Using outreach to involve the hard-to-reach in a health check: what difference does it make?

Objectives: Mortality from coronary heart disease remains higher in Scotland than the European average. Primary prevention programmes, such as Keep Well, aim to tackle the associated risk factors within deprived communities. In Lanarkshire, the problem of non-attendance amongst 'hard-to-reach' groups was addressed by an outreach team, but there was a need to understand the methods employed to achieve health screening attendance.

Study design: Qualitative interviews with a typical sample of those who initially failed to attend for health screening but were subsequently appointed after outreach intervention.

Methods: Semi-structured interviews (n = 30) were conducted following clinic attendance. Transcripts were subjected to a form of content analysis and concepts were arranged into themes.

Results: The group often referred to as 'hard-to-reach' are more accurately defined as either 'hard-to-contact' or 'hard-to-engage'. Non-attenders reported that outreach staff were effective in engaging them partly because of their personalities, but also because some of the contacts occurred at an opportune time.

Conclusions: Not all non-attenders for screening appointments are negatively disposed towards health screening, and defining them all as 'hard-to-reach' does them a disservice. The majority appeared to need outreach staff to convert them into attenders, but the costs of this need to be balanced against the benefits realized.