Special Issue "Health and Well-Being in Vulnerable Communities"

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Global Health".

Deadline for manuscript submissions: 30 November 2021.

Special Issue Editors

Dr. Igor Grabovac
E-Mail Website
Guest Editor
Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, 1090 Vienna, Austria
Interests: health promotion; health behaviour modification; occupational health; human sexuality; social discrimination; sports medicine
Special Issues and Collections in MDPI journals

Special Issue Information

Dear Colleagues,

Socioeconomically disadvantageous, discriminated, stigmatized or otherwise negatively labeled populations are often referred to as vulnerable groups. These may include immigrant populations, LGBTIQ+ people, racial or ethnic minorities, children, older adults, homeless, prisoners, etc. Now, while no strict lists of what groups may be considered as vulnerable exist, the available evidence shows that social inequalities perpetuate adverse health outcomes. Moreover, research also suggests that vulnerable communities are also at higher risk of issues in relation to accessing health care due to cultural, economic, societal or other reasons that have a disparate effect on various outcomes, including higher morbidity and mortality, as well as poorer quality of life and well-being. However, in spite of emerging evidence, the general level of understanding of the problems and needs of vulnerable communities is low. On the one hand, this is due to the general underrepresentation of vulnerable communities in scientific literature, and on the other, a lack of awareness within professional organizations and among political stakeholders.

The main goal of the “Health and Well-Being in Vulnerable Communities” Special Issue is to create a platform for researchers to showcase the newest results of research into physical, mental and social health of different vulnerable communities. As such, the Special Issue will not only focus on gathering research but also on voicing the need for action in improving the conditions for vulnerable communities. Therefore, we would like to invite you to submit original research articles, systematic reviews, pilot project results and intervention studies, as well as policy papers, focusing on all aspects of health and well-being of vulnerable communities.

Dr. Igor Grabovac
Dr. Lee Smith
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2300 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • vulnerable communities
  • health
  • well-being
  • LGBTIQ people
  • homeless
  • immigrants
  • older adults

Published Papers (8 papers)

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Research

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Article
Health Literacy and Frailty in Community-Dwelling Older Adults: Evidence from a Nationwide Cohort Study in South Korea
Int. J. Environ. Res. Public Health 2021, 18(15), 7918; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18157918 - 27 Jul 2021
Viewed by 301
Abstract
Health literacy is closely associated with poor health outcomes and mortality. However, only a handful of studies have examined the association between health literacy and frailty status. The current study used data from a nationwide sample of Korean adults aged 70–84 collected from [...] Read more.
Health literacy is closely associated with poor health outcomes and mortality. However, only a handful of studies have examined the association between health literacy and frailty status. The current study used data from a nationwide sample of Korean adults aged 70–84 collected from 10 cities, each of which represents a different region of South Korea (n = 1521). We used the propensity score matching (PSM) method to minimize the potential selection bias and confounding factors that are present in observational studies. After PSM, demographic and health-related characteristics between the limited health literacy (n = 486) and the nonlimited health literacy (n = 486) groups were not significantly different. Multinomial logistic regression analyses were conducted for the PSM-matched sample to examine the association between health literacy and frailty outcomes, where the robust group was set as a reference. Limited health literacy significantly increased the risk of pre-frailty (RRR = 1.45, p = 0.02) and frailty (RRR = 2.03, p = 0.01) after adjusting for demographic and health-related factors. Our findings underscore the need to foster health literacy programs and provide preliminary evidence to inform tailored intervention programs so that we might attenuate the risk of frailty in the older population. Full article
(This article belongs to the Special Issue Health and Well-Being in Vulnerable Communities)
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Article
Access to Healthcare for Migrant Patients in Europe: Healthcare Discrimination and Translation Services
Int. J. Environ. Res. Public Health 2021, 18(15), 7901; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18157901 - 26 Jul 2021
Viewed by 313
Abstract
Background: Discrimination based on ethnicity and the lack of translation services in healthcare have been identified as main barriers to healthcare access. However, the actual experiences of migrant patients in Europe are rarely present in the literature. Objectives: The aim of this study [...] Read more.
Background: Discrimination based on ethnicity and the lack of translation services in healthcare have been identified as main barriers to healthcare access. However, the actual experiences of migrant patients in Europe are rarely present in the literature. Objectives: The aim of this study was to assess healthcare discrimination as perceived by migrants themselves and the availability of translation services in the healthcare systems of Europe. Methods: A total of 1407 migrants in 10 European Union countries (consortium members of the Mig-HealthCare project) were surveyed concerning healthcare discrimination, access to healthcare services, and need of translation services using an interviewer-administered questionnaire. Migrants in three countries were excluded from the analysis, due to small sample size, and the new sample consisted of N = 1294 migrants. Descriptive statistics and multivariable regression analyses were conducted to investigate the risk factors on perceived healthcare discrimination for migrants and refugees in the EU. Results: Mean age was 32 (±11) years and 816 (63.26%) participants were males. The majority came from Syria, Afghanistan, Iraq, Nigeria, and Iran. Older migrants reported better treatment experience. Migrants in Italy (0.191; 95% CI [0.029, 0.352]) and Austria (0.167; 95% CI [0.012, 0.323]) scored higher in the Discrimination Scale to Medical Settings (DMS) compared with Spain. Additionally, migrants with better mental health scored lower in the DMS scale (0.994; 95% CI [0.993, 0.996]), while those with no legal permission in Greece tended to perceive more healthcare discrimination compared with migrants with some kind of permission (1.384; 95% CI [1.189, 1.611]), as opposed to Austria (0.763; 95% CI [0.632, 0.922]). Female migrants had higher odds of needing healthcare assistance but not being able to access them compared with males (1.613; 95% CI [1.183, 2.199]). Finally, migrants with chronic problems had the highest odds of needing and not having access to healthcare services compared with migrants who had other health problems (3.292; 95% CI [1.585, 6.837]). Conclusions: Development of culturally sensitive and linguistically diverse healthcare services should be one of the main aims of relevant health policies and strategies at the European level in order to respond to the unmet needs of the migrant population. Full article
(This article belongs to the Special Issue Health and Well-Being in Vulnerable Communities)
Article
The Ecology of Unsheltered Homelessness: Environmental and Social-Network Predictors of Well-Being among an Unsheltered Homeless Population
Int. J. Environ. Res. Public Health 2021, 18(14), 7328; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18147328 - 08 Jul 2021
Viewed by 551
Abstract
People experiencing homelessness (PEH) face extreme weather exposure and limited social support. However, few studies have empirically assessed biophysical and social drivers of health outcomes among unsheltered PEH. Social network, health, and outdoor exposure data were collected from a convenience sample of unsheltered [...] Read more.
People experiencing homelessness (PEH) face extreme weather exposure and limited social support. However, few studies have empirically assessed biophysical and social drivers of health outcomes among unsheltered PEH. Social network, health, and outdoor exposure data were collected from a convenience sample of unsheltered PEH (n = 246) in Nashville, TN, from August 2018–June 2019. Using multivariate fixed-effects linear regression models, we examined associations between biophysical and social environments and self-reported general health and emotional well-being. We found that study participants reported the lowest general health scores during winter months—Nashville’s coldest season. We also found a positive association between the number of nights participants spent indoors during the previous week and general health. Participants who spent even one night indoors during the past week had 1.8-point higher general health scores than participants who spent zero nights indoors (p < 0.01). Additionally, participants who experienced a conflict with a social contact in the past 30 days had lower emotional well-being scores than participants who experienced no conflict. Finally, women had worse general health and emotional well-being than men. Ecologically framed research about health and well-being among PEH is critically needed, especially as climate change threatens to increase the danger of many homeless environments. Full article
(This article belongs to the Special Issue Health and Well-Being in Vulnerable Communities)
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Article
Explicit and Intrinsic Intention to Receive COVID-19 Vaccination among Heterosexuals and Sexual Minorities in Taiwan
Int. J. Environ. Res. Public Health 2021, 18(14), 7260; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18147260 - 07 Jul 2021
Viewed by 408
Abstract
The present study compared the levels of explicit and intrinsic intention to receive COVID-19 vaccination among sexual minority and heterosexual individuals and examined the association of explicit and intrinsic intentions with sexual orientation. We enrolled 171 sexual minority and 876 heterosexual individuals through [...] Read more.
The present study compared the levels of explicit and intrinsic intention to receive COVID-19 vaccination among sexual minority and heterosexual individuals and examined the association of explicit and intrinsic intentions with sexual orientation. We enrolled 171 sexual minority and 876 heterosexual individuals through a Facebook advertisement. The participants’ explicit and intrinsic intentions to receive COVID-19 vaccination and their risk perception of COVID-19 were measured. We discovered that sexual minority individuals had higher levels of explicit and intrinsic intention to receive vaccination relative to heterosexual individuals. Intrinsic intention was positively associated with explicit intention after the effects of demographic characteristics and risk perception of COVID-19 were controlled for. Sexual orientation did not moderate the association between explicit and intrinsic intentions. The present study determined the relationship between sexual orientation and intention to receive COVID-19 vaccination. Full article
(This article belongs to the Special Issue Health and Well-Being in Vulnerable Communities)
Article
Experiences and Interactions with the Healthcare System in Transgender and Non-Binary Patients in Austria: An Exploratory Cross-Sectional Study
Int. J. Environ. Res. Public Health 2021, 18(13), 6895; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18136895 - 27 Jun 2021
Viewed by 590
Abstract
Medical care of transgender and non-binary (TNB) patients if often a complex interdisciplinary effort involving a variety of healthcare workers (HCWs) and services. Physicians not only act as gatekeepers to routine or transitioning therapies but are also HCWs with the most intimate and [...] Read more.
Medical care of transgender and non-binary (TNB) patients if often a complex interdisciplinary effort involving a variety of healthcare workers (HCWs) and services. Physicians not only act as gatekeepers to routine or transitioning therapies but are also HCWs with the most intimate and time-intensive patient interaction, which influences TNB patients’ experiences and health behaviors and healthcare utilization. The aim of this study was to investigate the physician–patient relationship in a sample of TNB individuals within the Austrian healthcare system, and explore its associations with sociodemographic, health-, and identity-related characteristics. A cross-sectional study utilizing an 56-item online questionnaire, including the Patient-Doctor Relationship Questionnaire 9 (PDRQ-9), was carried out between June and October 2020. The study involved TNB individuals 18 or older, residing in Austria, and previously or currently undergoing medical transition. In total, 91 participants took part, of whom 33.0% and 25.3% self-identified as trans men and trans women, respectively, and 41.8% as non-binary. Among participants, 82.7% reported being in the process of medical transitioning, 58.1% perceived physicians as the most problematic HCWs, and 60.5% stated having never or rarely been taken seriously in medical settings. Non-binary participants showed significantly lower PDRQ-9 scores, reflecting a worse patient–physician relationship compared to trans male participants. TNB patients in Austria often report negative experiences based on their gender identity. Physicians should be aware of these interactions and reflect potentially harmful behavioral patterns in order to establish unbiased and trustful relations. Full article
(This article belongs to the Special Issue Health and Well-Being in Vulnerable Communities)
Article
Direct and Inverse Correlates of Post-Traumatic Stress Disorder among School-Age Autistic Boys
Int. J. Environ. Res. Public Health 2021, 18(10), 5285; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18105285 - 16 May 2021
Viewed by 507
Abstract
Young people with autism are often bullied at school, a potential direct correlate of Post-Traumatic Stress Disorder (PTSD). This may be compounded by their difficulties in social interaction. Alternately, some of these young people may develop ‘coping strategies’ against bullying that may have [...] Read more.
Young people with autism are often bullied at school, a potential direct correlate of Post-Traumatic Stress Disorder (PTSD). This may be compounded by their difficulties in social interaction. Alternately, some of these young people may develop ‘coping strategies’ against bullying that may have an inverse association with PTSD. As a vulnerable population for PTSD, a sample of 71 young males with autism were surveyed for their self-reported experiences of being bullied at school, their coping strategies for dealing with this bullying, and their own evaluations of the severity of two of the key diagnostic criteria for PTSD. Their mothers also provided a rating of the severity of the three major diagnostic criteria for autism for these boys. Over 80% of this sample had been bullied, and there was a significant direct correlation between this and PTSD score, and between their mother-rated severity of the boys’ social interaction difficulties, but also a significant inverse correlation between their coping strategies and PTSD score. There were differences in these relationships according to whether the boys attended elementary or secondary school. These findings hold implications for the identification, assessment and support of autistic youth at risk of PTSD. Full article
(This article belongs to the Special Issue Health and Well-Being in Vulnerable Communities)
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Article
Development of Measures of Perceived Neighborhood Environmental Attributes Influencing, and Perceived Barriers to Engagement in, Healthy Behaviors for Older Chinese Immigrants to Australia
Int. J. Environ. Res. Public Health 2021, 18(9), 4531; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18094531 - 24 Apr 2021
Viewed by 679
Abstract
Environmental correlates, barriers, and facilitators of physical activity, healthy eating, and socializing are understudied in older immigrants to developed countries. This study developed/adapted and validated measures of perceived barriers and neighborhood environmental characteristics related to these health-enhancing behaviors appropriate for older Chinese immigrants [...] Read more.
Environmental correlates, barriers, and facilitators of physical activity, healthy eating, and socializing are understudied in older immigrants to developed countries. This study developed/adapted and validated measures of perceived barriers and neighborhood environmental characteristics related to these health-enhancing behaviors appropriate for older Chinese immigrants to Australia and similar Western countries. Older Chinese immigrants living in Melbourne (Australia) were recruited from neighborhoods varying in walkability and percentage of Chinese residents. Versions of the Neighborhood Environment for Healthy Aging–Chinese Immigrants to Australia (NEHA-CIA) questionnaire (20 subscales) and the Perceived Barriers to Health-Enhancing Behaviors questionnaire (four subscales) were developed from extant validated scales and information collected in formative qualitative research. Thirty-one participants took part in cognitive interviews aimed to pilot-test and refine the questionnaires. The modified questionnaires were administered to 52 participants twice, two weeks apart. Test-retest reliability (intraclass correlation coefficients), internal consistency (Cronbach’s α), and construct validity (associations with theoretically-relevant constructs) were examined. Most items and subscales of both questionnaires had good test-retest reliability and internal consistency, while the NEHA-CIA also showed good construct validity. Future studies need to further examine the construct validity of the questionnaire of perceived barriers and determine the factorial validity of both measures on large representative samples. Full article
(This article belongs to the Special Issue Health and Well-Being in Vulnerable Communities)

Review

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Review
Laparoscopy in Low-Income Countries: 10-Year Experience and Systematic Literature Review
Int. J. Environ. Res. Public Health 2021, 18(11), 5796; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18115796 - 28 May 2021
Viewed by 918
Abstract
Laparoscopy is a procedure that ultimately reduces hospital stay time and speeds up post-operative recovery. It is mainly performed in high-income countries but its implementation in many low- and middle-income countries (LMICs) is increasing. However, no aggregate data exist regarding the outcomes of [...] Read more.
Laparoscopy is a procedure that ultimately reduces hospital stay time and speeds up post-operative recovery. It is mainly performed in high-income countries but its implementation in many low- and middle-income countries (LMICs) is increasing. However, no aggregate data exist regarding the outcomes of this procedure in resource-limited settings. We retrospectively reviewed all cases of laparoscopy recorded from January 2007 to March 2017 at the Department of Surgery of Beira to assess the related outcomes. Moreover, we performed a systematic review of the laparoscopic practices and outcomes in low-income countries. Data from the Department of Surgery of Beira identified 363 laparoscopic procedures, mainly relating to gynecological diseases, cholelithiasis, and appendicectomy with only a 1.6% complication rate (6 cases) and a 1.9% conversion rate (7 cases) to open surgery. The systematic review showed a pooled risk of overall complications significantly lower in laparoscopic vs. open appendicectomy (OR = 0.43; 95% CI 0.19–0.97; I2 = 85.7%) and a significantly lower risk of infection (OR = 0.53; 95% CI 0.43–0.65; I2 = 0.00%). The pooled SMD in operation duration in laparoscopic vs. open appendectomy was 0.58 (95% CI −0.00; 1.15; I2 = 96.52), while the pooled SMD in hospitalization days was −1.35 (95% CI −1.87; −0.82; I2 = 96.41). Laparoscopy is an expensive procedure to adopt as it requires new equipment and specialized trained health workers. However, it could reduce post-operative costs and complications, especially in terms of infections. It is crucial to increase its accessibility, acceptability, and quality particularly in LMICs, especially during this COVID-19 era when the reduction of patient hospitalization is essential. Full article
(This article belongs to the Special Issue Health and Well-Being in Vulnerable Communities)
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