{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T17:26:45Z","timestamp":1791307605811,"version":"4.3.1"},"reference-count":44,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2021,5,12]],"date-time":"2021-05-12T00:00:00Z","timestamp":1620777600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Health Research Board, Ireland","award":["HRA-PHR-2015-1344"],"award-info":[{"award-number":["HRA-PHR-2015-1344"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Context<\/jats:title>\n<jats:p>The use of ethnic identifiers in health systems is recommended in several European countries as a means to identify and address heath inequities. There are barriers to implementation that have not been researched.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Objective<\/jats:title>\n<jats:p>This study examines whether and how ethnicity data can be collected in Irish general practices in a meaningful and acceptable way.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Qualitative case study data generation was informed by Normalization Process Theory (NPT) constructs about \u2018sense\u2019 making and \u2018engagement\u2019. It consisted of individual interviews and focus group discussions based on visual participatory techniques. There were 70 informants, including 62 general practitioner (GP) users of diverse ethnic backgrounds recruited through community organisations and eight GPs identified through an inter-agency steering group. Data were analysed according to principles of thematic analysis using NPT.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Results<\/jats:title>\n<jats:p>The link between ethnicity and health was often considered relevant because GP users grasped connections with genetic (skin colour, lactose intolerance), geographic (prevalence of disease, early years exposure), behavioural (culture\/food) and social determinant (housing) factors. The link was less clear with religion. There was some scepticism and questions about how the collection of data would benefit GP consultations and concerns regarding confidentiality and the actual uses of these data (e.g. risk of discrimination, social control). For GPs, the main theme discussed was relevance: what added value would it bring to their consultations and was it was their role to collect these data? Their biggest concern was about data protection issues in light of the European Union (EU) General Data Protection Regulation (GDPR). The difficulty in explaining a complex concept such as \u2018ethnicity\u2019 in the limited time available in consultations was also worrying.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Implementation of an ethnicity identifier in Irish general practices will require a strong rationale that makes sense to GP users, and specific measures to ensure that its benefits outweigh any potential harm. This is in line with both our participants\u2019 views and the EU GDPR.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0251192","type":"journal-article","created":{"date-parts":[[2021,5,12]],"date-time":"2021-05-12T17:35:07Z","timestamp":1620840907000},"page":"e0251192","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":12,"title":["\u2018If relevant, yes; if not, no\u2019: General practitioner (GP) users and GP perceptions about asking ethnicity questions in Irish general practice: A qualitative analysis using Normalization Process Theory"],"prefix":"10.1371","volume":"16","author":[{"given":"Maria","family":"Roura","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3026-830X","authenticated-orcid":true,"given":"Joseph W.","family":"LeMaster","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ailish","family":"Hannigan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Papyan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon","family":"McCarthy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diane","family":"Nurse","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nazmy","family":"Villarroel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9708-5025","authenticated-orcid":true,"given":"Anne","family":"MacFarlane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,5,12]]},"reference":[{"issue":"2","key":"pone.0251192.ref001","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1093\/pubmed\/fds004","article-title":"Research agenda for tackling inequalities related to migration and ethnicity in Europe","volume":"34","author":"RS Bhopal","year":"2012","journal-title":"J Public Health"},{"issue":"9873","key":"pone.0251192.ref002","doi-asserted-by":"crossref","first-page":"1235","DOI":"10.1016\/S0140-6736(12)62086-8","article-title":"Migration and health in an increasingly diverse Europe","volume":"381","author":"B Rechel","year":"2013","journal-title":"The Lancet"},{"key":"pone.0251192.ref003","volume-title":"How health systems can address health inequities linked to migration and ethnicity","author":"World Health Organisation","year":"2010"},{"key":"pone.0251192.ref004","first-page":"79","volume-title":"Social work and minorities: European perspectives","author":"M Johnson","year":"2002"},{"key":"pone.0251192.ref005","unstructured":"Fulton R. Ethnic monitoring: Is health equality possible without it? London: Race Equality Foundation; 2010."},{"issue":"Suppl 5","key":"pone.0251192.ref006","doi-asserted-by":"crossref","first-page":"101S","DOI":"10.1177\/1077558707305409","article-title":"Diabetes health disparities: a systematic review of health care interventions","volume":"64","author":"ME Peek","year":"2007","journal-title":"Med Care Res Rev"},{"issue":"3","key":"pone.0251192.ref007","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1093\/eurpub\/ckx001","article-title":"Interventions to improve immigrant health: a scoping review","volume":"27","author":"E Diaz","year":"2017","journal-title":"Eur J Public Health"},{"issue":"5","key":"pone.0251192.ref008","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1017\/S1463423618000075","article-title":"A risk-based intervention approach to eliminate diabetes health disparities","volume":"19","author":"N Calman","year":"2018","journal-title":"Prim Health Care Res Dev"},{"issue":"8","key":"pone.0251192.ref009","doi-asserted-by":"crossref","first-page":"1310","DOI":"10.1080\/01419870.2016.1140793","article-title":"The multiple dimensions of race","volume":"39","author":"WD Roth","year":"2016","journal-title":"Ethnic Racial Stud"},{"issue":"3","key":"pone.0251192.ref010","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1258\/JHSRP.2011.011079","article-title":"The health care experiences of Travellers compared to the general population: the All-Ireland Traveller Health Study","volume":"17","author":"All-Ireland Traveller Health Research Study Team","year":"2012","journal-title":"J Health Serv Res Polic"},{"key":"pone.0251192.ref011","volume-title":"Data collection in the field of ethnicity","author":"L Farkas","year":"2017"},{"key":"pone.0251192.ref012","volume-title":"Migration, ethnicity, race and health in multicultural societies","author":"R Bhopal","year":"2019","edition":"2"},{"key":"pone.0251192.ref013","unstructured":"Irish Human Rights and Equality Commission, Public sector equality and human rights duty, Section 42 of the Irish Human Rights and Equality Commission Act 2014. Dublin: Irish Statute Book."},{"key":"pone.0251192.ref014","volume-title":"Second national intercultural health strategy 2018\u20132023","author":"Health Service Executive","year":"2018"},{"key":"pone.0251192.ref015","volume-title":"The migrant integration strategy: A blueprint for the future","author":"Department of Justice and Equality","year":"2017"},{"key":"pone.0251192.ref016","unstructured":"Mac Einri P. Immigration into Ireland: Trends, policy responses, outlook. Cork: Irish Centre for Migration Studies, University College Cork; 2001."},{"key":"pone.0251192.ref017","unstructured":"Central Statistics Office. Population and migration estimates. Dublin: Central Statistics Office; 2018."},{"issue":"1","key":"pone.0251192.ref018","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1186\/s12889-019-6651-2","article-title":"Migrant health research in the Republic of Ireland: a scoping review","volume":"19","author":"N Villarroel","year":"2019","journal-title":"BMC Public Health"},{"key":"pone.0251192.ref019","unstructured":"Gilmartin M. The changing landscape of Irish migration, 2000\u20132012. Maynooth: National Institute for Regional and Spatial Analysis; 2013."},{"issue":"1","key":"pone.0251192.ref020","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/s12939-019-1107-y","article-title":"Ethnicity recording in health and social care data collections in Ireland: where and how is it measured and what is it used for?","volume":"19","author":"A Hannigan","year":"2019","journal-title":"Int J Equity Health"},{"issue":"10","key":"pone.0251192.ref021","doi-asserted-by":"crossref","first-page":"e026335","DOI":"10.1136\/bmjopen-2018-026335","article-title":"Ethnic minority health in Ireland\u2014Co-creating knowledge (EMH-IC): a participatory health research protocol","volume":"8","author":"A Hannigan","year":"2018","journal-title":"BMJ Open"},{"issue":"3","key":"pone.0251192.ref022","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1177\/0038038509103208","article-title":"Implementing, embedding, and integrating practices: an outline of Normalization Process Theory","volume":"43","author":"C May","year":"2009","journal-title":"Sociology"},{"key":"pone.0251192.ref023","volume-title":"Case study research: Design and methods","author":"RK Yin","year":"2003","edition":"3"},{"key":"pone.0251192.ref024","volume-title":"Qualitative inquiry & research design: Choosing among five approaches","author":"J Creswell","year":"2007","edition":"2"},{"issue":"1","key":"pone.0251192.ref025","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1186\/s12913-016-1587-z","article-title":"Learning from doing: the case for combining normalisation process theory and participatory learning and action research methodology for primary healthcare implementation research","volume":"16","author":"T de Br\u00fan","year":"2016","journal-title":"BMC Health Serv Res"},{"issue":"1","key":"pone.0251192.ref026","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1111\/hex.12598","article-title":"Material practices for meaningful engagement: an analysis of participatory learning and action research techniques for data generation and analysis in a health research partnership","volume":"21","author":"M O\u2019Reilly-de Brun","year":"2018","journal-title":"Health Expect"},{"key":"pone.0251192.ref027","volume-title":"Participatory workshops: A sourcebook of 21 sets of ideas and activities","author":"R Chambers","year":"2002"},{"key":"pone.0251192.ref028","first-page":"183","volume-title":"The counselling & psychotherapy research handbook","author":"V Braun","year":"2014"},{"key":"pone.0251192.ref029","unstructured":"Pavee Point Traveller and Roma Centre, Policy and practice in ethnic data collection and monitoring counting us in\u2014Human rights count! Dublin: Pavee Point Traveller and Roma Centre; 2016."},{"key":"pone.0251192.ref030","unstructured":"Pavee Point Traveller and Roma Centre & Mid West Traveller Health Unit. Traveller health needs assessment: County Clare. Limerick: Pavee Point Traveller and Roma Centre & Mid West Traveller Health Unit; 2019."},{"key":"pone.0251192.ref031","unstructured":"MacFarlane A. Report of the Health Service Executive Working Group: To develop a model for the implementation of trained interpreters in the Irish healthcare system. Dublin: Health Service Executive; 2017."},{"issue":"7","key":"pone.0251192.ref032","doi-asserted-by":"crossref","first-page":"989","DOI":"10.1111\/spol.12501","article-title":"\u2018Explain or change\u2019: the quality and uses of ethnicity data in universities and healthcare organisation in England","volume":"53","author":"A Afridi","year":"2019","journal-title":"Soc Polic Admin"},{"issue":"9","key":"pone.0251192.ref033","doi-asserted-by":"crossref","first-page":"1659","DOI":"10.1016\/j.socscimed.2009.02.034","article-title":"Harms and benefits: collecting ethnicity data in a clinical context","volume":"68","author":"C Varcoe","year":"2009","journal-title":"Soc Sci Med"},{"key":"pone.0251192.ref034","doi-asserted-by":"crossref","first-page":"k1676","DOI":"10.1136\/bmj.k1676","article-title":"NHS is harming patient confidentiality by sharing data for immigration purposes, say MPs","volume":"361","author":"G Iacobucci","year":"2018","journal-title":"Brit Med J"},{"issue":"4","key":"pone.0251192.ref035","doi-asserted-by":"crossref","first-page":"606","DOI":"10.3390\/ijerph16040606","article-title":"Reducing racial inequities in health: using what we already know to take action","volume":"16","author":"DR Williams","year":"2019","journal-title":"Int J Environ Res Pub Health"},{"issue":"4","key":"pone.0251192.ref036","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1080\/15332640.2013.830943","article-title":"Travellers accessing addiction services in Ireland (2007 to 2010): analysis of routine surveillance data","volume":"12","author":"AM Carew","year":"2013","journal-title":"J Ethn Subst Abuse"},{"issue":"2","key":"pone.0251192.ref037","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1080\/09687637.2016.1197886","article-title":"The changing landscape of Irish Traveller alcohol and drug use","volume":"24","author":"MC Van Hout","year":"2017","journal-title":"Drug Educ Prev Polic"},{"key":"pone.0251192.ref038","volume-title":"How to analyse ethnic differences in health, health care, and the workforce: a toolkit for the NHS","author":"PJ Aspinall","year":"2006"},{"issue":"1","key":"pone.0251192.ref039","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1186\/s12939-017-0525-y","article-title":"Implementing guidelines and training initiatives to improve cross-cultural communication in primary care consultations: a qualitative participatory European study","volume":"16","author":"E Teunissen","year":"2017","journal-title":"Int J Equity Health"},{"issue":"1","key":"pone.0251192.ref040","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1186\/s13012-016-0396-4","article-title":"Achieving change in primary care\u2014causes of the evidence to practice gap: systematic reviews of reviews","volume":"11","author":"R Lau","year":"2016","journal-title":"Implement Sci"},{"issue":"7","key":"pone.0251192.ref041","doi-asserted-by":"crossref","first-page":"e010822","DOI":"10.1136\/bmjopen-2015-010822","article-title":"Engaging migrants and other stakeholders to improve communication in cross-cultural consultation in primary care: a theoretically informed participatory study","volume":"6","author":"C Lionis","year":"2016","journal-title":"BMJ Open"},{"issue":"1","key":"pone.0251192.ref042","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1186\/s13012-016-0506-3","article-title":"Implementation, context and complexity","volume":"11","author":"CR May","year":"2016","journal-title":"Implement Sci"},{"key":"pone.0251192.ref043","volume-title":"Census pilot survey","author":"Central Statistics Office","year":"2018"},{"key":"pone.0251192.ref044","volume-title":"Strategy and action plan for refugee and migrant health in the WHO European Region","author":"World Health Organization","year":"2016"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0251192","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,5,12]],"date-time":"2021-05-12T17:36:02Z","timestamp":1620840962000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0251192"}},"subtitle":[],"editor":[{"given":"Barbara","family":"Schouten","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,5,12]]},"references-count":44,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2021,5,12]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0251192","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,12]]}}}