Primary healthcare, climate-related health impacts and intercultural dialogue: bibliometric evidence of a fragmented research field

Abstract

Primary healthcare, climate-related health impacts, and intercultural dialogue are increasingly relevant to health equity and health service adaptation, yet it remains unclear whether these domains form an integrated research field or remain partially connected literatures. This systematic bibliometric analysis addresses this question by mapping how primary healthcare, climate-related health impacts, and intercultural dialogue appear in the literature. For this purpose, records were retrieved from Scopus, Web of Science Core Collection, PubMed, SciELO, RCAAP and Google Scholar, with additional records identified through exploratory searching and the lead author's library. Records published between 1 January 2007 and 31 March 2026 in English, Portuguese or Spanish were included if they addressed one or more domains of the pre-specified Population–Exposure–Outcome framework: primary healthcare physicians and culturally diverse adult patients (Population); direct or indirect health impacts of climate change (Exposure); and intercultural dialogue strategies relevant to the primary-care doctor–patient relationship (Outcome). Records were managed in Rayyan and Microsoft Excel. Descriptive analyses characterised search yield, source contribution, screening attrition, document profile, language, geographical context, publication venues and citation visibility. VOSviewer supported keyword co-occurrence, temporal overlay and co-authorship mapping. These analyses were conducted on the full-text assessed corpus, distinct from the smaller subset retained for qualitative synthesis. Searches identified 19,211 records: 13,816 after deduplication; 801 reports sought for retrieval, of which 56 could not be retrieved. This left 745 reports for full-text assessment, none of which met the complete Population + Exposure + Outcome configuration; the strongest partial intersection comprised 64 reports addressing only Population and Outcome. Keyword co-occurrence analysis reinforced this pattern: a consolidated thematic core centred on access to healthcare, cultural competence, primary healthcare, communication, migrant populations and sociocultural diversity, whereas climate-related terms remained more peripheral, more recent and less structurally embedded. Taken together, these findings indicate that primary healthcare, climate-related health impacts and intercultural dialogue remain adjacent rather than integrated bodies of literature, with cultural competence and migrant-health research far more consolidated than the climate-health dimension. Closing this gap requires research that directly examines how climate-sensitive health risks are recognised, communicated and negotiated in intercultural primary-care encounters, to inform both clinical training and climate-adaptation policy. Systematic Review Registration : https://www.crd.york.ac.uk/PROSPERO/view/CRD420251038912 , PROSPERO CRD420251038912.