Who are we listening to? A Systematic Scoping Review of Surveys Exploring Patient Satisfaction, Care Experience, And Access to Primary Care Services

Background: Globally, patient surveys are used to improve quality of primary care services. Survey items lacking an equity focus may limit the applicability of findings, leading to changes in services that are not tailored to the needs of underserved populations (e.g., socially disadvantaged populations and those with greater needs). Aim: To review the global literature to 1) identify validated surveys used to evaluate quality in primary care and 2) assess if these surveys were designed for underserved populations (using the Candidacy Framework: a tool designed to examine equity in primary care). Design and setting: The Arksey and O’Malley framework for systematic scoping reviews guided the study. All findings were reported according to the PRISMA-Equity 2012 guidelines. Method: Five datasets Medline, CINHAL, PsycINFO, Embase, and Web of Science and reference lists of relevant published literature were systematically searched to identify studies that reported validated quantitative survey to assess access of primary care services, and/or care experience and patient satisfaction. Results: From 5,404 records, 69 articles were included, and 46 unique surveys identified. Twenty-one articles (30%) reported a survey tailored to underserved populations or contexts. Most survey items mapped to permeability of services, with few focused on adjudication by healthcare professionals or digital care experience. Tools assessing dimensions of quality in primary care often overlook the potentially nuanced experience of underserved populations (e.g., ableism, racism). Conclusions: Our findings revealed a significant gap in efforts to understand the factors that privilege some populations and disadvantage others, potentially widening the primary care divide.