Developing interventions to reduce ‘‘missingness’’ in health care

Aim To develop a rich understanding of 'missingness' in health and social care and identify plausible solutions to address it. Background 'Missingness' in care refers to when a person has a pattern of struggling to attend. This may be health care appointments they have arranged or appointments for procedures.This is an important area of study because a recent study of the GP records of more than half a million Scottish people showed that 'missingness' is linked to a high risk of having lots of health problems and a much higher risk of dying early. There has been some previous research done in this area but this has tended to look at individual conditions or it has failed to distinguish between people who miss just one appointment and those who miss many. Design and methods We will review the existing literature in health, social care and relevant areas to find out what is already known about what causes 'missingness' and how it might be addressed, having first described what the research team thinks are the issues we are trying to solve.The two theoretical perspectives of 'candidacy' and 'structural vulnerability' are used to guide our thinking. What we produce; called our ''missingness' programme theory' will then have the input of the first members of our Stakeholder Advisory Group (StAG) and people who take part in our research interviews. We will interview 30 people in Scotland and England who have experience themselves of 'missingness' and 30 professionals who design and deliver services. They will be invited based on being from groups who are high risk of 'missingness' or who work in a related area. We will ask what they think causes 'missingness' and what it means for them and for services. We will also ask what works already, what does not work and what could be done differently, whilst asking too about the various influences of people and society on what could be different. We use ways of sharing information about our review (e.g. by using illustrations), recruiting and gathering information that we know helps increase the likelihood people will take part. Then along with our full StAG, a group of 8 people with experience and 8 people who work with people or design services we will run 4 half day workshops. These will finalise our 'missingness' programme theory and use this understanding to develop solutions to address 'missingness' in health care. We have thought carefully about ensuring safe, meaningful, participation in the workshops. PPI Our team includes a public Co-I who works in a third sector organisation. They have led the way in Scotland in ensuring that people who use services (including those who have found it difficult to do so) are listened to and included in homelessness research and policy. The PPI lead is experienced in working with marginalised people in a range of settings. Careful co-design is integral to the project. Dissemination We will publish four papers about the three main aspects of the study, will employ professionals to produce illustrated visuals and short videos, talk about our work at conferences and publicise it in health and social care, policy and practice. The team are well connected to UK organisations who design, deliver and influence services including the media. This is so 'missingness' is taken seriously in the NHS and beyond and efforts made to address it. We will apply for future funding to test out the developed intervention.