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Structural Vulnerability in Health Research: A Systematic Mixed Studies Review
Levia A Sutton1, Carmen Alvarez1, Therese S Richmond1
1University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA.
Structural vulnerability in US health research is consistently defined by social positionality and as an analytic framework. Operationalization varies, highlighting needs for diverse studies and justice-oriented interventions to advance health equity.
Area of Science:
- Public Health
- Social Epidemiology
- Health Equity Research
Background:
- Structural vulnerability is a key concept in understanding health inequities.
- Previous research has lacked clarity in defining and operationalizing structural vulnerability.
- This study systematically reviews its application in US health research.
Purpose of the Study:
- To examine the definition and operationalization of structural vulnerability in US health research.
- To identify conceptual consistencies and methodological gaps.
- To propose core dimensions and implications for future research.
Main Methods:
- A systematic mixed-studies review using a parallel-results convergent synthesis design.
- Searched PubMed, Embase, Scopus, and CINAHL from inception through 2024.
- Included 37 predominantly high-quality, peer-reviewed empirical studies from the United States.
Main Results:
- Structural vulnerability consistently defined by social positionality (constrained resilience, limited agency, imposed risks) and as a framework for determinants of health.
- Quantitative studies used individual-level indicators and cross-sectional designs; qualitative studies focused on experiences.
- Infectious disease, substance use, and mental health were frequently studied outcomes.
Conclusions:
- Structural vulnerability reveals how systems produce and can reduce health risks.
- Emphasizes the need for geographically diverse, longitudinal studies and multidimensional measures.
- Advancing health equity requires critiquing systemic causes and pursuing justice-oriented interventions.
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