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Predictors of attrition from a weight loss program. A study of adult patients with obesity in a community setting. Eat Weight Disord 2021; 26:1729-1736. [PMID: 32816208 PMCID: PMC8292291 DOI: 10.1007/s40519-020-00990-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/11/2020] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Obesity unit attrition is frequent and contributes to treatment failure. Many studies evaluating attrition predictors were part of randomized trials, and different terminology and criteria were used in the engagement field. We aimed to investigate the factors potentially implicated in early (< 12 weeks) and late (> 12 weeks) attrition from an obesity unit in a community setting METHODS: This was a retrospective cohort study of 250 patients with obesity who were followed-up at our obesity unit. Our program included at least 6 meetings in 12 months. Sociodemographic and anthropometric data, and psychometric questionnaires were collected from all participants. RESULTS One-hundred thirty-four (53.6%) participants dropped out. Those individuals showed lower BMI, lower overall health status, and increased depression scores. In a multiple regression model, BMI (inversely; OR = 0.90; 95%CI 0.84-0.96) and depression score (directly, OR = 1.05; 1.00-1.10) were associated with attrition risk. Early dropouts (n = 47) had lower weights, smaller waist circumferences and worse mental health scores than late dropouts (n = 87) and more frequently lived alone. When compared to completers, early dropouts had lower weights, BMIs, waist circumferences, overall health and mental status scores, increased depression scores and percentage of individuals living alone. In a multiple regression, lower BMI (OR = 0.83; 0.75-0.92), lower mental status score (OR = 3.17; 1.17-8.59) and living alone (OR = 2.25; 1.02-4.97) were associated with early attrition risk. CONCLUSION Lower BMI and increased depression score were associated with attrition. Early attrition was associated with lower weight, decreased mental well-being, and living alone. Individuals with these characteristics might need tailored approaches to enhance their engagement. LEVEL OF EVIDENCE Level V, retrospective descriptive study.
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Joachim-Célestin M, Gamboa-Maldonado T, Dos Santos H, Montgomery SB. A Qualitative Study on the Perspectives of Latinas Enrolled in a Diabetes Prevention Program: Is the Cost of Prevention Too High? J Prim Care Community Health 2020; 11:2150132720945423. [PMID: 32755275 PMCID: PMC7543125 DOI: 10.1177/2150132720945423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: Latinas are among the groups most affected by diabetes health disparities, yet they often benefit less from diabetes interventions even when these are culturally adapted. The purpose of this qualitative study was to explore readiness of Latinas enrolled in a diabetes prevention program to adopt recommended preventive behaviors, and to identify factors associated with the adoption and maintenance of these recommended lifestyle changes. Insights gained will be used to inform future efforts at reducing diabetes disparities and the burden of chronic diseases among Latinas. Methods: Nine focus group discussions (FGDs) and 3 key informant interviews (KIIs) were conducted after the completion of a culturally adapted diabetes prevention program led by Latino community health workers. A grounded theory approach by Charmaz informed by the transtheoretical model guided the questions. Discussions and interviews were audio-taped with participants’ permission, transcribed, coded, and themed. Results: Forty low-income Latinas contributed to FGDs and KIIs. Baseline readiness to engage in new behaviors varied. Negative personal and family health events and physician referral impacted most readiness to enroll and to adopt preventive behaviors. Built environment, financial constraints, and threat of social alienation constituted major barriers to behavior adoption and maintenance, while physician involvement, awareness of diabetes complications, and social support partially mitigated these impediments. Conclusions: Our results suggest that timing of enrollment, physician-patient dynamics, and the emotional personal/family cost of behavior modification should all be considered when planning diabetes prevention programs for low-income Latinas. Besides appropriately timing referrals to accessible culturally informed prevention programs, health educators and health care providers should be aware of the potentially negative impact of behavior modification on family dynamics and be prepared to address resulting repercussions. Future research on Latinas should also include and report data on physician involvement, family context, and social determinants of health for more consistent program comparisons.
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Vincent AD, Drioli-Phillips PG, Le J, Cusack L, Schultz TJ, McGee MA, Turnbull DA, Wittert GA. Health behaviours of Australian men and the likelihood of attending a dedicated men's health service. BMC Public Health 2018; 18:1078. [PMID: 30165836 PMCID: PMC6117954 DOI: 10.1186/s12889-018-5992-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 08/24/2018] [Indexed: 12/02/2022] Open
Abstract
Background Redesigning primary health services may enhance timely and effective uptake by men. The primary aim of this study was to assess the likelihood of Australian men attending a dedicated men’s health service (DMHS). The further aims were to better understand the reasons for their preferences and determine how health behaviours influence likelihood. Methods A survey on health service use and preferences, health help-seeking behaviours, and the likelihood of attending a DMHS was administered by telephone to 1506 randomly selected men (median age 56 years, range 19–95). Likelihood of attending a DMHS was rated using a single item Likert scale where 0 was not at all likely and 10 highly likely. Respondents were classified by age (< or > = 65 years) and health status. Principal component analyses were used to define health behaviours, specifically help-seeking and delay/avoidance regarding visiting a doctor. Multivariable linear and logistic regression analyses were used to examine predictors of likelihood of attending a DMHS. Results The mean likelihood of attending a DMHS was 5.8 (SD 3.3, median 6, moderate likelihood) and 21%, 26% and 23% of men rated likelihood as moderate, high and very high respectively. Being happy with their existing doctor was the most common reason (52%) for being less likely to attend a DMHS. In unadjusted analyses, younger men reported being more likely to attend a DMHS (p < 0.001) with older-sick men reporting being least likely (p < 0.001). Younger men were more likely than older men to score higher on delay/avoidance and were more likely to self-monitor. In the full model, men with current health concerns (p ≤ 0.01), who scored higher on delay/avoidance (p ≤ 0.0006), who were more likely to be information-seekers (p < 0.0001) and/or were motivated to change their health (p ≤ 0.0001) reported a higher likelihood of attending a DMHS irrespective of age and health status. Conclusions Seventy percent of men reported a moderate or higher likelihood of attending a DMHS. As young healthy men are more likely than older men to display health behaviours that are associated with a higher likelihood of attending a DHMS, such as delay/avoidance, marketing a DMHS to such men may be of value. Electronic supplementary material The online version of this article (10.1186/s12889-018-5992-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andrew D Vincent
- Freemasons Foundation Centre for Men's Health, Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, 5005
| | - Phoebe G Drioli-Phillips
- Freemasons Foundation Centre for Men's Health, Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, 5005.,School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, 5005
| | - Jana Le
- Freemasons Foundation Centre for Men's Health, Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, 5005.,School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, 5005
| | - Lynette Cusack
- Adelaide Nursing School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, 5005
| | - Timothy J Schultz
- Adelaide Nursing School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, 5005
| | - Margaret A McGee
- Freemasons Foundation Centre for Men's Health, Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, 5005.
| | - Deborah A Turnbull
- Freemasons Foundation Centre for Men's Health, Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, 5005.,School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, 5005
| | - Gary A Wittert
- Freemasons Foundation Centre for Men's Health, Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, 5005
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Sturgiss EA, Elmitt N, Haesler E, van Weel C, Douglas KA. Role of the family doctor in the management of adults with obesity: a scoping review. BMJ Open 2018; 8:e019367. [PMID: 29453301 PMCID: PMC5829928 DOI: 10.1136/bmjopen-2017-019367] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 11/13/2017] [Accepted: 12/19/2017] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Obesity management is an important issue for the international primary care community. This scoping review examines the literature describing the role of the family doctor in managing adults with obesity. The methods were prospectively published and followed Joanna Briggs Institute methodology. SETTING Primary care. Adult patients. INCLUDED PAPERS Peer-reviewed and grey literature with the keywords obesity, primary care and family doctors. All literature published up to September 2015. 3294 non-duplicate papers were identified and 225 articles included after full-text review. PRIMARY AND SECONDARY OUTCOME MEASURES Data were extracted on the family doctors' involvement in different aspects of management, and whether whole person and person-centred care were explicitly mentioned. RESULTS 110 papers described interventions in primary care and family doctors were always involved in diagnosing obesity and often in recruitment of participants. A clear description of the provider involved in an intervention was often lacking. It was difficult to determine if interventions took account of whole person and person-centredness. Most opinion papers and clinical overviews described an extensive role for the family doctor in management; in contrast, research on current practices depicted obesity as undermanaged by family doctors. International guidelines varied in their description of the role of the family doctor with a more extensive role suggested by guidelines from family medicine organisations. CONCLUSIONS There is a disconnect between how family doctors are involved in primary care interventions, the message in clinical overviews and opinion papers, and observed current practice of family doctors. The role of family doctors in international guidelines for obesity may reflect the strength of primary care in the originating health system. Reporting of primary care interventions could be improved by enhanced descriptions of the providers involved and explanation of how the pillars of primary care are used in intervention development.
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Affiliation(s)
- Elizabeth A Sturgiss
- Academic Unit of General Practice, Australian Nation University Medical School, Canberra, Australia
| | - Nicholas Elmitt
- Academic Unit of General Practice, Australian Nation University Medical School, Canberra, Australia
| | - Emily Haesler
- Academic Unit of General Practice, Australian Nation University Medical School, Canberra, Australia
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
- School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
| | - Chris van Weel
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Health Services Research and Policy, Australian National University, Canberra, Australia
| | - Kirsty A Douglas
- Academic Unit of General Practice, Australian Nation University Medical School, Canberra, Australia
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An Overview of Factors Associated with Adherence to Lifestyle Modification Programs for Weight Management in Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14080922. [PMID: 28813030 PMCID: PMC5580624 DOI: 10.3390/ijerph14080922] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 07/19/2017] [Accepted: 08/08/2017] [Indexed: 12/13/2022]
Abstract
This review aims to provide an overview of the factors associated with adherence reported in existing literature on lifestyle modification programs for weight management among the adult population. An electronic search was performed using PubMed, Medline, PsycINFO and PsycARTICLE to identify studies that examined the factors of adherence to lifestyle modification programs with explicit definition of adherence indicators. We identified 19 studies published between 2004 and 2016. The most commonly used indicator of adherence was attrition, followed by attendance, self-monitoring and dietary adherence. A broad array of factors has been studied but only few studies exploring each factor. Limited evidence suggested older age, higher education, healthier eating and physical activity behaviours, higher stage of change at baseline and higher initial weight loss may predict better adherence. On the other hand, having depression, stress, strong body shape concern, more previous weight loss attempts and being unemployed may predict poor adherence. Inconsistent findings were obtained for self-efficacy, motivation and male gender. This review highlights the need for more rigorous studies to enhance our knowledge on factors related to adherence. Identification of the factors of adherence could provide important implication for program improvement, ultimately improving the effectiveness and the cost-effectiveness of lifestyle modification program.
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Perry RA, Daniels LA, Bell L, Magarey AM. Facilitators and Barriers to the Achievement of Healthy Lifestyle Goals: Qualitative Findings From Australian Parents Enrolled in the PEACH Child Weight Management Program. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2017; 49:43-52.e1. [PMID: 27780669 DOI: 10.1016/j.jneb.2016.08.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 08/29/2016] [Accepted: 08/30/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To describe the qualitative research methods used in the Parenting Eating and Activity for Child Health (PEACH) randomized controlled trial and to examine parent-reported facilitators and barriers to the achievement of program goals. DESIGN Qualitative study using semistructured interviews. SETTING Parents enrolled in the Australian PEACH randomized controlled trial, a family-focused child weight management program conducted blinded for review. PARTICIPANTS A total of 95 parents of overweight children aged 5-10 years participated in face-to-face semistructured interviews. PHENOMENON OF INTEREST Factors external to the PEACH intervention that facilitated or inhibited their success. ANALYSIS Interviews were recorded, transcribed, and analyzed using thematic analysis techniques. RESULTS Three facilitator themes were identified: (1) internal locus of parental control, (2) external locus of parental control, and (3) child factors. Six barrier themes were identified: (1) internal locus of parental control, (2) external locus of parental control, and (3) child factors; (4) maintenance and managing special occasions; (5) time management challenges; and (6) inconsistencies or lack of support. CONCLUSIONS AND IMPLICATIONS The social and environmental barriers and time pressures identified by parents are a common feature of Western family life such that many parents are raising families in stressful situations. Insights provided by this qualitative research provide an important understanding of these experiences. Consideration of such issues in the design and implementation of future child weight management interventions may help to increase the acceptability and effectiveness of such programs.
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Affiliation(s)
- Rebecca Anne Perry
- Department of Nutrition and Dietetics, Flinders University, Adelaide, South Australia, Australia.
| | - Lynne Anne Daniels
- Department of Exercise and Nutrition Sciences, Queensland University of Technology, Queensland, Australia
| | - Lucinda Bell
- Department of Nutrition and Dietetics, Flinders University, Adelaide, South Australia, Australia
| | - Anthea Margaret Magarey
- Department of Nutrition and Dietetics, Flinders University, Adelaide, South Australia, Australia
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Sohanpal R, Steed L, Mars T, Taylor SJC. Understanding patient participation behaviour in studies of COPD support programmes such as pulmonary rehabilitation and self-management: a qualitative synthesis with application of theory. NPJ Prim Care Respir Med 2015; 25:15054. [PMID: 26379121 PMCID: PMC4588031 DOI: 10.1038/npjpcrm.2015.54] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 06/11/2015] [Accepted: 06/22/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND In chronic obstructive pulmonary disease (COPD), the problem of poor patient participation in studies of self-management (SM) and pulmonary rehabilitation (PR) programmes (together referred to as COPD support programmes) is established. Understanding this problem beyond the previously reported socio-demographics and clinical factors is critical. AIMS The aim of this study was to explore factors that explain patient participation in studies of COPD support programmes. METHODS Thematic 'framework' synthesis was conducted on literature published from 1984 to 1 February 2015. Emergent themes and subthemes were mapped onto the adapted 'attitude-social influence-external barriers' and the 'self-regulation' models to produce analytical themes. RESULTS Ten out of 12 studies were included: PR (n=9) and SM (n=1). Three descriptive themes with 38 subthemes were mapped onto the models' constructs, and it generated four analytical themes: 'attitude', 'social influences' and 'illness' and 'intervention representations'. The following factors influenced (1) attendance-helping oneself through health improvements, perceived control of worsening condition, perceived benefits and positive past experience of the programme, as well as perceived positive influence of professionals; (2) non-attendance-perceived negative effects and negative past experience of the programme, perceived physical/practical concerns related to attendance, perceived severity of condition/symptoms and perceived negative influence of professionals/friends; (3) dropout-no health improvements perceived after attending a few sessions of the programme, perceived severity of the condition and perceived physical/practical concerns related to attendance. CONCLUSIONS Psychosocial factors including perceived practical/physical concerns related to attendance influenced patients' participation in COPD support programmes. Addressing the negative beliefs/perceptions via behaviour change interventions may help improve participation in COPD support programmes and, ultimately, patient outcomes.
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Affiliation(s)
- Ratna Sohanpal
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Liz Steed
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Thomas Mars
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Stephanie J C Taylor
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Casazza K, Brown A, Astrup A, Bertz F, Baum C, Brown MB, Dawson J, Durant N, Dutton G, Fields DA, Fontaine KR, Heymsfield S, Levitsky D, Mehta T, Menachemi N, Newby PK, Pate R, Raynor H, Rolls BJ, Sen B, Smith DL, Thomas D, Wansink B, Allison DB. Weighing the Evidence of Common Beliefs in Obesity Research. Crit Rev Food Sci Nutr 2015; 55:2014-53. [PMID: 24950157 PMCID: PMC4272668 DOI: 10.1080/10408398.2014.922044] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Obesity is a topic on which many views are strongly held in the absence of scientific evidence to support those views, and some views are strongly held despite evidence to contradict those views. We refer to the former as "presumptions" and the latter as "myths." Here, we present nine myths and 10 presumptions surrounding the effects of rapid weight loss; setting realistic goals in weight loss therapy; stage of change or readiness to lose weight; physical education classes; breastfeeding; daily self-weighing; genetic contribution to obesity; the "Freshman 15"; food deserts; regularly eating (versus skipping) breakfast; eating close to bedtime; eating more fruits and vegetables; weight cycling (i.e., yo-yo dieting); snacking; built environment; reducing screen time in childhood obesity; portion size; participation in family mealtime; and drinking water as a means of weight loss. For each of these, we describe the belief and present evidence that the belief is widely held or stated, reasons to support the conjecture that the belief might be true, evidence to directly support or refute the belief, and findings from randomized controlled trials, if available. We conclude with a discussion of the implications of these determinations, conjecture on why so many myths and presumptions exist, and suggestions for limiting the spread of these and other unsubstantiated beliefs about the obesity domain.
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Affiliation(s)
- Krista Casazza
- a Department of Nutrition Sciences , University of Alabama at Birmingham , Birmingham , Alabama USA
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Ghannadiasl F, Mahdavi R, AsghariJafarabadi M. Assessing Readiness to Lose Weight among Obese Women Attending the Nutrition Clinic. Health Promot Perspect 2014; 4:27-34. [PMID: 25097834 DOI: 10.5681/hpp.2014.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 03/08/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Assessing individual's readiness to change and targeting the inter-vention to the level of readiness may improve successful weight loss rates. This study aimed to assess readiness for weight loss in obese women using the trans theoretical model. METHODS A cross-sectional study was conducted on 90 volunteer apparently healthy obese women, in Ardabil, Iran. Participants completed the translated and validated University of Rhode Island Change Assessment questionnaire in their first visit. Subjects were categorized into one of the stages of change based on the highest of four z-transformed scale scores. The readiness to change score was calculated. RESULTS More than half of the participants were in early stages of weight loss and 24.5% were in the action stage. The readiness score in the precontemplation stage was significantly lower than the other stages, but no significant difference was observed among the contemplation, action and maintenance stages. The significant correlation was observed between the stages of change and waist-to-hip ratio (r=0.33, P<0.05). CONCLUSION Obese women attending the nutrition clinic are in different stages to change for weight loss. Understanding person specific stages of change ori-entates the dietitian to use the most appropriate counseling strategies. Hence the stages and readiness to change should be considered before implementing any intervention in clinical settings for optimal outcomes.
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Affiliation(s)
| | - Reza Mahdavi
- Nutrition Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Raffel KE, Goddu AP, Peek ME. "I Kept Coming for the Love": Enhancing the Retention of Urban African Americans in Diabetes Education. DIABETES EDUCATOR 2014; 40:351-360. [PMID: 24525568 DOI: 10.1177/0145721714522861] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE The purpose of the study was to investigate how retention strategies employed by the Diabetes Empowerment Program (DEP) contributed to retention. METHODS An experienced moderator conducted in-depth interviews (n = 7) and 4 focus groups (n = 29) with former DEP participants. Interviews were recorded, transcribed, and coded using iteratively modified coding guidelines. Results were analyzed using Atlas.ti 4.2 software. RESULTS Participants were African American and predominantly female, low income, and with more than 1 diabetes complication. Key retention themes included: (1) educator characteristics and interpersonal skills ("The warmth of the staff . . . kept me coming back for more."), (2) accessible information ("I didn't know anything about diabetes [before]. I was just given the medicine."), (3) social support ("I realized I wasn't the only one who has diabetes."), (4) the use of narrative ("It's enlightening to talk about [my diabetes]."), and (5) the African American helping tradition ("I went not just for myself but for my husband."). CONCLUSIONS While many interventions focus on costly logistics and incentives to retain at-risk participants, study findings suggest that utilizing culturally tailored curricula and emphasizing interpersonal skills and social support may be more effective strategies to retain low-income African Americans in diabetes education programs.
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Affiliation(s)
- Katie E Raffel
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois (Dr Raffel)
| | - Anna P Goddu
- Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, Illinois (Ms Goddu, Dr Peek),Center for Health and the Social Sciences, University of Chicago, Chicago, Illinois (Ms Goddu, Dr Peek),Chicago Center for Diabetes Translation Research, Chicago, Illinois (Ms Goddu, Dr Peek)
| | - Monica E Peek
- Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, Illinois (Ms Goddu, Dr Peek),Center for Health and the Social Sciences, University of Chicago, Chicago, Illinois (Ms Goddu, Dr Peek),Chicago Center for Diabetes Translation Research, Chicago, Illinois (Ms Goddu, Dr Peek),Center for the Study of Race, Politics and Culture, University of Chicago, Chicago, Illinois (Dr Peek)
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