Comorbidity and lack of education countered participation in a diabetes prevention self-management program

Abstract

Maindal HT, Skriver MV, Kirkevold M, Lauritzen T & Sandbaek A (2011) Journal of Nursing and Healthcare of Chronic Illness3, 293–301 Comorbidity and lack of education countered participation in a diabetes prevention self-management program Aim. To investigate socio-economic and disease-related predictors for non-participation in the ‘Ready to Act’ program offering self-management support to people with screen-detected dysglycaemia. Background. Screening for type 2 diabetes followed by support to people’s self-management strategies is increasingly being offered in primary care. Due to non-participation in self-management programs, healthcare providers often miss the opportunity to provide the basic knowledge and skills resulting in uninformed self-management decisions. Methods. A prospective cohort-study was conducted in 2010 within the framework of the Danish part of the Anglo–Danish–Dutch study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care (ADDITION). A total of 322 43- to 75-year-old screen-detected patients, receiving GP-multi-faceted intensive treatment were invited to an additional interdisciplinary 12-week self-management program ‘Ready to Act’. A comparison between participants and non-participants was conducted according to socio-economic outcomes: age, gender, cohabitant and education and disease-related outcomes: diagnosis (diabetes or prediabetes), duration of diagnosis, comorbidity measured by Charlson’s combined 17 medical conditions measure. Results. The participant rate was 44%. The most pronounced predictor for participation was vocational education. With no vocational education as the reference group, the OR for participation was 1·91 (95% CI 1·06–3·44) for 1–3 years of vocational education and 2·65 (95% CI 1·31–5·39) for more than 3 years of vocational education. Second, having comorbidity (a score of one or more at Charlson’s index) tended to decrease participation (OR 0·6, 95% CI 0·34–1·06). Conclusion. Educational level and comorbidity were the most decisive factors that influenced attendance to a diabetes prevention program. Both factors are available in daily clinical practice for healthcare planning. Relevance to clinical practice. The results incite improved awareness of how to develop different recruitment strategies accounting for educational level and comorbidity, involve the target groups in intervention development, and include individual, contextual and health-system factors when shaping self-management interventions.