Three nominal groups, as it seemed to be in our case. The number of high adherers recruited in this study is the largest nominal group sample studied to date. Second, this in-depth study has findings applicable to African-Americans with gout. We oversampled for women with gout (another understudied population) to improve the study’s generalizability. Generalizability to Caucasians was not our goal, since at least two small studies exist in Caucasians and our focus was disadvantaged minorities. However, several themes from earlier studies with Caucasians were replicated in this study, indicating some applicability to Caucasians. Study strengths included study of a difficult to reach, underserved and understudied group that bears a disproportionate burden of gout and the use of NGT to obtain an in-depth answer to the specific study question.Conclusion In conclusion, this study provides an in-depth insight into facilitators and barriers to ULT adherence in AfricanAmericans with gout. Several new themes were identified in this study. This new knowledge should serve as a foundation for research of behavioral and non-behavioral interventions to improve ULT adherence in minorities with gout. Such studies have the potential to improve gout care and outcomes in patients suffering from this disease.Abbreviations BBC chain: Body, Biographical time and PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/27488460 Conceptions of self; ICD-9CM: International Classification of Diseases, ninth revision, common modification; IRB: Institutional Review Board; NGT: Nominal group technique; NSAIDs: Non-steroidal anti-inflammatory drugs; SD: Standard deviation; sUA: serum urate; ULT: Urate-lowering therapy. Competing interests There are no financial conflicts related directly to this study. JAS has received research and travel grants from Takeda and Savient, and consultant fees from Savient, Takeda, Regeneron and Allergan. Acknowledgements I thank Dr. Isabel Scarinci for her comments on this manuscript, Bridgett Alday for contacting patients and providing support for conducting the nominal groups, Ana Oliviera and Aseem Bharat for help conducting the nominal groups and Mary Elkins for the administrative oversight. I thank the patients and several colleagues who provided informal input into drafting the question for the nominal groups. This material is the result of WP1066 price workSingh Arthritis Research Therapy 2014, 16:R82 http://arthritis-research.com/content/16/2/RPage 12 ofsupported by a grant from the Division of Rheumatology at the University of Alabama at Birmingham. JAS is supported by the resources and use of facilities at the Birmingham VA Medical Center, Birmingham, AL, USA. JAS is supported by grants from the Agency for Health Quality and Research Center for Education and Research on Therapeutics (AHRQ CERTs) U19 HS021110, National Institute of Arthritis, Musculoskeletal and Skin Diseases (NIAMS) P50 AR060772 and U34 AR062891, National Institute of Aging (NIA) U01 AG018947, and National Cancer Institute (NCI) U10 CA149950 and research contract CE-1304-6631 from Patient Centered Outcomes Research Institute (PCORI). IRB approval The University of Alabama at Birmingham’s Institutional Review Board approved this study and all investigations were conducted in conformity with ethical principles of research. Author details Medicine Service, Birmingham VA Medical Center, 805B, 510 20th Street S, Birmingham, AL, USA. 2Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, Uni.
