{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T07:20:11Z","timestamp":1788160811156,"version":"build-2803163510"},"reference-count":45,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"vor","delay-in-days":3,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Nurs"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Non-adherence to urate-lowering therapy (ULT) is a significant issue in the management of gout, a prevalent form of inflammatory arthritis that adversely affects patients\u2019 quality of life and burdens healthcare systems. Although ULT is effective in reducing serum uric acid levels, many patients fail to adhere to their medication regimens. Factors contributing to this non-adherence include treatment complexity, medication costs, side effects, forgetfulness, and individual health beliefs, as well as issues related to healthcare providers such as communication and education. Understanding these barriers is crucial for developing effective nursing interventions that enhance adherence and improve patient outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>Identify and analyze the factors influencing patient adherence to gout therapy and explore the barriers experienced by patients in a clinical setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A descriptive research design was utilized with a convenience sample of 150 adults aged 21\u201360 years diagnosed with gout, who had been prescribed urate-lowering therapy for at least three months. Data collection occurred from November 1, 2024, to March 30, 2025. Participants were required to have the capacity to provide informed consent and understand the study requirements. Individuals with comorbidities affecting medication adherence, those currently enrolled in other clinical trials, and individuals unable to provide informed consent were excluded from the study. The study employed two questionnaires: a sociodemographic and clinical data questionnaire to gather relevant participant information and Intentional Non-Adherence Scale (INAS) to assess medication adherence. Results: Approximately 60.7% of respondents indicate a low adherence level to medications, while 39.3% report a high adherence level to medications. Key factors affecting adherence include socio-demographic variables, such as higher rates among males and those aged 30\u201339, as well as sufficient income. In addition, the findings suggest that clinical data correlate with better adherence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion and implications<\/jats:title>\n                    <jats:p>This study highlights critical socio-demographic and clinical characteristics of gout patients, emphasizing the need for enhanced public awareness campaigns, early screening programs, and targeted interventions to improve healthcare access and medication adherence among underserved populations. By addressing barriers such as medication costs and psychological factors through tailored nursing interventions and multidisciplinary collaboration, we can significantly enhance patient outcomes and quality of life for individuals living with gout.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12912-026-05073-1","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T17:23:06Z","timestamp":1787937786000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Determinants of gout therapy non-adherence in patients attending an Egyptian rheumatology outpatient clinic"],"prefix":"10.1186","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-3420-385X","authenticated-orcid":false,"given":"Samira Saad","family":"Ali","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0706-8812","authenticated-orcid":false,"given":"Samah Ramadan Shaheen","family":"Ibrahim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6751-4268","authenticated-orcid":false,"given":"Manal Saeed","family":"Mohammed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,28]]},"reference":[{"key":"5073_CR1","doi-asserted-by":"publisher","unstructured":"Hugtenburg JG, Timmers L, Elders PJ, Vervloet M, van Dijk L. Definitions, variants, and causes of nonadherence with medication: a challenge for tailored interventions. Patient Prefer Adherence. 2013;7:675\u2013682. https:\/\/doi.org\/10.2147\/PPA.S29549.","DOI":"10.2147\/PPA.S29549"},{"issue":"8","key":"5073_CR2","doi-asserted-by":"publisher","first-page":"e494","DOI":"10.1016\/S2665-9913(24)00134-6","volume":"6","author":"K Jatuworapruk","year":"2024","unstructured":"Jatuworapruk K. Gout prevalence is rising in low-income and middle-income countries: are we ready? Lancet Rheumatol. 2024;6(8):e494\u20135. https:\/\/doi.org\/10.1016\/S2665-9913(24)00134-6.","journal-title":"Lancet Rheumatol"},{"key":"5073_CR3","doi-asserted-by":"publisher","first-page":"6928","DOI":"10.21608\/ejhm.2018.17149","volume":"2018736","author":"AA Al-Zahrani","year":"2018","unstructured":"Al-Zahrani AA, Batwie AA, Jamal AM, Alharbi EK, Alahmadi MO, Bakhsh AM, et al. Evaluation of Gout Diagnosis and Management in Primary Health Centers. Egypt J Hosp Med. 2018;2018736:6928\u201335.","journal-title":"Egypt J Hosp Med"},{"key":"5073_CR4","unstructured":"Fenando A, Rednam M, Gujarathi R, Widrich J. Gout. [Updated 2024 Feb 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan. Available from: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK546606\/."},{"key":"5073_CR5","doi-asserted-by":"publisher","first-page":"1047","DOI":"10.1186\/s12891-024-08180-9","volume":"25","author":"KM Asghari","year":"2024","unstructured":"Asghari KM, Zahmatyar M, Seyedi F, Motamedi A, Zolfi M, Alamdary SJ, Safiri S. Gout: global epidemiology, risk factors, comorbidities and complications: a narrative review. BMC Musculoskelet Disord. 2024;25:1047. https:\/\/doi.org\/10.1186\/s12891-024-08180-9.","journal-title":"BMC Musculoskelet Disord"},{"key":"5073_CR6","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1186\/s43166-022-00123-3","volume":"49","author":"Y El Miedany","year":"2022","unstructured":"El Miedany Y, Gadallah NA, Mansour M, et al. Egyptian consensus on treat-to-target approach of gout: evidence-based clinical practice guidelines for the management of gout. Egypt Rheumatol Rehabil. 2022;49:28. https:\/\/doi.org\/10.1186\/s43166-022-00123-3.","journal-title":"Egypt Rheumatol Rehabil"},{"issue":"6","key":"5073_CR7","doi-asserted-by":"publisher","first-page":"752","DOI":"10.1136\/ard-2023-224771","volume":"83","author":"P Mandl","year":"2024","unstructured":"Mandl P, D\u2019Agostino MA, Navarro-Comp\u00e1n V, Ge\u00dfl I, Sakellariou G, Abhishek A, et al. 2023 EULAR recommendations on imaging in diagnosis and management of crystal-induced arthropathies in clinical practice. Ann Rheum Dis. 2024;83(6):752\u20139. https:\/\/doi.org\/10.1136\/ard-2023-224771.","journal-title":"Ann Rheum Dis"},{"issue":"1","key":"5073_CR8","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1002\/art.42969","volume":"77","author":"A JI","year":"2025","unstructured":"Ji A, Sui Y, Xue X, Ji X, Shi W, Shi Y, et al. Novel genetic loci in early-onset gout derived from whole-genome sequencing of an adolescent gout cohort. Arthritis Rheumatol. 2025;77(1):107\u201315. https:\/\/doi.org\/10.1002\/art.42969.","journal-title":"Arthritis Rheumatol"},{"issue":"1","key":"5073_CR9","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1097\/RHU.0000000000001923","volume":"29","author":"U Nagaich","year":"2023","unstructured":"Nagaich U, Chaudhary S. Contemporary NSAID use in gout: A systematic review. J Clin Rheumatol. 2023;29(1):32\u20138. https:\/\/doi.org\/10.1097\/RHU.0000000000001923.","journal-title":"J Clin Rheumatol"},{"issue":"2","key":"5073_CR10","doi-asserted-by":"publisher","first-page":"87","DOI":"10.21608\/ejor.2021.225621","volume":"2","author":"O Daifallah","year":"2021","unstructured":"Daifallah O, Moshrif A, Khalifa H, Ali R. Awareness and attitude of Egyptian population towards gout. Egypt J Orthop Res. 2021;2(2):87\u201394. https:\/\/doi.org\/10.21608\/ejor.2021.225621.","journal-title":"Egypt J Orthop Res"},{"issue":"1","key":"5073_CR11","doi-asserted-by":"publisher","first-page":"165","DOI":"10.21608\/zumj.2024.313585.3538","volume":"31","author":"D Attia Sadoun","year":"2025","unstructured":"Attia Sadoun D, Elsaid A, Mohamed A. Egypt\u2019s Universal Health Insurance System: Strategies for Sustainability. Zagazig Univ Med J. 2025;31(1):165\u201371. https:\/\/doi.org\/10.21608\/zumj.2024.313585.3538.","journal-title":"Zagazig Univ Med J"},{"key":"5073_CR12","unstructured":"Sharma TS, Harrington TM, Olenginski TP. Aim for Better Gout Control: A Retrospective Analysis of Preventable Hospital Admissions for Gout.: 2322. Arthritis Rheumatol. 2014;66:S1014."},{"key":"5073_CR13","doi-asserted-by":"publisher","first-page":"40","DOI":"10.3892\/mi.2023.100","volume":"3","author":"P Tsiamalou","year":"2023","unstructured":"Tsiamalou P, Brotis AG, Vrekou E, Georgakopoulou VE, Papalexis P, Aravanatinou-Fatorou A, Paterakis K. The nurse\u2019s role in managing gout in the modern era: A systematic review of the literature. Med Int. 2023;3:40. https:\/\/doi.org\/10.3892\/mi.2023.100.","journal-title":"Med Int"},{"issue":"4","key":"5073_CR14","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1007\/s11926-023-01104-x","volume":"25","author":"V Kannuthurai","year":"2023","unstructured":"Kannuthurai V, Gaffo AL. Treatment adherence in gout: A systematic review. Curr Rheumatol Rep. 2023;25(4):75\u201386. https:\/\/doi.org\/10.1007\/s11926-023-01104-x.","journal-title":"Curr Rheumatol Rep"},{"issue":"5","key":"5073_CR15","doi-asserted-by":"publisher","first-page":"440","DOI":"10.1001\/jama.2022.11390","volume":"328","author":"E Cipolletta","year":"2022","unstructured":"Cipolletta E, Tata LJ, Nakafero G, Avery AJ, Mamas MA, Abhishek A. Association between gout flare and subsequent cardiovascular events among patients with gout. JAMA. 2022;328(5):440\u201350. https:\/\/doi.org\/10.1001\/jama.2022.11390.","journal-title":"JAMA"},{"key":"5073_CR16","doi-asserted-by":"publisher","unstructured":"El Miedany Y, Gadallah NA, Mansour M, El Gaafary M, Mortada M, Eissa M, Galal S. Egyptian consensus on treat-to-target approach of gout: evidence-based clinical practice guidelines for the management of gout. Egypt Rheumatol Rehabil. 2022;49:28. https:\/\/doi.org\/10.1186\/s43166-022-00123-3.","DOI":"10.1186\/s43166-022-00123-3"},{"issue":"6","key":"5073_CR17","doi-asserted-by":"publisher","first-page":"622","DOI":"10.3899\/jrheum.210950","volume":"49","author":"Y Emad","year":"2022","unstructured":"Emad Y, Dalbeth N, Weinman J, Chalder T, Petrie KJ. Why do patients with gout not take allopurinol? J Rhuematol. 2022;49(6):622\u20136.","journal-title":"J Rhuematol"},{"issue":"1\u20132","key":"5073_CR18","doi-asserted-by":"publisher","first-page":"e213","DOI":"10.1111\/jocn.13918","volume":"27","author":"XHJ Chua","year":"2018","unstructured":"Chua XHJ, Lim S, Lim FP, Lim YNA, He HG, Teng GG. Factors influencing medication adherence in patients with gout: a descriptive correlational study. J Clin Nurs. 2018;27(1\u20132):e213\u201322. https:\/\/doi.org\/10.1111\/jocn.13918.","journal-title":"J Clin Nurs"},{"key":"5073_CR19","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1016\/j.jpsychores.2018.10.010","volume":"115","author":"J Weinman","year":"2018","unstructured":"Weinman J, Graham S, Canfield M, Kleinst\u00e4uber M, Perera AI, Dalbeth N, Petrie KJ. The intentional non-adherence scale (INAS): initial development and validation. J Psychosom Res. 2018;115:110\u20136.","journal-title":"J Psychosom Res"},{"issue":"7","key":"5073_CR20","doi-asserted-by":"publisher","first-page":"1978","DOI":"10.1111\/bcp.15657","volume":"89","author":"JCJ Spragg","year":"2023","unstructured":"Spragg JCJ, Michael TJF, Aslani P, et al. Optimizing adherence to allopurinol for gout: patients\u2019 perspectives. Br J Clin Pharmacol. 2023;89(7):1978\u201391. https:\/\/doi.org\/10.1111\/bcp.15657.","journal-title":"Br J Clin Pharmacol"},{"key":"5073_CR21","doi-asserted-by":"publisher","first-page":"681378","DOI":"10.3389\/fphar.2021.681378","volume":"12","author":"SAMPAIO","year":"2021","unstructured":"SAMPAIO, Rute, et al. Portuguese Version of the Intentional Non-Adherence Scale: Validation in a Population of Chronic Pain Patients. Front Pharmacol. 2021;12:681378.","journal-title":"Front Pharmacol"},{"issue":"13","key":"5073_CR22","doi-asserted-by":"publisher","first-page":"215","DOI":"10.3238\/arztebl.2017.0215","volume":"114","author":"B Engel","year":"2017","unstructured":"Engel B, Just J, Bleckwenn M, Weckbecker K. Treatment Options for Gout. Dtsch Arztebl Int. 2017;114(13):215\u201322. https:\/\/doi.org\/10.3238\/arztebl.2017.0215.","journal-title":"Dtsch Arztebl Int"},{"issue":"7","key":"5073_CR23","doi-asserted-by":"publisher","first-page":"380","DOI":"10.1038\/s41584-020-0441-1","volume":"16","author":"M Dehlin","year":"2020","unstructured":"Dehlin M, Jacobsson L, Roddy E. Global epidemiology of gout: prevalence, incidence, treatment patterns, and risk factors. Nat Rev Rheumatol. 2020;16(7):380\u201390.","journal-title":"Nat Rev Rheumatol"},{"key":"5073_CR24","doi-asserted-by":"publisher","unstructured":"Tsiamalou P, et al. The nurse\u2019s role in managing gout in the modern era: A systematic review of the literature. Med Int. 2023;3(4):40. https:\/\/doi.org\/10.3892\/mi.2023.100.","DOI":"10.3892\/mi.2023.100"},{"key":"5073_CR25","doi-asserted-by":"publisher","first-page":"100789","DOI":"10.37349\/emd.2025.100789","volume":"3","author":"OWO, Gogo James; OKARI, Karibo Amakiri; KPOMAH, Enyohwo Dennis","year":"2025","unstructured":"OWO, Gogo James; OKARI, Karibo Amakiri; KPOMAH, Enyohwo Dennis. The prevalence and risk factors of gouty arthritis among fishermen in the Niger Delta region of Nigeria. Explor Musculoskelet Dis. 2025;3:100789. https:\/\/doi.org\/10.37349\/emd.2025.100789.","journal-title":"Explor Musculoskelet Dis"},{"key":"5073_CR26","unstructured":"THOMSEN, Su\u2019; SHAFIEE, Hamed, RUSSEL. Amy. Pacific peoples\u2019 wellbeing: Background paper to Te Tai Waiora: Wellbeing in Aotearoa New Zealand 2022. Analytical Paper, 2023. http:\/\/www.treasury.govt.nz\/publications\/ap\/ap-23-01."},{"issue":"5","key":"5073_CR27","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1056\/NEJMcp1001124","volume":"364","author":"T Neogi","year":"2011","unstructured":"Neogi T. Clinical practice. Gout. N Engl J Med. 2011;364(5):443\u201352. https:\/\/doi.org\/10.1056\/NEJMcp1001124.","journal-title":"N Engl J Med"},{"issue":"9711","key":"5073_CR28","doi-asserted-by":"publisher","first-page":"318","DOI":"10.1016\/S0140-6736(09)60883-7","volume":"375","author":"P Richette","year":"2010","unstructured":"Richette P, Bardin T, Gout. Lancet. 2010;375(9711):318\u201328. https:\/\/doi.org\/10.1016\/S0140-6736(09)60883-7.","journal-title":"Lancet"},{"issue":"10287","key":"5073_CR29","doi-asserted-by":"publisher","first-page":"1843","DOI":"10.1016\/S0140-6736(21)00569-9","volume":"397","author":"N Dalbeth","year":"2021","unstructured":"Dalbeth N, Gosling AL, Gaffo A, Abhishek A, Gout. Lancet. 2021;397(10287):1843\u201355. https:\/\/doi.org\/10.1016\/S0140-6736(21)00569-9.","journal-title":"Lancet"},{"key":"5073_CR30","doi-asserted-by":"publisher","first-page":"733","DOI":"10.2147\/PPA.S452196","volume":"18","author":"ET Fenta","year":"2024","unstructured":"Fenta ET, Ayal BG, Kidie AA, Anagaw TF, Mekonnen TS, Ketema Bogale E, Berihun S, Tsega TD, Mengistie Munie C, Talie Fenta T, Kassie Worku N, Shiferaw Gelaw S, Tiruneh MG. Barriers to Medication Adherence Among Patients with Non-Communicable Disease in North Wollo Zone Public Hospitals: Socio-Ecologic Perspective, 2023. Patient Prefer Adherence. 2024;18:733\u201344. https:\/\/doi.org\/10.2147\/PPA.S452196.","journal-title":"Patient Prefer Adherence"},{"key":"5073_CR31","doi-asserted-by":"publisher","first-page":"152358","DOI":"10.1016\/j.semarthrit.2023.152358","volume":"65","author":"K Lisa","year":"2024","unstructured":"Lisa K, Stamp N, Dalbeth. Moving urate-lowering therapy in gout beyond guideline recommendations. Semin Arthritis Rheum. 2024;65:152358. https:\/\/doi.org\/10.1016\/j.semarthrit.2023.152358.","journal-title":"Semin Arthritis Rheum"},{"key":"5073_CR32","doi-asserted-by":"publisher","unstructured":"Cheema E, Haseeb A, Khan TM, Sutcliffe P, Singer DR. Barriers to reporting of adverse drugs reactions: a cross sectional study among community pharmacists in United Kingdom. Pharm Pract (Granada). 2017;15(3). https:\/\/doi.org\/10.18549\/pharmpract.2017.03.931.","DOI":"10.18549\/pharmpract.2017.03.931"},{"issue":"7","key":"5073_CR33","doi-asserted-by":"publisher","first-page":"59","DOI":"10.22159\/ajpcr.2021.v14i7.41868","volume":"14","author":"sa Mir","year":"2021","unstructured":"Mir sa. sociodemographic factors affecting patient compliance to long-term therapies. Asian J Pharm Clin Res. 2021;14(7):59\u201362. https:\/\/doi.org\/10.22159\/ajpcr.2021.v14i7.41868.","journal-title":"Asian J Pharm Clin Res"},{"issue":"5","key":"5073_CR34","first-page":"847","volume":"39","author":"JA Singh","year":"2019","unstructured":"Singh JA, Bharat A, Edwards NL, Reddy S. Gender differences in gout epidemiology, clinical presentation, and treatment outcomes. Rheumatol Int. 2019;39(5):847\u201355.","journal-title":"Rheumatol Int"},{"key":"5073_CR35","first-page":"873","volume":"16","author":"Y Zhang","year":"2022","unstructured":"Zhang Y, Chen C, Lin H. Factors affecting medication adherence among gout patients: A cross-sectional study. Patient Prefer Adherence. 2022;16:873\u201381.","journal-title":"Patient Prefer Adherence"},{"key":"5073_CR36","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.ejim.2020.07.006","volume":"80","author":"C Borghi","year":"2020","unstructured":"Borghi C, Agabiti-Rosei E, Johnson RJ, et al. Hyperuricemia and gout in cardiovascular, metabolic and kidney disease. Eur J Intern Med. 2020;80:1\u201311. https:\/\/doi.org\/10.1016\/j.ejim.2020.07.006.","journal-title":"Eur J Intern Med"},{"issue":"9","key":"5073_CR37","first-page":"1276","volume":"66","author":"MA De Vera","year":"2014","unstructured":"De Vera MA, Bhole V, Burns LC, Lacaille D, Choi HK. Impact of adherence to urate-lowering therapy on hyperuricemia control among patients with gout. Arthritis Care Res. 2014;66(9):1276\u201382.","journal-title":"Arthritis Care Res"},{"issue":"1","key":"5073_CR38","first-page":"20","volume":"14","author":"BA Briesacher","year":"2008","unstructured":"Briesacher BA, Andrade SE, Fouayzi H, Chan KA. Medication adherence and the use of generic drug therapies. Am J Manag Care. 2008;14(1):20\u20138.","journal-title":"Am J Manag Care"},{"issue":"12","key":"5073_CR39","doi-asserted-by":"publisher","first-page":"e80633","DOI":"10.1371\/journal.pone.0080633","volume":"8","author":"R Horne","year":"2013","unstructured":"Horne R, Chapman SC, Parham R, Freemantle N, Forbes A, Cooper V. Understanding patients\u2019 adherence-related beliefs about medicines prescribed for long-term conditions: A meta-analytic review of the Necessity-Concerns Framework. PLoS ONE. 2013;8(12):e80633.","journal-title":"PLoS ONE"},{"issue":"9","key":"5073_CR40","doi-asserted-by":"publisher","first-page":"e69522","DOI":"10.7759\/cureus.69522","volume":"16","author":"SA Almaghamsi","year":"2024","unstructured":"Almaghamsi SA, Alzahrani KM. Exploring the Influence of Perceived Social Support on Medication Adherence Among Patients with Chronic Hypertension in 2024: A Cross-Sectional Study from Jeddah. Kingd Saudi Arabia. 2024;16(9):e69522. https:\/\/doi.org\/10.7759\/cureus.69522.","journal-title":"Kingd Saudi Arabia"},{"issue":"6","key":"5073_CR41","doi-asserted-by":"publisher","first-page":"726","DOI":"10.1080\/08870446.2022.2144923","volume":"38","author":"S-JF Stewart","year":"2022","unstructured":"Stewart S-JF, Moon Z, Horne R. Medication nonadherence: health impact, prevalence, correlates and interventions. Psychol Health. 2022;38(6):726\u201365. https:\/\/doi.org\/10.1080\/08870446.2022.2144923.","journal-title":"Psychol Health"},{"issue":"10","key":"5073_CR42","doi-asserted-by":"publisher","first-page":"2557","DOI":"10.1002\/art.39254","volume":"67","author":"T Neogi","year":"2015","unstructured":"Neogi T, Jansen TL, Dalbeth N, Fransen J, Schumacher HR, Berendsen D, et al. 2015 Gout classification criteria: An American College of Rheumatology\/European League Against Rheumatism collaborative initiative. Arthritis Rheumatol. 2015;67(10):2557\u201368.","journal-title":"Arthritis Rheumatol"},{"issue":"2","key":"5073_CR43","first-page":"150","volume":"17","author":"R Halpern","year":"2011","unstructured":"Halpern R, Khan ZM, Schmier J, Burnier M, Caro JJ, Cramer J. Recommendations for improving adherence to long-term medication therapy: A review of key literature. Am J Manag Care. 2011;17(2):150\u201360.","journal-title":"Am J Manag Care"},{"key":"5073_CR44","doi-asserted-by":"crossref","unstructured":"Doherty M, Jenkins W, Richardson H, Sarmanova A, Abhishek A, Ashton D, et al. Efficacy and cost-effectiveness of nurse-led care involving education and engagement of patients and a treat-to-target urate-lowering strategy versus usual care for gout: a randomised controlled trial. Lancet. 2018;392(10156):1403\u20131412.","DOI":"10.1016\/S0140-6736(18)32158-5"},{"key":"5073_CR45","doi-asserted-by":"crossref","unstructured":"Rasmussen C, Larsen JW, Christensen HM, Larsen MB, Thomsen AM, Leishmann T, et al. Optimising gout treatment: insights from a nurse-led cohort study. RMD Open. 2024;10(2).","DOI":"10.1136\/rmdopen-2024-004179"}],"container-title":["BMC Nursing"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12912-026-05073-1","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12912-026-05073-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12912-026-05073-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T07:12:59Z","timestamp":1788160379000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12912-026-05073-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,28]]},"references-count":45,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["5073"],"URL":"https:\/\/doi.org\/10.1186\/s12912-026-05073-1","relation":{},"ISSN":["1472-6955"],"issn-type":[{"value":"1472-6955","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,28]]},"assertion":[{"value":"9 June 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 July 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 August 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The study was conducted in accordance with the requirements of the Helsinki declaration. Before participant recruitment, approval of the research ethics committee, faculty of nursing, Alexandria university was obtained (IRB00013620 9\/19\/2025). Written informed consent was obtained from the participants after explaining the aim of the study, validating their ability to refuse participation or withdrawal at any time without any negative effects. Confirming that their information was confidential.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"777"}}