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Determinants Shaping Healthcare Experiences Among Vulnerable Populations in Hong Kong: A Qualitative Descriptive
Michelle Che Yan Lam1, Kadence Oi Kiu Wong1, Yat Chun Lim1
1Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
Journal of Primary Care & Community Health
|July 24, 2026
Summary
This study adapted the Dahlgren and Whitehead rainbow model to better understand healthcare access for vulnerable populations in urban Asia. The revised model incorporates infrastructure, health literacy, and social roles, offering a more context-sensitive approach.
Area of Science:
- Public Health
- Sociology
- Health Services Research
Background:
- Urban Asian cities face complex healthcare challenges due to infrastructure, multilingualism, aging populations, and diverse medical practices.
- Socioeconomic inequality and long healthcare wait times in Hong Kong exacerbate these issues for vulnerable groups.
- Existing multilevel frameworks inadequately capture the nuanced health determinants in high-density urban Asian settings.
Purpose of the Study:
- To qualitatively explore social, environmental, and healthcare system factors influencing vulnerable populations' health experiences in urban Asia.
- To adapt the Dahlgren and Whitehead rainbow model for a high-density urban Asian context, specifically Hong Kong.
- To identify determinants shaping healthcare-seeking behaviors and health outcomes in this unique setting.
Main Methods:
- Conducted 21 semi-structured interviews with purposively recruited vulnerable individuals (older adults, low-income, disabilities, minorities, caregivers).
- Employed thematic analysis using a hybrid deductive-inductive approach on translated and transcribed interview data.
- Ensured ethical approval and data saturation for robust qualitative insights.
Main Results:
- The original rainbow model requires adaptation for urban settings, notably excluding infrastructure's impact.
- Health literacy and digital literacy are crucial, necessitating a broader view than traditional education components.
- Reframing 'agriculture and food production' to 'food and nutrient' is more relevant for urban contexts.
- Family and cultural roles significantly influence health outcomes in urban environments.
Conclusions:
- The adapted rainbow model effectively captures healthcare-seeking experiences and determinants for vulnerable populations in urban Asia.
- The revised framework integrates localized structural and social dimensions, including systemic inequities.
- This context-sensitive adaptation provides a foundation for equitable policy and practice in similar urban settings globally.
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