Lesson learned: understanding attrition rate and influencing factors
ATTRITION
Attrition rate emerged as a significant concern. In the initial eight months of the Conkal intervention, equivalent to the entirety of the Komchen intervention, we observed a 33.74% abandonment rate (n=55), while Komchen experienced only an 8% rate at this time threshold.During the 2,216 person-month total follow-up in Conkal, 129 participants (79.4% of the sample; Estimates for the association between social and biophysical covariates on abandonment in Conkal.The model simultaneously adjusted for every covariate and met the proportional hazard assumption. Hb


Participants in Conkal cited various factors explaining their reduced attendance. These included transportation issues, time constraints, caregiving responsibilities, limited accessibility to meeting venues, and session location changes. A relocation was needed after 13 months due to the replacements of healthcare center directors and administrators who did not prioritize this education program. Unfortunately, the second venue lacked essential amenities, such as air conditioning in a hot tropical area with temperatures exceeding 100°F. This significant drawback could have contributed to accelerate abandon rates.Additionally, the involvement of local authorities (e.g., offering locations for educational sessions) with political affiliations that did not align with all participants’ preferences also contributed to dropouts. Increased dropouts were observed after the sessions’ relocation. These findings emphasize the importance of ensuring permanent facilities with suitable conditions for effective health education processes.