Table 1 Adapted description of the stages of the Candidacy Framework [1]

1. Identification of candidacy

Process in which a person comes to appraise their issue as needing medical help which legitimises them as a candidate for particular health services.

2. Navigation of services

Knowledge of services provided and appraisal of the practicalities involved in making contact with and accessing services. Includes barriers to accessing services such as needing transport, convenience of appointment times and accumulated costs of attending services.

3. Permeability of services

The ease with which a person can use health services. Includes levels of gate-keeping within a service, the complexity of its referral processes, and the ‘cultural alignment’ of services with the person’s needs and values.

4. Appearance at services

The person’s ability to assert their candidacy by presenting at services, articulating their issue and articulating their ‘need’ for care.

5. Adjudication by healthcare professionals

A person’s candidacy is judged by healthcare professionals, subsequently influencing the person’s progression through services and access to care. Adjudication may disadvantage certain people by perceiving them as either ‘deserving’ or ‘undeserving’.

6. Offers of, resistance to services

A person may refuse offers at multiple stages in their journey to treatment including resisting offers for appointments, referral, and treatment.

7. Operating conditions and local production of candidacy

Incorporates factors at societal and macro levels which influence candidacy, such as the availability of local resources for addressing candidacy, and relational aspects which develop between the healthcare provider and patient over multiple visits.