Exploration of Barriers to Diabetes Education

Background: The prevalence of diabetes continues to increase annually, with the estimated prevalence of diabetes escalating to 54.9 million Americans by 2030. Diabetes can lead to a variety of health complications, which may lead to increased health care costs. Diabetes Self-Management Education and Support (DSMES) decreases the risk of complications resulting in reduced healthcare costs by an estimated annual sum of $830 less than those who haven't attended DSMES. However, DSMES is not widely attended, with about 7% of private insurance holders and 4% of Medicare holders having attended DSMES. Methods: In this quality improvement project, individuals who were referred and scheduled for DSMES but did not attend were contacted by phone or email to assess attendance barriers and facilitators to overcoming the barriers through a 3 question survey. Results were recorded in an electronic data capture site, and analyzed. Resources of the University of Utah Health System were reviewed, including community clinics and telemedicine. Recommendations were compiled and presented at a Driving Out Diabetes Initiative meeting.Results: Of those referred and scheduled (N=369) to attend the Diabetes One-Day Education and Care Program, 37% (N=121) did not attend (last-minute cancellation or no show). Of the 121 non-attendees, two individuals were deceased, and contacted responses were obtained from 66 individuals. The average age of the participant sample was 54, average diabetes duration of 12 years, largely white/Caucasian, equally male and female, and mostly working full-time. The most common barrier was work conflict (N=16, 24.2%). The most common intervention for overcoming barriers was a shorter program (N=19, 29.7%). The most common facilitator to attend class was nothing (N=34, 54%). Hemoglobin a1c was not associated with the group who didn't want or feel they needed DSMES, and 42.9% of that group had a hemoglobin a1c less than 7. Participants were given the opportunity to reschedule, and 25% requested to reschedule. Conclusion: Attending DSMES can be difficult due to the everyday barriers people face. Abbreviating the program to a shorter, half-day program may make the program easier to attend, and would require taking less time off work. Evening and weekend classes would also address the work conflict barrier. The use of telemedicine can address the travel/transportation barrier as well as other health issues, particularly for homebound individuals. Identification of those who didn't want or feel like they needed DSMES with hemoglobin a1c less than 7 suggests that individuals who don't want or feel they need DSMES may not need it.