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Recruitment and retention in a 10-month social network-based intervention promoting diabetes self-management in socioeconomically deprived patients: a qualitative process evaluation
  1. Charlotte Vissenberg1,
  2. Vera Nierkens1,
  3. Paul J M Uitewaal2,
  4. Barend J C Middelkoop3,
  5. Karien Stronks1
  1. 1 Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  2. 2 Department of Public Health, The Hague's Public Health, The Hague, The Netherlands
  3. 3 Department of Public Health, Leiden University Medical Centre, Leiden, The Netherlands
  1. Correspondence to Ms Charlotte Vissenberg; c.vissenberg{at}


Objectives Socioeconomically deprived patients with type 2 diabetes often face challenges with self-management, resulting in more diabetes-related complications. However, these groups are often under-represented in self-management interventions. Evidence on effective recruitment and retention strategies is growing, but lacking for intensive self-management interventions. This study aims to explore recruitment, retention and effective intervention strategies in a 10-month group-based intervention among Dutch, Moroccan, Turkish and Surinamese patients from socioeconomically deprived neighbourhoods.

Methods Participants were recruited through general practitioners (GPs) and participated in a 10-month social network-based intervention (10 groups, n=69): Powerful Together with Diabetes. This intervention also targeted the significant others of participants and aimed to increase social support for self-management and to decrease social influences hindering self-management. A qualitative process evaluation was conducted. Retention was measured using log books kept by group leaders. Further, we conducted 17 in-depth interviews with participants (multiethnic sample) and 18 with group leaders. Interviews were transcribed, coded and analysed using framework analyses.

Results The GP's letter and reminder calls, an informational meeting and the intervention's informal nature facilitated recruitment. During the first months, positive group atmosphere, the intervention's perceived usefulness, opportunities to socialise and a reduction in practical barriers facilitated retention. After the first months, conflicting responsibilities and changes in the intervention's nature and planning hindered retention. Calls from group leaders and the prospect of a diploma helped participants overcome these barriers.

Conclusion To promote retention in lengthy self-management interventions, it seems important that patients feel they are going on an outing to a social gathering that is enjoyable, recreational, useful and easy to attend. However, rewards and intensive personal recruitment and retention strategies remained necessary throughout the entire intervention period.

Trial registration number Dutch Trial Register NTR1886; Results.

  • recruitment
  • retention
  • low socioeconomic groups
  • type 2 diabetes

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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  • Contributors CV coordinated the study, developed the intervention, constructed the design and drafted the manuscript. VN developed the study, constructed the design and revised the manuscript. PJMU and BJCM participated in the design of the study and revised the manuscript. KS developed the study, constructed the design and revised the manuscript.

  • Funding This work was supported by the Netherlands Organisation for Health Research and Development (ZonMw) (project number ZonMw 76500003).

  • Competing interests None declared.

  • Ethics approval Medical Ethics Committee of the Academic Medical Center (AMC) in Amsterdam, the Netherlands.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data.

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