Graduation Year

2009

Document Type

Thesis

Degree

M.S.P.H.

Degree Granting Department

Community and Family Health

Major Professor

Carol Bryant, Ph.D.

Keywords

No-shows, Military, Non-attendance, Outpatient, Dietitian

Abstract

During fiscal years 2006 and 2007, nearly 1 in 4 Veterans failed to keep their individual nutrition appointments, impeding clinic workflow, productivity, and management of weight and nutrition related health conditions. The purpose of this study was to identify determinants of nutrition appointment attendance in the Veteran population. This study examined the cognitive and structural factors that influence nutrition appointment attendance. Specifically, the study sought to determine: Veteran reported reasons for non-attendance and factors associated with appointment attendance. The research design entailed sequential use of qualitative and quantitative methods. Individual, semi-structured interviews and a mail survey were used to identify factors associated with outpatient nutrition appointment attendance.

Seventeen individuals were purposively selected to represent appointment attenders (8 individuals) and non-attenders (9 individuals) in the following age groups: 18-44, 45-64, and 65 and older. Individual interviews were analyzed using constant comparative analysis. For the survey portion of the study, 349 surveys were collected. Descriptive statistics were used to summarize demographic characteristics of the survey sample. Bivariate comparisons of attenders and non-attenders revealed significant relationships between appointment keeping and the following variables: past nutrition appointment attendance, non-VA insurance, health status, income, BMI, forgetting, satisfaction, perceived importance, understanding of scheduling system, RD knowledge, family support, how referred, reminders, input to appointment time, travel, weather, difficulty with transportation, family care, feeling well, cost, parking time, and preferred day.

Regression analyses suggest that only perceived family support, past attendance history, health status, and BMI remained correlated with appointment keeping when controlling for other factors. The results of this study will be used to identify ways to reduce no-shows thus increasing clinic efficiency of ambulatory care nutrition programs. The impact of increasing nutrition appointment attendance includes: improved access to nutrition appointments, more efficient use of resources, improved management of nutrition related conditions, and improved patient satisfaction.

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