Abstract
BackgroundDiabetes self-management education is a critical component in diabetes care. Despite worldwide efforts to develop efficacious DSME programs, high attrition rates are often reported in clinical practice. The objective of this study was to examine factors that may contribute to attrition behavior in diabetes self-management programs.MethodsWe conducted telephone interviews with individuals who had Type 2 diabetes (n = 267) and attended a diabetes education centre. Multivariable logistic regression was performed to identify factors associated with attrition behavior. Forty-four percent of participants (n = 118) withdrew prematurely from the program and were asked an open-ended question regarding their discontinuation of services. We used content analysis to code and generate themes, which were then organized under the Behavioral Model of Health Service Utilization.ResultsWorking full and part-time, being over 65 years of age, having a regular primary care physician or fewer diabetes symptoms were contributing factors to attrition behaviour in our multivariable logistic regression. The most common reasons given by participants for attrition from the program were conflict between their work schedules and the centre's hours of operation, patients' confidence in their own knowledge and ability when managing their diabetes, apathy towards diabetes education, distance to the centre, forgetfulness, regular physician consultation, low perceived seriousness of diabetes, and lack of familiarity with the centre and its services. There was considerable overlap between our quantitative and qualitative results.ConclusionReducing attrition behaviour requires a range of strategies targeted towards delivering convenient and accessible services, familiarizing individuals with these services, increasing communication between centres and their patients, and creating better partnerships between centres and primary care physicians.
Highlights
Diabetes self-management education is a critical component in diabetes care
The objective of this study is to investigate factors that may contribute to attrition behavior in Diabetes self-management education (DSME) using both quantitative and qualitative approaches
Participants were more likely to be referred to the centre by their primary care physician (47.7%) and endocrinologist (27.3%)
Summary
Diabetes self-management education is a critical component in diabetes care. Despite worldwide efforts to develop efficacious DSME programs, high attrition rates are often reported in clinical practice. Diabetes self-management education (DSME) has emerged as a resource to assist individuals in actively participating in their diabetes care. In meta-regression by Ellis et al, (2006), face-to-face delivery, cognitive re-framing, and exercise content were reported as statistically and clinically significant predictors of improved glycemic control in DSME interventions [4]. These interventions have proven to be efficacious [3,5], they have been observed to have high attrition [5], in clinical practice [6]. Little and inconsistent information is available about factors linked with attrition behavior in DSME interventions [6,58]
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