Factors influencing participation in a vascular disease prevention lifestyle program among participants in a cluster randomized trial

Abstract

BackgroundPrevious research suggests that lifestyle intervention for the prevention of diabetes and cardiovascular disease (CVD) are effective, however little is known about factors affecting participation in such programs. This study aims to explore factors influencing levels of participation in a lifestyle modification program conducted as part of a cluster randomized controlled trial of CVD prevention in primary care.MethodsThis concurrent mixed methods study used data from the intervention arm of a cluster RCT which recruited 30 practices through two rural and three urban primary care organizations. Practices were randomly allocated to intervention (n = 16) and control (n = 14) groups. In each practice up to 160 eligible patients aged between 40 and 64 years old, were invited to participate. Intervention practice staff were trained in lifestyle assessment and counseling and referred high risk patients to a lifestyle modification program (LMP) consisting of two individual and six group sessions over a nine month period. Data included a patient survey, clinical audit, practice survey on capacity for preventive care, referral and attendance records at the LMP and qualitative interviews with Intervention Officers facilitating the LMP. Multi-level logistic regression modelling was used to examine independent predictors of attendance at the LMP, supplemented with qualitative data from interviews with Intervention Officers facilitating the program.ResultsA total of 197 individuals were referred to the LMP (63% of those eligible). Over a third of patients (36.5%) referred to the LMP did not attend any sessions, with 59.4% attending at least half of the planned sessions. The only independent predictors of attendance at the program were employment status - not working (OR: 2.39 95% CI 1.15-4.94) and having high psychological distress (OR: 2.17 95% CI: 1.10-4.30). Qualitative data revealed that physical access to the program was a barrier, while GP/practice endorsement of the program and flexibility in program delivery facilitated attendance.ConclusionBarriers to attendance at a LMP for CVD prevention related mainly to external factors including work commitments and poor physical access to the programs rather than an individuals’ health risk profile or readiness to change. Improving physical access and offering flexibility in program delivery may enhance future attendance. Finally, associations between psychological distress and attendance rates warrant further investigation.Trial registrationACTRN12607000423415

Patient perspectives on factors associated with enrollment and retention in chronic disease self-management programs: a systematic review

“…23,26,27 However, researchers argue that understanding reasons for patients choosing to enroll/not enroll and participate in self-management can be determined by exploring patient attitudes and beliefs on factors that affect recruitment and retention. 28,29 Existing research exploring reasons for low enrollment and high attrition in chronic disease self-management programs has primarily focused on quantitative measures 30,31 to draw conclusions based on associations between patients' demographic factors, patient/provider time spent participating in self-management programs, and using patient feedback at follow-up. Verevkina et al 30 found that low baseline self-efficacy to self-manage chronic disease, younger patient age, and weekday program sessions were significantly associated with high patient attrition from chronic disease self-management programs.…”

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“…The redesign incorporated facilitators to enrollment in self-management support programs such as endorsement by health care providers, encouragement, and support by program facilitator to enroll in the program, and information provision on the purpose of the program. [8][9][10][11] As well, the program is available at no cost and is available on-line and at various locations within the region, minimizing some barriers to enrollment.…”

“…In a study of factors associated with participation in a lifestyle program for the prevention of cardiovascular disease, unemployment status was one factor associated with higher patient enrollment in the program. 9 Information on employment status was not collected for this study. Therefore, nonworking status associated with age cannot be confirmed.…”

“…Research studies examining factors associated with the enrollment in self-management programs have reported enrollment rates ranging from 22.8% 8 to as high as 59.6%. 9 Factors associated with attendance include having better physical health, social support, older age, a non-working status, program endorsement by health care providers, encouragement from program facilitators to attend, and patient perception of low self-management support from their primary care provider. [8][9][10][11] Conversely, barriers to attendance include lower income, challenges with access (transportation, scheduling, and cost), beliefs that current health care services are sufficient or the disease was not severe enough, and lack of knowledge about the purpose and structure of the program.…”

“…People are more likely to attend a CDSM program if they receive support and encouragement to do so and they perceive the potential benefits of the program. [8][9][10][11] Human Subject Protections According to the policy activities that constitute research at the local research institutes, this project met criteria for operational improvement activities exempt from ethics review. Usual clinical practices to obtain consent and protect privacy were implemented.…”