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Why does the patient not show up? Clinical case studies in a Danish migrant health clinic

Leila Saud Abdulkadir, Ida Nygaard Mottelson, Dorthe Nielsen


Purpose: This study explores the perspectives of both patients with an ethnic minority background and health professionals on missed appointments in a Danish migrant health clinic.

Study design: A clinical case study involving patients and health professionals. Since the patients represent a vulnerable group, who are difficult to reach, health professionals were included in the study. This aids the study by making sure to cover different perspectives.

Methods: Individual semi-structured interviews were conducted. In total, 6 patients and 6 health professionals, comprising one social worker, 2 nurses and 3 doctors, agreed to participate. Transcripts were analysed using Interpretative Phenomenological Analysis.

Results: Patients, who missed appointments, appeared to have poor mental health, limited financial resources, transport expenses and language barriers. Patients’ physical and mental health affects their everyday lives and hinders them from keeping their scheduled appointments.

Conclusion: These results may help health professionals provide a more person-centered care and to improve approaches and interventions aimed at reducing the number of patients missing appointments. This study identified barriers to keeping appointments and emphasizes that the reasons behind missed appointments at the clinic are complex and require a creative and holistic approach from health professionals.


Barriers, communication, economics, holistic, Interpretative Phenomenological Analysis (IPA), mental health, minority groups, missed appointments, no-show, patient adherence, person-centered healthcare, psychological stress, qualitative research

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Kheirkhah, P., Feng, Q., Travis, L.M., Tavakoli-Tabasi, S. & Sharafkhaneh, A. (2016). Prevalence, predictors and economic consequences of no-shows. BMC Health Services Research 16, 13.

Bennett, K.J. & Baxley, E.G. (2009). The effect of a carve-out advanced access scheduling system on no-show rates. Family Medicine 41 (1) 51-56.

Junod Perron, N., Dao, M.D., Righini, N.C., Humair, J.P., Broers, B., Narring, F., Haller, D.M. & Gaspoz, J.M. (2013). Text-messaging versus telephone reminders to reduce missed appointments in an academic primary care clinic: a randomized controlled trial. BMC Health Services Research 13, 125.

Lehmann, T.N., Aebi, A., Lehmann, D., Balandraux Olivet, M. & Stalder, H. (2007). Missed appointments at a Swiss university outpatient clinic. Public Health 121 (10) 790-799.

Filippidou, M., Lingwood, S. & Mirza, I. (2014). Reducing non-attendance rates in a community mental health team. BMJ Quality Improvement Reports 3 (1) pii: u202228w1114.

Knolhoff, J.B., Djenic, B., Hsu, C.H., Bouton, M.E. & Komenaka, I.K. (2016). Missed Appointments in a Breast Clinic: Patient-Related Factors. American Journal of the Medical Sciences 352 (4) 337-342.

Blaehr, E.E., Vaeggemose, U. & Sogaard, R. (2018). Effectiveness and cost-effectiveness of fining non-attendance at public hospitals: a randomised controlled trial from Danish outpatient clinics. BMJ Open 8 (4) 1-9.

Campbell, K., Millard, A., McCartney, G. & McCullough, S. (2015). Who is least likely to attend? An analysis of outpatient appointment ‘Did Not Attend’ (DNA) data in Scotland. Edinburgh: NHS Health Scotland.

Zidar, M.N., Larm, P., Tillgren, P. & Akhavan, S. (2015). Non-attendance of mammographic screening: the roles of age and municipality in a population-based Swedish sample. International Journal for Equity in Health 14, 157.

Faiz, K.W. & Kristoffersen, E.S. (2018). Association between age and outpatient clinic arrival time: myth or reality? BMC Health Services Research 18 (1) 235.

Zailinawati, A.H., Ng, C.J. & Nik-Sherina, H. (2006). Why do patients with chronic illnesses fail to keep their appointments? A telephone interview. Asia-Pacific Journal of Public Health 18 (1) 10-15.

Dantas, L.F., Fleck, J.L., Cyrino Oliveira, F.L. & Hamacher, S. (2018). No-shows in appointment scheduling - a systematic literature review. Health Policy (Amsterdam, Netherlands) 122 (4) 412-421.

Roberts, K., Callanan, I. & Tubridy, N. (2011). Failure to attend out-patient clinics: is it in our DNA? International Journal of Health Care Quality Assurance 24 (5) 406-412.

Crutchfield, T.M. & Kistler, C.E. (2017). Getting patients in the door: medical appointment reminder preferences. Patient Preference and Adherence 11, 141-150.

Samuels, R.C., Ward, V.L., Melvin, P., Macht-Greenberg, M., Wenren, L.M., Yi, J., Massey, G. & Cox, J.E. (2015). Missed Appointments: Factors Contributing to High No-Show Rates in an Urban Pediatrics Primary Care Clinic. Clinical Pediatrics 54 (10) 976-982.

Rodríguez-García, M., McLean-Carranza, A.A., Prado-Prado, J.C. & Domínguez-Caamaño, P. (2016). Managing Waiting Times to Predict No-shows and Cancelations at a Children’s Hospital. Journal of Industrial Engineering and Management 9 (5) 1107-1118.

Daye, D., Carrodeguas, E., Glover, M., Guerrier, C.E., Harvey, H.B. & Flores, E.J. (2018). Impact of Delayed Time to Advanced Imaging on Missed Appointments Across Different Demographic and Socioeconomic Factors. Journal of the American College of Radiology 15 (5) 713-720.

Neal, R.D., Hussain-Gambles, M., Allgar, V.L., Lawlor, D.A. & Dempsey, O. (2005). Reasons for and consequences of missed appointments in general practice in the UK: questionnaire survey and prospective review of medical records. BMC Family Practice 6, 47.

Parikh, A., Gupta, K., Wilson, A.C., Fields, K., Cosgrove, N.M. & Kostis, J.B. (2010). The effectiveness of outpatient appointment reminder systems in reducing no-show rates. American Journal of Medicine 123 (6) 542-548.

Hasvold, P.E. & Wootton, R. (2011). Use of telephone and SMS reminders to improve attendance at hospital appointments: a systematic review. Journal of Telemedicine and Telecare 17 (7) 358-364.

McLean, S., Gee, M., Booth, A., Salway, S., Nancarrow, S., Cobb, M. & Bhanbhro, S. (2014). Targeting the Use of Reminders and Notifications for Uptake by Populations (TURNUP): a systematic review and evidence synthesis. Health Services and Delivery Research 2, 34.

Gurol-Urganci, I., de Jongh, T., Vodopivec-Jamsek, V., Atun, R. & Car, J. (2013). Mobile phone messaging reminders for attendance at healthcare appointments. Cochrane Database of Systamic Reviews (12):CD007458.

Robotham, D., Satkunanathan, S., Reynolds, J., Stahl, D. & Wykes, T. (2016). Using digital notifications to improve attendance in clinic: systematic review and meta-analysis. BMJ Open 6 (10) e012116.

Jansbøl, K. & Wolf, R.T. (2016). Reduktion af udeblivelser - Et systematisk review om effekt og besparelse ved påmindelser og gebyr [Reduction of missed appointments - A systemical review of the effect and savings of reminders and fees]. Copenhagen: Det Nationale Institut for Kommuners og Regioners Analyse og Forskning.

Kofoed, P-E., Hansen, L.M. & Ammentorp, J. (2009). Årsager til udeblivelser og afbud i et børneambulatorium [Reasons for no-shows and missed appointments in a children's outpatient clinic}. Ugeskrift for Læger 171 (17) 1379-1383.

Andersen, B.B. & Munk-Jørgensen, P. (2010). Udeblivelser og sene afbud i psykiatrisk speciallægepraksis [Missed appointments and late cancellations in psychiatric practice]. Ugeskrift for Læger 172 (36) 2451-2454.

Kruse, L.V., Hansen, L.G. & Olesen, C. (2009). Udeblivelse fra aftale i børneambulatoriet - SMS-påmindelse hjælper [Missed appointments at a children's outpatient clinic - SMS-reminders help]. Ugeskrift for Læger 171 (17) 1372-1375.

Shrestha, M.P., Hu, C. & Taleban, S. (2016). Appointment Wait Time, Primary Care Provider Status, and Patient Demographics are Associated With Nonattendance at Outpatient Gastroenterology Clinic. Journal of Clinical Gastroenterology 51 (5) 433-438.

Kaplan-Lewis, E. & Percac-Lima, S. (2013). No-show to primary care appointments: why patients do not come. Journal of Primary Care Community Health 4 (4) 251-255.

Herber, O.R., Smith, K., White, M. & Jones, M.C. (2017). 'Just not for me' - contributing factors to nonattendance/noncompletion at phase III cardiac rehabilitation in acute coronary syndrome patients: a qualitative enquiry. Journal of Clinical Nursing 26 (21-22) 3529-3542.

Eriksen, M. & Kjellberg, J. (2013). Nedbringelse af udeblivelser i sundhedsvæsenet - internationalt litteraturstudie [Reduction of missed appointments in the healthcare system - international literature study]. Copenhagen: Det Nationale Institut for Kommuners og Regioners Analyse og Forskning.

Danmarks Statistik. (2017). Indvandrere i Danmark 2017 [Immigrants in Denmark 2017]. Copenhagen: Danmarks Statistik.

Nielsen, A.L., Jervelund, S.S., Villadsen, S.F., Vitus, K., Ditlevsen, K., Tørslev, M.K. & Kristiansen, M. (2017). Recruitment of ethnic minorities for public health research: An interpretive synthesis of experiences from six interlinked Danish studies. Scandinavian Journal of Public Health 45 (2) 140-152.

Laverty, S.M. (2003). Hermeneutic phenomenology and phenomenology: A comparison of historical and methodological considerations. International Journal of Qualitative Methods 2 (3) 21-35.

Giorgi, A. (2005). The phenomenological movement and research in the human sciences. Nursing Science Quarterly 18 (1) 75-82.

Palinkas, L.A., Horwitz, S.M., Green, C.A., Wisdom, J.P., Duan, N. & Hoagwood, K. (2015). Purposeful Sampling for Qualitative Data Collection and Analysis in Mixed Method Implementation Research. Administration and Policy in Mental Health and Mental Health 42 (5) 533-544.

Kvale, S. & Brinkmann, S. (2009). Interview: Introduktion til et håndværk [Interview: An introduction to a craft]. 2 edn. Copenhagen: Hans Reitzel.

Green, J. & Thorogood, N. (2014). Qualitative methods for health research. 3 edn., p. 342. London: SAGE.

Smith, J.A. & Osborn, M. (2008). Interpretative Phenomenological Analysis. In: Smith JA, editor. Qualitative psychology: A Practical Guide to Research Methods. 2 edn., p.276. Los Angeles: SAGE Publications.

Langdridge, D. (2007). Phenomenological psychology: theory, research and method. p. 181. Harlow: Pearson Education.

Andreae, M.H., White, R.S., Chen, K.Y., Nair, S., Hall, C. & Shaparin, N. (2017). The Effect of Initiatives to Overcome Language Barriers and Improve Attendance: A Cross-Sectional Analysis of Adherence in an Inner City Chronic Pain Clinic. Pain Medicine 18 (2) 265-274.

Odonkor, C.A., Christiansen, S., Chen, Y., Sathiyakumar, A., Chaudhry, H., Cinquegrana, D., Lange, J., He, C. & Cohen, S.P. (2017). Factors Associated With Missed Appointments at an Academic Pain Treatment Center: A Prospective Year-Long Longitudinal Study. Anesthesia & Analgesia 125 (2) 562-570.

Nwabuo, C.C., Dy, S.M., Weeks, K. & Young, J.H. (2014). Factors associated with appointment non-adherence among African-Americans with severe, poorly controlled hypertension. PloS One 9 (8) e103090.

Rosenbaum, J.I., Mieloszyk, R.J., Hall, C.S., Hippe, D.S., Gunn, M.L. & Bhargava, P. (2018). Understanding Why Patients No-Show: Observations of 2.9 Million Outpatient Imaging Visits Over 16 Years. Journal of the American College of Radiology 15 (7) 944-950.

Birt, L., Scott, S., Cavers, D., Campbell, C. & Walter, F. (2016). Member Checking: A Tool to Enhance Trustworthiness or Merely a Nod to Validation? Qualitative Health Research 26 (13) 1802-1811.

Waheed, W., Hughes-Morley, A., Woodham, A., Allen, G. & Bower, P. (2015). Overcoming barriers to recruiting ethnic minorities to mental health research: a typology of recruitment strategies. BMC Psychiatry 15, 101.

Robinson, J.M. & Trochim, W.M. (2007). An examination of community members', researchers' and health professionals' perceptions of barriers to minority participation in medical research: an application of concept mapping. Ethnicity & Health 12 (5) 521-539.



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