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Epidemiological study on gender bias and low-value practices in primary care: a study protocol
  1. Irene Carrillo1,
  2. Adriana Lopez-Pineda2,3,4,
  3. Virtudes Pérez-Jover1,
  4. Mercedes Guilabert1,
  5. María Asunción Vicente1,
  6. César Fernández1,
  7. Vicente F Gil-Guillen2,4,
  8. Domingo Orozco-Bletrán2,4,
  9. Elisa Chilet-Rosell5,6,
  10. Lourdes Luzon Oliver7,
  11. Maria Pilar Astier-Peña8,9,
  12. Susanna Tella10,11,
  13. Concepción Carratalá-Munuera2,4,
  14. José Joaquín Mira1,3,12
  1. 1Department of Health Psychology, Miguel Hernandez University of Elche, Elche, Spain
  2. 2Department of Clinical Medicine, Miguel Hernandez University of Elche, San Juan de Alicante, Spain
  3. 3Atenea Research Group, Foundation for the Promotion of Health and Biomedical Research, San Juan de Alicante, Spain
  4. 4Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), San Juan de Alicante, Spain
  5. 5Centro de Investigacion Biomedica en Red de Epidemiologia y Salud Publica, Madrid, Spain
  6. 6Department of Public Health, Miguel Hernandez University of Elche, San Juan de Alicante, Spain
  7. 7Totana Sur Primary Health Center, Murcia, Spain
  8. 8Grupo de investigación IIS-Aragón H36_23D Feminización, Ética y Profesionalidad de las ciencias de la salud (FEPS), Tarragona, Spain
  9. 9Territorial Quality Unit. Management of Camp de Tarragona, Catalan Health Institute, Tarragona, Spain
  10. 10Health & Wellbeing, LAB University of Applied Sciences—Lappeenrannan kampus, Lappeenranta, Finland
  11. 11Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
  12. 12Alicante-Sant Joan d'Alacant Health Department, San Juan de Alicante, Spain
  1. Correspondence to Dr Virtudes Pérez-Jover; v.perez{at}


Introduction Evidence shows that gender has a substantial impact on health behaviours, access to and use of health systems and health system responses. This study aims to assess gender bias in patients subjected to low-value practices in the primary care setting and to develop recommendations for reducing adverse events that women experience for this reason.

Methods and analysis A Delphi study will be performed to reach a consensus on the ‘Do Not Do’ recommendations with a possible gender bias. A retrospective cohort study in a random selection of medical records will then be carried out to identify the frequency of adverse events that occur when the selected ‘Do Not Do’ recommendations are ignored. Qualitative research techniques (consensus conference and nominal group) will be carried out to develop recommendations to address any gender bias detected, considering barriers and facilitators in clinical practice.

Ethics and dissemination The study was approved by the ethics committee of San Juan de Alicante Hospital (San Juan de Alicante, Spain) Reference N. 21/061. We will disseminate the research findings via peer-reviewed articles, presentations at national and international scientific forums and webinars.

Trial registration number The study was registered at (NCT05233852) on 10 February 2022.

  • Quality in health care
  • Health & safety

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  • IC and AL-P are joint first authors.

  • CC-M and JJM are joint senior authors.

  • Twitter @MerceGuilabert, @PilarAstier, @susanna_tella

  • Contributors All authors have contributed to the conception or design of this study. IC, AL-P, MVP-J, CC-M and JJM drafted this manuscript. MG, MAV, CF, VFG-G, DO, EC-R, LLO, M-PA-P and ST revised this manuscript critically for important content. All authors approved the final version of this manuscript and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding This work is supported by Project Prometeu 2021/061 granted by Conselleria de Innovación, Universidades, Ciencia y Sociedad Digital, Generalitat Valenciana.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.