Exploring reasons for clients’ non-attendance at appointments within a community-based alcohol service: clients’ and practitioners’ perspectives

Mahmood, F (2021) Exploring reasons for clients’ non-attendance at appointments within a community-based alcohol service: clients’ and practitioners’ perspectives. Doctoral thesis (PhD), Manchester Metropolitan University.

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Abstract

Aims: The main aim of this research was to gain a deeper understanding of the reasons for clients’ non-attendance at appointments within a community-based alcohol service, from the perspectives of clients and practitioners. Background: Clients’ non-attendance is a widespread issue in addiction treatment services (Milward et al., 2014). Non-attendance at appointments delays clients’ recovery processes and increases overall service delivery cost. This research project investigates reasons for clients’ non-attendance from both clients’ and practitioners’ perspectives and explores strategies to improve clients’ engagement and attendance. Design: A mixed methods study was conducted. First, secondary analysis was conducted on an existing dataset comprising 194,679 treatment appointments detailing 22,405 clients’ attendance history for four years (Jan 2010 – Dec 2013). The clinical data was analysed using a hierarchical four-stage binary logistic regression model to identify factors predicting non-attendance. Second, a qualitative strand sought practitioners’ perspectives (one-to-one semi-structured interviews; n=15) and clients’ perspectives (one focus group; n=8). The qualitative data were analysed using a template analysis approach. Results: Quantitative strand (logistic regression): Clients with the following characteristics were more likely to be recorded as ‘did not attend (DNA)’; those aged between 18-24 and 75+ years old compared to other age groups; people on employment support allowance; people who were economically inactive due to mental ill health; those recorded as long-term sick or disabled; people assessed with high risk levels; and young persons in settled accommodation. Clients who live with ‘some of their children’, had ‘none of the children with them’ and the clients ‘who were not parents’ were more likely to not attend compared to clients who have all their children living with them. Two appointment time slots 15.30-15.59pm and 11.00-11.29am increased the likelihood of non-attendance, whereas the 11:30-11:59 time slot reduced non-attendance by 74.5% (comparison group: 9:30-9:59am). Gender, smoking status, pregnancy status, and dual diagnosis did not significantly predict non-attendance. Qualitative strands: Practitioners’ and clients’ perspectives – Template analysis was used to analyse the semi-structured interviews with practitioners (n=15) and a focus group with clients (n=8). According to practitioners, certain client characteristics (the most prominent being younger clients, BAME people, and people with complex needs or in early recovery stages) were linked with higher non-attendance rates. Forgetfulness was reported by both groups (clients and practitioners) as the most common reason for clients’ non-attendance. DNA is also reported as a systems need – practitioners rely on the missed appointment times to undertake their administrative tasks. The key findings of the clients’ focus group analysis show that positive client-practitioner relationships support higher attendance rates. It suggests that practitioners’ lived experiences of addiction further enhance the client-practitioner relationship. Both groups of participants (clients and practitioners) referred to a lack of funding and resources impacting directly on service provision and clients’ engagement. Conclusions: The findings of this mixed methods study suggest a range of steps to improve clients’ attendance. These include additional funding for community-based outreach services, reducing waiting times, change of service delivery paradigm from a traditional ‘outpatient’ model to more creative methods of engagements. Additionally, improvements might include more group work, appropriate support for practitioners, use of text message reminders, use of phone-based interventions, and practitioners using ‘DNA’ time effectively by contacting the clients. The research thesis presents an innovative concept of ‘co-created motivation’ as a relational phenomenon that impacts the client-practitioner working alliance and clients’ attendance.