Exploring social determinants of health in primary care: Approaches to increase research inclusivity

Research on the social determinants of health (SDH) aims to foster a healthier, more equitable society by reducing health disparities. Nonetheless, primary care researchers often face challenges in engaging marginalized populations in their studies. It is essential to explore diverse methodologies to promote inclusive research. During the fifth annual Primary Care Research (PCR) Connect conference, dedicated to primary care research in Japan, we held a symposium to discuss strategies for enhancing inclusivity in SDH research. Using large-scale datasets from multiple centers or municipalities offers the advantage of evaluating the subtle effects of meso- and macro-level factors on individual health and their heterogeneities. However, the exclusion of individuals because of healthcare access barriers, language barriers, absence from official databases, or unstable housing situations can introduce sampling and selection biases. Such biases may compromise the studies' validity and generalizability of those findings.1 Therefore, the following studies focusing on marginalized populations highlight their potential benefits in specific contexts. By tailoring surveys to fit the target population, researchers can gather responses from individuals typically overlooked in large-scale surveys, allowing insights into their characteristics and concerns, including their lived experiences. For instance, investigations focus on individuals residing in marginalized communities, such as street dwellers living around train stations2 or residents in impoverished neighborhoods.3 Collaboration with local authorities ensures access to this data, essential for these studies. Furthermore, researchers should endeavor to mitigate health disparities by implementing interventions. Qualitative research offers researchers a window into the lived experiences, thoughts, and emotions of socially marginalized individuals. For instance, qualitative inquiry holds the potential to unveil the barriers perceived by women with a history of substance use, transgender individuals, or youth contemplating suicide,4 during their interactions within primary care settings. Case reports can elucidate the detailed experiences of patients facing complex social adversities.5 Reports concentrating on SDH equip primary care professionals with critical insights for managing SDH-related challenges in daily practice. Maintaining patient confidentiality is a critical responsibility for all reporters. Although we did not refer to a systematic review or scoping review in the conference, these reviews will synthesize the available evidence and identify evidence gaps. In conclusion, research on SDH can employ diverse methodologies to illuminate the experiences of marginalized populations. Primary care professionals, often the initial point of contact for patients facing social challenges, play a pivotal role in leveraging their position to amplify the voices of such individuals and engage in research focused on their health and well-being. We wish to thank Dr. Maki Nishimura for serving as the moderator of the symposium on which this paper is based. The authors have stated explicitly that there are no conflicts of interest in connection with this article.