Analysis of participation in an innovative psychiatric rehabilitation intervention: supported education

Low levels of program participation characterize many mental health interve ntions. Non-participation is a problem, particularly as it usually reflects systematic rather than random variation. However, evaluators have very lim ited knowledge of participant or program characteristics that relate to att endance. Few studies collect or analyze data relevant to this issue, and fi ndings that have been reported are inconsistent. The purpose of this article is to examine participation rates, self-reporte d barriers to attendance, and covariates of participation in a psychosocial rehabilitation program for adults with mental illness, the Michigan Suppor ted Education Program (MSEP). Each of the 397 individuals who enrolled in t his program over the 3-year research/demonstration period was asked open-en ded as well as closed-response questions about barriers to attending MSEP. Interviews also obtained information about possible covariates of participa tion - demographic and clinical characteristics, social context, and commun ity adjustment. Actual levels of MSEP participation were derived from detai led attendance and contact records. Focus groups were conducted with select ed enrollees who had limited or no participation in the program. Interview data indicated there were multiple barriers to participation, reflecting bo th individual characteristics and social context. Barriers changed over tim e as the program matured and, in general, bore a curvilinear relationship t o attendance. Analysis of covariates of attendance showed that predictors o f "any attendance" were different and sometimes converse to those for "regu lar attendance". While identifying some themes similar to the interview results, focus group s illuminated the multiple, complex, and interacting nature of the barriers experienced in MSEP. We discuss the importance of examining participation rates and the desirability of using information from diverse sources and mu ltiple measures to understand the reasons for and nature of nonparticipatio n.: 2000 Elsevier Science Ltd. All rights reserved.