Real-world evidence for primary care: A primer on observational research

Observational studies offer a non-experimental and minimally disruptive approach for generating real-world evidence, making them particularly valuable for informing clinical practice, research and health system strengthening - especially in primary care. This article, part of the African Journal of Primary Health Care Family Medicine (PHCFM) methods series, introduces key observational study designs including cross-sectional, cohort and (nested) case-control studies and discusses their application in doctoral-level research. Drawing on historical and contemporary examples, we examine methodological considerations, ethical issues and modern analytical strategies essential for the careful planning and execution of observational research. By integrating conceptual frameworks and causal inference methods, this primer aims to equip researchers at different career stages with a foundational understanding of how to choose and implement observational designs that are both methodologically robust and relevant to primary care contexts.