Towards a Contextualized Social Vulnerability Index: Defining Key Domains and Indicators for Iran's Health System.

Background: Social vulnerability is an inherently context-dependent concept that has recently gained increasing attention within the framework of the social determinants of health. This study aimed to define and conceptualize social vulnerability within the specific context of Iran. Methods: A sequential mixed-methods design was employed. An initial pool of indicators was systematically developed through a literature review. The Delphi consensus technique was used to conceptualize social vulnerability in Iranian society by identifying context-sensitive and culturally relevant indicators. Over six months, 23 national experts in health and social welfare participated in three rounds of discussions. To assess the relevance and importance of these indicators, statistical indices, including the mean, standard deviation, and coefficient of variation, were applied. A directed qualitative content analysis was conducted to systematically categorize the indicators into distinct dimensions. Results: Experts identified 65 relevant indicators of social vulnerability. Indicators with the strongest consensus included families living below the poverty line, the unemployment rate, the ratio of marginalized populations, the number of malnourished individuals, people lacking social insurance, the share of housing costs, the number of out-of-school children, the proportion of food expenses in total household spending, education levels below a diploma, and the under-five mortality rate. The ten identified dimensions of social vulnerability in Iran were: Populations at Risk; Family and Gender; Economic; Health Infrastructure and Public Health; Education; Housing and Built Environment; Transportation and Mobility; Crime and Social Security; Emergency Response and Disaster Preparedness; and Social Capital and Institutional Support. Conclusion: In developing countries such as Iran, social vulnerability is strongly influenced by macroeconomic fragility, governance constraints, and cultural factors. Developing a robust, context-sensitive framework for conceptualizing social vulnerability provides a foundation for practical tools to assess and monitor vulnerability more effectively. Ultimately, this approach supports targeted interventions aimed at improving the social determinants of health and enhancing population well-being.