Developing interventions to reduce "missingness" in healthcare

"Missingness interventions" aims to develop a theoretically informed understanding of "missingness" from patient, professional and policy perspectives with the intent of co-producing a complex intervention with multiple components for primary care to test in a future study.

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We define "missingness" as the repeated tendency not to take up offers of care such that it has a negative impact on the person and their life chances.

We seek to frame this across services and within the wider context of people’s lives and life experiences.

The research brings together a new team.

The British Journal of General Practice invited Andrea Williamson, the project co PI, to write a lead editorial for the October 2023 issue, following on from a lecture given at SAPC earlier in the year. 

The image on the journal cover, shown here, used the word "Missingness" as defined above.

Cover image to illustrate the concept of missingness from healthcare. Cover credit Untitled. Artist Unknown. Image from DrugFAM Art CompetitionCover credit: UNTITLED. Artist: UNKNOWN. Image from DrugFAM Art Competition.

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This research aims to address the problem of multiple missed appointments and low uptake of care offers in health care, described as "missingness".

This is an under-researched area, disproportionately affects the most marginalised groups in society and is associated with high levels of premature mortality. Our research seeks to more fully understand the drivers of missingness, its consequences, the populations who are most at risk, and to develop targeted interventions to address it.

The study will be undertaken in three overlapping stages.

  1. The first is a review of the existing literature and knowledge pertaining to missingness. This will be used to create a "programme theory" about the known causes of missingness in different contexts across identified at-risk groups, and about the kinds of interventions which may target these causes to address missingness.
  2. The second will involve refining this programme theory by gathering knowledge, through in-depth interviews, with two groups who have a deep understanding of missingness; "experts-by-experience" who have missed multiple appointments in the past, and professionals and practitioners who work with people who have experienced missingness across health and social care settings. This research will be undertaken with a sample of thirty people from each of these populations across Scotland and England.
  3. The third stage will draw on the knowledge accrued across the previous two stages to develop targeted interventions tailored towards different causes of missingness across these at-risk populations.

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The research is funded by the National Institute for Health and Care Research, with members of the research team based at the University of Glasgow, University of Oxford, University of Bath and Homeless Network Scotland. Ethical approval for the study has been obtained from University of Glasgow's College of Medical, Veterinary and Life Sciences Ethics Committee (project number 200220187).

The full study protocol can be found on the NIHR website.

Research team

To contact a member of the research team directly, follow the link to their profile or organisation page. For contact about the project in general, you can use our email address 

Principal Investigator

Prof Andrea Williamson 
Professor of General Practice and Inclusion Health (General Practice and Primary Care, University of Glasgow) 

Co-Principal Investigator

Prof Kate O’Donnell
Professor of Primary Care Research and Development (General Practice and Primary Care, University of Glasgow) 

Other team members

  • Dr David Baruffati
    Research Associate (College of Medical, Veterinary and Life Sciences, University of Glasgow) 
  • Dr Calum Lindsay
    Research Associate (College of Medical, Veterinary and Life Sciences, University of Glasgow) 
  • Ms Elspeth Rae 
    Research Administrator (College of Medical, Veterinary and Life Sciences, University of Glasgow) 
  • Dr Geoff Wong 
    Associate Professor of Primary Care (University of Oxford) 
  • Ms Claire Duddy 
    Realist Reviewer and NIHR Pre-Doctoral Fellow (University of Oxford) 
    (01 December 2022 to 05 June 2023)
  • Prof Mhairi Mackenzie
    Professor of Public Policy (Urban Studies, University of Glasgow) 
  • Ms Michelle Major 
    Improvement Lead (Homeless Network Scotland) 
  • Prof Sharon Simpson
    Professor of Behavioural Sciences and Health (MRC/CSO Social & Public Health Sciences Unit, University of Glasgow) 
  • Prof David Ellis 
    Professor of Behavioural Science (University of Bath)