Retention in group-based diabetes care programs: a multiple-case study design
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ORIGINAL ARTICLE
Retention in group-based diabetes care programs: a multiple-case study design Ahlam Awata 1 & Alexandra Dzubina 1 & Christiana Correa e Castro Martine 2 & Upasana Saha 2 & Arrani Senthinathan 2 & Husayn Marani 2 & Andrea Duncan 2 Received: 2 June 2020 / Accepted: 22 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Aim Group-based programs have the potential to help patients manage their diabetes and prevent complications. However, participant retention has been identified as one of the major issues hampering these programs. Previous empirical studies have identified factors related to retention, such as age and body mass index. However, there has been little investigation on the factors that contribute to retention in group-based diabetes programs. This study explored the perspectives of diabetes program educators on the factors that lead to participant retention in group-based diabetes programs. Methods A qualitative multiple case study design was employed to understand retention factors across six purposefully selected group-based diabetes programs. Diabetes educators participated in a one-time, in-depth, semi-structured phone interview. Data was analyzed inductively using within and cross-case thematic analysis. Results Four major themes were identified that impact retention in these programs, including individual factors, logistical factors, social factors, and program factors. Conclusion The findings of this study shed insight on the factors impacting participant retention across group-based diabetes programs. These findings have the potential to inform diabetes educators on how to improve retention in ongoing or future diabetes programs. Keywords Retention . Diabetes . Diabetes education . Group-based programs . Symptom management . Retention factors
Approximately 90% to 95% of individuals with diabetes have type 2 diabetes (Government of Canada n.d.), which can result in physical health complications, including stroke, cardiovascular disease, blindness, nerve damage, and increased mortality, which imposes a significant financial burden on the health system (Diabetes Canada 2016). There are a variety of groupbased approaches for those at risk of developing or already diagnosed with diabetes; including lifestyle modifications that address exercise, diet, or stress management (Sumamo et al.
* Andrea Duncan [email protected] 1
Department of Occupational Science and Occupational Therapy, University of Toronto, 160-500 University Ave, Toronto, Ontario M5G 1V7, Canada
2
Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, ON M5T 3M6, Canada
2011) or educational approaches, where participants gain knowledge and skills related to diabetes prevention and management (van der Ven 2003). Completion of these programs has been associated with a lower incidence of diabetes (van der Ven 2003), decreased body mass index (BMI) and cholesterol levels (Gilis-Januszewska et al. 2011; Kramer et al. 2009)
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