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

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  • Mhairi Mackenzie
  • Fiona Turner
  • Stephen Platt
  • Maggie Reid
  • Yingying Wang
  • Julia Clark
  • Sanjeev Sridharan
  • Catherine O'Donnell
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Article number350
<mark>Journal publication date</mark>28/12/2011
<mark>Journal</mark>BMC Health Services Research
Volume11
Number of pages12
Publication StatusPublished
<mark>Original language</mark>English

Abstract

Background
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.

Methods
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.

Results
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.

Conclusions
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.

Bibliographic note

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.