Patients with diabetes cite a variety of complex reasons why they cannot or will not attend a diabetes education program, including logistical, financial and medical reasons, but also emotional and cultural issues, according to a recent analysis of surveys and studies.

“Marketing is not a skill typically associated with health care professionals or health care services, but diabetes education could be seen as a product which would benefit from an effective marketing campaign,” the researchers wrote. “Too many people are simply rejecting educational opportunities without fully understanding what is involved and what they might gain from attending.”

In a systematic analysis, researchers reviewed 12 studies conducted between 2005 and 2015 focusing on patient-reported reasons for nonattendance at structured diabetes education (five qualitative studies; seven surveys). Included studies were published in the United Kingdom (n = 3), the United States (n = 3), Pakistan (n = 1), Canada (n = 2), Germany (n = 2) and India (n = 1), with a total sample size of 2,260 people who provided specific reasons for not attending diabetes education. Education programs were offered primarily to patients with type 2 diabetes; four studies included programs for patients with type 1 diabetes and prediabetes.

Of the eight studies reporting sex, 80% of nonattenders were men. Across all studies, researchers identified 36 reasons for nonattendance. Researchers identified two broad categories of nonattender: those who could not attend for logistical, medical or financial reasons (timing, costs or existing comorbidities), and those who would not attend because they perceived no benefit from doing so, felt they had sufficient knowledge already or had emotional and cultural reasons.

“The need for diabetes education to be curriculum-centered rather than patient-centered and for it usually to be commissioned and delivered in group settings promotes quality and efficiency, but mitigates against flexibility with regard to patient circumstances and needs,” the researchers wrote. – by Regina Schaffer