How do we find out why people withdraw from a service?

2 adults looking in a booklet As a student psychologist, I’m interested in learning what factors contribute to a successful social care service or intervention. During my time as an evaluation assistant at the NSPCC, there was nothing more rewarding than hearing people tell me about the positive changes that happened in their lives as a direct result of one of our services.

But I feel it’s equally important to find out about instances when a programme hasn’t worked as well, for instance where participants have a negative experience or have withdrawn from the service. At the NSPCC, this attrition might occur if a child or family stops attending one of our programmes , or if an organisation decides not to implement one of the services we’re scaling up .

I’m interested in how the NSPCC’s Evidence team addresses attrition in their work and wanted to learn more about the challenges involved. I interviewed some of the team to find out about their views and experiences.

Why is it important to identify the reasons for attrition?

To an extent, it’s inevitable that not all the people who start a service will finish it. But learning why people chose to disengage with a service can help ensure future participants don’t have the same negative experience. After identifying which factors contributed to individuals deciding not to continue, we can make improvements to help reduce levels of attrition in the future.

Through conversations with some of the NSPCC’s Evidence team, I learnt about their experiences of attrition. They explained the value of incorporating attrition interviews into the initial evaluation plan to ensure that all service users have the opportunity to give their views – whether or not they complete the programme.

It’s easier to find out what’s working well from those who are still engaging with a service, but individuals who disengage can provide a completely different and equally as valid perspective. Finding out about their experience can help us identify any barriers which make the programme less effective – and start to resolve these issues for future delivery. 

When evaluating the way we scale up our services, it’s also important to determine why commissioners who were initially interested in adopting an NSPCC model ultimately chose not to do so. For example, during the evaluation of our scale-up of Domestic Abuse Recovering Together (DART™), we found out that staffing issues in some of the organisations prevented them from successfully implementing the programme. The NSPCC was then able to make adaptions to the DART™ model so that future commissioners will be more able and willing to take on the service.

Why can interviewing ‘drop-outs’ be challenging?

It can be really difficult to make contact with individuals who have stopped taking part in a service. NSPCC evaluators told me about a range of reasons for this.

Firstly, there is a negative association with the term ‘dropping out’, which may mean that some individuals feel they are at fault for not being able to complete the programme. This means they may be reluctant to talk to an evaluator. Likewise, practitioners may feel that they didn’t do enough for the service user - or they may think that the user disengaged for personal reasons (rather than a barrier that was part of the service).

Evaluators and practitioners sometimes felt it wasn’t appropriate to contact service users, for example if a family were currently experiencing a traumatic event such as having a child being taken into care. Evaluators also told me about instances where it would be potentially dangerous to contact an ex-service user, for example some of the women who stopped taking part in DART™ had re-entered a relationship with an abusive partner. Therefore contacting them about the service could put them at risk.

What I found most surprising from my discussions with evaluators was that the main barrier to interviewing people who had withdrawn from a service wasn’t a lack of cooperation from the service users themselves, but instead a lack of capacity or resources to set up and conduct the interviews. It’s harder to gain contact with people who have left a service, and more difficult to find suitable places to carry out an interview. This means it takes more time to set up an interview than it does with those that are already attending a service centre regularly. Researchers and evaluators said that if they had been more strategic in their planning they would have been more able to schedule in interviews with those that hadn’t finished a programme. They said that in the future they would try to build an early rapport with service centres to help set the scene for these interviews to go ahead.

How to make sure all service users’ views are included in evaluations

An evaluation should aim to include both positive and negative experiences. Talking to people who chose to stop participating in a programme means evaluators can gain a fuller understanding of any barriers to people getting the full benefit of a service. This can lead to adaptions to the service and ultimately means that more families may benefit.

To help evaluators explore attrition in more depth I recommend:

  1. When planning your evaluation, work out how you will include the experiences of individuals who have withdrawn from the service. Gain early ethics approval for this.
  2. Build rapport with practitioners and get them on board from the beginning. These are gate-keepers who may be able to help you contact people who are no longer taking part in a programme. 
  3. Make agreements with service centres early on about interviewing people who haven’t completed a programme. 
  4. Encourage people who have withdrawn from a programme to participate in the evaluation by highlighting the value of their views and experiences in helping improve services.
  5. Ensure the confidentiality of everyone you interview will be maintained so participants don’t have to worry about sharing negative experiences.

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