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BMC Health Services Research
Published in: BMC Health Services Research 1/2013

Open Access 01-12-2013 | Research article

Mapping the concept of vulnerability related to health care disparities: a scoping review

Authors: Cristina Grabovschi, Christine Loignon, Martin Fortin

Published in: BMC Health Services Research | Issue 1/2013

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Abstract

Background

The aim of this paper is to share the results of a scoping review that examined the relationship between health care disparities and the multiplicity of vulnerability factors that are often clustered together.

Methods

The conceptual framework used was an innovative dynamic model that we developed to analyze the co-existence of multiple vulnerability factors (multi-vulnerability) related to the phenomenon of the ‘Inverse Care Law’. A total of 759 candidate references were identified through a literature search, of which 23 publications were deemed relevant to our scoping review.

Results

The review confirmed our hypothesis of a direct correlation between co-existing vulnerability factors and health care disparities. Several gaps in the literature were identified, such as a lack of research on vulnerable populations’ perception of their own vulnerability and on multimorbidity and immigrant status as aspects of vulnerability.

Conclusions

Future research addressing the revealed gaps would help foster primary care interventions that are responsive to the needs of vulnerable people and, eventually, contribute to the reduction of health care disparities in society.
Appendix
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Literature
1.
Centers for Disease Control and Prevention CDC: CDC health disparities and inequalities report. MMWR Morb Mortal Wkly Rep. 2011, 60 (Suppl): 116.
2.
3.
4.
Smedley BD, Stith AY, Nelson AR: Unequal treatment: confronting racial and ethnic disparities in health care. 2003, Washington, D.C.: The National Academies Press
5.
Wilkinson R: The impact of inequality. How to make sick societies healthier. 2005, New York, NY: The New Press
6.
Williams RA: Historical perspectives in healthcare disparities: is the pas prologue?. Eliminating healthcare disparities in America. Beyond the IOM report. Edited by: Williams RA. 2007, Totowa, NJ: Humana PressCrossRef
7.
Aday LA: At risk in America: The health and health care needs of vulnerable populations in the United States. 2001, San Francisco: Jossey-Bass, 2
8.
Shi L, Stevens GD: Vulnerable populations in the United States. 2010, San Francisco, CA: Jossey-Bass, 2
9.
Alwang J, Siegel PB, Jorgenson SL: Vulnerability as viewed from different disciplines. Presented at sustaining food security and managing natural resources in southeast Asia: challenges for the 21 st century. 2002, Chiang Mai, Thailand: International Symposium.
10.
Shi L, Stevens GD, Faed P, Tsai J: Rethinking vulnerable populations in the United States: an introduction to a general model of vulnerability. Harvard Health Policy Rev. 2008, 9 (1): 43-48.
11.
Arskey H, O’Malley L: Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005, 8 (1): 19-32. 10.1080/1364557032000119616.CrossRef
12.
Anderson S, Allen P, Peckham S, Goodwin N: Asking the right questions: scoping studies in the commissioning of research on the organization and delivery of health services. Health Res Policy Syst. 2008, 6 (7): 1-12.
13.
Levac D, Colquhoun H, O’Brien KK: Scoping studies: advancing the methodology. Implement Sci. 2010, 5 (6): 1-9.
14.
Davis K, Drey N, Gould D: What are scoping studies? a review of the nursing literature. Int J Nurs Stud. 2009, 46: 1386-1400. 10.1016/j.ijnurstu.2009.02.010.CrossRefPubMed
15.
Brien S, Lorenzetti D, Lewis S, Kennedy J, Ghali W: Overview of a formal scoping review on health system report cards. Implement Sci. 2010, 5 (1): 2-10.1186/1748-5908-5-2.CrossRefPubMedPubMedCentral
16.
Hemingway P, Brereton N: What is a systematic review?. 2009, London, UK: Hayward Medical Communications
17.
18.
Mercer SW, Watt GCM: The inverse care Law: clinical primary care encounters in deprived and affluent areas of Scotland. Ann Fam Med. 2007, 5 (6): 503-510. 10.1370/afm.778.CrossRefPubMedPubMedCentral
19.
Hutchison B: Disparities in healthcare access and use: yackety - yack, yackety - yack. Healthcare Policy. 2007, 3 (2): 10-18.
20.
Lasser KE, Himmelstein DU, Woolhandler S: Access to care, health status and health disparities in the United States and Canada: results of a cross-national population-based survey. Am J Public Health. 2006, 96 (7): 1300-1307. 10.2105/AJPH.2004.059402.CrossRefPubMedPubMedCentral
21.
Shi L, Stevens GD: Vulnerability and unmet health care needs. The influence of multiple risk. J Gen Intern Med. 2005, 20 (2): 148-154. 10.1111/j.1525-1497.2005.40136.x.CrossRefPubMedPubMedCentral
22.
Rogers AC: Vulnerability, health and health care. J Adv Nurs. 1997, 26: 65-72. 10.1046/j.1365-2648.1997.1997026065.x.CrossRefPubMed
23.
Larkin M: Vulnerable groups in health and social care. 2009, Thousand Oaks, CA: Sage PublicationsCrossRef
24.
Flaskerud JH, Winslow BJ: Conceptualizing vulnerable populations health-related research. Nurs Res. 1998, 47 (2): 69-78. 10.1097/00006199-199803000-00005.CrossRefPubMed
25.
Denberg TD, Kim FJ, Flanigan RC, Fairclough D, Beaty BL, Steiner JF, Hoffman RM: The Influence of Patient Race and Social Vulnerability on Urologist Treatment Recommendations in Localized Prostate Carcinoma. Med Care. 2006, 44 (12): 1137-1141. 10.1097/01.mlr.0000233684.27657.36.CrossRefPubMed
26.
Giger J, Davidhizar RE, Purnell L, Harden JT, Phillips J, Strickland O: American academy of nursing expert panel report: developing cultural competence to eliminate health disparities in ethnic minorities and other vulnerable populations. J Transcult Nurs. 2007, 18 (95): 95-102.CrossRefPubMed
27.
Fiscella K, Shin P: The inverse care law implications for healthcare of vulnerable populations. J Ambulatory Care Manage. 2005, 28 (4): 304-312.CrossRefPubMed
28.
Rieder J-P, Gravier B, Bertrand D, Pasche C, Bodenmann P, Wolff H: Santé en milieu pénitentiaire: vulnérabilité partagée entre détenus et professionnels de la santé. Rev Med Suisse. 2010, 6: 1462-1465.PubMed
29.
Ruiz J, Egli M: Syndrome métabolique, diabète sucré et vulnérabilité: une approche «syndémique» de la maladie chronique. Rev Med Suisse. 2010, 6: 2205-2208.PubMed
30.
Shi L, Stevens GD: The role of community health centers in delivering primary care to the underserved. Experiences of the uninsured and Medicaid insured. J Ambulatory Care Manage. 2007, 30 (2): 159-170.CrossRefPubMed
31.
Stone J: Race and healthcare disparities: overcoming vulnerability. Theor Med Bioeth. 2002, 23 (6): 499-518. 10.1023/A:1021524431845.CrossRefPubMed
32.
Carlson MJ, Blustein J: Access to care among vulnerable populations enrolled in commercial HMOs. J Health Care Poor Underserved. 2003, 14 (3): 372-385. 10.1353/hpu.2010.0635.CrossRefPubMed
33.
Monod S, Sautebin A: Vieillir et devenir vulnérable. Rev Med Suisse. 2009, 5: 2353-2357.PubMed
34.
Pauly MV, Pagán JA: Spillovers and vulnerability: the case of community uninsurance. Health Aff. 2007, 26 (5): 1304-1314. 10.1377/hlthaff.26.5.1304.CrossRef
35.
Pitkin Derose K, Escarce JJ, Lurie N: Immigrants and health care: sources of vulnerability. Health Aff. 2007, 26 (5): 1258-1268. 10.1377/hlthaff.26.5.1258.CrossRef
36.
German D, Latkin CA: Social stability and HIV risk behavior: evaluating the role of accumulated vulnerability. AIDS Behavior Journal. 2012, 16: 168-178. 10.1007/s10461-011-9882-5.CrossRef
37.
Bieler G, Paroz S, Faouzi M, Trueb L, Vaucher P, Althaus F, Daeppen J-B, Bodenmann P: Social and medical vulnerability factors of emergency department frequent users in a universal health insurance system. Academic Emergency Med. 2012, 19 (1): 63-68. 10.1111/j.1553-2712.2011.01246.x.CrossRef
38.
Mechanic D, Tanner J: Vulnerable people, groups, and populations: societal view. Health Aff. 2007, 26 (5): 1220-1230. 10.1377/hlthaff.26.5.1220.CrossRef
39.
Stevens GD, Seid M, Mistry R, Halfon N: Disparities in primary care for vulnerable children: the influence of multiple risk factors. Health Serv Res. 2006, 41 (2): 507-531. 10.1111/j.1475-6773.2005.00498.x.CrossRefPubMedPubMedCentral
40.
Broyles RW, McAuley WJ, Baird-Holmes D: The medically vulnerable: their health risks, health status and use of physician care. J Health Care Poor Underserved. 1999, 10 (2): 186-200. 10.1353/hpu.2010.0498.CrossRefPubMed
41.
Broyles RW, Narine L, Brandt EN: Equity concerns with the use of hospital services by the medically vulnerable. J Health Care Poor Underserved. 2000, 11 (3): 343-360. 10.1353/hpu.2010.0752.CrossRefPubMed
42.
Walker KO, Steers N, Liang L-J, Morales LS, Forge N, Jones L, Brown AF: The vulnerability of middle-aged and older adults in a multiethnic, low-income area: contributions of Age, ethnicity, and health insurance. J Am Geriatr Soc. 2010, 58 (12): 2416-2422. 10.1111/j.1532-5415.2010.03189.x.CrossRefPubMedPubMedCentral
43.
Shi L, Forrest CB, von Schrader S, Ng J: Vulnerability and the patient–practitioner relationship: the roles of gatekeeping and primary care performance. Am J Public Health. 2003, 93 (1): 138-144. 10.2105/AJPH.93.1.138.CrossRefPubMedPubMedCentral
44.
Shi L, Stevens GD: Vulnerability and the receipt of recommended preventive services: the influence of multiple risk factors. Med Care. 2005, 43 (2): 193-198. 10.1097/00005650-200502000-00014.CrossRefPubMed
45.
Andersen RM: Revisiting the behavioral model and access to medical care: does it matter?. J Health Soc Behav. 1995, 36 (1): 1-10. 10.2307/2137284.CrossRefPubMed
46.
Andersen R, Aday LA: Access to medical care in the U.S.: realized and potential. Med Care. 1978, 16 (7): 533-546. 10.1097/00005650-197807000-00001.CrossRefPubMed
47.
IOM- Institute of Medicine: A manpower policy for primary health care. 1978, Washington, DC: National Academy of Sciences
48.
Blumenthal D, Mort E, Edwards J: The efficacy of primary care for vulnerable population groups. Health Serv Res. 1995, 30 (1, Part 2): 253-273.PubMedPubMedCentral
49.
50.
Pescosolido B, Kronenfeld JJ: Health, illness, and healing in an uncertain era: challenges from and for medical sociology. J Health Soc Beha. 1995, Extra issue: 5-33.CrossRef
51.
Herzlich C: Health and illness. 1973, London, UK: Academic
52.
Kleinman A, Eisenberg L, Good B: Culture, illness and care: clinical lessons from anthropological and cross-cultural research. Ann Intern Med. 1978, 88: 251-288. 10.7326/0003-4819-88-2-251.CrossRefPubMed
53.
Spiers J: New perspectives on vulnerability using emic and etic approaches. J Adv Nurs. 2000, 31 (3): 715-721. 10.1046/j.1365-2648.2000.01328.x.CrossRefPubMed
54.
Guilfoyle J, Kelly L, St Pierre-Hansen N: Prejudice in medicine. Our role in creating health care disparities. Can Fam Physician. 2008, 54: 1511-1513.PubMedPubMedCentral
55.
Cutter SL: Vulnerability to environmental hazards. Prog Hum Geogr. 1996, 20: 529-539. 10.1177/030913259602000407.CrossRef
56.
Cutter SL, Boruff BJ, Lynn Shirley W: Social vulnerability to environmental hazards. Soc Sci Quaterly. 2003, 84 (2): 242-10.1111/1540-6237.8402002.CrossRef
57.
Cutter SL, Mitchell JT, Scott S: Revealing the vulnerability of people and places: a case study of Georgetown county, south Carolina. Ann Assoc Am Geogr. 2000, 90 (4): 713-737. 10.1111/0004-5608.00219.CrossRef
58.
Becker G, Beyene Y, Newsom EM, Rodgers DV: Knowledge and care of chronic illness in three ethnic minority groups. Fam Med. 1998, 30 (3): 173-178.PubMed
59.
Bury M: Chronic illness as biographical disruption. Sociol Health Illn. 1982, 4 (2): 167-182. 10.1111/1467-9566.ep11339939.CrossRefPubMed
60.
Janson S, Becker G: Reasons for delay in seeking treatment for acute asthma: the patient’s perspective. J Asthma. 1998, 35 (5): 427-435. 10.3109/02770909809048951.CrossRefPubMed
61.
Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B: Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012, 10.1016/S0140-6736(12)60240-2. published online May 10, 2012
62.
Boyd CM, Fortin M: Future of multimorbidity research: How should understanding of multimorbidity inform health system design?. Public Health Rev. 2010, 32 (2): 451-474.
63.
Fortin M, Lapointe L, Hudon C, Vanasse A: Multimorbidity in medical literature: is it commonly researched?. Can Fam Physician. 2005, 51: 244-245.PubMed
64.
Anderson G, Horvath J: Chronic conditions: making the case for ongoing care. 2002, Baltimore, MD: Johns Hopkins University
65.
Parekh AK, Barton MB: The challenge of multiple comorbidity for the US health care system. JAMA. 2010, 303 (13): 1303-1304. 10.1001/jama.2010.381.CrossRefPubMed
66.
Fortin M, Soubhi H, Hudon C, Bayliss EA, van den Akker M: Multimorbidity’s Many challenges: time to focus on the needs of this vulnerable and growing population. BMJ. 2007, 334: 1016-1017. 10.1136/bmj.39201.463819.2C.CrossRefPubMedPubMedCentral
67.
Lucas JW, Barr-Anderson DJ, Kington RS: Health status, health insurance, and health care utilization patterns of immigrant black men. Am J Public Health. 2003, 93 (10): 1740-1747. 10.2105/AJPH.93.10.1740.CrossRefPubMedPubMedCentral
68.
McDermott S, Gupta S, DesMeules M, Kazanjian A, Vissandjée B, Ruddick E, Kliewer E: Recours des immigrants et des réfugiés canadiens aux services de santé. Sante Canada: Bulletin de recherche sur les politiques de santé: La santé des migrants. 2010, 17: 37-41.
69.
Wagner TH, Guendelman S: Healthcare utilization among hispanics: findings from the 1994 minority health survey. Am J Managed Care. 2000, 6 (3): 355-364.
70.
Anderson LM, Scrimshaw SC, Fullilove MT, Fielding JE, Normand J: Culturally competent healthcare systems. A systematic review. Am Am J Prev Med. 2003, 24 (3S): 68-79.CrossRefPubMed
71.
Fiscella K, Franks P, Doescher MP, Saver BG: Disparities in health care by race, ethnicity, and language among the insured. Med Care. 2002, 40: 52-59. 10.1097/00005650-200201000-00007.CrossRefPubMed
72.
Siddiqi A, Zuberi D, Nguyen QC: The role of health insurance in explaining immigrant versus non-immigrant disparities in access to health care: comparing the United States to Canada. Soc Sci Med. 2009, 69 (10): 1452-1459. 10.1016/j.socscimed.2009.08.030.CrossRefPubMed
73.
Wu Z, Penning MJ, Schimmele CM: Immigrant status and unmet health care needs. Can J Public Health. 2005, 96 (5): 369-73.PubMed
74.
75.
76.
Betancourt MT, Roberts KC: Pleins feux sur la recherche: tendances des maladies chroniques chez les immigrants au Canada: analyse des données récentes. Sante Canada: Bulletin de recherche sur les politiques de santé: La santé des migrants. 2010, 17: 22-25.
77.
Carpenter K: Exploring immigrant chronic disease management. School of Public and Environmental Affairs -SPEA Honors Paper Series. 2008, 2 (6): 1-30.
78.
Weeks L, Strudsholm T: A scoping review of research on complementary and alternative medicine (CAM) and the mass media: looking back, moving forward. BMC Complement Altern Med. 2008, 8: 43-10.1186/1472-6882-8-43.CrossRefPubMedPubMedCentral
79.
Armstrong R, Hall BJ, Doyle J, Waters E: ‘Scoping the scope’ of a Cochrane review. J Pub Health. 2011, 33 (1): 147-150. 10.1093/pubmed/fdr015.CrossRef
Metadata
Title
Mapping the concept of vulnerability related to health care disparities: a scoping review
Authors
Cristina Grabovschi
Christine Loignon
Martin Fortin
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2013
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-13-94

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