Program Attrition Research Articles

Sculpting the good surgeon or excising the bad one: How clinical teachers could perpetuate attrition in surgical residency programmes.

Attrition in surgical residencies remains a significant issue, with traditional research focusing mainly on individual and programme factors. This study explores the role of clinical teachers (CTs) in influencing attrition rates. CTs are essential in moulding residents' training, serving both as enablers of workplace learning and guardians of their medical fields. We employed a hermeneutic phenomenology framework to understand the sociocultural impacts on attrition. Data were collected through semi-structured interviews involving 19 CTs, 3 residents who left the programme and 2 who underwent remediation, following a six-step hermeneutic phenomenological analysis process. The entrenched 'good surgeon' narrative within the department demanded selflessness and total dedication, which CTs reinforced, thereby normalising a rigorous and challenging environment. This has led to attrition when residents fail to meet these challenges or choose to disengage from the system. We illustrated that CTs were pivotal in perpetuating these expectations, contributing significantly to resident attrition. CTs played a crucial role in resident attrition by enforcing a stringent cultural norm within surgical training programmes. Addressing this issue requires a visible change in CTs' role to foster a more supportive educational environment. Emphasising the beneficial aspects of the 'good surgeon' narrative and mitigating its adverse impacts is essential for reducing attrition rates and assisting all residents, including those facing challenges, in successfully completing their training.

A Multi-site Examination of Relationship Violence Intervention Program Attrition for Male and Female Clients

The current study addresses the paucity of research on relationship violence intervention program (RVIP) attrition examining both male and female clients and risk factors for attrition across gender. Bivariate comparison tests and logistic regression were used to examine gender differences among participants from four RVIPs in Maryland that serve both male and female clients ( n = 1,307). Findings showed significant bivariate differences by gender for 14 of the factors examined. Less than half of clients (48%) completed RVIP, and women were significantly more likely to complete than men. A greater number of factors predicted attrition for male clients, but unemployment was the strongest predictor of attrition for both men and women. Implications for integrating gender-responsive practices into RVIP are discussed.

Falling short in bariatric surgery: An exploration of key barriers and motivators of attrition

BackgroundIn the United States, obesity-related diseases pose significant healthcare challenges, with bariatric surgery offering a potential solution. However, bariatric surgery completion rates, particularly among Black and Hispanic populations, remain low. ObjectiveThis study applied the Theoretical Domains Framework (TDF) to explore behavioral factors influencing bariatric surgery program attrition among a majority Black participant population to inform interventions for improving attrition. MethodsWe conducted semi-structured interviews with 40 surgical and non-surgical participants and conducted deductive content analysis informed by six TDF constructs to explore factors influencing bariatric surgery program attrition. ResultsParticipants’ decision-making regarding bariatric surgery is influenced by behavioral factors, including knowledge, skills, social roles, beliefs about capabilities, optimism, and beliefs about consequences. ConclusionUnderstanding multifaceted factors influencing bariatric surgery attrition will inform the development of tailored interventions that address knowledge gaps, enhance skills, and consider social role conflicts to improve patient engagement and decision-making in managing obesity, especially for Black populations.

A Pilot Study of BRAIN BOOTCAMP, a Low-Intensity Intervention on Diet, Exercise, Cognitive Activity, and Social Interaction to Improve Older Adults’ Dementia Risk Scores

BackgroundLittle is known about the impact of short, low-intensity multidomain dementia risk reduction interventions in older adults.ObjectivesTo examine the effectiveness and feasibility of a low-intensity multidomain lifestyle intervention on dementia risk and dementia literacy in Australian older adults.DesignSingle-group pre-post design.SettingCommunity-dwelling.ParticipantsA total of 853 older Australians (Mean age=73.3 years, SD=6.1) recruited from the community.InterventionA 3-month dementia risk reduction program, BRAIN BOOTCAMP, including education, personalised risk information, physical cues for healthier choices and goal setting and planning to target four modifiable risk factors of diet, exercise, cognitive activity and social interaction in older adults.MeasurementsThe ‘LIfestyle for BRAin health’ (LIBRA) index was used to assess participants’ modifiable dementia risk based on 12 factors, with higher scores indicating greater risk. Dementia literacy was measured using a modified questionnaire derived from Dutch and British surveys, encompassing knowledge, risk reduction, and awareness aspects. Paired t-tests were used to compare dementia risk scores and dementia literacy before and after the program. Multivariate regressions were performed to identify sociodemographic and psychological factors associated with change in the LIBRA index.ResultsProgram attrition was high (58.3%). Participants who completed the program had decreased dementia risk scores (Cohen’s d=0.59, p<0.001), increased dementia literacy and awareness (Cohen’s d=0.64, p<0.001) and increased motivation to change lifestyle behaviors (Cohen’s d=0.25–0.52, p<0.016). Participants with higher motivational beliefs had greater dementia risk reduction.ConclusionsImproving older adults’ motivation and knowledge may help modify lifestyle behaviors to reduce dementia risk. However, program attrition remains a challenge, suggesting the need for strategies to enhance participant engagement and retention in such interventions.

Patient Adherence to a Real-World Digital, Asynchronous Weight Loss Program in Australia That Combines Behavioural and GLP-1 RA Therapy: A Mixed Methods Study.

Increasingly large numbers of people are using digital weight loss services (DWLSs) to treat being overweight and obesity. Although it is widely agreed that digital modalities improve access to care in general, obesity stakeholders remain concerned that many DWLSs are not comprehensive or sustainable enough to deliver meaningful health outcomes. This study adopted a mixed methods approach to assess why and after how long patients tend to discontinue Australia's largest DWLS, a program that combines behavioural and pharmacological therapy under the guidance of a multidisciplinary care team. We found that in a cohort of patients who commenced the Eucalyptus DWLS between January and June 2022 (n = 5604), the mean program adherence was 171.2 (±158.2) days. Inadequate supplying of a patient's desired glucose-like peptide-1 receptor agonist medication was the most common reason for discontinuation (43.7%), followed by program cost (26.2%), result dissatisfaction (9.9%), and service dissatisfaction (7.2%). Statistical tests revealed that ethnicity and age both had a significant effect on patient adherence. These findings suggest that DWLSs have the potential to improve access to comprehensive, continuous obesity care, but care models need to improve upon the one observed in the Eucalyptus Australia DWLS to mitigate common real-world program attrition factors.

The value of improving insurance quality: Evidence from long-run Medicaid attrition

The US government increasingly provides public health insurance coverage through private firms. We examine associated welfare implications for beneficiaries, using a ‘revealed preference’ framework based on beneficiaries’ program attrition rates. Focusing on the Medicaid program in New York State, we exploit quasi-random variation in the initial assignment at birth to public versus private Medicaid based on birth weight. We find that infants assigned to private Medicaid at birth are less likely to subsequently leave Medicaid. We provide suggestive evidence that reduced attrition reflects beneficiary responses to improved program quality, rather than alternative mechanisms such as private Medicaid plans reducing re-enrollment barriers.

Quantifying uptake and completion of pulmonary rehabilitation programs in people with chronic obstructive pulmonary disease known to tertiary care.

People with symptomatic chronic obstructive pulmonary disease (COPD) benefit from pulmonary rehabilitation programs (PRPs), but program attrition is common. For people with COPD who presented to tertiary care and appeared appropriate for a PRP, we prospectively mapped their PRP journey, explored factors influencing attendance to pre-program assessment and captured program attrition. Of the 391 participants, 31% (95% CI 27 to 36) were referred to a PRP (n = 123; age 68 ± 10years, 62 males [50%], FEV1 45 ± 19%predicted). Of those referred, 94 (76% [69 to 84]) attended a pre-program assessment. Ex-smokers and those who had a healthcare professional (HCP) explain they would be referred were more likely to attend a pre-program assessment (odds ratio [95%CI]; 2.6 [1.1 to 6.1]; and 4.7 [1.9 to 11.7], respectively). Of the 94 who attended, 63 (67% [58 to 77]) commenced; and of those who commenced, 35 (56% [43 to 68]) completed a PRP. All who completed (n = 35, 100%) were provided at least one strategy to maintain training-related gains. Attrition occurs throughout the PRP journey. Interactions with HCPs about PRPs positively influenced attendance. Understanding how HCPs can best contextualise PRPs to encourage referral acceptance and uptake is an important area for further work.

Real-Life Effectiveness of Smoking Cessation Delivery Modes: A Comparison Against Telephone Counseling and the Role of Individual Characteristics and Health Conditions in Quit Success.

Professional behavioral counseling for smoking cessation can be delivered in many forms, which may not work equally well for everyone. We aim to explore in a real-world setting whether different delivery modes yield different rates of quit success and whether quit success varies based on gender, age, educational level, and being treated for a health condition. We used monitoring data (n = 13 747) from a smoking cessation counseling provider in the Netherlands (September 2018 to August 2021) to compare differences in quit success immediately after the end of counseling and at 12-month follow-up between telephone and other modes of counseling. Participants chose which mode of counseling they received. At the 12-month follow-up, we also examined differences in quit success based on demographic characteristics and whether one is being treated for various health conditions. Participants of in-person group counseling and online in-company group counseling were significantly more likely to have quit immediately after the counseling compared with telephone counseling (OR = 1.25, 95% CI = 1.08-1.44; OR = 1.63, 95% CI = 1.18-2.24). Analyses revealed no significant differences in quit success between telephone and other modes of counseling after 12 months. Those treated for a respiratory or psychological condition were less likely to have maintained quit success, as were women, and participants with a lower educational level. When chosen by oneself, the mode of smoking cessation counseling received does not appear to be important for long-term quit success. However, certain groups warrant extra support to prevent excessive program attrition and unsuccessful quit attempts. Our findings suggest that when chosen by oneself, the delivery mode of smoking cessation counseling does not appear to be important for long-term quit success. This finding is of particular relevance for those who are unable to attend in-person cessation counseling due to, for instance, reduced accessibility or mobility. We also found that women, lower educated, and younger participants were more likely to dropout of the cessation program or to not have maintained a quit attempt, signaling that disparities in smoking cessation persist when standardized counseling is given, and therefore more tailored counseling may be necessary for these groups.

Predictors of attrition and program dismissal in a nursing major

BackgroundIncreasing the representation of nurses and other health professionals from minority populations is one way to address health disparities. The purpose of this study was to investigate nursing admission criteria that predicted first, second, third semester attrition and program dismissal. MethodA retrospective secondary data analysis was conducted on existing student records spanning from 2016 to 2020 in one BSN program from a Hispanic-serving institution to gain an understanding about program attrition and dismissal. A total of n = 349 student records were included in the analysis. ResultsPre-nursing science GPA, pre-nursing college GPA, and reading ability were found significant predictors for attrition and dismissal, respectively. ConclusionsAptitudes in the sciences and in reading should be emphasized in pre-nursing to enhance student success in nursing. Findings from this study could inform administrators in postsecondary and in secondary education about establishing infrastructures for at-risk students to better prepare the latter for a nursing major.

Participants' Engagement With and Results From a Web-Based Integrative Population Mental Wellness Program (CHAMindWell) During the COVID-19 Pandemic: Program Evaluation Study.

The COVID-19 pandemic involved a prolonged period of collective trauma and stress during which substantial increases in mental health concerns, like depression and anxiety, were observed across the population. In this context, CHAMindWell was developed as a web-based intervention to improve resilience and reduce symptom severity among a public health care system's patient population. This program evaluation was conducted to explore participants' engagement with and outcomes from CHAMindWell by retrospectively examining demographic information and mental health symptom severity scores throughout program participation. We examined participants' symptom severity scores from repeated, web-based symptom screenings through Computerized Adaptive Testing for Mental Health (CAT-MH) surveys, and categorized participants into symptom severity-based tiers (tier 1=asymptomatic to mild; tier 2=moderate; and tier 3=severe). Participants were provided tier-based mindfulness resources, treatment recommendations, and referrals. Logistic regressions were conducted to evaluate associations between demographic variables and survey completion. The McNemar exact test and paired sample t tests were performed to evaluate changes in the numbers of participants in tier 1 versus tier 2 or 3 and changes in depression, anxiety, and posttraumatic stress disorder severity scores between baseline and follow-up. The program enrolled 903 participants (664/903, 73.5% female; 556/903, 61.6% White; 113/903, 12.5% Black; 84/903, 9.3% Asian; 7/903, 0.8% Native; 36/903, 4% other; and 227/903, 25.1% Hispanic) between December 16, 2020, and March 17, 2022. Of those, 623 (69%) completed a baseline CAT-MH survey, and 196 completed at least one follow-up survey 3 to 6 months after baseline. White racial identity was associated with completing baseline CAT-MH (odds ratio [OR] 1.80, 95% CI 1.14-2.84; P=.01). Participants' odds of having symptom severity below the clinical threshold (ie, tier 1) were significantly greater at follow-up (OR 2.60, 95% CI 1.40-5.08; P=.001), and significant reductions were observed across symptom domains over time. CHAMindWell is associated with reduced severity of mental health symptoms. Future work should aim to address program engagement inequities and attrition and compare the impacts of CHAMindWell to a control condition to better characterize its effects.

Finding Room for Indigenous Women in Educational Leadership: Why Structured Mentorship and Training Are Needed

While the educational system attempts to recover from the last few years of teacher attrition and lower enrollments in teacher education programs, there is an opportunity within adult education to both promote and mentor indigenous women in educational leadership roles by providing education, resources, and opportunities during their training. As long as indigenous women educators are still left out of academic leadership spaces, the lack of diverse voices of women in educational leadership is an issue worth exploring. A troubling lack of mentorship, support, and opportunities exacerbates the exclusion of indigenous women educational leaders. The purpose of this paper is to explore ways that adult education programs and human resource development interventions can and should help prepare indigenous women for positions in educational leadership. Educational leadership training in higher education institutions must include structured mentorship and networking programs, efforts to understand how indigenous women learn and lead, and an embracing of alternate, indigenous ways of leading.

The NEURON Program: Utilizing Low-Cost Neuroscience for Remote Education Outreach.

The NEURON initiative (Neuroscience Education in Undergraduate Research, Outreach, and Networking) is a free program engaging first year students, including underrepresented minority (URM) students in Neuroscience and Cognitive Science (NSCS) at the University of Arizona (UA). The NEURON program builds on former Grass Foundation-sponsored workshops run by Dr. Ricoy (2010-2019) implementing hands-on and culturally responsive active learning curriculum with low-cost equipment from Backyard Brains to increase student retention of URM students in the sciences at Hispanic Serving Institutions (HSI). We present the implementation of the NEURON program at the onset of the COVID pandemic. Combining best practices of distance learning and peer mentoring, we conducted three-week projects exploring principles of neuroscience and neurophysiology. Enrollment and demographic data from NSCS at the UA demonstrate historical disenfranchisement and program attrition primarily impacting URM students. As an extension on previous URM peer mentorship programs in Neuroscience (Ricoy, presentation at Northern New Mexico College Research Symposium, 2010, 2011; presentation at Society for Advancement of Chicanos/Hispanics and Native Americas in Science, 2012), we leveraged low-cost equipment and remote sessions to advance the community of undergraduate mentors and pair with high school mentees on hands-on curriculum. Throughout the program, undergraduate mentors received guidance while crafting and delivering four laboratory lessons to mentees. By coordinating with a Title I school, we better connected with historically underserved students. Critical to this program was providing hands-on opportunities to students who were undergoing distance-based learning during the pandemic. Distribution of equipment allowed high school students to experiment remotely, guided by undergraduate mentors. The NEURON program met its objectives of fostering both mentors and mentees as burgeoning scientists.

Commentary: Addressing Health Disparities in Hospital-Based Interventions for Adolescents and Their Caregivers.

Adolescent obesity is a complex and significant public health concern affecting over 340 million children and adolescents aged 5–19 worldwide in 2016 (WHO, 2021). To mitigate such risks, the U.S. Preventative Services Task Force recommended behavioral weight management (WM) interventions for children >6 years of age (Grossman et al., 2017). However, the prevalence of income disparities in structured WM programs amongst adolescents from lower-income backgrounds exhibits fewer positive outcomes (e.g., reduction in weight, body fat, blood pressure) than peers from middle-class backgrounds (Demeule-Hayes et al., 2016; Kalarchian et al., 2009). Concerningly, adolescents from low-income backgrounds have higher attrition and less engagement in structured WM programs suggesting a need to identify the specific mechanisms influencing the lack of engagement with this population (Hawkins et al., 2018; Rhodes et al., 2017). Kilbourne and colleagues’ (2006) framework highlights the necessity to identify existing health disparities (phase 1), specific mechanisms driving health disparities (phase 2), and action on interventions and policy change (phase 3) to understand, reduce, and eliminate gaps in healthcare. (Darling et al., this issue)’ qualitative study (this issue) goes beyond describing existing differences in access to care, expanding our understanding of specific factors influencing WM program initiation, engagement, and attrition amongst adolescents and their caregivers from low-income backgrounds. Overall, findings highlight a clear gap concerning participants’ comprehension of program goals, misconceptions, and the importance of engaging caregivers to enhance adolescent program engagement and positive outcomes. There is no doubt that this study fills a significant gap in the literature; however, it is important to consider (a) strengths and (b) future directions to inform research in the broader context of pediatric psychology.

Paramedic educational program attrition accounts for significant loss of potential EMS workforce.

Recent concerns for the strength and stability of the emergency medical services (EMS) workforce have fueled interest in enhancing the entry of EMS clinicians into the workforce. However, the educational challenges associated with workforce entry remain unclear. Our objective was to evaluate the educational pathway of entry into the EMS workforce and to identify factors that lead to the loss of potential EMS clinicians. This is a cross-sectional evaluation of all US paramedic educational programs, with enrolled students, in the 2019 Committee on Accreditation of Educational Programs for the EMS Professions annual report survey. This data set includes detailed program characteristics and metrics including program attrition rate (leaving before completion), and certifying exam pass rates. Descriptive statistics were calculated, and multivariable logistic regression analysis was conducted to evaluate the association between high program attrition rates (>30%) and program specific characteristics. In 2019, 640 accredited programs met inclusion with 17,457 students enrolled in paramedic educational programs. Of these, 13,884 students successfully graduated (lost to attrition, 3,573/17,457 [21%]) and 12,002 passed the certifying exam on the third attempt (lost to unable to certify, 1,882/17,457 [11%]). High program attrition rates were associated with longer programs (>12 months), small class sizes (<12 students), and regional locations. Nearly 1 in 3 paramedic students were lost from the potentially available workforce either owing to attrition during the educational program or failure to certify after course completion. Attrition represented the largest loss, providing an avenue for future targeted research and interventions to improve EMS workforce stability.

Dynamics of Pre-Exposure (PrEP) Eligibility Because of Waxing and Waning of HIV Risk in Rakai, Uganda.

We conducted a retrospective population-based study to describe longitudinal patterns of prevalence, incidence, discontinuation, resumption, and durability of substantial HIV risk behaviors (SHR) for pre-exposure prophylaxis (PrEP) eligibility. The study was conducted among HIV-negative study participants aged 15-49 years who participated in survey rounds of the Rakai Community Cohort Study between August 2011 and June 2018. Substantial HIV risk was defined based on the Uganda national PrEP eligibility as reporting sexual intercourse with >1 partner of unknown HIV status, nonmarital sex without a condom, having genital ulcers, or having transactional sex. Resumption of SHR meant resuming of SHR after stopping SHR, whereas persistence of SHR meant SHR on >1 consecutive visit. We used generalized estimation equations with log-binomial regression models and robust variance to estimate survey-specific prevalence ratios; Generalized estimation equations with modified Poisson regression models and robust variance to estimate incidence ratios for incidence, discontinuation, and resumption of PrEP eligibility. Incidence of PrEP eligibility increased from 11.4/100 person-years (pys) in the first intersurvey period to 13.9/100 pys (adjusted incidence rate ratios = 1.28; 95%CI = 1.10-1.30) and declined to 12.6/100 pys (adjusted incidence rate ratios = 1.06; 95%CI = 0.98-1.15) in the second and third intersurvey periods, respectively. Discontinuation rates of SHR for PrEP eligibility were stable (ranging 34.9/100 pys-37.3/100 pys; P = 0.207), whereas resumption reduced from 25.0/100 pys to 14.5/100 pys ( P < 0.001). PrEP eligibility episodes lasted a median time of 20 months (IQR = 10-51). Pre-exposure prophylaxis use should be tailored to the dynamic nature of PrEP eligibility. Preventive-effective adherence should be adopted for assessment of attrition in PrEP programs.

Racial and Sex Disparities in Resident Attrition Among Surgical Subspecialties

Racial and sex disparities are prevalent in surgical trainees. Although retrospective studies on resident attrition have been conducted for individual specialties, this study analyzes racial and sex differences in resident attrition among all surgical subspecialties over an 18-year period. To evaluate the racial and sex differences in resident attrition among surgical specialties over an 18-year period. This was a large, cross-sectional, database study that analyzed program-reported resident censuses (program information, resident demographics, and attrition status) obtained by the Association of American Medical Colleges from 2001 to 2018 for trainees in surgical residency programs. Data were analyzed from March 20, 2021, to June 8, 2022. Demographic trends (including race and ethnicity and sex) for all surgical subspecialty training programs over an 18-year period. Resident attrition includes all-cause withdrawals, dismissals, and transfers to another specialty. Unintended attrition encompasses all withdrawals, dismissals, and transfers except for changing career plans. This study included 407 461 program-reported resident years collected from 112 205 individual surgical residents (67 351 male individuals [60.0%]). The mean percentage of female trainees was 40.0% (44 835) and increased over the study period. Sex disparity remained greatest in orthopedic surgery. Residents who were underrepresented in medicine (URiM) comprised 14.9% (16 695) of all surgical trainees but demonstrated a 2.1% decrease over the study period. Overall attrition rate among all specialties was 6.9% (7759), with an unintended attrition rate of 2.3% (2556). Female residents had a significantly higher relative risk (RR) of attrition (RR, 1.16; 95% CI, 1.11-1.22; P < .001) and unintended attrition (RR, 1.17; 95% CI, 1.08-1.26; P < .001) compared with their male counterparts. URiM residents were at significantly higher RR for attrition (RR, 1.40; 95% CI, 1.32-1.48; P < .001) and unintended attrition (RR, 1.92; 95% CI, 1.75-2.11; P < .001) compared with non-URiM residents. The highest attrition (10.6% [746 of 7043]) and unintended attrition (5.2% [367 of 7043]) rates were in Black/African American residents. The lowest attrition and unintended attrition rates were seen in White residents at 6.2% (4300 of 69 323) and 1.8% (1234 of 69 323), respectively. Black/African American residents were at disproportionate risk for attrition (RR, 1.66; 95% CI, 1.53-1.80; P < .001) and unintended attrition (RR, 2.59; 95% CI, 2.31-2.90; P < .001) compared with all other residents. Orthopedic surgery had the highest attrition (RR, 3.80; 95% CI, 2.84-5.09; P < .001) and unintended attrition (RR, 7.20; 95% CI, 4.84-10.71; P < .001) for Black/African American residents. Results of this cross-sectional study suggest that the percentage of female residents in surgical specialties has improved over the last 18 years, and the percentage of URiM residents has remained relatively unchanged. Risk for attrition and unintended attrition was significantly elevated for female and URiM residents, specifically Black/African Americans. These results highlight current racial and sex disparities in resident attrition and demonstrate the importance of developing strategies to recruit, retain, and support residents.

Depression and PTSD as Predictors of Attrition in Older Adult Exercise Programs

Background: In older adults, exercise is extremely important and has been demonstrated to improve physical health, cognition, and mood. However, attrition in exercise programs in general is high, with up to 50% of participants leaving in the first 3 to 6 months. Methods: A systematic review of PubMed and PsycINFO databases was conducted using PRISMA criteria assessing the association of baseline depression and/or posttraumatic stress disorder (PTSD) with attrition rates in older adult exercise programs. Results: Ten articles were identified that assessed baseline depression and attrition in older adult exercise programs. No studies assessed baseline PTSD as a risk for attrition. Attrition rate overall ranged from 19% to 38%, and depression at baseline was found to be significantly associated with higher attrition rates. Other factors associated with attrition included anxiety, lower life satisfaction, worse cognitive health, higher illness rating, shorter program duration, common illnesses, lower social support, male sex, single relationship status, and transportation dependence. Discussion: Depression at baseline was significantly related with increased attrition in older adult exercise programs. Screening and consideration of adjunctive mood treatment are recommended. Further study of PTSD as an attrition risk is recommended, particularly in veteran or other populations with greater base rates.

Attrition and social vulnerability during 2-year-long structured care in type 2 diabetes, the ERMIES randomized controlled trial

BackgroundDiabetes self-management education is exposed to attrition from services and structured ambulatory care. However, knowledge about factors related to attrition in educational programs remains limited. The context of social vulnerability due to low income may interfere. The aim of this study was to identify the sociodemographic, clinical, psychometric, and lifestyle factors associated with attrition from the ERMIES multicentre randomized parallel controlled trial (RCT) that was interrupted due to the combination of both slow inclusion and high attrition.MethodsThe ERMIES trial was performed from 2011 to 2016 on Reunion Island, which is characterized by a multicultural population and high social vulnerability. The original objective of the RCT was to test the efficacy of a2-year structured group self-management education in improving blood glucose in adult patients with nonrecent, insufficiently controlled type 2 diabetes. One hundred participants were randomized to intensive educational intervention maintained over two years (n = 51) versus only initial education (n = 49). Randomization was stratified on two factors: centres (five strata) and antidiabetic treatment (two strata: insulin-treated or not). Sociodemographic, clinical, health-care access and pathway, psychometric and lifestyle characteristics data were collected at baseline and used to assess determinants of attrition in a particular social context and vulnerability. Attrition and retention rates were measured at each visit during the study. Multiple correspondence analysis and Cox regression were performed to identify variables associated with attrition.ResultsThe global attrition rate was 26% during the study, with no significant difference between the two arms of randomization (9 dropouts out of 51 patients in the intervention group and 17 out of 49 in the control group). Male gender, multiperson household, low household incomes (< 800 euros), probable depression and history of hospitalization or medical leave at inclusion were associated with a higher risk of attrition from the study in multivariate regression.ConclusionsSocial context, vulnerability, and health care history were related to attrition in this 2-year longitudinal comparative study of structured care. Considering these potential determinants and biases is of importance in scaling up interventions aimed at the optimization of long-term care in type 2 diabetes mellitus.Trial registrationID_RCB number: 2011-A00046-35, Clinicaltrials.gov number: NCT01425866 (Registration date: 30/08/2011).Source of funding: Ministry of Health, France.

Feasibility and Acceptability Of An Outdoor Walking-Group Intervention For Adults With Moderate-To-Severe Traumatic Brain Injury

Research Objectives Promoting physical activity (PA) after moderate-to-severe traumatic brain injury (TBI) is challenging due to elevated PA barriers (e.g., transportation, accessibility, endurance, self-consciousness) and COVID-19-related restrictions leading to the closure of community fitness centres. There was a need to create an outdoor walking-groups to promote PA participation. Study objectives were to determine the feasibility and acceptability of an outdoor walking-group intervention for adults with moderate-to-severe TBI. Design Mixed-method feasibility study. Setting Community-based outdoor setting during COVID-19. Participants Convenience sample of 18 adults (10 male, 8 female) with moderate-to-severe TBI recruited from a community TBI association. Interventions 6-week walking intervention (60-90-minutes, 2 days per week) with progressively increased walking intensity and telehealth supports (e.g., Zoom meetings, social media page). Main Outcome Measures Feasibility outcomes included program participation, attrition, and safety. Acceptability outcomes included a program satisfaction scale and supplemental qualitative data about program experiences collected through 30-60-minute semi-structured Zoom-facilitated interviews. Results 15/18 (83%) study participants completed ≥ 9 sessions (75%). Two participants were lost to attrition, and one for unrelated medical reasons. No major adverse events were reported. Minor adverse events included fatigue and muscle soreness. All participants reported high satisfaction with the intervention (M = 9.2/10, SD = 0.9) and would recommend the walking group to others. Thematic analyses of the transcribed audio recordings identified three major themes about Program Resources, Program Delivery, and Program Efficacy. Results may be used to optimize the program for the future. Conclusions A 6-week walking-group intervention is feasible and acceptable for adults with moderate-to-severe TBI. Outcomes support the development, implementation, and evaluation of formalized walking-group interventions in the community after moderate-to-severe TBI. Implications for using PA to improve health outcomes after moderate-to-severe TBI are discussed. Author(s) Disclosures Authors have no conflicts of interest to disclose. Promoting physical activity (PA) after moderate-to-severe traumatic brain injury (TBI) is challenging due to elevated PA barriers (e.g., transportation, accessibility, endurance, self-consciousness) and COVID-19-related restrictions leading to the closure of community fitness centres. There was a need to create an outdoor walking-groups to promote PA participation. Study objectives were to determine the feasibility and acceptability of an outdoor walking-group intervention for adults with moderate-to-severe TBI. Mixed-method feasibility study. Community-based outdoor setting during COVID-19. Convenience sample of 18 adults (10 male, 8 female) with moderate-to-severe TBI recruited from a community TBI association. 6-week walking intervention (60-90-minutes, 2 days per week) with progressively increased walking intensity and telehealth supports (e.g., Zoom meetings, social media page). Feasibility outcomes included program participation, attrition, and safety. Acceptability outcomes included a program satisfaction scale and supplemental qualitative data about program experiences collected through 30-60-minute semi-structured Zoom-facilitated interviews. 15/18 (83%) study participants completed ≥ 9 sessions (75%). Two participants were lost to attrition, and one for unrelated medical reasons. No major adverse events were reported. Minor adverse events included fatigue and muscle soreness. All participants reported high satisfaction with the intervention (M = 9.2/10, SD = 0.9) and would recommend the walking group to others. Thematic analyses of the transcribed audio recordings identified three major themes about Program Resources, Program Delivery, and Program Efficacy. Results may be used to optimize the program for the future. A 6-week walking-group intervention is feasible and acceptable for adults with moderate-to-severe TBI. Outcomes support the development, implementation, and evaluation of formalized walking-group interventions in the community after moderate-to-severe TBI. Implications for using PA to improve health outcomes after moderate-to-severe TBI are discussed.

An Examination of Predictors of Attrition in Physician Assistant Programs

The purpose of this study was to explore the relationship between program characteristics and attrition rates. Program graduation rates, attrition rates, and Physician Assistant National Certifying Examination (PANCE) pass rates were extracted from program websites from February-March 2021 and summarized for 2018, 2019, and 2020. Means were compared across categories of independent variables. Attrition rates and PANCE pass rates were correlated. Prerequisites and attrition rate were evaluated with multiple regression. Mean attrition rates varied little across years. Significant differences in mean attrition were limited to a few US Census Bureau regions or divisions. No significant correlation between the total number of prerequisite courses or total prerequisite credits and attrition existed. In 2020, mean attrition rate was statistically significantly greater when biochemistry was required (M = 6.89, SD = 7.04) than when not required (M = 4.91, SD = 4.75) and was statistically significantly lower when an additional chemistry course was required (M = 3.65, SD = 4.00) than when not required (M = 5.93, SD = 5.82). No significant predictors of attrition were found with regression. The mean attrition rates have been relatively stable from 2018-2020, suggesting that the presence of prerequisite coursework has no significant impact on attrition rates. This suggests that specific prerequisites may not predict success in a program, supporting the idea of decreasing or eliminating prerequisites. Additional studies are needed to understand the factors, including specific combinations of prerequisites, that predict completion of a physician assistant program.