Strategies for enhancing the impact of interventions in chronic healtha transnational qualitative metastudy on sampling, recruting and communication with vulnerable populations

Resumen

The psychosocial vulnerability of individuals and communities (and vice versa) is determined by a complex network of circumstances that should be analysed from an intersectional and relational approach. The greater vulnerability affecting individuals and communities impairs their health literacy, access to healthcare and communication with health professionals, which impacts their decision-making process and their self-management of health abilities. The progress towards health equality requires an in-depth structural reform, policy-making and empowerment of these communities; besides, the training and information available for social and healthcare professionals are scarce and not systematised except in the scientific literature, whilst the scientific evidence is also dispersed. The consequences of health inequalities are multiple and complex: this dissertation is focused on how these consequences impact health communication and literacy and, thus, the living experience of the diseases and the communities´health. The present qualitative synthesis analysed 103 primary studies with the objective to unveil how a complex and multidimensional set of factors and circumstances, permanently changing nowadays, interact and impact individuals and communities´health, engagement, and empowerment. Thus, the dissertation aims at delivering a multidimensional framework for analysing and interpreting how the social vulnerability influences the counselling, access to information and health literacy, self-management of chronic care, decision-making, patients´autonomy and communities´empowerment; then, unveiling the intersections and factors involved in health disparities and the formal factors that may entail the individuals´and communities´vulnerabilities. Also, the present dissertation will analyse the health communication dimensions and its societal transfer as well as the engagement mechanisms in selfmanagement and health decision-making of individual. Our work encountered key mechanisms, problem areas, challenges, enhancers, and barriers related to healthcare access, communication and counselling, autonomy, patient access to information, self-management of chronic conditions, and decision-making health literacy and education and communities´empowerment, also offering critical recommendations for social and healthcare professionals directly transferable to practical settings.Social and health disparities should be unveiled and addressed from a socio-political approach, directly stressing and addressing the macro settings and promoting a profoundly transformation and change of paradigm in the relationships within the social field, the care system, and public policies overcoming the inequality health gap. Without recognising its broad, deep, complex and structural nature, all public health efforts targeted to the individuals are at risk of being trivial, banal, insignificant and meaningless.