Which patients participate in DSME, what are the reasons for nonparticipation, and how do participants rate DSME training? - data from a nationwide survey

Solveig Weise, Jens Baumert, Christin Heidemann, Yong Du, Thomas Frese, Marcus Heise

Keywords: diabetes self-management education; population-based study; cross-sectional study; reasons to decline patient education

Background:

Population-based studies on reasons for non-participation in diabetes self-management education (DSME) are scarce in the literature.

Research questions:

1) What socio-demographic and disease-related factors are associated with participation in DSME? 2) What are the reasons contributing to the decision to decline participation in DSME?

Method:

We conducted an analysis using data from the “Disease knowledge and information needs – Diabetes mellitus 2017” survey, a nationwide population-based survey. 1396 participants reported having diabetes mellitus (DM) in the last 12 months. Of these, 394 had never attended DSME, while 1002 had participated in a DSME at some point. To address the research questions, we performed weighted logistic or multinominal regression analyses, using both bivariate and multivariable approaches. Furthermore, we considered beliefs and information about diabetes of participants as well as socioeconomic variables as confounding variables, using subscales from the Risk Perception Survey-Diabetes Mellitus, the IPQ-R , and the DAWN-2 questionnaire.

Results:

Study participants were significantly more likely to attend DSME if they had a medium to high level of education versus low educational level(OR 1.82 [95% 1.21-2.73], OR 2.04 [95%CI 1.30-3.21], respectively), had type 1 DM versus type 2 DM (OR 2.46 [95% 1.24-4.90]), and insulin treatment compared with non-insulin treatment (OR 1.96 [95%CI 1.33-2.90]). Study participants were significantly less likely to attend DSME if they lived in eastern Germany (OR 0.57 [95% CI 0.39-0.83]), did not agree that DM was a lifelong disease (OR 0.30 [95% CI 0.15 -0.62]), had never been encouraged by their physician to attend a DSME (OR 0.19 [95% CI 0.13 -0.27]).. The main reasons for not attending DSME was a lack of information or advice (48.6%), followed by personal perception that DSME was not necessary (26.6%).

Conclusions:

General practitioners (GPs) should be aware of their important role in informing, encouraging and referring patients to DSME.

Points for discussion:

How can the uptake of DSME be improved?

How would you design a "marketing campaign" for DSME as a preventive and potentially disease-modfying intervention?

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