Open Access Research article

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

Mhairi Mackenzie1*, Fiona Turner2, Stephen Platt3, Maggie Reid2, Yingying Wang4, Julia Clark5, Sanjeev Sridharan6 and Catherine A O'Donnell2

Author affiliations

1 Urban Studies, School of Social & Political Sciences/Institute of Health &Wellbeing, University of Glasgow, 27 Bute Gdns, Glasgow, UK, G12 8RS

2 General Practice & Primary Care/Institute of Health & Wellbeing, University of Glasgow, 1 Horslethill Rd, Glasgow, UK, G12 9LX

3 Centre for Population Health Sciences, Medical School, University of Edinburgh, Teviot Place, Edinburgh, UK, EH8 9AG

4 MRC Social & Public Health Sciences Unit, 4 Lilybank Gardens, Glasgow, UK, G12 8RZ

5 Institute of Applied Health Research, 70 Cowcaddens Rd, Glasgow Caledonian University, Glasgow, UK, G4 OBA

6 St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, Ontario, Canada, M5B 1W8

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Citation and License

BMC Health Services Research 2011, 11:350  doi:10.1186/1472-6963-11-350

Published: 28 December 2011



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.


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.


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.


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.