and support experience with health literacy in mind to ensure readability and comprehension.

Atlantis Health designs and delivers personalized multichannel behavior change solutions that improve patient engagement and adherence to medications and other health behaviors across long-term health conditions.

Working with patients, pharma, healthcare, and life sciences organizations, we co-design and deliver personalized behavior change solutions across multiple channels.

Read more about the results and outcomes our solutions can bring.