Reasons for non-attendance nutrition appointment among medically underserved community in Rural Mississippi

Abstract

Objective: This study sought to examine the reasons for nonattendance of nutrition appointments and explore the determinants that contribute to this phenomenon among medically underserved and uninsured individuals.

Methods: A cross-sectional quantitative study was conducted with five sections questionnaires distributed at a healthcare clinic in a rural area in south Mississippi. Participants (n = 346) were surveyed who had attended the clinic for a health appointment. Nutrition appointment attendance, reasons to miss a scheduled nutrition appointment, and effective appointment reminders were evaluated. Descriptive statistics were determined for the variables, Chi square and bivariate correlation tests were used to determine relationships between participants’ demographics, health conditions, and other variables.

Results: About 87% of participants indicated that they had not attended a nutrition appointment and 26.8% indicated that they had missed a nutrition appointment. Most participants specified that forgetfulness (39%) and transportation problems (25%) were the most likely reasons to miss a nutrition appointment. Most indicated that a phone call would be the most effective appointment reminder. About half of participants believed the reason behind missing a nutrition appointment is that their physicians did not place importance on attending such appointment. No significant association or differences were found between the variables.

Conclusion: Findings can be used to improve access to nutrition counseling among underserved patients, and to develop effective appointment reminders to decrease nonattendance rates. Future research is warranted to analyze the effect that nutrition appointments has on individual’s health.

Keywords

Health service / Nutrition care access / Nutrition counseling / Rural health

References

[1] Walker MH, Murimi MW, Kim Y, et al. Multiple point-of-testing nutrition counseling sessions reduce risk factors for chronic disease among older adults. J Nutr Gerontol Geriatr. 2012; 31(2): 146-157. PMid:22607103. https://doi.org/10.1080/21551197.2012.678233

[2] Salameh E, Olsen S, Howard D. Nonattendance with clinic follow-up appointments: Diabetes as exemplar. J Nurse Pract. 2012; 8(10): 797-803. https://doi.org/10.1016/j.nurpra.2012.09.017

[3] Schectman JM, Schorling JB, Voss JD. Appointment adherence and disparities in outcomes among patients with diabetes. J Gen Intern Med. 2008; 23(10): 1685-1687. PMid:18661189. https://doi.org/10.1007/s11606-008-0747-1

[4] Johnson BJ, Mold JW, Pontious JM. Reduction and management of no-shows by family medicine residency practice exemplars. Ann Fam Med. 2007; 5(6): 534-539. PMid:18025491. https://doi.org/10.1370/afm.752

[5] Sharp DJ, Hamilton W. Non-attendance at general practices and outpatient clinics. BMJ. 2001; 323(7321): 1081-1082. https://doi.org/10.1136/bmj.323.7321.1081

[6] Hixon AL, Chapman RW, Nuovo J. Failure to keep clinic appointments: implications for residency education and productivity. Fam Med. 1999; 31: 627-630. PMid:10554721.

[7] Krishna M, Amarjothi S. Reminder letters to improve the rate of attendance at community mental health center. Br J Med Pract. 2012; 5(1): 17-20.

[8] Waller J, Hodgkins P. Defaulters in general practice: who are they and what can be done about them? Fam Pract. 2000; 17(3): 252-253. https://doi.org/10.1093/fampra/17.3.252

[9] Clark J. Appointment cancelation options-a new system to help decrease no-show appointments. IACH Informer. 2006.

[10] Pavlovich WD, Waters H, Weller W, et al. Systematic review of literature on the cost-effectiveness of nutrition services. J Am Diet Assoc. 2004; 104(2): 226-232. PMid:14760571. https://doi.org/10.1016/j.jada.2003.09.025

[11] Beck RS, Daughtridge R, Sloane PD. Physician-patient communication in the primary care office: A systematic review. J Am Board Fam Pract. 2002; 15(1): 25-38. PMid:11841136.

[12] Bell CF. Determinants of nutrition appointment nonattendance among male veterans. 2009.

[13] Shook M. Transportation barriers and health access for patient attending a community health center. Field area paper. 2005.

[14] Sarnquist CC, Soni S, Hwang H, et al. Rural HIV-infected women’s access to medical care: ongoing needs in California. AIDS Care. 2011; 23(7): 792-796. PMid:21287418. https://doi.org/10.1080/09540121.2010.516345

[15] Iezzoni LI, Killeen MB, O’day BL. Rural residents with disabilities confront substantial barriers to obtaining primary care. Health Serv Res. 2006.

[16] Guidry JJ, Aday LA, Zhang D, et al. Transportation as a barrier to cancer treatment. Cancer Pract. 1997; 5(6): 361-366. PMid:9397704.

[17] Stubbs ND, Sanders S, Jones DB, et al. Methods to reduce outpatient non-attendance. Am J of Med Sci. 2012; 344(3): 211-219. PMid:22475731. https://doi.org/10.1097/MAJ.0b013e31824997c6

[18] Perron NJ, Dominice MD, Kossovsky MP, et al. Reduction of missed appointments at an urban primary care clinic: a randomized controlled study. BMC FAM Pract. 2010; 11(1): 79. PMid:20973950. https://doi.org/10.1186/1471-2296-11-79

[19] Delaney NM. Obstacles to attending treatment in an urban mental health clinic: A client’s perspective approach to identifying factors influencing treatment attendance. Counselor Education Master’s Thesis [Internet]. 2012 - [cited 2018 May 31]. Available from: http://digitalcommons.brockport.edu/edc_theses/125?utm_source=digitalcommons.brockport.edu%2Fedc_theses%2F125&utm_medium=PDF&utm_campaign=PDFCoverPages|

[20] Alakaam A, Townsend D, Lemacks J. Accuracy of weight status perception related to weight loss stage of change among medically underserved adults. J Epidemiol Res. 2017; 3(1): 37. https://doi.org/10.5430/jer.v3n1p37

[21] Alakaam A, Lemacks J. Fruit and vegetable consumption, fat intake, and physical activity participation in relation to socio-demographic factors among medically underserved adults. AIMS Public Health. 2015; 2(3): 402-410. PMid:29546116. https://doi.org/10.3934/publichealth.2015.3.402

[22] Geiger SL. Nonattendance rates and barriers to healthcare in outpatient clinic settings. Walden University Scholar Works [Internet]. 2015 - [cited 2018 May 31]. Available from: https://scholarworks.waldenu.edu/cgi/viewcontent.cgi?article=1221&context=dissertations

[23] Bell C, Bryant C. Determinants of nutrition appointment attendance among male veterans attending veterans’ health administration clinics. J Nutr Educ Behav. 2013; 45(6): 739-744. PMid:23735718. https://doi.org/10.1016/j.jneb.2013.01.013

[24] Martin C, Perfect T, Mantle G. Non-attendance in primary care: The views of patients and practices on its causes, impact and solutions. Fam Pract. 2005; 22(6): 638-643. PMid:16055472. https://doi.org/10.1093/fampra/cmi076

[25] Bleich SN, Bennett WL, Gudzune KA, et al. National survey of US primary care physicians’ perspectives about causes of obesity and solutions to improve care. BMJ Open. 2012; 2(6): e001871. PMid:23257776. https://doi.org/10.1136/bmjopen-2012-001871

[26] Spikmans FJ, Brug J, Doven MM, et al. Why do diabetic patients not attend appointments with their dietician? J Hum Nutr Diet. 2003; 16(3): 151-158. https://doi.org/10.1046/j.1365-277X.2003.00435.x

[27] Probst JC, Laditka SB, Wang J, et al. Effects of residence and race on burden of travel for care: cross sectional analysis of the 2001 US National Household Travel Survey. BMC Health Serv Res. 2007; 11(1): 79. https://doi.org/10.1186/1472-6963-7-40

[28] Skinner AC, Slifkin RT. Rural/urban differences in barriers to and burden of care for children with special health care needs. J Rural Health. 2007; 23(2): 150-157. PMid:17397371. https://doi.org/10.1111/j.1748-0361.2007.00082.x

[29] Brown EKA, Shetty V, Delrahim S, et al. Correlates of missed appointments in orofacial injury patients. Oral Surg Oral Med, Oral Pathol Oral Radiol Endodo. 1999; 87(4): 405-410. https://doi.org/10.1016/S1079-2104(99)70238-6

[30] Begley C, Basu R, Lairson D, et al. Socioeconomic status, health care use, and outcomes: Persistence of disparities over time. Epilepsia. 2011; 52(5): 957-964. PMid:21320113. https://doi.org/10.1111/j.1528-1167.2010.02968.x

[31] Neal RD, Heywood PL, Morley S. Real world data-retrieval and validation of consultation data from four general practices. Fam Pract. 1996; 13(5): 455-461. https://doi.org/10.1093/fampra/13.5.455