Defining the term "underserved:" A scoping review towards a standardized description of inadequate access to veterinary services.

This scoping review aims to establish a comprehensive definition of the term "underserved" as it applies to communities, individuals, and populations with inadequate access to animal health services, particularly for dogs. The review adhered to PRISMA guidelines and analyzed 30 articles, applying concepts of One Health and social determinants of health, by using 3 pre-determined categories of contributors to and indicators of underservice. The review categorized article-specific exemplars into veterinary-dependent barriers; community- and individual-related barriers; and health and welfare indicators; with subcategories illustrating features of underserved communities, individuals, or populations in each category. Ultimately, 3 definitions were developed. Animal Health Underserved Areas (AHUA) identify negative human and animal health and welfare outcomes secondary to inadequate access to animal health services in the community. Individuals may identify as underserved based on the same criteria (Animal Health Underserved Individuals, AHUI), and certain groups within otherwise adequately served areas may be identified as Animal Health Underserved Populations (AHUP). The AHUA, AHUI, and AHUP are frequently characterized as rural, remote, and/or Indigenous, and often face systemic marginalization. This inequitable access to animal health services creates human, animal, and community health challenges, underscoring the need for veterinary professionals and other stakeholders to prioritize equitable access to care. Findings from this review should inform development of a scoring system to enable comparative assessment of communities, individuals, and populations and allow strategic service and resource allocation in the future.