10.17037/DATA.00004835
This replication package provides the data and code to reproduce the results reported in the published paper: "Do doctors contribute to socioeconomic inequalities in health care provision? An audit experiment in Tunisia".
Data were collected through structured questionnaires completed by Standardised Patients (SPs) after visits to primary care providers in public facilities and private clinics in urban Tunisia. The dataset includes 260 SP visits, portraying either a middle-class or a lower socioeconomic (poor) patient profile. The questionnaires captured consultation time and duration, questions asked, physical examinations performed, communication and advice provided, treatment plans (including drugs that were prescribed or given free-of-charge), and visit costs. The study also included a GP survey and clinical vignettes to test the knowledge of GPs.
An audit study using standardized patients (SPs) was conducted in public and private primary care facilities in Tunis. Thirteen trained SPs presented a consistent case of acute bronchitis under two socio-economic profiles (poor and middle-class). After each consultation, SPs completed a structured paper questionnaire on clinical care, costs, and communication. Supervisors debriefed SPs and transferred data into an electronic format, coding drugs using national guidelines and official pharmacy price lists. In total, 260 provider–patient interactions were collected, forming the final dataset for analysis.
Data Grand Tunis (4 governorates: Tunis, Ariana, La Manouba, Ben Arous)
Several quality control measures were implemented. Standardised Patients (SPs) underwent 10 days of intensive training to ensure consistent presentation of symptoms and adherence to a standardised script. After each consultation, supervisors debriefed the SPs and reviewed the completed questionnaires before entering information into an electronic database. Drug information was coded by supervisors using medical expertise and cross-checked with national guidelines and official pharmacy price lists. To assess detection risk, providers were contacted four weeks after the study; only 0.77% of visits were recognised as involving an SP, confirming the credibility of the method.
The participants are primary health care providers (General Practitioners) practicing in public and private facilities in Grand Tunis in Tunisia.
Providers have been assigned an unlinked study numbers. External identifiers have been removed.
| Organisation | Ethics ID | Other information |
| London School of Hygiene & Tropical Medicine | 12274 | - |
| Ministry of Health of Tunisia | 2017/10237 | - |
Health Care Provision; Socioeconomic Inequalities; Communication Quality, Standardised Patients; Audit Experiment; Tunisia
Mainly English. French and Arabic for data collection tools.
This is a PHD project of Rym Ghouma (2024) entitled: Investigating the quality of primary health care: the determinants of doctor provision of care and clinical behaviour in Tunisia.
| Project name | Funder/sponsor | Grant number |
| Investigating the quality of primary health care: the determinants of doctor provision of care and clinical behaviour in Tunisia | London School of Hygiene & Tropical Medicine, London, United Kingdom | Doctoral project travelling scholarship |
| Investigating the quality of primary health care: the determinants of doctor provision of care and clinical behaviour in Tunisia | London School of Economics, London, United Kingdom | Research fellowship |
| Forename | Surname | Faculty / Dept | Institution | Role |
| Rym | Ghouma | - | Data Creator | |
| Mylene | Lagarde | Health Policy | London School of Economics, London, United Kingdom | Supervisor |
| Timothy | Powell-Jackson | Public Health and Policy / Dept of Global Health and Development | London School of Hygiene & Tropical Medicine, London, United Kingdom | Supervisor |
Data was collected with a promise of strict confidentiality. Limited access may be provided for the purpose of validation and replication of the original study, in accordance with academic practice. However, the ethical approval does not allow data to be used for new research. The contact form may be used to clarify the research findings with the study authors.
| Filename | Description | Access status | Licence |
| sp-ses_data | Dataset containing details of 260 visits (observations) by Standard Patients with middle-class and poor backgrounds to previously consenting primary health care providers. Each row represents an SP visit. It contains a unique ID (real_ID), Provider Socio-demographic characteristics and knowledge variables measured with GP survey and vignettes, quality of Clinical care, cost of care, and GP communication outcomes (based on SP exit questionnaires), and 4. SP Profile (or scenario) variables and other fieldworkers variables. | Closed | None |
| sp-ses_data_codebook | Codebook for SP-SES dataset | Open to all | Creative Commons Attribution (CC-BY) |
| analysis | A STATA DO file containing the full analysis presented in the article including all results presented in the Appendix. | Open to all | Creative Commons Attribution (CC-BY) |
| sp_data_collection archive | |||
| sp_health_check_up_questionnaire-recruitment_French | Health Check-up Questionnaire for recruiting standardised patients, in French | Open to all | Creative Commons Attribution (CC-BY) |
| sp_leaflet-fieldwork_French | Fieldwork support material, SP leaflet, in French | Open to all | Creative Commons Attribution (CC-BY) |
| sp_potential_risks-mitigation_strategies | A table summarising the potential risks and mitigation strategies for the SPs (fieldworkers) and doctors (participants) | Open to all | Creative Commons Attribution (CC-BY) |
| sp_training_tool-simplified_English | SP training material, short version, English | Open to all | Creative Commons Attribution (CC-BY) |
| sp_scripts archive | |||
| middle-class_sp_script_Arabic | SP script, middle class profile, in Arabic | Open to all | Creative Commons Attribution (CC-BY) |
| poor_sp_script_Arabic | SP script, poor profile, in Arabic | Open to all | Creative Commons Attribution (CC-BY) |
| survey_tools | |||
| Clinical_vignette_survey_French | Clinical vignette survey, in French | Open to all | Creative Commons Attribution (CC-BY) |
| GP_survey_French | GP individual survey, in French | Open to all | Creative Commons Attribution (CC-BY) |
| SP_exit_questionnaire_French_Arabic | SP exit questionnaire, in French and Arabic | Open to all | Creative Commons Attribution (CC-BY) |
| 4835_UserGuide | User guide for replication package | Open to all | Creative Commons Attribution (CC-BY) |
The following documents are held on the LSHTM secure server.
| Filename | Description | Access status | Licence |
| Consent_ENG_quali | Consent form to participate to the qualitative pre-study work, in English | Open to all | Creative Commons Attribution (CC-BY) |
| Consent_ENG_gp_survey-vignettes | Consent form to participate to the GP survey and vignette survey, in English | Open to all | Creative Commons Attribution (CC-BY) |
| Consent_ENG_private_gp-public_facility_sp | Consent form to participate to the SP study (public and private providers), in English | Open to all | Creative Commons Attribution (CC-BY) |
| Consent_FR_quali | Consent form to participate to the qualitative pre-study work, in French | Open to all | Creative Commons Attribution (CC-BY) |
| Consent_FR_gp_survey-vignettes | Consent form to participate to the GP survey and vignette survey, in French | Open to all | Creative Commons Attribution (CC-BY) |
| Consent_FR_private_gp_sp | Consent form to participate to the SP study (private providers), in French | Open to all | Creative Commons Attribution (CC-BY) |
| Consent_FR_public_facility_sp | Consent form to participate to the SP study (public providers), in French | Open to all | Creative Commons Attribution (CC-BY) |
| Information_sheet_ENG_quali | Information sheet to participants, to the qualitative pre-study work, in English | Open to all | Creative Commons Attribution (CC-BY) |
| Information_sheet_FR_gp_survey-vignettes | Information sheet to participants, to the GP survey and vignette survey, in English | Open to all | Creative Commons Attribution (CC-BY) |
| Information_sheet_ENG_sp | Information sheet to participants, to the SP study, in English | Open to all | Creative Commons Attribution (CC-BY) |
| Information_sheet_FR_quali | Information sheet to participants, to the qualitative pre-study work, in French | Open to all | Creative Commons Attribution (CC-BY) |
| Information_sheet_FR_gp_survey-vignettes | Information sheet to participants, to the GP survey and vignette survey, in French | Open to all | Creative Commons Attribution (CC-BY) |
| Information_sheet_FR_sp_phase | Information sheet to participants, to the SP study, in French | Open to all | Creative Commons Attribution (CC-BY) |