Absent or not invited? A qualitative study of barriers and enablers of attendance at outpatient appointments in the Region of Southern Denmark

Absent or not invited? A qualitative study of barriers and enablers of attendance at outpatient appointments in the Region of Southern Denmark | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Absent or not invited? A qualitative study of barriers and enablers of attendance at outpatient appointments in the Region of Southern Denmark Daria Morgounova Schwalbe, Luna Richardt, Morten Sodemann, Nina Høy Chodkiewicz, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7801188/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 27 Apr, 2026 Read the published version in BMC Health Services Research → Version 1 posted 10 You are reading this latest preprint version Abstract Background: An increased focus has been directed towards the qualitative research aspect of non-attendance at Danish hospitals. This article reports findings from on participatory evaluations of missed outpatient appointments in the Region of Southern Denmark and demonstrates how participatory action research (PAR) can be used to examine barriers to, and enablers of, attendance at outpatient appointments from the user perspective, to inform practical interventions. Method: As part of a participatory framework, we conducted a series of workshops and focus group interviews working closely with patients, stakeholders, professional interpreters, managerial staff, and medical secretaries to identify meaningful patterns and barriers within the practice context. We combined this approach with ethnographic observations and on-site, semi-structured interviews with head nurses and medical secretaries at orthopaedic surgical departments in two different regional hospitals. Field notes, workshop transcripts, and interview data were categorized by relevant themes and analysed using a thematic framework. Results: The PAR process revealed that non-attendance goes beyond poor patient compliance. It may stem from communication inadequacies, systemic limitations, and structural shortcomings within the healthcare system. Key barriers included digital and logistic inequalities, repeated diagnostic procedures, and hospital-initiated cancellations, appointment errors, unclear or dismissive communication, and lack of language assistance. These factors compromise both attendance and quality of care. While most patients make active efforts to attend their appointments, these efforts often remain overlooked and unacknowledged within the standardized healthcare system. Digital solutions may further exclude vulnerable groups, particularly those lacking necessary resources or digital identification to access the care system. Suggestions to potential solutions included optimizing cross-department collaboration, adopting more person-centred communication, and implementing multilingual communication tools. Conclusions: To improve appointment attendance, healthcare systems must address hospital-initiated cancellations, communication inadequacies in care delivery, and systemic barriers to ensure the system functions effectively. Reducing failed appointments also requires addressing digital and language inequalities and ensuring that patient communication is clear, respectful, and free from stigma or blame. Non-attendance outpatient appointments participatory action research (PAR) ethnography communication structural barriers healthcare system Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 27 Apr, 2026 Read the published version in BMC Health Services Research → Version 1 posted Editorial decision: Revision requested 07 Jan, 2026 Reviews received at journal 06 Jan, 2026 Reviewers agreed at journal 05 Jan, 2026 Reviews received at journal 02 Dec, 2025 Reviewers agreed at journal 14 Nov, 2025 Reviewers invited by journal 17 Oct, 2025 Editor assigned by journal 15 Oct, 2025 Editor invited by journal 13 Oct, 2025 Submission checks completed at journal 10 Oct, 2025 First submitted to journal 10 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7801188","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":549952602,"identity":"0d78896f-d1e7-40b5-bbfe-5029e3bf1d1d","order_by":0,"name":"Daria Morgounova 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This article reports findings from on participatory evaluations of missed outpatient appointments in the Region of Southern Denmark and demonstrates how participatory action research (PAR) can be used to examine barriers to, and enablers of, attendance at outpatient appointments from the user perspective, to inform practical interventions.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eMethod:\u003c/strong\u003e\u003c/em\u003e\u003cem\u003e \u003c/em\u003eAs part of a\u003cem\u003e \u003c/em\u003eparticipatory framework, we conducted a series of workshops and focus group interviews working closely with patients, stakeholders, professional interpreters, managerial staff, and medical secretaries to identify meaningful patterns and barriers within the practice context. We combined this approach with ethnographic observations and on-site, semi-structured interviews with head nurses and medical secretaries at orthopaedic surgical departments in two different regional hospitals. Field notes, workshop transcripts, and interview data were categorized by relevant themes and analysed using a thematic framework.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003c/em\u003e\u003cem\u003e \u003c/em\u003eThe PAR process revealed that non-attendance goes beyond poor patient compliance. It may stem from communication inadequacies, systemic limitations, and structural shortcomings within the healthcare system. Key barriers included digital and logistic inequalities, repeated diagnostic procedures, and hospital-initiated cancellations, appointment errors, unclear or dismissive communication, and lack of language assistance. These factors compromise both attendance and quality of care. While most patients make active efforts to attend their appointments, these efforts often remain overlooked and unacknowledged within the standardized healthcare system. Digital solutions may further exclude vulnerable groups, particularly those lacking necessary resources or digital identification to access the care system. Suggestions to potential solutions included optimizing cross-department collaboration, adopting more person-centred communication, and implementing multilingual communication tools.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e\u003c/em\u003e\u003cem\u003e \u003c/em\u003eTo improve appointment attendance, healthcare systems must address hospital-initiated cancellations, communication inadequacies in care delivery, and systemic barriers to ensure the system functions effectively. Reducing failed appointments also requires addressing digital and language inequalities and ensuring that patient communication is clear, respectful, and free from stigma or blame.\u003c/p\u003e","manuscriptTitle":"Absent or not invited? 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