Review framework and registration

The scoping review will follow the methodological framework set out by Arksey and O’Malley [31] and developed further by Levac et al. [32]. The review will be conducted and reported according to PRISMA-ScR guidance [33] which we have also used to guide the reporting of this protocol. The scoping review is registered with the Open Science Framework (https://osf.io/h9p83/). Our search strategy has also been reviewed by a research librarian.

Stage 1: identifying the research question

Our proposed research question is: “How has intersectionality theory and methodology been applied to investigate inequalities in primary care services?”. We developed this primary research question using the population, context, and concept framework [34], where:

The population will include all patients eligible to receive care and health professionals who provide primary care services including unregistered patients.

The context will focus on the primary care setting. We plan to consider primary care provided in the community in a general practitioner setting, considering both primary care and primary health care services where the latter encompasses a broader definition beyond the traditional family doctor care [35].

We use the Bauer et al. [23] definition of intersectionality to define the underlying concept of the research question as the investigation of inequalities across two or more patient characteristics. This definition is consistent with seminal studies on intersectionality theory [20, 36].

Stage 2: identifying relevant studies

The databases and search terms that we propose to use are provided in Table 1. We plan to conduct the search in three parts, including published studies and the grey literature to maximise the scope of the search. Databases will be chosen based on their relevance to health research and ability to track citations. In the first part of the search, we will screen the title and abstract of all published studies in peer-reviewed academic journals. These will be obtained via an electronic search of the title, abstract, and keywords in Ovid MEDLINE, Embase, Econlit, PsycArticles, Social Policy and Practice and Scopus (all but the latter via Ovidsp). In the second part of the search, we will utilise the same methodology to identify published and unpublished grey literature studies, via an electronic search of OpenGrey. We propose to use no date restrictions during the search process, to ensure all potentially relevant studies are captured.

Table 1 Database, rationale, and search terms

We plan to use a range of primary care search terms, utilizing the search filter specified by Gill et al. [37]. These terms are presented in Table 1. We will use the Boolean operators “AND” and “OR” for search strings.

To assess the feasibility of these search terms, we have conducted a preliminary search in Ovid across five databases. We present the search results in Appendix 1: Table A1 which resulted in 899 abstracts. Our proposed review plans to extend this search.

We propose the following four-part inclusion criteria listed in Table 2. First, we plan to only include studies focusing on primary care or primary health care services, defined as care delivered in a GP practice or equivalent. Second, we propose to only include studies investigating inequalities in primary care using an intersectionality approach. To do so, we will use the definition of intersectionality adopted by Bauer et al. [23] that defines intersectionality as the investigation of two or more patient characteristics. Third, we will only include empirical studies using quantitative, qualitative or mixed methods. In doing so, we will exclude theoretical studies and commentary pieces. These types of studies do not align with the objectives of the scoping review which seeks to investigate the application of intersectionality in primary care and its practical implications, rather than generate theoretical hypotheses. Our search will have no publication date restriction, however, due to resource constraints, we will only include studies written in English.

Table 2 Proposed inclusion criteriaStage 3: study selection

Following the search, we propose to collate and upload all identified citations into Zotero (v6) and remove duplicates. These will then be exported into Microsoft Excel to undergo an initial screening test.

Titles and abstracts will be screened independently by five reviewers for assessment against the inclusion criteria. Two reviewers will conduct a 10% check of the searched studies. The group will meet to discuss the included studies and resolve any disagreements. We will then perform a forward and backwards citation search of the included studies, to identify any overlooked literature. We will record the number of studies included and excluded in the template provided in Fig. 1. The results of the search and the study inclusion process will be reported in full in the final scoping review.

Fig. 1

Example study selection flow chart

Stage 4: charting the data

We propose to extract the following information listed in the data extraction form in Table 3. One reviewer will extract information from the included papers.

Table 3 Proposed data extraction form

We plan to use the following draft data extraction form which was developed from discussion with the authorship team. This will be modified and revised as necessary during the process of extracting data from each included evidence source. Modifications will be detailed in the scoping review. If appropriate, authors of papers will be contacted to request missing or additional data, where required. Extracted data will be recorded in Microsoft Excel. The completed data extraction form will be included in the final scoping review.

We will begin by charting the data with a pilot test of ten studies using the data extraction form which is in line with current guidance [32]. Two reviewers will complete the form on the same ten studies independently to ensure consistency between reviewers. Any disagreements will be resolved through discussion with the authorship team.

Stage 5: collating, summarising and reporting the results

We will analyse and present the extracted data in table format. We will also provide a descriptive numerical summary of the included studies and a narrative synthesis of the results. In line with most scoping reviews we will not undertake a critical appraisal. Finally, we will use the results of the scoping review to provide a summary of the implications for future primary care policy and practice.

Patient and public involvement

There was no patient and public involvement in this protocol.