A Psychological Exploration of Factors Which Affect the Uptake and Retention of Diabetes Prevention Programmes

Aims: The overall aims of this thesis are to investigate which factors are associated with higher uptake and retention of Diabetes Prevention Programmes (DPPs), and also to examine the role of modifiable psychological factors in predicting uptake and completion of the NHSDPP in England. This includes a qualitative exploration of influences on attendance and completion for a DPP in Southwark.

Methods: This thesis consists of: (i) a systematic review identifying recruitment strategies associated with high uptake and behaviour change techniques (BCTs) associated with high levels of retention in group-based DPPs; (ii) two qualitative studies which explore key influences on whether or not participants from ethnically diverse backgrounds attend and complete a DPP in a socioeconomically deprived area; and (iii) a quantitative study investigating whether psychological variables predict uptake and/or completion of a DPP, independent from other possible non-modifiable factors.

Results: Regarding attendance, a range of recruitment strategies were used making it difficult to discern associations with uptake rates. Qualitative data found how understanding type 2 diabetes, making lifestyle changes, comparisons with others, having support and self-perceptions can affect motivations to attend, with accessibility and practicalities influencing both motivation and attendance. The quantitative study identified how illness perceptions, mental wellbeing, age and deprivation were significant predictors of uptake. Regarding completion, programmes with high retention were more likely to have specific BCTs, such as problem-solving. Qualitative data found that DPP completion was related to beliefs relating to illness threat, programme perceptions, influence from family and friends, lifestyle changes, and practicalities, in addition to motivation and communication issues. The quantitative study identified how those with higher self-efficacy, who were younger and/or from a specific area (West Yorkshire) were less likely to complete a DPP.

Conclusions: The findings have identified a range of different influences on attendance and completion of a DPP. Understanding these various influences when organising and delivering sessions will contribute towards maximising response, uptake and retention rates, thus improving programme viability.