Introduction Many studies that have included reports of attendance at ECHO sessions have focused on networks that have purposively selected participants to attend. This data may not provide an accurate reflection of participation rates within the constraints of everyday practice.

Aim The aim of this study was to explore attendance patterns across ECHO networks attended by both medical and social care professionals within the confines of normal working practice, and identify the reasons for any observed variations.

Methods Network activity data were collected from 28 ECHO networks to include the number of ECHO sessions delivered within each network and the number attended by each participant. The number of ‘low’ (attended 1-32% of sessions), ‘medium’ (attended 34-67% of sessions) and ‘high attenders’ (attended ≥ 68% of sessions) for each network were calculated. Data were examined and explanations for observed attendance patterns were extracted.

Results The majority of networks delivered nine ECHO sessions held monthly. 1588 participants attended at least once across all 28 networks. Variations in the proportion of low, medium and high attenders were observed across the networks. In 20/28 networks ≥ 50% of participants were ‘low’ attenders. Reasons for low attendance included competing workplace demands and staff shortages. However, interview data indicated that for several networks with a high proportion of ‘low attenders’ participation in the network was at service rather than individual level. Impacts at a service level were still identified through qualitative data collection. Networks with a larger proportion of ‘medium’ or ‘high’ attenders were characterised by strong leadership and/or a link to wider service developments.

Conclusion It needs to be considered what outcomes are realistic to assess based on levels of attendance and number of ECHO sessions delivered. Qualitative data collection is recommended to unpick reasons for observed attendance patterns and identify any unexpected outcomes.