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dc.rights.licenseCreative Commons Attribution License
dc.contributor.authorDiaconu, Karinen
dc.contributor.authorFalconer, Jenniferen
dc.contributor.authorVidal, Nicole L.en
dc.contributor.authorO'May, Fionaen
dc.contributor.authorAzasi, Estheren
dc.contributor.authorElimian, Kellyen
dc.contributor.authorBou-Orm, Ibrahim R.en
dc.contributor.authorSarb, Cristinaen
dc.contributor.authorWitter, Sophieen
dc.contributor.authorAger, Alastairen
dc.date.accessioned2019-12-12T10:24:41Z
dc.date.available2019-12-12T10:24:41Z
dc.date.issued2019-12-10
dc.identifier.citationDiaconu, K., Falconer, J., Vidal, N. L., O'May, F., Azasi, E., Elimian, K., Bou-Orm, I. R., Sarb, C., Witter, S. & Ager, A. (2020) Understanding fragility: Implications for global health research and practice. Health Policy and Planning, 35(2), pp. 235-243.en
dc.identifier.issn1460-2237en
dc.identifier.urihttps://eresearch.qmu.ac.uk/handle/20.500.12289/10270
dc.identifier.urihttps://doi.org/10.1093/heapol/czz142
dc.descriptionKarin Diaconu - ORCID 0000-0002-5810-9725 https://orcid.org/0000-0002-5810-9725en
dc.descriptionSophie Witter - ORCID 0000-0002-7656-6188 https://orcid.org/0000-0002-7656-6188
dc.description.abstractAdvances in population health outcomes risk being slowed—and potentially reversed—by a range of threats increasingly presented as ‘fragility’. Widely used and critiqued within the development arena, the concept is increasingly used in the field of global health, where its relationship to population health, health service delivery, access and utilization is poorly specified. We present the first scoping review seeking to clarify the meaning, definitions and applications of the term in the global health literature. Adopting the theoretical framework of concept analysis, 10 bibliographic and grey literature sources, and five key journals, were searched to retrieve documents relating to fragility and health. Reviewers screened titles and abstracts and retained documents applying the term fragility in relation to health systems, services, health outcomes and population or community health. Data were extracted according to the protocol; all documents underwent bibliometric analysis. Narrative synthesis was then used to identify defining attributes of the concept in the field of global health. A total of 377 documents met inclusion criteria. There has been an exponential increase in applications of the concept in published literature over the last 10 years. Formal definitions of the term continue to be focused on the characteristics of ‘fragile and conflict-affected states’. However, synthesis indicates diverse use of the concept with respect to: level of application (e.g. from state to local community); emphasis on particular antecedent stressors (including factors beyond conflict and weak governance); and focus on health system or community resources (with an increasing tendency to focus on the interface between two). Amongst several themes identified, trust is noted as a key locus of fragility at this interface, with critical implications for health seeking, service utilization and health system and community resilience.en
dc.description.sponsorshipThis research was funded by the National Institute for Health Research (NIHR) Global Health Research Programme 16/136/100. The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR or the Department of Health.en
dc.description.urihttps://doi.org/10.1093/heapol/czz142en
dc.format.extent235-243
dc.language.isoenen
dc.publisherOxford University Pressen
dc.relation.ispartofHealth Policy and Planningen
dc.rights© The Author(s) 2019. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.subjectFragilityen
dc.subjectResilienceen
dc.subjectHealth Systemsen
dc.subjectAccountabilityen
dc.titleUnderstanding fragility: Implications for global health research and practiceen
dc.typeArticleen
dcterms.accessRightspublic
dcterms.dateAccepted2019-10-08
dc.description.volume35
dc.description.ispublishedpub
rioxxterms.typeJournal Article/Reviewen
rioxxterms.publicationdate2019-12-10
refterms.dateFCA2019-12-10
refterms.dateFCD2019-12-12
refterms.depositExceptionpublishedGoldOAen
refterms.accessExceptionNAen
refterms.technicalExceptionNAen
refterms.panelUnspecifieden
qmu.authorDiaconu, Karinen
qmu.authorFalconer, Jenniferen
qmu.authorVidal, Nicole L.en
qmu.authorWitter, Sophieen
qmu.authorAger, Alastairen
qmu.centreInstitute for Global Health and Developmenten
dc.description.statuspub
dc.description.number2
refterms.versionVoRen
refterms.dateDeposit2019-12-12


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