糖尿病自我管理项目中导致退出行为的因素：一种混合方法研究
Factors contributing to attrition behavior in diabetes self-management programs: a mixed method approach.
作者信息
Gucciardi Enza, Demelo Margaret, Offenheim Ana, Stewart Donna E
机构信息
Ryerson University, School of Nutrition, Toronto, Ontario, Canada.
出版信息
BMC Health Serv Res. 2008 Feb 4;8:33. doi: 10.1186/1472-6963-8-33.
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.
CONCLUSION
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.
背景
糖尿病自我管理教育是糖尿病护理的关键组成部分。尽管全球都在努力开发有效的糖尿病自我管理教育项目，但临床实践中经常报告高流失率。本研究的目的是探讨可能导致糖尿病自我管理项目中流失行为的因素。
方法
我们对患有2型糖尿病（n = 267）并参加糖尿病教育中心的个体进行了电话访谈。进行多变量逻辑回归以确定与流失行为相关的因素。44%的参与者（n = 118）过早退出该项目，并被问及关于他们停止服务的开放性问题。我们使用内容分析进行编码并生成主题，然后根据卫生服务利用行为模型进行组织。
结果
在我们的多变量逻辑回归中，全职和兼职工作、65岁以上、有固定的初级保健医生或较少的糖尿病症状是导致流失行为的因素。参与者给出的退出该项目的最常见原因是他们的工作时间表与中心的运营时间冲突、患者对自己管理糖尿病的知识和能力的信心、对糖尿病教育的冷漠、到中心的距离、健忘、定期看医生、对糖尿病严重性的低认知以及对中心及其服务缺乏熟悉度。我们的定量和定性结果之间存在相当大的重叠。
结论
减少流失行为需要一系列策略，包括提供方便和可及的服务、使个体熟悉这些服务、加强中心与患者之间的沟通以及在中心与初级保健医生之间建立更好的伙伴关系。
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