A scoping review on the application of intersectionality as an analytical approach in primary care research

Background
While inequalities in primary care are well-documented, far less attention has been paid to how these vary when social identities, geographic contexts, and economic disadvantage combine. Intersectionality theory provides a critical framework for understanding how overlapping social identities can jointly shape individuals’ experiences. Despite its potential, little is known about how this theory has been applied to investigate inequalities in primary care, including the methods used and the populations or outcomes examined.

Aim
We aim to map how intersectionality theory and methodologies have been applied to investigate inequalities in primary care.

Method
We conducted this scoping review following PRISMA-ScR guidelines. We searched six databases and grey literature sources (up to June 2023) for empirical studies applying intersectionality in primary care contexts. Data was extracted and synthesised descriptively, categorising studies by their research methodology and intersectional approach.

Results
Out of 1612 retrieved records, 37 studies met the inclusion criteria, with 86.5% (k = 32) published after 2017. Included studies were mainly based in high-income countries. Quantitative studies (k = 20) outnumbered qualitative (k = 15), highlighting a reliance on additive statistical models rather than experiential depth. Race and gender were the most frequently examined intersections. Studies primarily focused on patient outcomes, largely exploring disadvantage, with limited attention to provider perspectives or focused on the evaluation of interventions. Methodologically, more studies compared social groups (intercategorical) than explored unique subgroup experiences (intracategorical), and the application of intersectionality often served more as a guiding lens than a rigorous analytical tool.

Conclusion
Intersectionality as an applied analytical approach in primary care research is relatively new but growing. It offers significant potential to reveal complex inequalities missed by more commonly applied descriptive or regression approaches. Key gaps remain regarding the geographic and demographic scope of research, the range of quantitative methods used, and the application of intersectional findings to develop and test interventions. Explicitly adopting intersectional approaches to identify those facing the greatest barriers in care is crucial to allow primary care to meet population needs.

Trial Registration
This scoping review adhered to a protocol previously published in BMC Systematic Reviews, and that is registered on the Open Science Framework website (https://osf.io/h9p83).