Reframing Healthcare Quality in Resource-Constrained Settings: Patients’ Narratives on Empathy and Responsiveness in Eastern Indonesia

Humairah Almahdali

Authors

Humairah Almahdali Universitas Pattimura, Indonesia

Keywords:

Empathy, Patient Narratives, Relational Care, Responsiveness, Service Quality

Abstract

This study aims to reframe the concept of public healthcare quality in resource-constrained settings by foregrounding patients’ lived experiences, with particular emphasis on empathy and responsiveness as core dimensions. It responds to the limitations of dominant technocratic approaches that prioritize quantitative indicators while neglecting relational aspects of care. A qualitative descriptive-interpretive design was employed, drawing on in-depth interviews with purposively selected outpatients and inpatients, complemented by participatory observation and document analysis. Data were analyzed thematically through processes of reduction, display, and interpretation, with credibility ensured through triangulation and member checking. The findings reveal that empathy, manifested through warm communication, personal attention, and sensitivity to patients’ emotional conditions, plays a central role in shaping perceived service quality. Responsiveness further strengthens patient trust, although its enactment is constrained by structural limitations, including workforce shortages, inadequate facilities, and high workloads. These findings expose a paradox between the aspiration to deliver human-centered care and systemic pressures that hinder relational practices. This study contributes by advancing a relational and experience-based reconceptualization of healthcare quality, integrating patient narratives into structural analyses of public service delivery in peripheral contexts. It highlights the importance of embedding humanistic competencies within policy and community-based interventions to promote more responsive, inclusive, and sustainable healthcare systems.

References

Abbasi, N., Jebraeily, M., Gheibi, S., & Mohammadpoor, Y. (2024). Designing and evaluating a web-based training program for medical record documentation: Insights from a developing country experience. Informatics in Medicine Unlocked, 51, 101599. https://doi.org/10.1016/j.imu.2024.101599

Adomah-Afari, A., & Kwaffo, M. (2025). Relationship between organisational factors and compliance with patient safety incidents reporting at two specialist hospitals, Ghana. International Journal of Health Governance, 30(4), 386–396. https://doi.org/10.1108/IJHG-06-2025-0082

Ahmed, S., Ashrafi, D. M., Ahammad, M. F., Rahman, M. K., & Sakib, M. N. (2026). Role of governance on patient safety in private hospitals through the mediating effects of teamwork and continuous improvement. International Journal of Quality & Reliability Management, 43(2), 406–434. https://doi.org/10.1108/IJQRM-04-2025-0115

Ariyanti, F., Nurmansyah, M. I., Wardani, R. K., Zilhadia, & Kilic, B. (2025). The impact of health system responsiveness on tuberculosis treatment adherence in public primary healthcare facilities in Indonesia. Clinical Epidemiology and Global Health, 34, 102107. https://doi.org/10.1016/j.cegh.2025.102107

Aydogdu, A. L. F. (2024). Nurses’ perceptions of nursing management: A metaphorical analysis. Collegian, 31(5), 333–341. https://doi.org/10.1016/j.colegn.2024.06.005

Azmeraw Getie, B., Engida Yismaw, A., & Eskezia Tiguh, A. (2022). Kangaroo mother care knowledge and practice among mothers who gave birth to preterm and low birth weight babies in Amhara regional state referral hospitals, North West Ethiopia. International Journal of Africa Nursing Sciences, 17, 100470. https://doi.org/10.1016/j.ijans.2022.100470

Banerjee, R., Mishra, V., & Maruta, A. A. (2021). Energy poverty, health and education outcomes: Evidence from the developing world. Energy Economics, 101, 105447. https://doi.org/10.1016/j.eneco.2021.105447

Binsar, F., & Sasmoko. (2025). Integrating chain of thought and explainable AI in BERT-based deep learning for interpretable medical diagnosis. Procedia Computer Science, 269, 389–399. https://doi.org/10.1016/j.procs.2025.08.291

Bouzarjomehri, H., Maleki, M., Masoudi-Asl, I., Ranjbar, M., & Herandi, Y. (2026). Healthcare transparency in Iran: anticipated benefits, risks, opportunities and barriers. Journal of Health Organization and Management, 40(2), 389–407. https://doi.org/10.1108/JHOM-11-2024-0486

Brehm, M. E., & Brehm, P. A. (2022). Drill, baby, drill: Natural resource shocks and fertility in Indonesia. Labour Economics, 76, 102178. https://doi.org/10.1016/j.labeco.2022.102178

Cao, Q., Hu, Y., & Cai, W.-T. (2025). Research Topics of Self-efficacy in Nursing from 2013 to 2022: A Bibliometric Analysis. Asian Nursing Research, 19(4), 371–381. https://doi.org/10.1016/j.anr.2025.05.007

Cassidy, R., Semwanga, A. R., Binyaruka, P., Blanchet, K., Singh, N. S., Maiba, J., & Borghi, J. (2025). Identifying the active ingredients in payment for performance programmes using system dynamics modelling. SSM - Health Systems, 4, 100040. https://doi.org/10.1016/j.ssmhs.2024.100040

Chanda, R. C., Vafaei-Zadeh, A., Hanifah, H., Nikbin, D., & Ahmed, T. (2025). Adoption of telemedicine services among older adults in a low-income developing country: an fsQCA, ANN and PLS-SEM approach. Aslib Journal of Information Management, 77(6), 1176–1222. https://doi.org/10.1108/AJIM-07-2024-0542

Dahleez, K. A., Aboramadan, M., & Abu sharikh, N. (2022). Empowering leadership and healthcare workers performance outcomes in times of crisis: the mediating role of safety climate. Journal of Organizational Effectiveness: People and Performance, 9(3), 401–421. https://doi.org/10.1108/JOEPP-03-2021-0080

Del Rosario, P. J. B., Ofilada, F. M., & Vicente, R. A. D. (2021). Comparative study on Vietnam’s and Philippines’ COVID-19 response using historical institutionalism. International Journal of Health Governance, 26(4), 418–431. https://doi.org/10.1108/IJHG-03-2021-0027

Dharmawan, P. B., Maharani, I. G. A. N. S., & Tho, C. (2023). Big Data Capabilities for Hospital: A Systematic Literature Review. Procedia Computer Science, 227, 272–281. https://doi.org/10.1016/j.procs.2023.10.525

Diao, Y., Kodera, S., Anzai, D., Gomez-Tames, J., Rashed, E. A., & Hirata, A. (2021). Influence of population density, temperature, and absolute humidity on spread and decay durations of COVID-19: A comparative study of scenarios in China, England, Germany, and Japan. One Health, 12, 100203. https://doi.org/10.1016/j.onehlt.2020.100203

Egan, K. A., Xuan, Z., Hofman, M., Ma Shum, J., Fernández-Pastrana, I., Fiechtner, L., Sandel, M., Buitron de la Vega, P., Kistin, C. J., & Hsu, H. (2024). Food Pantry Referral and Utilization in a Pediatric Primary Care Clinic. American Journal of Preventive Medicine, 66(3), 444–453. https://doi.org/10.1016/j.amepre.2023.10.006

Erdebilli, B., Sicakyuz, C., & Yilmaz, İ. (2024). An integrated multiple-criteria decision-making and data envelopment analysis framework for efficiency assessment in sustainable healthcare systems. Healthcare Analytics, 5, 100327. https://doi.org/10.1016/j.health.2024.100327

Erfina, E., Kadar, K. S., Hapsah, H., Rachmawaty, R., Arafat, R., Sabriyanti, W. O. N. I., & Malik, G. (2025). Translation and psychometric validation of the Evidence-Based Practice Competency Questionnaire for Registered Nurses (EBP-COQ Prof©) in Bahasa Indonesia. Applied Nursing Research, 81, 151881. https://doi.org/10.1016/j.apnr.2024.151881

Ezeudoka, B. C., Igwe, C., Ukaegbu, O. C., Okeke, E. S., & Okeke, V. C. (2024). The use of digital health services to combat E-waste health hazards: A review on the impact and awareness in Southwest Nigeria. Toxicology, 509, 153969. https://doi.org/10.1016/j.tox.2024.153969

Fauzi, M. A., Mohd Aripin, N., Alimin, N. S. N., Ting, I. W. K., Wider, W., Maidin, S. S., & Zainul Abideen, A. (2024). Medical tourism in South East Asia: science mapping of present and future trends. Asian Education and Development Studies, 13(5), 393–411. https://doi.org/10.1108/AEDS-04-2024-0093

Forsyth, P., Maguire, B., Carey, J., O’Brien, R., Maguire, J., Giblin, L., O’Hare, R., Rushworth, G. F., Cunningham, S., & Radley, A. (2025). Alienation and/or anomie in pharmacists: A systematic review and narrative synthesis of the international literature. Research in Social and Administrative Pharmacy, 21(5), 392–407. https://doi.org/10.1016/j.sapharm.2025.01.017

Gorelick, P. B., Hainsworth, A. H., & Wallin, A. (2024). What will it take to achieve brain health globally? Cerebral Circulation - Cognition and Behavior, 6, 100209. https://doi.org/10.1016/j.cccb.2024.100209

Harun, M. G. D., Anwar, M. M. U., Sumon, S. A., Mohona, T. M., Hassan, M. Z., Rahman, A., Abdullah, S. A. H. M., Islam, M. S., Oakley, L. P., Malpiedi, P., Kaydos-Daniels, S. C., & Styczynski, A. R. (2023). Hand hygiene compliance and associated factors among healthcare workers in selected tertiary-care hospitals in Bangladesh. Journal of Hospital Infection, 139, 220–227. https://doi.org/10.1016/j.jhin.2023.07.012

Herrador, M. (2024). Assessment of the first-ever circular economy framework of Cambodia: Barriers, international opportunities and recommendations. Journal of Cleaner Production, 438, 140778. https://doi.org/10.1016/j.jclepro.2024.140778

Huang, C.-W., Wu, B. C. Y., Nguyen, P. A., Wang, H.-H., Kao, C.-C., Lee, P.-C., Rahmanti, A. R., Hsu, J. C., Yang, H.-C., & Li, Y.-C. J. (2023). Emotion recognition in doctor-patient interactions from real-world clinical video database: Initial development of artificial empathy. Computer Methods and Programs in Biomedicine, 233, 107480. https://doi.org/10.1016/j.cmpb.2023.107480

Huang, M.-T., Wu, J.-L., Lee, S.-C., Kuo, C.-W., Chen, C.-Y., Lin, E. C.-L., Chang, Y.-H., Lo, S.-Y., Martin, S., Hargono, A., Tsai, T.-Y., & Li, C.-Y. (2025). Institutional variation of smoking cessation success in Taiwan: A multi-level analysis of the National Second-Generation Tobacco Cessation Program Data. Journal of Substance Use and Addiction Treatment, 170, 209615. https://doi.org/10.1016/j.josat.2024.209615

Irvanizam, I., & Zahara, N. (2024). An improved RAFSI method based on single-valued trapezoidal neutrosophic number and its Harmonic and Arithmetic mean operators for healthcare service quality evaluation. Expert Systems with Applications, 248, 123343. https://doi.org/10.1016/j.eswa.2024.123343

Ivziku, D., Filomeno, L., Forte, D., Caruso, R., Conte, G., Magon, A., Gualandi, R., Di Muzio, M., & Tartaglini, D. (2024). Reliability and validity of the Italian Version of the Chase Nurse Manager Competencies Scale. International Journal of Nursing Sciences, 11(3), 338–348. https://doi.org/10.1016/j.ijnss.2024.06.001

Jaya, V. A. F. T., Kim, Y., & Kang, M. (2024). Cutting through complexity: An intersectional analysis of female genital cutting in Indonesia. Women’s Studies International Forum, 104, 102906. https://doi.org/10.1016/j.wsif.2024.102906

Jonathan, G. M., Perjons, E., & Rusu, L. (2024). Digital Transformation-driven Decentralisation of Public Governance. Procedia Computer Science, 239, 1220–1229. https://doi.org/10.1016/j.procs.2024.06.290

Kang, M. H., & Kim, S. (2025). Research trends in entertainment robots: A comprehensive review of the literature from 1998 to 2024. Digital Business, 5(1), 100102. https://doi.org/10.1016/j.digbus.2024.100102

Kartika, Y., Rusetiyanti, N., & Pertiwi, A. A. P. (2021). Nurses and physicians’ perceptions on the Electronic Health Record implementation. Enfermería Clínica, 31, 521–525. https://doi.org/10.1016/j.enfcli.2020.10.039

Khairulbahri, M. (2023). The SEIR model incorporating asymptomatic cases, behavioral measures, and lockdowns: Lesson learned from the COVID-19 flow in Sweden. Biomedical Signal Processing and Control, 81, 104416. https://doi.org/10.1016/j.bspc.2022.104416

Kumar, S., Tarei, P. K., & Swarnakar, V. (2025). Analyzing barriers to sustainable healthcare waste disposal: a hybrid decision-making framework. Benchmarking: An International Journal, 32(6), 2301–2329. https://doi.org/10.1108/BIJ-10-2023-0744

Lei, X., Mak, H. Y., Shi, J., & Ta, Y. (2025). A comprehensive assessment of provider payment reform: Insights from China. Journal of Economic Behavior & Organization, 237, 107160. https://doi.org/10.1016/j.jebo.2025.107160

Lin, E. C.-L., Hsiao, F.-H., Schröder, A., Lundqvist, L.-O., Chao, H.-L., Lee, S.-K., Hung, T.-M., Lu, M.-J., Lu, H.-L., Laio, S.-J., Chang, K.-Y., & Pan, A.-N. (2021). Factors influencing patient-perceived quality of care in psychiatric hospitals in Taiwan. Archives of Psychiatric Nursing, 35(1), 9–16. https://doi.org/10.1016/j.apnu.2020.10.006

Loomba, A. P. S. (2022). Pharmacovigilance in emerging economies: modeling interaction among barriers. Journal of Advances in Management Research, 19(5), 713–740. https://doi.org/10.1108/JAMR-02-2022-0036

Maket, I., & Naibei, R. (2025). Fiscal decentralization and devolved healthcare service availability outcomes in Kenya: Evidence from panel dynamic approach. Regional Science Policy & Practice, 17(9), 100213. https://doi.org/10.1016/j.rspp.2025.100213

Meniz, B., Ozturk Usun, S., Akin Bas, S., Yafez, E., & Ahlatcioglu Ozkok, B. (2025). Integration of Type-2 fuzzy TOPSIS and Quality Function Deployment to address patient satisfaction in healthcare. Applied Soft Computing, 177, 113187. https://doi.org/10.1016/j.asoc.2025.113187

Mohamad, W. N., Kassim, N. M., & Fei, Z. (2025). Analyzing the impact of service quality on companion’s satisfaction with the Malaysian public hospitals amidst the COVID-19 pandemic. International Journal of Health Care Quality Assurance, 38(4), 338–357. https://doi.org/10.1108/IJHCQA-09-2024-0084

Mousavi, S. E., Ilaghi, M., Aflatoonian, S., & Nejadghaderi, S. A. (2025). Epidemiology, socioeconomic correlates, and trend projections of multiple myeloma in Asia over 2020–2040. Heliyon, 11(9), e43325. https://doi.org/10.1016/j.heliyon.2025.e43325

Nham, F. H., Kassis, E., Xu, W., El-Othmani, M. M., & Sarpong, N. O. (2024). Race and ethnic disparities arthroplasty trends and hotspots: Bibliometric analysis. Journal of Orthopaedics, 56, 141–150. https://doi.org/10.1016/j.jor.2024.05.021

Nkhwashu, T. E., Moloko, S. M., & Zikalala, M. J. (2023). The drivers and impediments of implementing the quality improvement programmes at a government hospital in Eswatini: The registered nurses’ perspective. International Journal of Africa Nursing Sciences, 18, 100569. https://doi.org/10.1016/j.ijans.2023.100569

Ouakil, H., Sarsar, H., & Ait Soussane, J. (2025). Does universalization of healthcare coverage promote inward FDI in health sectors? an empirical investigation using panel data of 59 countries. Transnational Corporations Review, 17(2), 200125. https://doi.org/10.1016/j.tncr.2025.200125

Phillips, S., Wyatt, L. C., Turner, M. M., Trinh-Shevrin, C., & Kwon, S. C. (2021). Patient-provider communication patterns among Asian American immigrant subgroups in New York City. Patient Education and Counseling, 104(5), 1049–1058. https://doi.org/10.1016/j.pec.2020.10.002

Rahmah, S. O., Handayani, P. W., Hidayanto, A. N., & Siswanto, B. B. (2025). Healthcare data governance assessment based on hospital management perspectives. International Journal of Information Management Data Insights, 5(1), 100342. https://doi.org/10.1016/j.jjimei.2025.100342

Raunaq, F. F., Islam, S., Anam, M. Z., & Bari, A. B. M. M. (2025). Assessing the challenges to digital technology adoption in the healthcare sector: Implications for sustainability in emerging economies. Informatics and Health, 2(2), 194–209. https://doi.org/10.1016/j.infoh.2025.09.001

Regragui, H., Sefiani, N., Azzouzi, H., & Cheikhrouhou, N. (2024). A hybrid multi-criteria decision-making approach for hospitals’ sustainability performance evaluation under fuzzy environment. International Journal of Productivity and Performance Management, 73(3), 855–888. https://doi.org/10.1108/IJPPM-10-2022-0538

Risky, S., Hadju, L., Mulyani, S., Azlimin, & Rachmat, M. (2021). A case study of document readiness in the Administration and Management Working Group on accreditation results at Lalolae Health Center. Gaceta Sanitaria, 35, S495–S497. https://doi.org/10.1016/j.gaceta.2021.07.027

Shaban, A. (2023). Regional economic growth and development in the Global South. Regional Science Policy & Practice, 15(5), 934–938. https://doi.org/10.1111/rsp3.12684

Shabil, M., Gaidhane, A. M., Vadia, N., Menon, S. V, Chennakesavulu, K., Panigrahi, R., Bushi, G., Jena, D., Kumar, H., Rani, A., Sah, S., Singh, M., Goh, K. W., & Jain, L. (2025). Maternal hypertensive disorders among Individuals of reproductive age (15–49 Years) in South Asia: A global Burden of Disease study (1990–2021) with future Projections. European Journal of Obstetrics & Gynecology and Reproductive Biology, 308, 214–221. https://doi.org/10.1016/j.ejogrb.2025.03.012

Shao, B., Harlyjoy, A., Kozel, O. A., Still, M. E., Widodo, S. B., Agwu, C., Sagaityte, E., Schroeder, C., Gilder, H. E., Hamzah, R., Sun, F. W., Feler, J. R., Santos, S., Sawyer, K., Svokos, K. A., Klinge, P. M., Johnson, W., Baticulon, R. E., & Park, K. B. (2025). Bibliometric Analysis of Myelomeningocele Management: National Disease Burden versus Publication Volume. World Neurosurgery, 194, 123444. https://doi.org/10.1016/j.wneu.2024.11.027

Stefanidis, A., Dagher, G. K., & Banai, M. (2025). Fall seven times and stand up eight: grit, ethical idealism and work engagement. International Journal of Productivity and Performance Management, 74(10), 3374–3397. https://doi.org/10.1108/IJPPM-05-2024-0317

Suryadinata, N., Eka, N. G. A., Manik, M. J., Puspitasari, V., Marlina, M., & Houghty, G. S. (2024). Effectiveness of online interprofessional education-communication course during the COVID-19 pandemic. Heliyon, 10(4), e25764. https://doi.org/10.1016/j.heliyon.2024.e25764

Talabani, S. N., & Mikhael, E. M. (2025). Exploring the experiences and perspectives of Iraqi healthcare providers on the challenges and determinants of HIV management: a qualitative study. Pharmacia, 72, 1–15. https://doi.org/10.3897/pharmacia.72.e163561

Thuong, N. T. T. (2021). Catastrophic health expenditure and impoverishment in Vietnam: Evidence from national Household Living Standards Surveys 2008–2018. Economic Analysis and Policy, 72, 668–684. https://doi.org/10.1016/j.eap.2021.10.009

Tran, N. T., Nguyen Thi Thu, P., Thao, N. T. T., Van Minh, D., Binh, N. T. T., & Ngo, Q.-M. T. (2024). Readiness for interprofessional education among health profession lecturers at a University in Vietnam: A cross-sectional study. Currents in Pharmacy Teaching and Learning, 16(10), 102151. https://doi.org/10.1016/j.cptl.2024.102151

Useche, S. A., Alonso, F., Aktaş, A., Araujo, K. D., Brlek, P., Calota, M. A., Cendales, B., Domenech, R., Faus, M., Gené-Sampedro, A., Guido, G., Hidayati, I., Jevremović, S., Koliou, K., Lima, L. C., Makarova, I., Mehdizadeh, M., Møller, M., Mukhametdinov, E., … Gene-Morales, J. (2025). Sustainably breaking the cycle: How closely are countries’ development and welfare indicators related to their cycling safety outcomes? Sustainable Futures, 10, 101223. https://doi.org/10.1016/j.sftr.2025.101223

Vargas, S. C., Rios-Zertuche, D., & Bauhoff, S. (2025). Changes and heterogeneity in quality-amenable excess mortality in Mexico: a systematic analysis for the years 2012, 2018, and 2021. The Lancet Regional Health - Americas, 45, 101061. https://doi.org/10.1016/j.lana.2025.101061

Vasquez, N. A., Oga-Omenka, C., Yellappa, V., Lestari, B. W., Sassi, A., Sheokand, S., Olusola-Faleye, B., Huria, L., Brubacher, L. J., Baruwa, E., Alisjahbana, B., & Pai, M. (2025). COVID-19 policies and tuberculosis services in private health sectors of India, Indonesia, and Nigeria. Journal of Clinical Tuberculosis and Other Mycobacterial Diseases, 38, 100503. https://doi.org/10.1016/j.jctube.2024.100503

Vijayasree, S., Praveen Kumar, P., Harini, S., & Raja Shree, K. . (2025). Enhancing healthcare quality and patient safety: exploring the impact of working environment, support and communication. Journal of Health Organization and Management, 39(8), 1868–1884. https://doi.org/10.1108/JHOM-11-2024-0485

Visbal-Cadavid, D., Delahoz-Domínguez, E., & Mendoza-Mendoza, A. (2025). A multiple factor analysis and hierarchical clustering of global logistics governance and development. Decision Analytics Journal, 15, 100579. https://doi.org/10.1016/j.dajour.2025.100579

Wahab, S. N., Singh, J., & Subramaniam, N. (2023). Telemedicine implementation framework for Malaysia: An integrated SWOT-MCDM approach. Health Policy and Technology, 12(4), 100818. https://doi.org/10.1016/j.hlpt.2023.100818

Wang, G., & Nurcahyo, A. (2023). Designing Personalized Integrated Healthcare Monitoring System through Blockchain and IoT. Procedia Computer Science, 227, 223–232. https://doi.org/10.1016/j.procs.2023.10.520

Wijiseno, B., Arini, M., & Listiowati, E. (2023). Healthcare workers’ acceptance of the integrated tuberculosis–COVID-19 screening in central Java Private Hospitals, Indonesia. Journal of Taibah University Medical Sciences, 18(6), 1311–1320. https://doi.org/10.1016/j.jtumed.2023.05.010

Wulandari, A. R. C., Rachmawaty, R., Ilkafah, I., & Erfina, E. (2021). Patient satisfaction towards healthcare quality in Indonesian Public Hospital. Enfermería Clínica, 31, S745–S750. https://doi.org/10.1016/j.enfcli.2021.09.006

Xu, C., Zhou, E., Shen, Y., Xiao, L., Huang, W., Zhou, T., Yao, J., Lu, W., Xu, F., Jiang, S., & Yi, H. (2025). Assessment and future projection of brain and central nervous system cancer burden using a modified quality care index: evidence from the Global Burden of Disease 2021. European Journal of Oncology Nursing, 79, 102997. https://doi.org/10.1016/j.ejon.2025.102997

Xu, D., Zhou, J., Yang, M., Yang, L., Li, Q., & Zeng, Y. (2025). Barriers and facilitators to reporting workplace violence among healthcare workers: A mixed-methods systematic review. Nursing Outlook, 73(4), 102443. https://doi.org/10.1016/j.outlook.2025.102443

Yunir, E., Soewondo, P., Soelistijo, S. A., & Rudijanto, A. (2021). Knowledge and behavior changes in clinician after training of partnership for Diabetes Control in Indonesia. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 15(3), 719–724. https://doi.org/10.1016/j.dsx.2021.03.012

Zaremba, A., Kizys, R., Tzouvanas, P., Aharon, D. Y., & Demir, E. (2021). The quest for multidimensional financial immunity to the COVID-19 pandemic: Evidence from international stock markets. Journal of International Financial Markets, Institutions and Money, 71, 101284. https://doi.org/10.1016/j.intfin.2021.101284

Zhang, D., Li, G., Shi, L., Martin, E., Chen, Z., Li, J., Chen, L., Li, Y., Wen, M., Chen, B., Li, H., Su, D., & Han, X. (2022). Association between racial discrimination and delayed or forgone care amid the COVID-19 pandemic. Preventive Medicine, 162, 107153. https://doi.org/10.1016/j.ypmed.2022.107153

Zhang, H., Wang, S., Wu, K., (Lucy) Qiu, Y., Wang, S., & Zhao, Y. (2025). Freezing or searing: Unraveling the impact of extreme temperatures on poverty in China. Environmental Impact Assessment Review, 112, 107841. https://doi.org/10.1016/j.eiar.2025.107841

Zhang, T., Zhang, B., & Tang, X. (2025). Global Burden of Peptic Ulcer Disease in Adolescents and Young Adults: Trends and Disparities from 1990–2021. Archives of Medical Research, 56(8), 103320. https://doi.org/10.1016/j.arcmed.2025.103320

Zhou, H., Liang, S., Chen, L., Yang, M., Li, Y., & Wu, X. (2025). Impacts of international food trade on methylmercury-related health risks. Cell Reports Sustainability, 2(2), 100308. https://doi.org/10.1016/j.crsus.2025.100308