FAIRSTEPS study - Framework Addressing Inequities in pRimary care using STakEholder PerspectiveS: Integrative evidence review and Delphi consensus

Abstract

Objectives: Health inequities are unjust and avoidable differences in health outcomes across populations and between population groups. Though these arise predominantly from social determinants of health, healthcare is estimated to contribute around 20 % and primary healthcare reduces inequities in healthcare outcomes. As each provider works in their local context, we sought to provide an evidence-informed framework for designing, implementing, and evaluating local health inequity interventions in primary care.

Study design: Mixed methods approach: an integrative evidence review, a multidisciplinary Delphi consensus study and collaborative patient and public participation.

Methods: We searched published and grey literature for examples of primary care health inequity interventions. Our Delphi survey then asked primary care professionals how feasible and useful similar interventions would be in their local contexts. We incorporated an ongoing dialogue people with lived experience of health inequity in our design, implementation, and analysis.

Results: Sixty-nine published papers and 19 grey literature papers were included. Interventions included multiple objectives (e.g., tailored provision, practitioner training) or focus (e.g., medical care, screening). Theory underpinning intervention design was rarely explicit but some specific tools and theory was identified for the framework. Practitioners and our patient group prioritised 28 example interventions to aid the design of local contextually sensitive interventions.

Conclusions: We combined evidence synthesis, practitioner consultation and dialogue with people with lived experience produced an evidence-informed framework for the design, implementation and evaluation of local primary care health inequity interventions. The public and practitioner voice increases the credibility of our framework as a useful tool for service development.

Keywords: Health inequalities; Patient care; Primary care.