medwireNews: Focusing efforts on convincing people to return after the first session of the US National Diabetes Prevention Program (DPP) lifestyle change program, and after the transition to less frequent sessions, may help to optimize program retention, say researchers.
Michael Cannon (Centers for Disease Control and Prevention, Atlanta, Georgia, USA) and colleagues found these to be the points at which people were particularly likely to drop out. Immediately after the first session the dropout rate was approximately 4.5% and at weeks 17 and 18, “where session frequency typically transitions from weekly to monthly,” the rates were approximately 5% and 3.5%, respectively.
This contrasted with a background weekly attrition rate of no more than 2% over the 44 weeks of the program.
The researchers note that dropouts after week 1 “may be related to a misunderstanding of program expectations,” and point to evidence for the success of a “session zero” or pre-session, which sets up participant expectations and examines barriers to attendance.
Regarding attrition when sessions reduce to monthly, they say: “Anecdotally, some programs have recognized this issue and made the transition more gradual by moving to bimonthly sessions before eventually extending to monthly sessions.
“Future research may help to determine what leads participants to drop out of the program at these points, as well as identify new approaches to limit this attrition.”
The findings are based on data from 41,203 people who enrolled in the DPP between 2012 and 2017. They were an average age of 56.8 years with an average BMI of 35.2 kg/m2, and the majority were female (80%) and non-Hispanic White (54.6%).
Participant characteristics also influenced the likelihood of them remaining in the program, the team reports. Specifically, significantly more older than younger people were retained at week 18 (67.7 vs 45.9% for ≥65 vs 18–29 years), as were significantly more non-Hispanic White than Non-Hispanic Black or Hispanic people (70.5 vs 60.5 and 52.6%, respectively).
Men and women were equally likely to remain on the program, but people were more likely to persist if they achieved weight loss and increased their physical activity while on the program. In all, 78.4% of participants lost weight on the program.
Cannon and team say that “although retention needs improvement” the median retention was 28 weeks, meaning that half the participants persisted for a duration that “previous studies have shown is sufficient time to achieve program goals related to weight loss and physical activity.”
The researchers now “plan to focus on these high-impact opportunities” – after the first week and at the switch to monthly sessions – “in order to develop strategies for improved retention, thus increasing the number of individuals who prevent or delay the development of type 2 diabetes.”
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