Determinants Shaping Healthcare Experiences Among Vulnerable Populations in Hong Kong: A Qualitative Descriptive Study.

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.