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.
Get full access to this article
View all access options for this article.
References
1.
PeekMECargillAHuangES. Diabetes health disparities: a systematic review of health care interventions. Med Care Res Rev. 2007;64(5):101S-156S.
2.
GucciardiEDemeloMOffenheimAStewartDE. Factors contributing to attrition behavior in diabetes self-management programs: a mixed method approach. BMC Health Services Research. 2008;8:33.
3.
KawaharaRAmemiyaTYoshinoMMiyamaeMSasamotoKOmoriY. Dropout of young non-insulin-dependent diabetics from diabetic care. Diabetes Res Clin Pract. 1994;24(3):181-185.
LantingLCJoungIMMackenbackJPLambertsSWBootsmaAH. Ethnic differences in mortality, end-stage complications, and quality of care among diabetic patients: a review. Diabetes Care. 2005;28(9):2280-2288.
6.
GuKCowieCCHarrisMI. Mortality in adults with and without diabetes in a national cohort of the US population, 1971-1993. Diabetes Care. 1998;21(7):1138-1145.
7.
HarrisELShermanSHGeorgopoulosA. Black-white differences in risk of developing retinopathy among individuals with type 2 diabetes. Diabetes Care. 1999;22(5):779-783.
8.
BondsDEZaccaroDJKarterAJSelbyJVSaadMGoffDCJr.Ethnic and racial differences in diabetes care: the Insulin Resistance Atherosclerosis Study. Diabetes Care. 2003; 26(4):1040-1046.
YoungBAMaynardCBoykoEJ. Racial differences in diabetic nephropathy, cardiovascular disease, and mortality in a national population of veterans. Diabetes Care. 2003;26(8):2392-2399.
11.
DavisMJAddisME. Predictors of attrition from behavioral medicine treatments. Ann Behav Med. 1999;21(4):339-249.
12.
Toth-CapelliKBrawerRPlumbJDaskalakisC. Stage of change and other predictors of participant retention in a behavioral weight management program in primary care. Health Promot Pract. 2013;14(3):441-450.
13.
Warren-FindlowJProhaskaTRFreedmanD. Challenges and opportunities in recruiting and retaining underrepresented populations into health promotion research. Gerontologist. 2003;43(1):37-46.
14.
DunnMZ. Psychosocial mediators of a walking intervention among African-American women. J. Transcult Nurs. 2008;19(1):40-46.
15.
YanceyAKMcCarthyWJHarrisonGGWongWKSiegelJMLeslieJ. Challenges in improving fitness: results of a community-based, randomized, controlled lifestyle change intervention. J Women’s Health. 2006;15(4):412-429.
16.
LoftinWBarnettSBunnPSullivanP. Recruitment and retention of rural African-Americans in diabetes research: lessons learned. Diabetes Educ. 2005;31:251-259.
17.
Parra-MedinaDD’AntonioASmithSMLevinSKirknerGMayer-DavisE. Randomized weight management trial for people with diabetes living in rural, medically underserved counties of South Carolina: power study. J Am Diet Assoc. 2004;104:70-74.
18.
PeekMEHarmonSAScottSJ. Culturally tailoring patient education and communication skills training to empower African-Americans with diabetes. Behav Med Pract Policy Res. 2002;2(2):2296-2308.
19.
SchillingerDPietteJGrumbachK. Closing the loop: physician communication with diabetic patients who have low health literacy. Arch Intern Med. 2003;163(1):83-90.
20.
MerriamSBCaffarellaRS. Learning in Adulthood: A Comprehensive Guide. San Francisco: Jossey-Bass Publishers; 1999:502.
21.
ShawBAHolmesSBFosterNL. Caregivers’ attitudes toward their family members’ participation in Alzheimer disease research: implications for recruitment and retention. Alzheimer Dis Assoc Disord. 2001;15(3):137-145.
22.
HorowitzCRColsonKAHebertPLLancasterK. Barriers to buying healthy foods for people with diabetes: evidence of environmental disparities. Am J Public Health. 2004;94:1549-1554.
23.
Diez RouxAVEvensonKRMcGinnAP. Availability of recreational resources and physical activity in adults. Am J Public Health. 2007;97:493-499.
24.
HornungCAEleazerGPStrothersHSIII. J Am Geriatric Soc. 1998;46(3):280-286.
RitchieJSpencerL. Qualitative data analysis for applied policy research. In: BrymanABurgessR, eds. Analysing Qualitative Data. London: Routledge; 1993:173-194.
27.
RobinsonKADennisonCRWaymanDMPronovostPJNeedhamDM. Systematic review identifies number of strategies important for retaining study participants. J Clin Epidemiol. 2007;60(8):757-765.
28.
CodayMBoutin-FosterCSherT. Strategies for retaining study participants in behavioral intervention trials: retention experiences of the NIH behavior change consortium. Ann Behav Med. 2005;29:55-65.
29.
CassidyELBairdESheikhJI. Recruitment and retention of elderly patients in clinical trials: issues and strategies. Am J Geriatr Psychiatry. 2001;9(2):136-140.
30.
AtwoodJRHaaseJRees-McGeeS. Reasons related to adherence in community-based field studies. Patient Educ Couns. 1992;19:251-259.
31.
Executive summary: standards of medical care in diabetes—2013. Diabetes Care. 2013;36:S4-S10.
32.
Anderson-LoftinWMoneyhamL. Long-term disease management needs of southern African-Americans with diabetes. Diabetes Educ. 2000;26(5):821-832.
33.
PolonskyWHAndersonBJLohrerPA. Assessment of diabetes-related distress. Diabetes Care. 1995;18(6):754-760.
34.
AndersonRJFreedlandKEClouseRELustmanPJ. The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes Care. 2001;24(6):1069-1078.
35.
CoffmanMJ. Effects of tangible social support and depression on diabetes self-efficacy. J Gerontol Nurs. 2008;34(4):32-39.
36.
RoslandAMKiefferEIsraelB. When is social support important? The association of family support and professional support with specific diabetes self-management behaviors. J Gen Intern Med. 2008;23(12):1992-1999.
37.
TillotsonLMSmithMS. Locus of control, social support, and adherence to the diabetes regiment. Diabetes Educ. 1996;22(2):133-139.
38.
GallantM. The influence of social support on chronic illness self-management: a review and directions for research. Health Educ Behav. 2003;30(2)170-195.
39.
Williams-BrownSBaldwinDMBakosA. Storytelling as a method to teach African American women breast health information. J Cancer Educ. 2002;17(4):227-230.
40.
KreuterMWBuskirkTDHolmesK. What makes cancer survivor stories work? An empirical study among African-American women. J Cancer Surviv. 2008;2(1):33-44.
41.
HoustonTKAllisonJJSussmanM. Culturally appropriate storytelling to improve blood pressure: a randomized trial. Ann Intern Med. 2001;154(2):77-84.
42.
MartinJMMartinEP. Helping Tradition in the Black Family and Community. Silver Spring, MD: National Association of Social Workers; 1995.
43.
HarrellEB. The religious and spiritual values that motivate older African-American women to volunteer in their communities. Dissertation Abstracts International, A: The Humanities and Social Sciences.
44.
RasheedMNRasheedJM. Rural African American older adults and the black helping tradition. J Gerontological Social Work. 2004;41:1-2, 137-150.
45.
Nápoles-SpringerAPérez-StableE. The role of culture and language in determining best practices. J Gen Intern Med. 2001;16(7):493-495.
46.
DunnMZ. Psychosocial mediators of a walking intervention among African-American women. J Transcult Nurs. 2008;19(1):40-46.
47.
BaskinMLGaryLHardyCM. Predictors of retention of African American women in a walking program. Am J Health Behav. 2001;35(1):40-50.
