Mar Estupiñán Fernández De Mesa

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).
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).
The Arksey and O'Malley framework for systematic scoping reviews guided the study. All findings were reported according to the PRISMA-Equity 2012 guidelines.
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.
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).
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.

Background
Exploring the role of structural power in relation to an individual's location in society can yield novel insights into cancer inequities. We aimed to understand how minority ethnic women's identities (age, gender, ethnicity, social position) intersected with social networks and healthcare services to influence their experiences of breast cancer care.

Methods
Semi-structured interviews with 20 women aged 31–60 years with a breast cancer diagnosis identifying as: Asian (n = 7), Black (n = 9), and of mixed ethnicity (n = 4) about their breast cancer journey. Data were analysed using Framework Analysis.

Results
We developed four themes; feeling stereotyped by (a) healthcare professionals (HCPs) and (b) social networks; influence of HCPs' knowledge, attitudes, and behaviours; perceived barriers in healthcare services; and influence of cultural beliefs. We provided a visual representation to illustrate the multifaceted factors that explain pathways to breast cancer inequities for these groups.

Conclusion
Our findings underscored that minority ethnic women negotiated complex processes that influence their coping responses, access to services, and management of their disease. Our study exposed institutional deficiencies that systematically disadvantage minority ethnic women. These findings suggest that policymakers and clinicians should reformulate policies and cancer services to ensure all women with breast cancer receive equal and optimal care.