Ethnic Discrimination Within Primary Care

Discrimination for Real? Rigorous Examination of Ethnic Discrimination Within Swedish Primary Health Care

The aim of this study is to examine whether patients are subjected to ethnic discrimination when seeking medical care within the digital Swedish primary health care service: 1177-direct. In doing so, we aim to identify and statistically control for other major pathways through which treatment differences may arise and which do not constitute direct discrimination, e.g., ethnic group differences in comorbidity. The stored data from the "1177-direct" digital platform enable rigorous examination of discrimination of patients with different ethnic backgrounds that are matched in many respects (e.g., reported symptoms, comorbidity, socioeconomic status, gender). Discrimination as manifested by ethnic differences in health care professionals' patient-centered communication (from the digital chat) and medical treatment will be probed for. By pinpointing the mechanisms underlying unequal care (e.g., discrimination), the results should be of relevance to future interventions aimed at combating inequalities in health care.

Study Overview

• Status: Completed
• Conditions: Health Care Disparities

• Study Type: Observational
• Enrollment (Actual): 5367

Contacts and Locations

Study Locations

• Sweden
  • Kalmar, Sweden, 39231
    • Linnaeus University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: N/A

• Sampling Method: Non-Probability Sample

Study Population

The base population consists of patient "visits" in the digital "1177 direct" health care service platform. Health care professionals who digitally interacted with these patients are also included in the study population. The study population comes from Region Kalmar county and includes all patients 18 years or older who appear in the "1177 direct" data base.

Description

Inclusion Criteria:

• patients being 18 years or older and appearing in the "1177-direct" data base

Exclusion Criteria:

-

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort
Ethnic majority group patients; Patients with Swedish ethnic background
Ethnic minority group patients; Patients with Middle Eastern and North African ethnic background

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Patient centered communication	Name of measurement: Person centered communication. Unit of measurement: Incidence of patient centered communication displayed in health care professionals' chat messages. Measurement tool: manual deductive coding of chat messages according to a patient centeredness manual developed by our research group.	Duration of the patient visit in the platform "1177 direct". Duration typically varies between 10-20 minutes, although some visits may take significantly longer.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Type of care received	Self-devised categorical variable capturing the type of care received. Unit of measure; for example, recommended self-care, physical appointment with a nurse, physical appointment with a doctor, referral to emergency/acute care.	Duration of the patient visit in the platform "1177 direct". Duration typically varies between 10-20 minutes, although some visits may take significantly longer.

Collaborators and Investigators

• Sponsor: Linnaeus University

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2024
• Primary Completion (Actual): July 31, 2025
• Study Completion (Actual): July 31, 2025

Study Registration Dates

• First Submitted: June 3, 2026
• First Submitted That Met QC Criteria: June 16, 2026
• First Posted (Actual): June 22, 2026

Study Record Updates

• Last Update Posted (Actual): June 22, 2026
• Last Update Submitted That Met QC Criteria: June 16, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: ethicity, discrimination, health care
• Other Study ID Numbers: 2024-01618-01; 2025-07820-0; 2023-05843 (Other Grant/Funding Number: Swedish Research Council)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

IPD Plan Description

Individual participant data cannot be shared feely and made publicly because it may contain sensitive personal information and is located on Statistics Sweden's secure server: MONA. Researchers who would like to reproduce our results need to obtain the necessary approvals and be granted access to the registry and MONA. If approvals are obtained, we will share:

Study Protocol Statistical Analysis Plan (SAP) Analytic Code

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No