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Diabet Med. 2009 May;26(5):510-7. doi: 10.1111/j.1464-5491.2009.02713.x.

Individual and contextual factors associated with follow-up use of diabetes self-management education programmes: a multisite prospective analysis.

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School of Nutrition, Ryerson University, 350 Victoria Street, Toronto, ON M5B 2K3, Canada.



Although a considerable body of research supports the efficacy of diabetes self-management education (DSME), these programmes are often challenged by high attrition rates. Little is known about factors influencing follow-up use of DSME services, thus the aim of this study was to identify these factors.


In this multisite prospective analysis, adults with Type 2 diabetes (n = 268) who attended one of two diabetes management centres (DMCs) were followed over a 1-year period from their initial visit. The influence of individual and contextual factors on the number of contacts with DMC providers was examined. Data were analysed within the context of the Health Behavioral Model of Health Services Utilization.


In a multivariable negative binomial regression model, the number of contacts over 1 year was greater for those who were female, non-smokers, unemployed, self-referred to the DMC, lived closer to the DMC, had a lower body mass index, or had a longer known duration of diabetes. Follow-up use of services differed significantly between the two sites. Provider contacts were greater at the centre that offered flexible hours of services and a variety of optional educational modules.


Healthcare professionals need to encourage ongoing use of DSME, particularly for individuals prone to lower follow-up use of these services. Providing services that are accessible, convenient, and can easily fit into patients' schedules may increase follow-up use. Further exploration into how operations and delivery of these services influence utilization patterns is strongly recommended.

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