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Open Access Highly Accessed Research article

Overcoming barriers to engaging socio-economically disadvantaged populations in CHD primary prevention: a qualitative study

Christopher Harkins1, Rebecca Shaw1, Michelle Gillies1, Heather Sloan3, Kate MacIntyre1, Anne Scoular2, Caroline Morrison2, Fiona MacKay3, Heather Cunningham3, Paul Docherty4, Paul MacIntyre5 and Iain N Findlay5*

Author Affiliations

1 Public Health and Health Policy, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK

2 Greater Glasgow & Clyde NHS Board, Dalian House, 350 St Vincent Street, Glasgow, G3 8YZ, UK

3 Renfrewshire Community Health Partnership, NHS Greater Glasgow & Clyde, Renfrewshire House, Paisley, PA1 1UJ, UK

4 NHS Greater Glasgow & Clyde Health Information & Technology, Development Department, Westward House, St James Street, Paisley, PA3 2HL, UK

5 Department of Cardiology, Royal Alexandra Hospital, Paisley, PA2 9PN, UK

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BMC Public Health 2010, 10:391  doi:10.1186/1471-2458-10-391

Published: 2 July 2010



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).


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.


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.


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.