Attrition and Retention in Multidisciplinary Weight Management Interventions for Adults with Obesity: A Systematic Review

Background High rates of attrition undermine the success of weight management interventions (WMIs), but a comprehensive understanding of the factors that increase dropout risk remains absent. This is partly explained by heterogeneity of intervention design, and the absence of a universal definition of attrition. This systematic review aimed to identify the factors related to- and predictive of attrition and retention in multidisciplinary WMIs for adults with obesity. Methods The systematic literature search, conducted in Cochrane, Medline, PsycInfo, and Scopus, aimed to identify original research articles published between February 2008 and December 2019. Articles investigating attrition or retention in multidisciplinary WMIs were eligible for inclusion if interventions were for adults (≥18) with obesity identified by body mass index ≥30kg/M2 and lasted ≥6 months. Multidisciplinary was defined as ≥2 interventionist disciplines or professions, for the purpose of this review. Data was synthesised narratively. Results The literature search resulted in seventeen studies which satisfied the inclusion criteria. Attrition rates ranged from 10% at 3-months to 81% at 3-years. The sociodemographic factors associated with reduced risk of attrition included older age, living in less deprived areas, higher levels of education, and female gender. Poor mental health, low social support, high weight loss goals and poor or unsatisfactory results may increase the likelihood of participant dropout, but evidence was limited and inconclusive because of different methodologies, and only a small number of studies investigating some of the variables. Conclusions The scope for targeted retention strategies is limited because few variables were consistently associated with attrition. Until a comprehensive understanding of attrition emerges, WMIs should seek to reduce social inequities in the benefit of WMI provision. Future research should consider factors reported qualitatively, such as intervention expectations and satisfaction, social support, patient-clinician relationships, and logistical barriers. Adopting a universal definition of attrition and de-homogenising participant dropouts would advance future research. As qualitative evidence is limited, exploring participant experiences of WMIs would help understand how attrition rates can be reduced, and in-turn improve WMI effectiveness.

Seeking elsewhere: a systematic review of literature surrounding attrition and retention of female architects in the profession post-registration

PurposeThe purpose of this study is to provide a global snapshot of the current state of knowledge regarding attrition rates of women architects. The intended audience includes all the stakeholders of the profession, as well as those interested in professional attrition studies, with the aim to contribute to a social debate, which places increasing value on diversity, equal representation and retention in this field.Design/methodology/approachThis paper has utilized the structured analytical technique of a systematic review of the scholarship involving scholarship published over two decades between the years 2000 and 2020. Having selected research on this topic following a series of exclusionary and inclusionary criteria for relevancy and accuracy, this select research has been categorically and thoroughly analyzed using this technique.FindingsThis literature review identifies four main recurring themes among the literature, which address this research question, including: (1). cross-national differences and similarities; (2) demotivating factors leading to attrition; (3) graduate/architect terminology, which blurs the distinction between participants in architecture; and (4) implications of female architects as represented in professional publications and the “reward system.” Consequently, this literature review finds that to date no singular cause can be pinpointed as the sole cause of women's attrition, but rather a series of complex and intertwining factors, some of them specific to the profession.Originality/valueThis paper suggests areas for further study into the reduction of attrition rates of registered women in this discipline, with an emphasis that further research may expand to focus rather on positive aspects of the profession resulting in areas of retention, which has been of little focus in current research. Additionally, these findings make suggestions toward a series of recommendations that may assist in framing the industry toward more positive and equitable career and industry trajectories.

Students’ Non-Cognitive Profiles and their Relationships with Academic Stress and Persistence in Higher Education

To reduce their attrition rates, institutions need to ensure that their students can manage the stressors they confront in their academic work and persist to complete their study programs. Given the significance of non-cognitive attributes in education, this study aimed to identify the non-cognitive profiles exhibited by students which related significantly to academic stress and persistence levels in the middle of a given academic year. Undergraduate students from one of the largest private higher education institutions in Singapore participated in two online surveys. A total of 565 and 122 students participated in the first and second surveys, respectively. Results indicated that three distinct non-cognitive profiles could be identified, which were associated significantly with students’ academic stress levels and their intentions to persist with their studies. Possible implications for enhancing student outcomes by offering students with opportunities to enhance their affective ‘readiness’ profiles are discussed.

Attrition of Police Officers With Immigrant Background

Recruiting police officers with immigrant backgrounds has a limited effect if many of these recruits leave the police service. The dropout and attrition rates among officers with immigrant backgrounds are also an important indicator of the challenges this group faces when joining the police profession. We investigated police education dropout patterns and attrition rates among police students and officers with immigrant backgrounds. Our study is based on detailed longitudinal data with total coverage of the population, which were previously unavailable for police career studies. Using logistic regression and coarsened exact matching, we analysed administrative registry data covering all individuals admitted to the Norwegian police university college (1995–2010, N = 6570) and all police-educated staff employed in the Norwegian police (1995–2014, N = 7001). Students and police officers with non-Western immigrant backgrounds have a greater tendency to both dropout of education and leave the police service. Prior academic performance can only partly explain these higher educational dropout rates. Female and males with non-Western immigrant backgrounds have similar dropout patterns. Our results provide a rationale for developing policy aimed at not only recruiting, but also retaining police officers with immigrant backgrounds.

Understanding Healthcare Students’ Experiences of Racial Bias: A Narrative Review of the Role of Implicit Bias and Potential Interventions in Educational Settings

Implicit racial bias is a persistent and pervasive challenge within healthcare education and training settings. A recent systematic review reported that 84% of included studies (31 out of 37) showed evidence of slight to strong pro-white or light skin tone bias amongst healthcare students and professionals. However, there remains a need to improve understanding about its impact on healthcare students and how they can be better supported. This narrative review provides an overview of current evidence regarding the role of implicit racial bias within healthcare education, considering trends, factors that contribute to bias, and possible interventions. Current evidence suggests that biases held by students remain consistent and may increase during healthcare education. Sources that contribute to the formation and maintenance of implicit racial bias include peers, educators, the curriculum, and placements within healthcare settings. Experiences of implicit racial bias can lead to psychosomatic symptoms, high attrition rates, and reduced diversity within the healthcare workforce. Interventions to address implicit racial bias include an organizational commitment to reducing bias in hiring, retention, and promotion processes, and by addressing misrepresentation of race in the curriculum. We conclude that future research should identify, discuss, and critically reflect on how implicit racial biases are enacted and sustained through the hidden curriculum and can have detrimental consequences for racial and ethnic minority healthcare students.

How Much Is the Lack of Retention Evidence Costing Trial Teams in Ireland and the United Kingdom?

BackgroundEvidence to support the use of many retention strategies in clinical trials is lacking. Despite this, trial teams still need to have some form of retention strategy in their trials to try and avoid high attrition rates. This study aimed to estimate how much this lack of retention evidence might be costing trials in Ireland and the United Kingdom.Methods We selected the top ten most routinely used retention strategies by Clinical Trial Units in the United Kingdom and made assumptions as to how each of these strategies was most likely to be conducted and the costs involved. We applied our costing model to a hypothetical trial scenario in both Ireland and the United Kingdom as well as to three published trial protocols. We developed the costing model and calculated the costs in Microsoft Excel.Results Retention strategies can be extremely expensive, some of the costliest interventions included “a timeline of participant visits for sites” (with integrated participant reminders) (€1,418.44 - €108,471.99), “routine site visits by CTU staff” (€777.67 - €14,753.48), and “data collection scheduled with routine care” (€900 - €32,503.25). Others such as “telephone reminders for questionnaire response” (€34.58 - €568.62), “inclusion of pre-paid envelopes” (€93.44 - €942.50), and “targeted recruitment of sites/GPs” (€30 - €1,620) were less costly compared to the other interventions. DiscussionThe resources invested in the use of some retention interventions may outweigh known or imagined benefits on retention. Where benefits are imagined, evaluation should be a priority. Conclusion More evaluation of the effectiveness and cost of trial retention strategies is needed to avoid widespread use of strategies that are both expensive and ineffective.

Kuakini HHP Center for Translational Research on Aging: Aims and Preliminary Findings

Kuakini Medical Center (Kuakini) is creating an interdisciplinary Hawai’i-based Center for translational research on aging. This Center will build upon Kuakini’s five-decades of NIH-funded research, its 420,000-specimen biorepository, and existing strengths in aging research, notably, the 56-year ongoing Kuakini Honolulu Heart Program cohort study (Kuakini HHP), Kuakini Honolulu-Asia Aging Study (Kuakini HAAS), and Kuakini HHP Offspring Study. The overall goal is to find practical means to enhance healthy human lifespan (healthspan). Four research project leaders (RPLs) have been selected from various disciplines for mentorship in translational aging research. The first RPL presentation will introduce a novel mouse model, enabling controlled expression of the pro-longevity gene FoxO3, and assess the impact on lifespan and healthspan phenotypes in mice. These phenotypes will be compared to similar phenotypes in humans with/without the FOXO3 longevity genotype. The second RPL presentation will assess the relation between leukocyte telomere attrition rates (from banked blood collected at three time points over 20-plus years) in older Kuakini HHP men with/without the FOXO3 longevity genotype. The third RPL presentation will assess whether FOXO3 genotype, peripheral leukocyte telomere dynamics (attrition rate, telomerase activity) and inflammatory cytokines mediate the human brain integrity and function with age. This project will utilize structural and functional MRI data from male and female Kuakini HHP Offspring Study participants. The fourth RPL presentation will assess whether APOE e2, e4, and FOXO3 longevity-associated alleles impact 34-year incidence of intracerebral hemorrhage. We will summarize the findings, address the healthspan implications and provide future directions. Supported by NIH 5P20GM125526.

Digital Therapeutic Care and Decision Support Interventions for People With Low Back Pain: Systematic Review

Background Low back pain (LBP) is the leading cause of worldwide years lost because of disability, with a tremendous economic burden for health care systems. Digital therapeutic care (DTC) programs provide a scalable, universally accessible, and low-cost approach to the multidisciplinary treatment of LBP. Moreover, novel decision support interventions such as personalized feedback messages, push notifications, and data-driven activity recommendations amplify DTC by guiding the user through the program while aiming to increase overall engagement and sustainable behavior change. Objective This systematic review aims to synthesize recent scientific literature on the impact of DTC apps for people with LBP and outline the implementation of add-on decision support interventions, including their effect on user retention and attrition rates. Methods We searched bibliographic databases, including MEDLINE, Cochrane Library, Web of Science, and the Physiotherapy Evidence Database, from March 1, 2016, to October 15, 2020, in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and conducted this review based on related previously published systematic reviews. Besides randomized controlled trials (RCTs), we also included study designs with the evidence level of at least a retrospective comparative study. This enables the consideration of real-world user-generated data and provides information regarding the adoption and effectiveness of DTC apps in a real-life setting. For the appraisal of the risk of bias, we used the Risk of Bias 2 Tool and the Risk of Bias in Non-Randomized Studies of Interventions Tool for the RCTs and nonrandomized trials, respectively. The included studies were narratively synthesized regarding primary and secondary outcome measures, DTC components, applied decision support interventions, user retention, and attrition rates. Results We retrieved 1388 citations, of which 12 studies are included in this review. Of the 12 studies, 6 (50%) were RCTs and 6 (50%) were nonrandomized trials. In all included studies, lower pain levels and increased functionality compared with baseline values were observed in the DTC intervention group. A between-group comparison revealed significant improvements in pain and functionality levels in 67% (4/6) of the RCTs. The study population was mostly homogeneous, with predominantly female, young to middle-aged participants of normal to moderate weight. The methodological quality assessment revealed moderate to high risks of biases, especially in the nonrandomized trials. Conclusions This systematic review demonstrates the benefits of DTC for people with LBP. There is also evidence that decision support interventions benefit overall engagement with the app and increase participants’ ability to self-manage their recovery process. Finally, including retrospective evaluation studies of real-world user-generated data in future systematic reviews of digital health intervention trials can reveal new insights into the benefits, challenges, and real-life adoption of DTC programs.

Pushing 'pause' on video evidence: An analysis of the proposed amendments to s 106 of the Evidence Act 2006

<p>This paper assesses the ramifications of the Cabinet Social Policy Committees proposals contained in the paper Amendments to the Evidence Act 2006. The Committee proposed a change to s 106 of the Evidence Act, which currently lies in favour of full disclosure of video evidence to the defence. The proposed amendments will reverse this presumption, ultimately restricting the defence’s access to the complainants video evidence. This paper will assess the validity and practicality of these proposed amendments, by assessing whether they are consistent with the New Zealand Bill of Rights Act, the equality of arms doctrine and international case law. Although the proposed amendments were made to protect vulnerable complainants, attrition rates in New Zealand show that vulnerable witnesses do not drop out of the criminal justice system just because they are fearful about their video evidence being disclosed. The attrition rates are more complex. However, this paper argues that there are still adequate safeguards in place to protect the defence’s right to a fair trial. Whilst these safeguards holdfast, any effort to protect vulnerable victims should be encouraged.</p>

Pushing 'pause' on video evidence: An analysis of the proposed amendments to s 106 of the Evidence Act 2006

<p>This paper assesses the ramifications of the Cabinet Social Policy Committees proposals contained in the paper Amendments to the Evidence Act 2006. The Committee proposed a change to s 106 of the Evidence Act, which currently lies in favour of full disclosure of video evidence to the defence. The proposed amendments will reverse this presumption, ultimately restricting the defence’s access to the complainants video evidence. This paper will assess the validity and practicality of these proposed amendments, by assessing whether they are consistent with the New Zealand Bill of Rights Act, the equality of arms doctrine and international case law. Although the proposed amendments were made to protect vulnerable complainants, attrition rates in New Zealand show that vulnerable witnesses do not drop out of the criminal justice system just because they are fearful about their video evidence being disclosed. The attrition rates are more complex. However, this paper argues that there are still adequate safeguards in place to protect the defence’s right to a fair trial. Whilst these safeguards holdfast, any effort to protect vulnerable victims should be encouraged.</p>