Aligning Advanced Public Health Nursing Strategies with Population Vulnerabilities: A Needs-Based Framework for Equity-Oriented Primary Care
DOI:
https://doi.org/10.61978/curatio.v3i1.1416Keywords:
Advanced Public Health Nursing, Health Equity, Vulnerable Populations, Primary Care, Conceptual Framework, Proxy OutcomesAbstract
Health inequities in primary and community care stem from multidimensional vulnerabilities combining chronic clinical conditions, behavioral health needs, and social and structural risks. Advanced Public Health Nursing (APHN) is central to addressing these inequities, yet clear guidance for aligning APHN strategies with diverse population needs remains scarce. This study aimed to develop a needs-based framework linking vulnerable population profiles with bundled APHN strategies and realistic outcome measures to support equity-oriented practice and evaluation. Using a qualitative, conceptual framework development design based on secondary synthesis of literature from public health, nursing, health services research, and implementation science, the study analyzed conceptually rich sources to identify vulnerability patterns, APHN strategy domains, and feasible proxy outcomes. An iterative analytic process aligned population profiles with multicomponent strategy packages, supported by theoretical anchoring, transparent procedures, and an audit trail. Findings showed that populations such as low-income groups with comorbidities, homeless individuals, migrants, frail older adults, and maternal–child dyads face overlapping clinical and social vulnerabilities that isolated interventions cannot adequately address. Bundled strategies—outreach, case management, culturally safe communication, intersectoral coordination, and system navigation—proved more relevant. Traditional clinical outcomes alone were deemed insufficient; proxy outcomes on access, engagement, continuity, utilization, and experience are essential. The resulting framework supports coherent practice planning, workforce role delineation, and policy-relevant evaluation, with future research needed to empirically test and refine it across contexts.
References
Adeniran, R. K. (2023). Racism Declared a Public Health Emergency. Holistic Nursing Practice, 37(1), 3–5. https://doi.org/10.1097/hnp.0000000000000564 DOI: https://doi.org/10.1097/HNP.0000000000000564
Agic, B., Fruitman, H., Maharaj, A., Taylor, J. L., Ashraf, A., Henderson, J., Ronda, N., McKenzie, K., Soklaridis, S., & Sockalingam, S. (2022). Advancing Curriculum Development and Design in Health Professions Education: A Health Equity and Inclusion Framework for Education Programs. Journal of Continuing Education in the Health Professions, 43(4S), S4–S8. https://doi.org/10.1097/ceh.0000000000000453 DOI: https://doi.org/10.1097/CEH.0000000000000453
Alamneh, T. S., Teshale, A. B., Yeshaw, Y., Alem, A. Z., Ayalew, H. G., Liyew, A. M., Tessema, Z. T., Tesema, G. A., & Worku, M. G. (2022). Barriers for Health Care Access Affects Maternal Continuum of Care Utilization in Ethiopia; Spatial Analysis and Generalized Estimating Equation. Plos One, 17(4), e0266490. https://doi.org/10.1371/journal.pone.0266490 DOI: https://doi.org/10.1371/journal.pone.0266490
Angier, H., Jacobs, E. A., Huguet, N., Likumahuwa-Ackman, S., Robert, S., & DeVoe, J. E. (2018). Progress Towards Using Community Context With Clinical Data in Primary Care. Family Medicine and Community Health, 7(1), e000028. https://doi.org/10.1136/fmch-2018-000028 DOI: https://doi.org/10.1136/fmch-2018-000028
Baker, K., Adams, J., & Steel, A. (2021). Experiences, Perceptions and Expectations of Health Services Amongst Marginalized Populations in Urban Australia: A Meta‐ethnographic Review of the Literature. Health Expectations, 25(5), 2166–2187. https://doi.org/10.1111/hex.13386 DOI: https://doi.org/10.1111/hex.13386
Berkman, N. D., Chang, E., Seibert, J., Ali, R., Porterfield, D. S., Jiang, L., Wines, R., Rains, C., & Viswanathan, M. (2021). Management of High-Need, High-Cost Patients: A “Best Fit” Framework Synthesis, Realist Review, and Systematic Review. https://doi.org/10.23970/ahrqepccer246 DOI: https://doi.org/10.23970/AHRQEPCCER246
Bierman, A. S., & Mistry, K. B. (2023). Commentary: Achieving Health Equity – The Role of Learning Health Systems. Healthcare Policy | Politiques De Santé, 19(2), 21–27. https://doi.org/10.12927/hcpol.2023.27236 DOI: https://doi.org/10.12927/hcpol.2023.27236
Carcary, M. (2021). The Research Audit Trail: Methodological Guidance for Application in Practice. The Electronic Journal of Business Research Methods, 18(2). https://doi.org/10.34190/jbrm.18.2.008 DOI: https://doi.org/10.34190/JBRM.18.2.008
Cassidy, B., Fischl, A., Fasone, A., & Braxter, B. (2023). Stakeholders Inform an LGBTQIA+ Health Best Practices Learning Module for Nursing Students. Journal of Transcultural Nursing, 34(6), 453–463. https://doi.org/10.1177/10436596231191250 DOI: https://doi.org/10.1177/10436596231191250
Chaudhuri, E. R. (2022). The Syndemic of Inequity and COVID-19 in Virtual Care. Journal of Medical Internet Research, 24(6), e37717. https://doi.org/10.2196/37717 DOI: https://doi.org/10.2196/37717
Cornes, M., Whiteford, M., Manthorpe, J., Neale, J., Byng, R., Hewett, N., Clark, M., Kilmister, A., Fuller, J., Aldridge, R. W., & Tinelli, M. (2017). Improving Hospital Discharge Arrangements for People Who Are Homeless: A Realist Synthesis of the Intermediate Care Literature. Health & Social Care in the Community, 26(3), e345–e359. https://doi.org/10.1111/hsc.12474 DOI: https://doi.org/10.1111/hsc.12474
Dawe, J., McDonald, E., Riggs, E., Szwarc, J., & Yelland, J. (2023). Interpreter Requirements of Women From Non-English Speaking Migrant Backgrounds in Maternity Hospitals in Melbourne, Australia. International Journal of Migration Health and Social Care, 19(3/4), 299–309. https://doi.org/10.1108/ijmhsc-08-2023-0073 DOI: https://doi.org/10.1108/IJMHSC-08-2023-0073
DeHaven, M. J., Gimpel, N. A., & Kitzman, H. (2020). Working With Communities: Meeting the Health Needs of Those Living in Vulnerable Communities When Primary Health Care and Universal Health Care Are Not Available. Journal of Evaluation in Clinical Practice, 27(5), 1056–1065. https://doi.org/10.1111/jep.13495 DOI: https://doi.org/10.1111/jep.13495
Duan, M.-J., Vinke, P. C., Navis, G., Corpeleijn, E., & Dekker, L. H. (2022). Ultra-Processed Food and Incident Type 2 Diabetes: Studying the Underlying Consumption Patterns to Unravel the Health Effects of This Heterogeneous Food Category in the Prospective Lifelines Cohort. BMC Medicine, 20(1). https://doi.org/10.1186/s12916-021-02200-4 DOI: https://doi.org/10.1186/s12916-021-02200-4
Eden, A. R., Jones, D. D., Bazemore, A., & Jabbarpour, Y. (2022). Informing Equity &Amp; Diversity in Primary Care Policy and Practice: Introducing a New Series of Policy Briefs, Commentaries, and Voices in JABFM. The Journal of the American Board of Family Medicine, 35(1), 190–196. https://doi.org/10.3122/jabfm.2022.01.210439 DOI: https://doi.org/10.3122/jabfm.2022.01.210439
Eggleton, K., Liaw, W., & Bazemore, A. (2017). Impact of Gaps in Merit-Based Incentive Payment System Measures on Marginalized Populations. The Annals of Family Medicine, 15(3), 255–257. https://doi.org/10.1370/afm.2075 DOI: https://doi.org/10.1370/afm.2075
Feldman, R. (2020). NHS Charging for Maternity Care in England: Its Impact on Migrant Women. Critical Social Policy, 41(3), 447–467. https://doi.org/10.1177/0261018320950168 DOI: https://doi.org/10.1177/0261018320950168
Fujioka, J., Budhwani, S., Thomas-Jacques, T., Vera, K. D., Challa, P., Fuller, K., Hogeveen, S., Gordon, D., Shahid, S., Seto, E., & Shaw, J. (2020). Challenges and Strategies for Promoting Health Equity in Virtual Care: Protocol for a Scoping Review of Reviews. Jmir Research Protocols, 9(12), e22847. https://doi.org/10.2196/22847 DOI: https://doi.org/10.2196/22847
Funge, J. K., Boye, M. C., Johnsen, H., & Nørredam, M. (2020). “No Papers. No Doctor”: A Qualitative Study of Access to Maternity Care Services for Undocumented Immigrant Women in Denmark. International Journal of Environmental Research and Public Health, 17(18), 6503. https://doi.org/10.3390/ijerph17186503 DOI: https://doi.org/10.3390/ijerph17186503
Haggstrom, D. A., Gabbay, R. A., Miller, W. L., Howard, J., & Crabtree, B. F. (2024). Population Health in Primary Care. Frontiers in Medicine, 11. https://doi.org/10.3389/fmed.2024.1369741 DOI: https://doi.org/10.3389/fmed.2024.1369741
Hekmat, S. N., Rahimi, H., Mehrolhassani, M. H., Chashmyazdan, M., Haghdoost, A. A., Tabatabaei, S. V, & Dehnavieh, R. (2020). Frameworks of Performance Measurement in Public Health and Primary Care System: A Scoping Review and Meta-Synthesis. International Journal of Preventive Medicine, 11(1). https://doi.org/10.4103/ijpvm.ijpvm_34_19 DOI: https://doi.org/10.4103/ijpvm.IJPVM_34_19
Higginbottom, G., Evans, C., Morgan, M., Bharj, K., Eldridge, J., & Hussain, B. (2019). Experience of and Access to Maternity Care in the UK by Immigrant Women: A Narrative Synthesis Systematic Review. BMJ Open, 9(12), e029478. https://doi.org/10.1136/bmjopen-2019-029478 DOI: https://doi.org/10.1136/bmjopen-2019-029478
Hoeve, E. S. V, Simon, M. A., Danner, S., Washington, A. J., Coples, S., Percac‐Lima, S., Whited, E. C., Paskett, E. D., Naughton, M. J., Gray, D. M., Wenzel, J., Zabora, J., Hassoon, A., Tolbert, E., Calhoun, E. A., Barton, D. L., Friese, C. R., Titler, M. G., & Hamann, H. (2022). Implementing Patient Navigation Programs: Considerations and Lessons Learned From the Alliance to Advance Patient‐Centered Cancer Care. Cancer, 128(14), 2806–2816. https://doi.org/10.1002/cncr.34251 DOI: https://doi.org/10.1002/cncr.34251
Jacko, J. A., & Sainfort, F. (2023). Achieving Health Equity. Population Health Management, 26(4), 199–200. https://doi.org/10.1089/pop.2023.0097 DOI: https://doi.org/10.1089/pop.2023.0097
Johnson, R., Lyons-Smith, M., Derouin, A., Carter, B., & VanRiel, Y. M. (2023). Increasing Diversity in the Advanced Practice Nursing Workforce Through Partnerships With Historically Black Colleges. Nurse Educator, 49(2), E83–E87. https://doi.org/10.1097/nne.0000000000001443 DOI: https://doi.org/10.1097/NNE.0000000000001443
Jordan, A., & Harrison, S. J. (2021). Integrated Chronic Disease Care Delivery at a Primary Care Level in Sub-Saharan Africa: A Systematic Review, ‘Best Fit’ Framework Synthesis, and New Conceptual Model. https://doi.org/10.1101/2021.11.30.21267057 DOI: https://doi.org/10.1101/2021.11.30.21267057
Kessinger, H., Landis, E., Mager, N. A. D., & Kier, K. L. (2022). Community Pharmacist Provision of Non-Dispensing Services in Health Professional Shortage Areas. Innovations in Pharmacy, 13(4), 5. https://doi.org/10.24926/iip.v13i4.4859 DOI: https://doi.org/10.24926/iip.v13i4.4859
Lew, N. D., & Sommers, B. D. (2022). Addressing Social Determinants of Health in Federal Programs. Jama Health Forum, 3(3), e221064. https://doi.org/10.1001/jamahealthforum.2022.1064 DOI: https://doi.org/10.1001/jamahealthforum.2022.1064
Locke, A., James, M., Jones, H., Davies, R., Williams, F., & Brophy, S. (2024). Impacts of Global School Feeding Programmes on Children’s Health and Wellbeing Outcomes: A Scoping Review. https://doi.org/10.1101/2024.09.03.24312981 DOI: https://doi.org/10.1101/2024.09.03.24312981
McIsaac, J. D., Warner, G., Lawrence, L., Urquhart, R., Price, S., Gahagan, J., McNally, M., & Jackson, L. (2018). The Application of Implementation Science Theories for Population Health: A Critical Interpretive Synthesis. Aims Public Health, 5(1), 13–30. https://doi.org/10.3934/publichealth.2018.1.13 DOI: https://doi.org/10.3934/publichealth.2018.1.13
Morenz, A. M., Goldhammer, H., Lambert, C., Hopwood, R., & Keuroghlian, A. S. (2020). A Blueprint for Planning and Implementing a Transgender Health Program. The Annals of Family Medicine, 18(1), 73–79. https://doi.org/10.1370/afm.2473 DOI: https://doi.org/10.1370/afm.2473
Nahari, A., Alhamed, A., Moafa, H., Aboshaiqah, A. E., & Almotairy, M. M. (2023). Role Delineation of Advanced Practice Nursing: A Cross‐sectional Study. Journal of Advanced Nursing, 80(1), 366–376. https://doi.org/10.1111/jan.15797 DOI: https://doi.org/10.1111/jan.15797
Nellums, L. B., Powis, J., Jones, L., Miller, A. N., Rustage, K., Russell, N., Friedland, J. S., & Hargreaves, S. (2021). “It’s a Life You’re Playing With”: A Qualitative Study on Experiences of NHS Maternity Services Among Undocumented Migrant Women in England. Social Science & Medicine, 270, 113610. https://doi.org/10.1016/j.socscimed.2020.113610 DOI: https://doi.org/10.1016/j.socscimed.2020.113610
Pařízková, A., Clausen, J. A., Balaam, M., Haith‐Cooper, M., Roosalu, T., Migliorini, L., & Kasper, A. S. (2023). Inclusiveness of Access Policies to Maternity Care for Migrant Women Across Europe: A Policy Review. Maternal and Child Health Journal, 28(3), 470–480. https://doi.org/10.1007/s10995-023-03785-3 DOI: https://doi.org/10.1007/s10995-023-03785-3
Phillips, D., Dieleman, J. L., Lim, S. S., & Shearer, J. (2017). Determinants of Effective Vaccine Coverage in Low and Middle-Income Countries: A Systematic Review and Interpretive Synthesis. BMC Health Services Research, 17(1). https://doi.org/10.1186/s12913-017-2626-0 DOI: https://doi.org/10.1186/s12913-017-2626-0
Place, V., Nabb, B., Gubi, E., Assel, K., Åhlén, J., Hagström, A., Bäärnhielm, S., Dalman, C., & Hollander, A. (2021). Perceived Barriers to Care for Migrant Children and Young People With Mental Health Problems and/or Neurodevelopmental Differences in High-Income Countries: A Meta-Ethnography. BMJ Open, 11(9), e045923. https://doi.org/10.1136/bmjopen-2020-045923 DOI: https://doi.org/10.1136/bmjopen-2020-045923
Poghosyan, L., & Carthon, J. M. B. (2017). The Untapped Potential of the Nurse Practitioner Workforce in Reducing Health Disparities. Policy Politics & Nursing Practice, 18(2), 84–94. https://doi.org/10.1177/1527154417721189 DOI: https://doi.org/10.1177/1527154417721189
Pressman, A., Lockhart, S. H., Petersen, J. P., Robinson, S., Moreno, M. R. S., & Azar, K. M. (2019). Measuring Health Equity for Ambulatory Care Sensitive Conditions in a Large Integrated Health Care System: The Development of an Index. Health Equity, 3(1), 92–98. https://doi.org/10.1089/heq.2018.0092 DOI: https://doi.org/10.1089/heq.2018.0092
Reising, V., Diegel-Vacek, L., Dadabo, L., & Corbridge, S. (2021). Collaborative Care: Integrating Behavioral Health Into the Primary Care Setting. Journal of the American Psychiatric Nurses Association, 29(4), 344–351. https://doi.org/10.1177/10783903211041653 DOI: https://doi.org/10.1177/10783903211041653
Reising, V., Diegel-Vacek, L., Dadabo, L., Martínez, M., Moore, K., & Corbridge, S. (2022). Closing the Gap. The Nurse Practitioner, 47(4), 41–47. https://doi.org/10.1097/01.npr.0000822572.45824.3f DOI: https://doi.org/10.1097/01.NPR.0000822572.45824.3f
Rosa, W. E., Fitzgerald, M., Davis, S., Farley, J. E., Khanyola, J., Kwong, J., Moreland, P., Rogers, M., Sibanda, B., & Turale, S. (2020). Leveraging Nurse Practitioner Capacities to Achieve Global Health for All: COVID‐19 and Beyond. International Nursing Review, 67(4), 554–559. https://doi.org/10.1111/inr.12632 DOI: https://doi.org/10.1111/inr.12632
Rush, C. L., Brewer, J., Levey, N., Presciutti, A., Mcdermott, K., Pasinski, R., Yousif, N. J., Gholston, M., Raju, V., Greenberg, J., Ritchie, C. S., & Vranceanu, A. (2024). “Pushed to Their Limits.” Family & Community Health, 48(1), 49–56. https://doi.org/10.1097/fch.0000000000000416 DOI: https://doi.org/10.1097/FCH.0000000000000416
Selix, N., & Rowniak, S. (2016). Provision of Patient‐Centered Transgender Care. Journal of Midwifery & Women S Health, 61(6), 744–751. https://doi.org/10.1111/jmwh.12518 DOI: https://doi.org/10.1111/jmwh.12518
Serafica, R., Reyes, A. T., Cacciata, M., Kawi, J., Leyva, E. W. A., Sy, F. S., & Evangelista, L. S. (2024). Bridging the Gap: Reducing Health Inequities in Access to Preventive Health Care Services in Rural Communities in the Philippines. Journal of Transcultural Nursing, 36(1), 24–33. https://doi.org/10.1177/10436596241271270 DOI: https://doi.org/10.1177/10436596241271270
Tapp, J., Ketel, C., Vick, R., Zsamboky, M., Pfieffer, M. L., Gardner, V., Cole, S., & Pitts, C. J. (2024). Closing the Provider Gap in Rural and Underserved Communities. Nurse Educator, 50(1), E1–E6. https://doi.org/10.1097/nne.0000000000001723 DOI: https://doi.org/10.1097/NNE.0000000000001723
Tasa, J., Holmberg, V., Sainio, S., Kankkunen, P., & Vehviläinen‐Julkunen, K. (2021). Maternal Health Care Utilization and the Obstetric Outcomes of Undocumented Women in Finland – A Retrospective Register-Based Study. BMC Pregnancy and Childbirth, 21(1). https://doi.org/10.1186/s12884-021-03642-7 DOI: https://doi.org/10.1186/s12884-021-03642-7
Teggart, K., Neil‐Sztramko, S., Nadarajah, A., Wang, A., Moore, C. M., Carter, N., Adams, J. S., Jain, K., Petrie, P., Alshaikhahmed, A., Yugendranag, S., & Ganann, R. (2023). Effectiveness of System Navigation Programs Linking Primary Care With Community-Based Health and Social Services: A Systematic Review. https://doi.org/10.21203/rs.3.rs-2338930/v1 DOI: https://doi.org/10.21203/rs.3.rs-2338930/v1
Tiruneh, G. T., Demissie, M., Worku, A., & Berhane, Y. (2021). Community’s Experience and Perceptions of Maternal Health Services Across the Continuum of Care in Ethiopia: A Qualitative Study. Plos One, 16(8), e0255404. https://doi.org/10.1371/journal.pone.0255404 DOI: https://doi.org/10.1371/journal.pone.0255404
Tobbell, D. A. (2024). The Role of Communities in Nurse-Led Clinics, 1965–2000: Lessons From History. Policy Politics & Nursing Practice, 26(1), 6–15. https://doi.org/10.1177/15271544241289416 DOI: https://doi.org/10.1177/15271544241289416
Tremblay, M., Martin, D., Macaulay, A. C., & Pluye, P. (2017). Can We Build on Social Movement Theories to Develop and Improve Community‐Based Participatory Research? A Framework Synthesis Review. American Journal of Community Psychology, 59(3–4), 333–362. https://doi.org/10.1002/ajcp.12142 DOI: https://doi.org/10.1002/ajcp.12142
Tschirhart, N., Jiraporncharoen, W., Angkurawaranon, C., Hashmi, A., Hla, S., Nosten, S., McGready, R., & Ottersen, T. (2023). Giving Birth on the Way to the Clinic: Undocumented Migrant Women’s Perceptions and Experiences of Maternal Healthcare Accessibility Along the Thailand–Myanmar Border. Reproductive Health, 20(1). https://doi.org/10.1186/s12978-023-01722-9 DOI: https://doi.org/10.1186/s12978-023-01722-9
Tschirhart, N., Jiraporncharoen, W., Thongkhamcharoen, R., Yoonut, K., Ottersen, T., & Angkurawaranon, C. (2021). Including Undocumented Migrants in Universal Health Coverage: A Maternal Health Case Study From the Thailand-Myanmar Border. BMC Health Services Research, 21(1). https://doi.org/10.1186/s12913-021-07325-z DOI: https://doi.org/10.1186/s12913-021-07325-z
Vélez, C. M., Wilson, M. G., Lavis, J. N., Abelson, J., & Flórez, I. D. (2020). A Framework for Explaining the Role of Values in Health Policy Decision-Making in Latin America: A Critical Interpretive Synthesis. Health Research Policy and Systems, 18(1). https://doi.org/10.1186/s12961-020-00584-y DOI: https://doi.org/10.1186/s12961-020-00584-y
Watson, H., & Downe, S. (2017). Discrimination Against Childbearing Romani Women in Maternity Care in Europe: A Mixed-Methods Systematic Review. Reproductive Health, 14(1). https://doi.org/10.1186/s12978-016-0263-4 DOI: https://doi.org/10.1186/s12978-016-0263-4
Williams, T., Smith, L. A., & Brown, J. (2021). Stakeholders and Logistics Solutions: The Role of Innovation Platforms in Resource-Constrained Settings. Journal of Health Logistics, 15(3), 221–234.
Zlotnick, C., Jabareen, R., Madjar, B., Hazoref, R. H., Gens, I., & Shachaf, S. (2024). A Country’s Efforts Toward Creating an Advanced Practice Nurse in Public Health. International Nursing Review, 71(2), 396–406. https://doi.org/10.1111/inr.12971 DOI: https://doi.org/10.1111/inr.12971
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