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Advancing Health Services and Systems for Vulnerable Populations including People with Chronic Conditions

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Infectious Diseases, Chronic Diseases, and Disease Prevention".

Deadline for manuscript submissions: 15 August 2025 | Viewed by 19245

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Special Issue Editors

Dr. Chiung-Jung (Jo) Wu

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Guest Editor

School of Health, University of the Sunshine Coast, Petrie, QLD 4502, Australia
Interests: cardiac; clinical research; diabetes; self-efficacy; self-management; telehealth; synthesis of literature review
Special Issues, Collections and Topics in MDPI journals

Dr. Xiang-Yu Hou

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Guest Editor

UQ Poche Centre for Indigenous Health, The University of Queensland, Brisbane, QLD 4066, Australia
Interests: behavioural epidemiology; social epidemiology; health system research; health program evaluation; emergency medicine; paramedicine; mental health
Special Issues, Collections and Topics in MDPI journals

Dr. Lijun Fan

E-Mail Website
Guest Editor

School of Public Health, Southeast University, Nanjing 210009, China
Interests: social epidemiology; health policy; health economics; chronic diseases management; chronic diseases epidemiology; health programs/policy evaluation; healthcare services and management; healthcare for vulnerable populations; healthy aging research
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

People with chronic conditions, including chronic diseases, usually experience multimorbidity. Globally, this plays a major role in the burden of diseases in both developed and developing countries. To address this major challenge for healthcare systems, this Special Issue of IJERPH is dedicated to celebrating our achievement and progress in this significant area by sharing international research findings, including (but not limited to) findings in the fields of risk factors, self-management and support, adherence to medications/treatment, family/carer and community support, participation in prevention services, access to primary/secondary/tertiary care, clinical information systems, case management, life expectancy and deaths, models of care, coordination of care, patient-centred care, transitional care (for example, between primary and secondary/tertiary care), cultural safety/competency for vulnerable populations, health system design/re-design, rehabilitation services, surveillance system, telehealth, and policy and procedures in the health system.

It is our intention and hope that this Special Issue will provide the most recently updated and high-quality evidence to guide our practice worldwide to benefit people with chronic conditions, their families, communities, and society in general.

Dr. Chiung-Jung (Jo) Wu
Dr. Xiang-Yu (Janet) Hou
Dr. Lijun Fan
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 submissions that pass pre-check are 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 monthly 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 2500 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

health system
health policy
health services
health programs
health evaluation
patients
patient-centred care
primary healthcare
hospital care
tertiary healthcare
transitional healthcare
chronic diseases
chronic conditions
treatment
medication
surgery self-management
cancer
cardiovascular diseases
mental health
diabetes
dementia
overweight and obesity

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Published Papers (8 papers)

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Research

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17 pages, 1756 KiB

Open AccessArticle

SARS-CoV-2 Infection and the Risk of New Chronic Conditions: Insights from a Longitudinal Population-Based Study

by David De Ridder, Anshu Uppal, Serguei Rouzinov, Julien Lamour, María-Eugenia Zaballa, Hélène Baysson, Stéphane Joost, Silvia Stringhini, Idris Guessous and Mayssam Nehme

Int. J. Environ. Res. Public Health 2025, 22(2), 166; https://doi.org/10.3390/ijerph22020166 - 26 Jan 2025

Viewed by 2374

Abstract

Background: The post-acute impact of SARS-CoV-2 infections on chronic conditions remains poorly understood, particularly in general populations. Objectives: Our primary aim was to assess the association between SARS-CoV-2 infections and new diagnoses of chronic conditions. Our two secondary aims were to explore geographic variations in this association and to assess the association between SARS-CoV-2 infections and the exacerbation of pre-existing conditions. Methods: This longitudinal study used data from 8086 participants of the Specchio-COVID-19 cohort in the canton of Geneva, Switzerland (2021–2023). Mixed-effects logistic regressions and geographically weighted regressions adjusted for sociodemographic, socioeconomic, and healthcare access covariates were used to analyze self-reported SARS-CoV-2 infections, new diagnoses of chronic conditions, and the exacerbation of pre-existing ones. Results: Participants reporting a SARS-CoV-2 infection were more likely to be diagnosed with a new chronic condition compared to those who did not report an infection (adjusted odds ratio [aOR] = 2.15, 95% CI 1.43–3.23, adjusted p-value = 0.002). Notable geographic variations were identified in the association between SARS-CoV-2 infections and new diagnoses. While a positive association was initially observed between SARS-CoV-2 infections and exacerbation of pre-existing chronic conditions, this association did not remain significant after adjusting p-values for multiple comparisons. Conclusions: These findings contribute to understanding COVID-19’s post-acute impact on chronic conditions, highlighting the need for targeted health management approaches and calling for tailored public health strategies to address the pandemic’s long-term effects. Full article

(This article belongs to the Special Issue Advancing Health Services and Systems for Vulnerable Populations including People with Chronic Conditions)

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18 pages, 359 KiB

Open AccessArticle

Stakeholder Perspectives on the Acceptability, Design, and Integration of Produce Prescriptions for People with Type 2 Diabetes in Australia: A Formative Study

by Kristy K. Law, Kathy Trieu, Jennifer Madz, Daisy H. Coyle, Kimberly Glover, Maoyi Tian, Yuze Xin, David Simmons, Jencia Wong and Jason H. Y. Wu

Int. J. Environ. Res. Public Health 2024, 21(10), 1330; https://doi.org/10.3390/ijerph21101330 - 8 Oct 2024

Cited by 1 | Viewed by 2114

Abstract

Produce prescription programs can benefit both individuals and health systems; however, best practices for integrating such programs into the Australian health system are yet unknown. This study explored stakeholders’ perspectives on the acceptability, potential design and integration of produce prescription programs for adults with type 2 diabetes in Australia. Purposive sampling was used to recruit 22 participants for an online workshop, representing six stakeholder groups (government, healthcare service, clinician, food retailer, consumer, non-government organisation). Participant responses were gathered through workshop discussions and a virtual collaboration tool (Mural). The workshop was video-recorded and transcribed verbatim, and thematic analysis was conducted using a deductive–inductive approach. Stakeholders recognised produce prescription as an acceptable intervention; however, they identified challenges to implementation related to contextuality, accessibility, and sustainability. Stakeholders were vocal about the approach (e.g., community-led) and infrastructure (e.g., screening tools) needed to support program design and implementation but expressed diverse views about potential funding models, indicating a need for further investigation. Aligning evaluation outcomes with existing measures in local, State and Federal initiatives was recommended, and entry points for integration were identified within and outside of the Australian health sector. Our findings provide clear considerations for future produce prescription interventions for people with type 2 diabetes. Full article

(This article belongs to the Special Issue Advancing Health Services and Systems for Vulnerable Populations including People with Chronic Conditions)

18 pages, 322 KiB

Open AccessArticle

Attitudes to Short-Term Staffing and Workforce Priorities of Community Users of Remote Aboriginal Community-Controlled Health Services: A Qualitative Study

by Zania Liddle, Michelle S. Fitts, Lisa Bourke, Lorna Murakami-Gold, Narelle Campbell, Deborah J. Russell, Supriya Mathew, Jason Bonson, Edward Mulholland, John S. Humphreys, Yuejen Zhao, John Boffa, Mark Ramjan, Annie Tangey, Rosalie Schultz and John Wakerman

Int. J. Environ. Res. Public Health 2024, 21(4), 482; https://doi.org/10.3390/ijerph21040482 - 15 Apr 2024

Cited by 1 | Viewed by 2463

Abstract

In recent years, there has been an increasing trend of short-term staffing in remote health services, including Aboriginal Community-Controlled Health Services (ACCHSs). This paper explores the perceptions of clinic users’ experiences at their local clinic and how short-term staffing impacts the quality of service, acceptability, cultural safety, and continuity of care in ACCHSs in remote communities. Using purposeful and convenience sampling, community users (aged 18+) of the eleven partnering ACCHSs were invited to provide feedback about their experiences through an interview or focus group. Between February 2020 and October 2021, 331 participants from the Northern Territory and Western Australia were recruited to participate in the study. Audio recordings were transcribed verbatim, and written notes and transcriptions were analysed deductively. Overall, community users felt that their ACCHS provided comprehensive healthcare that was responsive to their health needs and was delivered by well-trained staff. In general, community users expressed concern over the high turnover of staff. Recognising the challenges of attracting and retaining staff in remote Australia, community users were accepting of rotation and job-sharing arrangements, whereby staff return periodically to the same community, as this facilitated trusting relationships. Increased support for local employment pathways, the use of interpreters to enhance communication with healthcare services, and services for men delivered by men were priorities for clinic users. Full article

(This article belongs to the Special Issue Advancing Health Services and Systems for Vulnerable Populations including People with Chronic Conditions)

14 pages, 352 KiB

Open AccessArticle

Cancer Survivors’ Experiences of Navigating the Australian Health Care System for Physical and Mental Health Care Needs

by Amelia Gulliver, Alyssa R. Morse and Michelle Banfield

Int. J. Environ. Res. Public Health 2023, 20(5), 3988; https://doi.org/10.3390/ijerph20053988 - 23 Feb 2023

Cited by 5 | Viewed by 2279

Abstract

People living with cancer experience many impacts on their health and mental health, and are thus likely to require ongoing health care. The aim of the current study was to investigate the health and mental health care experiences and needs of Australian cancer survivors. A total of 131 people (119 female, 12 male) with lived experience of a cancer diagnosis (at least 12 months ago) participated in an online survey collecting qualitative and quantitative data, advertised via social media groups and paid advertising. Analysis of the written responses was conducted using inductive qualitative content analysis. The findings showed that a major issue facing cancer survivors was difficulties around access to and management of services for both their mental and physical health. There was also a strong preference for increasing access to allied health care, such as physiotherapy, psychology, and remedial massage. There appear to be some inequities in the experiences of cancer survivors, particularly in accessing care. Improving the experiences of health care for physical and mental health cancer survivors should focus on increasing access to and improving the management of services, specifically allied health, through a variety of avenues, including reducing costs, increasing transport, and providing closer and more co-located services. Full article

(This article belongs to the Special Issue Advancing Health Services and Systems for Vulnerable Populations including People with Chronic Conditions)

11 pages, 546 KiB

Open AccessArticle

Cumulative Health Drivers of Overnight Hospitalization for Australian Working-Age Adults Living Alone: The Early Warning Potential of Functionality

by John Rodwell

Int. J. Environ. Res. Public Health 2022, 19(22), 14707; https://doi.org/10.3390/ijerph192214707 - 9 Nov 2022

Viewed by 1323

Abstract

There is a need to better understand the drivers of hospital utilization for the large and growing number of adults living alone. The cumulative effect of health drivers can be assessed by initially considering clinically advised information, then considering issues that a general practitioner or the person themselves may know. Logistic regression analyses were conducted on longitudinal data from the Household, Income, and Labor Dynamics in Australia (HILDA) survey with three time points over four years (n = 1019). The significant predictors of overnight hospitalization were the presence of a long-term health condition (Time 1), hospitalization severity and comorbidity (Time 1), work ability (Time 2), physical functioning (Time 2), being separated/divorced and having one or more health care cards. Health issues were predictive up to four years before the hospitalization window. That baseline risk of hospitalization was modified as symptoms and relatively salient changes in functionality accumulated. Specific sub-groups of hospital users had access due to insurance or special coverage. The impact of living alone on hospitalization may be able to be partly addressed through interventions such as improving access to primary care and using early warning triggers such as decreasing functionality to seek primary care before seeking hospitalization. Full article

(This article belongs to the Special Issue Advancing Health Services and Systems for Vulnerable Populations including People with Chronic Conditions)

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9 pages, 920 KiB

Open AccessArticle

Incidence Characteristics and Histological Types of Head and Neck Cancer among Adults in Central Sudan: A Retrospective Study

by Marwa Ahmed Balila Gebril, Wail Nuri Osman Mukhtar, Moawia Mohammed Ali Elhassan and Ibrahim Mahmoud

Int. J. Environ. Res. Public Health 2022, 19(21), 13814; https://doi.org/10.3390/ijerph192113814 - 24 Oct 2022

Viewed by 2666

Abstract

Head and neck cancers (HNCs) are prevalent in Sudan, but the reasons for this and the incidence of different types of HNCs are not well understood. A cross-sectional retrospective study was conducted to provide baseline data on the epidemiology of HNCs among patients treated at the National Cancer Institute (NCI) in central Sudan. All cancer cases from 2016 to 2020 were retrieved from the NCI records. Of the 9475 new cancer patients who were registered at the NCI during the study period, 1033 (11%) had HNCs, of whom 767 (74.2%) were adults. The mean age of the adult patients was 54.5 years (standard deviation 15.8) and 449 (58.5%) patients were male. The annual incidence in adults was 4/10⁵ population. The most common HNC sites were the nasopharynx (25.3%), hypopharynx (22.8%), and oral cavity (22.2%). Carcinoma was the most common diagnosis (87.6%), followed by lymphoma (5.6%). Most patients’ tumors were at a locally advanced (22%) or metastatic stage (47%) of HNCs at the time of presentation. Further studies to identify risk factors for HNCs, particularly for the most prevalent types in central Sudan, are needed. In addition, Sudan requires capacity building for cancer, including a national cancer registry. Full article

(This article belongs to the Special Issue Advancing Health Services and Systems for Vulnerable Populations including People with Chronic Conditions)

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Review

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13 pages, 388 KiB

Open AccessReview

Indigenous Australians’ Experiences of Cancer Care: A Narrative Literature Review

by Saira Sanjida, Gail Garvey, James Ward, Roxanne Bainbridge, Anthony Shakeshaft, Stephanie Hadikusumo, Carmel Nelson, Prabasha Thilakaratne and Xiang-Yu Hou

Int. J. Environ. Res. Public Health 2022, 19(24), 16947; https://doi.org/10.3390/ijerph192416947 - 16 Dec 2022

Cited by 8 | Viewed by 4113

Abstract

To provide the latest evidence for future research and practice, this study critically reviewed Indigenous peoples’ cancer care experiences in the Australian healthcare system from the patient’s point of view. After searching PubMed, CINAHL and Scopus databases, twenty-three qualitative studies were included in this review. The inductive approach was used for analysing qualitative data on cancer care experience in primary, tertiary and transitional care between systems. Three main themes were found in healthcare services from Indigenous cancer care experiences: communication, cultural safety, and access to services. Communication was an important theme for all healthcare systems, including language and literacy, understanding of cancer care pathways and hospital environment, and lack of information. Cultural safety was related to trust in the system, privacy, and racism. Access to health services was the main concern in transitional care between healthcare systems. While some challenges will need long-term and collective efforts, such as institutional racism as a downstream effect of colonisation, cultural training for healthcare providers and increasing the volume of the Indigenous workforce, such as Indigenous Liaison Officers or Indigenous Care Coordinators, could effectively address this inequity issue for Indigenous people with cancer in Australia in a timely manner. Full article

(This article belongs to the Special Issue Advancing Health Services and Systems for Vulnerable Populations including People with Chronic Conditions)

Other

Jump to: Research, Review

9 pages, 516 KiB

Open AccessBrief Report

Gain-Framed Text Messages and Nicotine Replacement Therapy for Smoking Cessation Among Lung Cancer Screening Patients: A Brief Report of a Pilot Randomized Controlled Trial

by Kinsey Pebley, Benjamin A. Toll, Matthew J. Carpenter, Gerard Silvestri and Alana M. Rojewski

Int. J. Environ. Res. Public Health 2025, 22(4), 543; https://doi.org/10.3390/ijerph22040543 - 2 Apr 2025

Viewed by 358

Abstract

People who undergo lung cancer screening (LCS) and continue to smoke are at risk for negative clinical outcomes and lowered survival and need effective smoking cessation interventions. This pilot study tested an 8-week intervention for smoking cessation after LCS. The participants (N = 40) were randomized to the intervention group (combination nicotine replacement therapy [NRT] plus gain-framed text messaging for 8 weeks) or the control group (standard cessation counseling) after LCS. Assessments were completed at 8-week and 3-month follow-ups, including self-reported 7-day point prevalence abstinence. The mean age was 64.4 years old (SD = 6.2); 32.5% were Black or African American; and 55% were female. At Week 8, 14.3% (3/21) of the participants in the intervention group were abstinent versus 0% (0/19) in the control group (p > 0.05). At 3-month follow-up, 4.8% (1/21) of the participants in the intervention group were abstinent versus 0% (0/19) in the control group. Among the intervention group participants, up to 52.4% used the provided patches and up to 61.9% used the provided lozenges during the study period. This study demonstrated modest quit rates for LCS patients receiving gain-framed text messages and NRT. The results highlight the need for more effective smoking cessation interventions for this priority population. Full article

(This article belongs to the Special Issue Advancing Health Services and Systems for Vulnerable Populations including People with Chronic Conditions)

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