Abstract
BackgroundThe concept 'vulnerability' is prevalent in the public domain, health care, social institutions and multidisciplinary research. Conceptual heterogeneity is present, hampering the creation of a common evidence-base of research achievements and successful policies. Recently an international expert group combined a specific literature review with a 2-stage Delphi procedure, arriving at a seemingly universal concept of vulnerability for the elderly with applications for research instruments. We replicated and extended this study, to generalize this result to health in general, and perinatal health in particular.MethodsTwo independent expert panels (general health, perinatal health) repeated the Delphi-procedure, using an extended and updated literature review to derive statements on the concept and defining pathways of vulnerability. Additional views were collected on research tools. Consensus-by-design was explicitly avoided. Data collection and processing was independent.ResultsBoth panels showed surprising convergence on the pathways of vulnerability to health/ill-health, and their interaction. The agreed conceptual model describes a dynamic relation between health and ill-health and vulnerability. The 2 key pathways that link to vulnerability, are complementary, but not symmetrical as biological processes of maintaining health or obtaining better health are not reciprocal to recovery, so also not in terms of vulnerability impacts. An individual's degree of vulnerability is the net balance of risk effects and protective and healing factors (socially, biologically and in terms of health literacy and health care access). These factors can for measurement purposes (according to the panels: interview for exploration, checklists for population research) be grouped into ‘material resources’, ‘taking responsibility for one’s own health’, ‘risky activities and behaviors’, and ‘social support’.Supportive and transforming action can thus be undertaken.ConclusionA universal concept of vulnerability in the context of health was successfully derived after careful replication and extension of an international Delphi study on vulnerability among the elderly.
Highlights
In the past decade there has been an increased focus on “vulnerability” in health [1]
Accepting some heterogeneity of definitions and contexts, it is generally accepted that the population’s health, access to and results from medical care are at the individual and aggregate level strongly related to vulnerability [2,3,4]
The first to converge on an encompassing, global concept of vulnerability was the Commission on Social Determinants (CSDH) of the World Health Organization (WHO) [6] while working on health care and cross-sectoral recommendations to reduce the effects of vulnerability
Summary
In the past decade there has been an increased focus on “vulnerability” in health [1]. Accepting some heterogeneity of definitions and contexts, it is generally accepted that the population’s health, access to and results from medical care are at the individual and aggregate level strongly related to vulnerability [2,3,4]. Several authors proposed a definition of vulnerability [1] with different views of vulnerability as either a determinant of ill-health or impeding factor in the process of recovering from ill-health. Due to this conceptual heterogeneity, research results in this context and recommendations are difficult to compare, lessons learnt in one clinical area or subpopulation cannot be transferred to another, altogether hampering the creation of an evidence-base. We replicated and extended this study, to generalize this result to health in general, and perinatal health in particular
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