Thoolen Bart, de Ridder Denise, Bensing Jozien, Gorter Kees, Rutten Guy
The Department of Clinical and Health Psychology, Utrecht University, Utrecht, the Netherlands (Mr Thoolen, Dr de Ridder, Dr Bensing)
Netherlands Institute for Health Services Research, Utrecht, the Netherlands (Dr Bensing)
Diabetes Educ. 2007 May-Jun;33(3):465-74. doi: 10.1177/0145721707301491.
The purpose of this study was to examine reasons for nonparticipation and drop out in a diabetes self-management intervention.
A total of 468 recently screen-detected patients, receiving usual care or intensive pharmacological treatment, were invited and randomized into either a control or intervention condition, consisting of a brief self-management course. A nonresponse survey was conducted, and participants, nonparticipants, and dropouts were compared on sociodemographic variables, diabetes attitudes, and self-care.
A total of 227 patients consented and were allocated to the control (n=108) or intervention group (n=119). Two hundred forty-one patients declined participation, 41 dropped out, and 78 completed the intervention. Major reasons for refusal and drop out were hesitancy toward research and practical barriers. Nonparticipants were less educated and reported higher self-management, while participation also varied by treatment and disease duration: intensively treated patients were more likely to participate in their first year, and usual-care patients participated more often 2 to 3 years after diagnosis. Dropouts had a lower education level but did not differ on any other measure.
Participants, nonparticipants, and dropouts did not differ in their attitudes toward diabetes, but the intervention did attract patients with lower self-care. Variations in participation by treatment and disease duration suggest that patients prefer self-management interventions at different times depending on their medical treatment. Finally, education appears to be the most important factor determining participation. Alternative strategies are needed to attract and retain patients with low education.
本研究旨在探讨糖尿病自我管理干预中不参与和退出的原因。
共邀请了468名近期筛查出的患者，他们接受常规护理或强化药物治疗，并随机分为对照组或干预组，干预组接受一个简短的自我管理课程。进行了一项无应答调查，并比较了参与者、非参与者和退出者在社会人口统计学变量、糖尿病态度和自我护理方面的差异。
共有227名患者同意并被分配到对照组（n = 108）或干预组（n = 119）。241名患者拒绝参与，41名退出，78名完成了干预。拒绝和退出的主要原因是对研究的犹豫和实际障碍。非参与者受教育程度较低，自我管理程度较高，而参与情况也因治疗和病程而异：强化治疗的患者在第一年更有可能参与，而常规护理的患者在诊断后2至3年参与得更多。退出者的教育水平较低，但在其他方面没有差异。
参与者、非参与者和退出者对糖尿病的态度没有差异，但该干预确实吸引了自我护理能力较低的患者。参与情况因治疗和病程的不同而有所差异，这表明患者根据其医疗治疗情况在不同时间更喜欢自我管理干预。最后，教育似乎是决定参与情况的最重要因素。需要采取替代策略来吸引和留住低教育水平的患者。
