Lost to the System #1 - Exploring the reasons for non-participation

by Stuart Stokes on February 17, 2017

Let's start by looking at people that have declined the offer to participate in a public health intervention namely, weight management, exercise referral, smoking cessation and health trainers. 

Understanding the reasons why people decline the offer of an intervention is an important metric to get hold of. These reasons can often link to the overall impression of the service such as cost or linked to other reasons such as non awareness that a referral had been made.

The sample

We took 39,924 records from the ReferAll system for referrals that had been classified as 'Not Participating'. We analysed the reasons for Not participating across all 161 services and then grouped the reasons into linked themes.

The themes chosen were:

  • Already in a service - had been referred but were already in another service
  • Consent changed - had agreed at the point of referral but declined consent when approached by the service
  • Cost/Location - Either cost was an issue or the location of the service was an issue
  • Deceased - Following referral the person had passed away
  • Did not attend - Although confirming and making a booking to the service the person failed to attend
  • Failed assessment - At the initial meeting something precluded the person from commencing
  • Mis-referred - Person's information did not meet the inclusion criteria for the service
  • Not interested - Although referred, once contacted the person stated they were no longer interested
  • Unable to contact - Through various methods the person could not be contacted to commence in the service
  • Other - Various reasons not covered by the themes above


Of the 39,924 records analysed and then grouped the most occurring reason was 'Other' (43%). The next most popular reason was 'Not Interested' (28%).

Further information can be seen in the graph below



It is interesting to note that the majority of Scheme Administrators when selecting a reason for Not Participating chose other. We strongly recommend that greater variability is offered when selecting a reason. Without the reason behind the state action cannot be undertaken.

Some of the themes cited above need further understanding. For example, if a person is not interested, does not meet inclusion criteria then why was a referral made. In our sample this represents over 14,000 people which is costly for a service to administer and time wasted for the person making the referral.

If a person is interested in a service why was it that they didn't then attend? Could it be that they simply forgot about their appointment or called to cancel and couldn't reach the person responsible. Unlocking better communication methods such as automated text reminders will help reduce levels of DNA.


Read more

Download our free Lost to the System guide by clicking the image below.

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Next time

We explore the reasons why people leave a service once they have started and share with our findings from over 23,000 people.

Topics: Referral Schemes