What is the 'problem' that outreach work seeks to address and how might it be tackled? Seeking theory in a primary health prevention programme

Mackenzie, M. , Turner, F., Platt, S., Reid, M., Wang, Y., Clark, J., Sridharan, S. and O'Donnell, C.A. (2011) What is the 'problem' that outreach work seeks to address and how might it be tackled? Seeking theory in a primary health prevention programme. BMC Health Services Research, 11(Dec), p. 350. (doi: 10.1186/1472-6963-11-350)

Abstract

<b>Background</b> Preventive approaches to health are disproportionately accessed by the more affluent and recent health improvement policy advocates the use of targeted preventive primary care to reduce risk factors in poorer individuals and communities. Outreach has become part of the health service response. Outreach has a long history of engaging those who do not otherwise access services. It has, however, been described as eclectic in its purpose, clientele and mode of practice; its effectiveness is unproven. Using a primary prevention programme in the UK as a case, this paper addresses two research questions: what are the perceived problems of non-engagement that outreach aims to address; and, what specific mechanisms of outreach are hypothesised to tackle these.<p></p> <b>Methods</b> Drawing on a wider programme evaluation, the study undertook qualitative interviews with strategically selected health-care professionals. The analysis was thematically guided by the concept of 'candidacy' which theorises the dynamic process through which services and individuals negotiate appropriate service use.<p></p> <b>Results</b> The study identified seven types of engagement 'problem' and corresponding solutions. These 'problems' lie on a continuum of complexity in terms of the challenges they present to primary care. Reasons for non-engagement are congruent with the concept of 'candidacy' but point to ways in which it can be expanded.<p></p> <b>Conclusions</b> The paper draws conclusions about the role of outreach in contributing to the implementation of inequalities focused primary prevention and identifies further research needed in the theoretical development of both outreach as an approach and candidacy as a conceptual framework.

• Item Type: Articles
• Additional Information: This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Turner, Ms Fiona and Mackenzie, Professor Mhairi and O'Donnell, Professor Kate
• Authors: Mackenzie, M., Turner, F., Platt, S., Reid, M., Wang, Y., Clark, J., Sridharan, S., and O'Donnell, C.A.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Social Scientists working in Health and Wellbeing; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Mental Health and Wellbeing; College of Social Sciences > School of Social and Political Sciences > Urban Studies
• Journal Name: BMC Health Services Research
• Publisher: BioMed Central
• ISSN: 1472-6963
• Published Online: 28 December 2011
• Copyright Holders: Copyright © 2011 Mackenzie et al; licensee BioMed Central Ltd.
• First Published: First published in BMC Health Services Research 2011 11(Dec): 350
• Publisher Policy: Reproduced in accordance with the copyright policy of the publisher