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

Harkins, Christopher; Shaw, Rebecca; Gillies, Michelle; Sloan, Heather; MacIntyre, Kate; Scoular, Anne; Morrison, Caroline; MacKay, Fiona; Cunningham, Heather; Docherty, Paul; MacIntyre, Paul; Findlay, Iain N.
January 2010
BMC Public Health;2010, Vol. 10 Issue 1, p391
Academic Journal
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 socioeconomically 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. Conclusion: 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.


Related Articles

  • Age and Gender Biases in Secondary Prevention of Coronary Heart Disease in a Finnish University Hospital Setting. Michou, Sanna-Maria; Kähönen, Mika; Lehtimäki, Terho; Nikus, Kjell; Viik, Jari; Niemelä, Kari; Kallio, Janne; Lehtinen, Rami; Kööbi, Tiit; Turjanmaa, Väinö; Nieminen, Tuomo // Clinical Drug Investigation;2007, Vol. 27 Issue 10, p673 

    Background and objectives: Several studies have shown that treatment of coronary heart disease (CHD) does not meet the goals set in recommendations. The aim of this study was to investigate the adequacy of CHD drug treatment and secondary prevention measures, particularly with respect to age and...

  • Quality Of Care For Coronary Heart Disease In Two Countries. Ayanian, John Z.; Quinn, Thomas J. // Health Affairs;May/Jun2001, Vol. 20 Issue 3, p55 

    Focuses on strategies for improving quality of care for coronary heart disease in the United States and England including clinical guidelines, national standards and professional leadership. Importance of information systems, organizational culture and incentives to improve quality of care.

  • Review of Cost-Effectiveness Analysis of Medical Treatment For Myocardial Infarction. Yanmei Liu; Dalal, Koustuv // International Journal of Preventive Medicine;Spring2011, Vol. 2 Issue 2, p64 

    Objectives: Myocardial infarction (MI) is a leading cause of death in both the industrialized and developing countries globally. The economic evaluation of MI is undertaken to rationale the allocation of scarce healthcare resource. The objective is to review costeffectiveness analysis of MI with...

  • Determinants and trajectory of phobic anxiety in patients living with an implantable cardioverter defibrillator. Nicole Cho, En-Young; Känel, Roland von; Marten-Mittag, Birgit; Ronel, Joram; Kolb, Christof; Baumert, Jens; Ladwig, Karl-Heinz // Heart;May2012, Vol. 98 Issue 10, p806 

    Objective The implantable cardioverter defibrillator (ICD) is the gold standard therapy to prevent life-threatening arrhythmias. Phobic anxiety predicts ventricular arrhythmia in coronary heart disease patients, but little is known about phobic anxiety in ICD patients. This study aimed to...

  • A Pharmacoeconomic Evaluation of the Myocardial Ischaemia Reduction with Aggressive Cholesterol Lowering (MIRACL) Study in the United Kingdom. Buller, Nigel; Gillen, David; Casciano, Roman; Doyle, John; Wilson, Koo // PharmacoEconomics;2003 Supplement 1, Vol. 21 Issue 5, p25 

    Objective: To determine the short-term healthcare costs associated with intensive lipid lowering with atorvastatin initiated within 24-96 hours of the occurrence of acute coronary syndrome (ACS) in patients in the UK. Methods: Patient-level clinical outcome data from the Myocardial Ischaemia...

  • Overoptimism about percutaneous coronary interventions. Whittle, Jeff; Fyfe, Robert; Iles, Robert D.; Wildfong, Jay // BMJ: British Medical Journal;10/11/2014, Vol. 349 Issue 7978, pg5613 

    The authors reflect on the study by Kureshi and colleagues regarding the performance of percutaneous coronary interventions (PCIs) for the extension of the life or prevention of myocardial infarction. Topics discussed include the belief of patients that mortality can be reduced by PCI, the...

  • National treatment guidelines reduce hospital deaths. Peterson, E. D.; Roe, M. T.; Mulgund, J. // OR Manager;Jun2006, Vol. 22 Issue 6, p24 

    Claims that receiving care at a hospital with higher adherence to guidelines for treatment of patients with acute coronary syndromes (ACS) is associated with a decreased likelihood of in-hospital death, according to the April 26, 2006 "Journal of the American Medical Association." Results of the...

  • Similar 5-year clinical outcomes in patients with stable coronary artery disease and myocardial ischaemia managed with an initial approach of medical therapy compared with medical therapy plus percutaneous coronary intervention. Archbold, R. Andrew // Evidence Based Medicine;Oct2014, Vol. 19 Issue 5, p171 

    The author reflects on the study "Percutaneous coronary intervention outcomes in patients with stable obstructive coronary artery disease and myocardial ischaemia: a collaborative meta-analysis of contemporary randomized clinical trials" by WE Boden and others, in the periodical "JAMA Internal...

  • Patient perspective on coronary artery disease care. Tušek Bunc, Ksenija // Cardiologia Croatica;Sep/Oct2015, Vol. 10 Issue 9/10, p20 

    BACKGROUND : Patient's perspective of the management of their chronic disease better reflects the quality of care and offers health-care professionals more feedback. METHODS AND PATIENTS: The study was cross-sectional, included 423 patients with coronary artery disease. A comprehensive...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics