Authors
Michelle Che Yan Lam, Kadence Oi Kiu Wong, Yat Chun Lim, Amreen Malik Maryam, Wing Yin Jayne Chong, Mei Li Khong, Po Ling Pauline Luk
Published in
Journal of primary care & community health. Volume 17. Pages 21501319261470065. Epub Jul 24, 2026.
Abstract
BackgroundIn many urban Asian cities, healthcare experiences are situated at the intersection of infrastructure-dictated living, multilingual and aging populations, and pluralistic medical practices. In Hong Kong, these dynamics are intensified by socioeconomic inequality and long wait times for subsidized care within the public-private healthcare system. Few qualitative studies have examined how social, environmental, and healthcare system factors shape the experiences of vulnerable populations in this context against a multilevel framework. The study explored these determinants and their implications for adapting the Dahlgren and Whitehead rainbow model to a high-density urban Asian setting.MethodsTwenty-one semi-structured individual interviews with data saturation reached were conducted between August 2024 and March 2025 with participants purposively recruited through non-governmental organizations. The Human Research Ethics Committee at The University of Hong Kong provided ethical approval. Participants included older adults, low-income households, persons with disabilities or mental health conditions, caregivers, and ethnic minorities. Interviews were translated, transcribed, and analyzed thematically using a hybrid deductive-inductive approach.ResultsOur findings indicate that the original rainbow model does not fully capture the health determinants relevant to urban city settings. Specifically, it overlooks the impact of infrastructure on health; oversimplifies education by not accounting for health literacy and digital literacy, both of which are increasingly important for technology-based information seeking; and includes agriculture and food production, which are less applicable in urban contexts-therefore we propose reframing this as "food and nutrient." Additionally, our results highlight that family and culturally embedded social roles have a significant influence on health outcomes in urban environments.ConclusionBy integrating these localized structural and social dimensions, our adapted rainbow model captures the healthcare-seeking experiences and complex health determinants of vulnerable populations in urban Asia. This adaptation expands on the original framework by accounting for underlying systemic inequities, thus providing a more context-sensitive approach to understand and address these challenges through equitable policy and practice in Hong Kong and similar settings.
PMID:
42495822
Bibliographic data and abstract were imported from PubMed on 24 Jul 2026.
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