Swiss Paraplegic Research, Guido A. Zäch Strasse 4, Nottwil, Lucerne, 6207, Switzerland.
Faculty of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, Lucerne, 6002, Switzerland.
BMC Public Health. 2023 Mar 6;23(1):428. doi: 10.1186/s12889-023-15295-6.
The COVID-19 pandemic has exacerbated health disparities in vulnerable groups (e.g., increased infection, hospitalization, and mortality rates in people with lower income, lower education, or ethnic minorities). Communication inequalities can act as mediating factors in this relationship. Understanding this link is vital to prevent communication inequalities and health disparities in public health crises. This study aims to map and summarize the current literature on communication inequalities linked with health disparities (CIHD) in vulnerable groups during the COVID-19 pandemic and to identify research gaps.
A scoping review of quantitative and qualitative evidence was conducted. The literature search followed the guidelines of PRISMA extension for scoping reviews and was performed on PubMed and PsycInfo. Findings were summarized using a conceptual framework based on the Structural Influence Model by Viswanath et al. RESULTS: The search yielded 92 studies, mainly assessing low education as a social determinant and knowledge as an indicator for communication inequalities. CIHD in vulnerable groups were identified in 45 studies. The association of low education with insufficient knowledge and inadequate preventive behavior was the most frequently observed. Other studies only found part of the link: communication inequalities (n = 25) or health disparities (n = 5). In 17 studies, neither inequalities nor disparities were found.
This review supports the findings of studies on past public health crises. Public health institutions should specifically target their communication to people with low education to reduce communication inequalities. More research about CIHD is needed on groups with migrant status, financial hardship, not speaking the language in the country of residence, sexual minorities, and living in deprived neighborhoods. Future research should also assess communication input factors to derive specific communication strategies for public health institutions to overcome CIHD in public health crises.
COVID-19 大流行加剧了弱势群体中的健康差距（例如，收入较低、受教育程度较低或少数族裔人群的感染率、住院率和死亡率上升）。沟通不平等可能是这种关系的中介因素。了解这种联系对于防止公共卫生危机中的沟通不平等和健康差距至关重要。本研究旨在绘制和总结 COVID-19 大流行期间弱势群体中与健康差距相关的沟通不平等（CIHD）的现有文献，并确定研究空白。
对定量和定性证据进行了范围综述。文献检索遵循 PRISMA 扩展用于范围综述的指南，并在 PubMed 和 PsycInfo 上进行。研究结果使用基于 Viswanath 等人的结构影响模型的概念框架进行总结。
搜索结果产生了 92 项研究，主要评估了低教育作为社会决定因素和知识作为沟通不平等的指标。在 45 项研究中确定了弱势群体中的 CIHD。观察到低教育与知识不足和预防行为不当之间的关联最为频繁。其他研究仅发现了部分联系：沟通不平等（n=25）或健康差距（n=5）。在 17 项研究中，既没有不平等也没有差距。
本综述支持了过去公共卫生危机研究的发现。公共卫生机构应特别针对受教育程度较低的人群开展宣传，以减少沟通不平等。需要对具有移民身份、经济困难、不会讲居住国语言、性少数群体和生活在贫困社区的群体进行更多关于 CIHD 的研究。未来的研究还应评估沟通投入因素，为公共卫生机构制定具体的沟通策略，以克服公共卫生危机中的 CIHD。
