What is the 'problem' that outreach work seeks to address and how might it be tackled? Seeking theory in a primary health prevention programme.
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.
Urban Studies, School of Social & Political Sciences/Institute of Health &Wellbeing, University of Glasgow, 27 Bute Gdns, Glasgow, UK, G12 8RS. mhairi.mackenzie@glasgow.ac.uk
Mhairi
M
Mackenzie
Fiona
F
Turner
Stephen
S
Platt
Maggie
M
Reid
Yingying
Y
Wang
Julia
J
Clark
Sanjeev
S
Sridharan
Catherine A
CA
O'Donnell
D001291:Attitude of Health Personnel; D055812:Community-Based Participatory Research; D003159:Community-Institutional Relations; D006293:Health Promotion / Q000379:methods* / Q000458:organization & administration; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D008962:Models, Theoretical; D011320:Primary Health Care / Q000379:methods*; D011322:Primary Prevention / Q000379:methods / Q000458:organization & administration*; D011369:Professional-Patient Relations; D016730:Program Development; D015397:Program Evaluation; D036301:Qualitative Research; D011785:Quality Assurance, Health Care