Recruitment to groups (see columns 1 and 2 in the table below)
Sometimes, situational barriers prevent people from attending programs, such as prior commitments or lack of transport. However, often there are avoidable factors that result in a patient choosing not to attend because of low motivation. Common patterns of thinking, which become barriers, include:
- Denial of the seriousness of cardiac disease – ‘My heart isn’t that bad; I don’t need to come’
- Not seeing how the program will benefit them –‘I wouldn’t enjoy talking to/exercising with a bunch of other patients’, ‘Turning up to that program won’t help me’
- A negative expectation of the program – ‘They will make me do some really hard exercise’
Retention of participants (see column 3 in the table below)
If participants are not staying in the program, it could mean they do not perceive any benefits of attending, or that the program itself is not enjoyable. Clinicians can gain feedback about the participants’ experience to identify any factors affecting the drop off rate. It may be useful to contact participants who drop out of programs to find out why they have done so.
Evaluation and sustainability of outcomes (see column 4 in the table below)
Clinicians commonly find that participants do not continue to engage in the relevant behaviours or skills once the program has finished. This could reflect a lack of emphasis on supporting self-regulation and maintenance after completion of the program. Clinicians should ensure that participants have the skills to continue with what they have learned after the program. Some clinicians invite participants in the final session to create a ‘survival kit’ containing individualised tips for them to get back on track if their new lifestyle and treatment habits taper off at any stage.
Table 1: Questions to consider asking to help improve participant involvement
|Engaging Referring Clinicians
|Recruitment of Participants
|Retention of Participants
|Evaluation & Sustainability of Outcomes
|Who are your referral sources?
|What do you want to enrol in your program and are they registering?
|Are participants staying until the end of the program?
|Does the program have a component on maintaining skills?
|What knowledge do patients need to have about the program?
|What’s in it for the patient? Do they understand the benefits?
|What is the percentage who complete the program?
|Are patients continuing with behaviour changes after the program?
|How can you communicate the benefits of your program to referring clinicians and services so that they refer effectively?
|What is affecting the enrolment rate? What can be done about this?
|What is affecting the drop out rate? What can be done about this?
|Are you collecting follow-up data on participant outcomes? If so, what type (motivational, psychosocial, behavioural, physiological) and over what timeframe?
|Have you asked referral sources why they have/haven’t referred patients to your program? Are you providing feedback on patients that have enrolled/attended?
|Have you asked patients why they did/didn’t enrol in the program?
|Have you collected participant feedback on the program?
|What other resources can participants access to aid self-regulation after your program?
©2012 HCA. Reproduced with permission from Health Change Australia (from training materials)