title: Factors contributing to attrition behavior in diabetes self-management programs: a mixed method approach.
abstract: BACKGROUND
  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. The objective of this study was to examine factors that may contribute to attrition behavior in diabetes self-management programs.
  
  
  METHODS
  We 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.
  
  
  RESULTS
  Working 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.
  
  
  CONCLUSIONS
  Reducing 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.
authors.affiliation: Ryerson University, School of Nutrition, Toronto, Ontario, Canada. egucciar@ryerson.ca
authors.forename: Enza
authors.initials: E
authors.lastname: Gucciardi
authors.forename: Margaret
authors.initials: M
authors.lastname: Demelo
authors.forename: Ana
authors.initials: A
authors.lastname: Offenheim
authors.forename: Donna E
authors.initials: DE
authors.lastname: Stewart
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D004651:Employment / Q000706:statistics & numerical data; D005260:Female; D015438:Health Behavior; D006306:Health Surveys; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000523:psychology / Q000706:statistics & numerical data; D010352:Patient Dropouts / Q000523:psychology; D011320:Primary Health Care; D015397:Program Evaluation; D012648:Self Care / Q000379:methods*; D011795:Surveys and Questionnaires