title: Overcoming barriers to engaging socio-economically disadvantaged populations in CHD primary prevention: a qualitative study.
abstract: BACKGROUND
  Preventative medicine has become increasingly important in efforts to reduce the burden of chronic disease in industrialised countries. However, interventions that fail to recruit socio-economically representative samples may widen existing health inequalities. This paper explores the barriers and facilitators to engaging a socio-economically disadvantaged (SED) population in primary prevention for coronary heart disease (CHD).
  
  
  METHODS
  The primary prevention element of Have a Heart Paisley (HaHP) offered risk screening to all eligible individuals. The programme employed two approaches to engaging with the community: a) a social marketing campaign and b) a community development project adopting primarily face-to-face canvassing. Individuals living in areas of SED were under-recruited via the social marketing approach, but successfully recruited via face-to-face canvassing. This paper reports on focus group discussions with participants, exploring their perceptions about and experiences of both approaches.
  
  
  RESULTS
  Various reasons were identified for low uptake of risk screening amongst individuals living in areas of high SED in response to the social marketing campaign and a number of ways in which the face-to-face canvassing approach overcame these barriers were identified. These have been categorised into four main themes: (1) processes of engagement; (2) issues of understanding; (3) design of the screening service and (4) the priority accorded to screening. The most immediate barriers to recruitment were the invitation letter, which often failed to reach its target, and the general distrust of postal correspondence. In contrast, participants were positive about the face-to-face canvassing approach. Participants expressed a lack of knowledge and understanding about CHD and their risk of developing it and felt there was a lack of clarity in the information provided in the mailing in terms of the process and value of screening. In contrast, direct face-to-face contact meant that outreach workers could explain what to expect. Participants felt that the procedure for uptake of screening was demanding and inflexible, but that the drop-in sessions employed by the community development project had a major impact on recruitment and retention.
  
  
  CONCLUSIONS
  Socio-economically disadvantaged individuals can be hard-to-reach; engagement requires strategies tailored to the needs of the target population rather than a population-wide approach.
authors.affiliation: Department of Cardiology, Royal Alexandra Hospital, Paisley PA29PN, UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: Harkins
authors.forename: Rebecca
authors.initials: R
authors.lastname: Shaw
authors.forename: Michelle
authors.initials: M
authors.lastname: Gillies
authors.forename: Heather
authors.initials: H
authors.lastname: Sloan
authors.forename: Kate
authors.initials: K
authors.lastname: Macintyre
authors.forename: Anne
authors.initials: A
authors.lastname: Scoular
authors.forename: Caroline
authors.initials: C
authors.lastname: Morrison
authors.forename: Fiona
authors.initials: F
authors.lastname: Mackay
authors.forename: Heather
authors.initials: H
authors.lastname: Cunningham
authors.forename: Paul
authors.initials: P
authors.lastname: Docherty
authors.forename: Paul
authors.initials: P
authors.lastname: Macintyre
authors.forename: Iain N
authors.initials: IN
authors.lastname: Findlay
mesh_terms: D000328:Adult; D003327:Coronary Disease / Q000517:prevention & control*; D005260:Female; D017144:Focus Groups; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D007407:Interviews as Topic; D008019:Life Style; D008297:Male; D008403:Mass Screening / Q000523:psychology / Q000706:statistics & numerical data*; D008875:Middle Aged; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data; D011322:Primary Prevention / Q000379:methods*; D036301:Qualitative Research; D012307:Risk Factors; D012606:Scotland; D040241:Social Marketing; D012959:Socioeconomic Factors