Improving how healthcare providers communicate about gout with whānau Māori and Pacific peoples is essential to changing health outcomes and reshaping community beliefs.
Gout disproportionately affects Māori and Pacific peoples; prevalence is estimated at 3 to 4 times higher than in NZ European populations, making culturally responsive, evidence-informed communication a clinical priority.
Whānau Māori and Pacific peoples develop understanding of gout from lived experience (e.g., 'I ate kaimoana and then I got gout') and knowledge shared by trusted whānau, friends, and community members.
Historically, the health sector has at times reinforced a dietary causation narrative, despite genetic factors and impaired renal urate excretion being the predominant drivers of hyperuricaemia in these populations.
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Providing information alone is insufficient to change deeply held illness beliefs. Effective communication requires clinicians to first understand a person’s existing knowledge and beliefs (their schema), then work collaboratively to address misconceptions and build accurate understanding, a process supported by health literacy frameworks and behaviour change theory.
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We recommend that your team use the ‘Three Steps to Meeting Health Literacy Needs’ framework in conversations with whānau Māori and Pacific patients with gout. (3)
Your team can use the 3-step process to assess prior knowledge and explore illness beliefs, thoughts and feelings. The aim is to provide targeted information to fill any gaps, address any misinformation, and confirm understanding.
This structured approach is grounded in health literacy principles and supports shared decision-making in clinical consultations.
To shift a person’s strongly held beliefs about gout, your team first needs to identify what the person already knows, thinks, does and believes (their schema – Step 1 of the 3-step process).
This is the most critical step: without this foundation, new information may be rejected or misunderstood.
Only once you understand a person's world view can accurate information be connected meaningfully to existing beliefs (Step 2). This is when targeted education; including the role of genetics, urate physiology, and urate-lowering therapy, can be introduced effectively.
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Watch this webinar by Carla White and Susan Reid from Health Literacy NZ (who developed the Three Steps approach) talking about using the Three Steps framework in relation to gout conversations.
Webinar by Carla White and Susan Reid
Webinar by Carla White and Susan Reid
Health Literacy NZ trains health coaches and support workers who are working in primary care teams in New Zealand. For many years Susan and Carla have engaged with whānau and members of healthcare teams to shift the conversation about gout being caused by food and drink to understanding the role of kidneys and medicines to reduce underlying causes of high uric acid.