Socioeconomic inequalities in primary care research: how can we make research more equitable? A quantitative and qualitative service evaluation.

Abstract

Health research should reflect contexts where interventions are needed to provide evidence generalisable to practice. There is concern that socioeconomically disadvantaged populations with poorer health and care outcomes are underrepresented in research, potentially exacerbating health inequalities. Evidence on the relationship between socioeconomic deprivation and general practice research involvement is limited. To explore the relationship between socioeconomic deprivation, general practice research involvement, and recruitment. Quantitative analysis of routine data and qualitative interviews with clinical and non-clinical general practice staff in the North East and North Cumbria (NENC) area of England. Analysis of general practice and National Institute for Health and Care Research (NIHR) Clinical Research Network (now the Regional Research Delivery Network [RDN]) data to understand associations between neighbourhood deprivation and research recruitment. Semi-structured interviews with GPs and practice managers or administrators explored barriers and facilitators to research involvement and patient recruitment in disadvantaged areas. Interviews were recorded, transcribed, and thematically analysed. Research recruitment was lower among practices (<i>n</i> = 358) with more deprived populations (χ²(4) = 7520.8, <i>P</i><0.001), and significantly lower among 'Deep End' practices in areas of blanket socioeconomic disadvantage (<i>P</i><0.001). Eleven GPs and four practice managers or administrators were interviewed. Barriers included greater difficulty recruiting patients, resource pressures, limited financial benefit, and awareness. Supporting factors were research designed to meet needs of socioeconomically disadvantaged populations that was accurately costed, remunerated, and resourced, with concise, practically focused communications. To support equitable general practice research participation, research should be relevant for and designed to meet the needs of socioeconomically disadvantaged populations, and be accurately costed and remunerated. Targeting additional resource at practices in socioeconomically disadvantaged areas could incentivise equitable research participation.