Health financial resilience in individuals and households: a scoping review of components, strategies and outcomes

Abstract

Background

Financial resilience, the ability to withstand and recover from financial shocks, has become increasingly critical amid economic volatility, rising healthcare costs, and global crises such as the COVID-19 pandemic. While prior research has explored broad determinants of financial resilience.

Methods

Following the Arksey and O’Malley framework, this review systematically mapped literature from multiple databases (PubMed, Scopus, Web of Science, EconLit) and Google Scholar search engine from 1990 to 2024. Inclusion criteria focused on studies discussing financial, resilience components, strategies and outcomes in individuals or households. Data were extracted and analyzed thematically.

Results

A comprehensive search strategy was developed to identify relevant studies across multiple databases, including PubMed, Scopus, Web of Science, EconLit.The review included 30 studies from 15 countries, highlighting four key components of financial resilience: economic resources, financial knowledge and behavior, social capital, and access to financial services. Common strategies to enhance resilience included income diversification, savings, borrowing, reducing expenditures, and leveraging social networks. Outcomes of financial resilience included reduced financial fragility, improved life satisfaction, and enhanced financial stability. High-income countries emphasized financial literacy and planning, while low- and middle-income countries relied more on informal coping mechanisms like borrowing and asset sales. Some coping strategies have been used in times of illness.

Conclusion

Financial resilience is a multidimensional construct influenced by economic resources, financial knowledge, social capital, and access to financial services. Policymakers should prioritize financial literacy, expand access to financial services, and strengthen social safety nets to promote financial resilience, particularly among vulnerable populations, such as low-income individuals and the sick. Future research should explore the intersectionality of financial resilience and the role of digital financial services in enhancing resilience. Policymakers and financial institutions should focus on promoting financial literacy, expanding access to financial services, and strengthening social safety nets to support individuals and households in building financial resilience.

Introduction

Financial resilience has become increasingly recognized as a vital factor in how individuals and households manage economic challenges while maintaining health and well-being. We define financial resilience as the capacity to anticipate, withstand, and recover from financial shocks without compromising health outcomes [1]. This concept encompasses three key elements: structural components like savings and insurance, adaptive strategies including budgeting and debt management, and health-related outcomes such as mental health and healthcare access [2]. Importantly, financial resilience differs from related concepts like financial fragility, which describes a precarious state where even minor economic shocks can lead to severe health consequences due to limited resources [3].

The connection between financial resilience and health has become particularly evident during recent global crises. Events like the COVID-19 pandemic have demonstrated how financial instability directly impacts health through multiple pathways [4, 5]. When faced with economic pressures, individuals may delay medical care, skip essential medications, or experience chronic stress all of which can worsen physical and mental health outcomes [6, 7]. These challenges are compounded for vulnerable populations who often lack adequate safety nets. Research shows that components of financial resilience, such as social capital (the networks and relationships that provide support during hardships) and financial literacy, can serve as protective factors against these negative health impacts [8, 9].

Despite growing academic interest in this field, significant gaps remain in our understanding of financial resilience [10].Current literature lacks comprehensive syntheses that examine how different resilience components interact to influence health outcomes [11]. There is particularly limited evidence about which strategies are most effective for protecting health during financial crises, or how these relationships may vary across different socioeconomic groups. Furthermore, existing studies often examine financial resilience components in isolation, missing opportunities to understand their combined effects on health and well-being [12, 13].

This scoping review aims to address these critical gaps in the literature. Through systematic examination of existing research, we will identify key dimensions of financial resilience and their health implications, evaluate the effectiveness of various resilience-building strategies, and analyze how these relationships differ across populations. Our goal is to develop a comprehensive framework that connects financial resilience to health outcomes, ultimately informing policies and interventions that can simultaneously improve economic security and population health. By bridging these research gaps, this work will provide valuable insights for creating more equitable and health-promoting financial support systems.

Methodology

This scoping review follows the methodological framework outlined by Arksey and O’malley (2005) [14] and further refined by Levac et al. (2010) [15]. The purpose of this scoping review is to systematically map the existing literature on financial resilience in individuals and households, focusing on its components, strategies, and outcomes. The methodology is structured into five key stages, as described below:

Identifying the research question

The primary research question guiding this scoping review is:

What are the key components, strategies, and outcomes associated with financial resilience in individuals and households?

This question is further broken down into sub-questions:

• What are the main components of financial resilience identified in the literature?

• What strategies do individuals and households employ to enhance financial resilience?

• What outcomes are associated with financial resilience, and how are they measured?

Identifying relevant studies

A comprehensive search strategy was developed to identify relevant studies across multiple databases, including PubMed, Scopus, Web of Science, EconLit, (Additional file- Search strategy in databases). The search was limited to peer-reviewed articles published in English between January 1990 and December 2024 to ensure relevance and currency. Gray literature, such as reports and working papers, was also included to capture a broader range of perspectives. (Table 1)

Table 1.

Search strategy

Database	Strategy
Pubmed (325)	((((((((individual*[Title/Abstract]) OR (person*[Title/Abstract])) OR (household*[Title/Abstract])) OR (family*[Title/Abstract])) OR (adult*[Title/Abstract])) OR (health*[Title/Abstract])) OR (disease*[Title/Abstract])) OR (healthcare[Title/Abstract])) AND (((((((“financial resilience“[Title/Abstract]) OR (“financial coping“[Title/Abstract])) OR (“financially resilient“[Title/Abstract])) OR (“economic resilience“[Title/Abstract])) OR (“financial adapt*“[Title/Abstract])) OR (“financial recovery“[Title/Abstract])) OR (“financial bounce back“[Title/Abstract]))
Web Of Science (201)	((TS=(individual* OR person* OR household* OR family* OR adult* OR health* OR disease* OR healthcare)) AND (TS=(“financial resilience” OR “financial coping” OR “financially resilient” OR “economic resilience” OR “financial adapt*” OR “financial recovery” OR “financial bounce back”)))
Scopus (175)	((TITLE-ABS-KEY(individual* OR person* OR household* OR family* OR adult* OR health* OR disease* OR healthcare)) AND (TITLE-ABS-KEY(“financial resilience” OR “financial coping” OR “financially resilient” OR “economic resilience” OR “financial adapt*” OR “financial recovery” OR “financial bounce back”)))

Study selection

The study selection process was carefully designed to ensure the inclusion of relevant and high-quality research while maintaining methodological rigor. Inclusion criteria were established to identify studies focusing on financial resilience at the individual or household level, including those examining components, strategies, or outcomes of financial resilience. Empirical studies, theoretical frameworks, and review articles published in English were considered eligible for inclusion. Conversely, exclusion criteria eliminated studies concentrating solely on corporate financial resilience, those unrelated to financial resilience concepts, and non-English publications due to potential linguistic biases and translation limitations. The selection process employed a two-stage screening approach to maximize accuracy and minimize bias. In the initial phase, two independent reviewers conducted title and abstract screening, with any discrepancies resolved through discussion or third-party consultation. This was followed by a comprehensive full-text review of potentially relevant studies to verify their alignment with inclusion criteria. The language restriction to English publications, while potentially introducing some selection bias, was implemented to ensure terminological consistency, practical feasibility, and reproducibility of findings. This systematic approach yielded a curated collection of studies providing robust, multi-dimensional insights into financial resilience, though future research could benefit from incorporating multilingual resources to capture a more diverse range of perspectives. The rigorous selection methodology strengthened the validity of the review’s conclusions while effectively minimizing the risk of overlooking critical evidence in the field of financial resilience research.

Charting the data

To ensure a structured and comprehensive analysis of the included studies, a standardized data extraction template was developed. This template facilitated the systematic organization of key information, allowing for consistent comparisons across studies. The extracted data were categorized into several critical sections to capture the multifaceted nature of financial resilience. First, study details were recorded, including the author(s), publication year, country of origin, study design, and methodological approach, providing context for the research. Next, the components of financial resilience were documented, such as economic resources (e.g., savings, assets), financial literacy, social capital (e.g., family and community support), and access to financial services (e.g., banking, credit). These components helped identify the foundational elements that contribute to an individual’s or household’s ability to withstand financial shocks.

Additionally, the strategies for enhancing financial resilience were charted, encompassing methods like income diversification (e.g., side businesses, multiple income streams), savings habits, responsible borrowing, and cost-cutting measures. Understanding these strategies provided insights into practical approaches that individuals and institutions can adopt to strengthen financial resilience. The outcomes of financial resilience were also examined, including reduced financial fragility (e.g., lower debt stress), improved life satisfaction, and enhanced long-term financial stability. These outcomes highlighted the broader societal and personal benefits of fostering financial resilience. Finally, a summary of each study’s key findings was compiled to synthesize the main contributions to the literature on financial resilience.

To ensure accuracy and minimize bias, the data extraction process was conducted independently by two reviewers in cases where the two reviewers could not reach an agreement, a third person (L.D) with more knowledge and experience in the field was consulted for an opinion.

Any discrepancies in the extracted data were resolved through discussion and consensus, enhancing the reliability of the findings. This rigorous approach to data charting laid a strong foundation for subsequent thematic analysis and synthesis, enabling a deeper understanding of the factors that influence financial resilience across different contexts.

Collecting, summarizing, and reporting the results

The extracted data were analyzed using a thematic approach to identify recurring patterns, emerging trends, and gaps in the existing literature on financial resilience. This method allowed for a structured synthesis of findings, ensuring that key insights were systematically categorized and interpreted. The results were organized into three central themes to provide a clear and coherent understanding of financial resilience.

The first theme, Components of Financial Resilience, consolidated the fundamental dimensions that contribute to an individual’s or household’s ability to withstand financial shocks. These components included economic resources (such as savings, assets, and stable income), financial literacy (knowledge of budgeting, investing, and debt management), social capital (support from family, community networks, and institutional aid), and access to financial services (including banking, credit, and insurance). By summarizing these elements, the analysis revealed that financial resilience is multifaceted, requiring both personal capabilities and systemic support structures.

The second theme, Strategies for Enhancing Financial Resilience, examined the practical approaches individuals and households adopt to strengthen their financial stability. Commonly cited strategies included income diversification (engaging in side businesses or multiple income streams), disciplined savings habits, responsible borrowing (such as using low-interest loans or microfinance), and expenditure reduction (cutting non-essential costs). Additionally, some studies emphasized the role of financial education and policy interventions, such as government safety nets and employer-based financial wellness programs, in fostering resilience. This theme highlighted the proactive measures that can mitigate financial vulnerability.

The third theme, Outcomes of Financial Resilience, explored the tangible and intangible benefits of being financially resilient. Key outcomes included reduced financial fragility (lower likelihood of falling into debt or poverty), improved mental well-being and life satisfaction, and enhanced long-term economic security. Some studies also noted broader societal impacts, such as reduced strain on public welfare systems and increased community stability. By analyzing these outcomes, the review underscored the significance of financial resilience not only for individual prosperity but also for economic sustainability at larger scales.

The findings were reported in a structured manner, ensuring clarity and facilitating comparisons across studies. This thematic organization not only synthesized existing knowledge but also identified areas requiring further research, such as the long-term effects of financial resilience strategies in varying socioeconomic contexts. Overall, the analysis provided a comprehensive overview of how financial resilience is built, maintained, and measured, offering valuable insights for policymakers, financial institutions, and individuals seeking to improve financial well-being.

Consultation

As recommended by Arksey and O’malley (2005) [14], an optional consultation phase was conducted with experts in the field of financial resilience to validate the findings and provide additional insights. This step helped to ensure the comprehensiveness and relevance of the review.

Results

Of the 816 retrieved articles, 29 were excluded due to duplicates between different databases. In the title and abstract screening phase, 561 articles were excluded. 72 articles were excluded in the full-text screening phase. Finally, 30 articles [1, 3, 16–43]were included in the analysis (Fig. 1).

Fig. 1.

PRISMA 2020 flow diagram for screening the studies related to Financial Resilience in Individuals and Households: A Scoping Review of Components, Strategies, and Outcomes

Studies characteristics

The scoping review included studies from 15 countries (Two multi-country studies), with a strong focus on cross-sectional (80% of studies) (Table 2). The study populations ranged from general adult populations to vulnerable groups, such as low-income households, healthcare patients, and indigenous communities. The diversity in study designs and populations highlights the global relevance of financial resilience and coping strategies across different contexts. (Additional file- data extraction forms included detailed data from included studies)

Table 2.

Summary of the characteristics of the articles that reported the results of financial resilience in individuals and households

Variables	Variable level	N (%)	Variables	Variable level	N (%)
Countries Conducting Studies	USA	7 (23)	The year of the study	2024	3 (10)
	Indonesia	3 (10)		2023	4 (13)
	Australia	2 (6.6)		2022	2 (6.6)
	Ireland	2 (6.6)		2021	4 (13)
	Malaysia	2 (6.6)		2020	2 (6.6)
	India	2 (6.6)		2019	2 (6.6)
	Multi-country	2 (6.6)		2018	1 (3.3)
	Greece	1 (3.3)		2017	2 (6.6)
	Rwanda	1 (3.3)		2016	2 (6.6)
	Kenya	1 (3.3)		2014	2 (6.6)
	Pakistan	1 (3.3)		2013	1(3.3)
	Ethiopia	1 (3.3)		2011	1(3.3)
	Mexico	1 (3.3)		2010	1(3.3)
	Cambodia	1 (3.3)		2009	1(3.3)
	Burkina Faso	1 (3.3)		2008	1(3.3)
	China	1 (3.3)		1996	1(3.3)
	No report	1 (3.3)	Sample Sizes	Small samples (1–500 participants)	6 (20)
Study design	Cross-sectional	24 (80)		Medium samples (501–5,000 participants)	15 (50)
	Longitudinal	3 (10)		Large samples (5,001 + participants):	9 (30)
	Qualitative	1 (3.3)
	Quantitative	1 (3.3)
	Mixed-method	1 (3.3)

Key findings by region

Most studies were conducted in high-income countries (USA) and most studies were cross-sectional (80%) and had medium-samples (50%). The selected studies were conducted from 1996 to 2024.

The review revealed significant regional variations in the focus and findings of financial resilience research, shaped by differing economic conditions, institutional frameworks, and sociocultural contexts.

High-Income countries

The majority of studies on financial resilience were conducted in high-income countries (HICs), such as the United States, Australia, and Western European nations. Research in these regions predominantly examined financial fragility—defined as the inability to cope with unexpected expenses—and the role of financial literacy in mitigating economic vulnerability. A recurring theme was the impact of the COVID-19 pandemic, which exposed financial precarity even in affluent societies. For instance, Clark et al. (2022) found that households with strong financial planning skills and effective debt management strategies were better equipped to navigate pandemic-induced economic disruptions. Their study highlighted that access to emergency savings, diversified income sources, and financial education played a crucial role in sustaining resilience during crises. Additionally, research in HICs often explored the effectiveness of government interventions, such as stimulus packages and unemployment benefits, in buffering financial shocks. However, some studies pointed out gaps in policy coverage, particularly for gig workers and low-income households, suggesting that systemic inequalities persist even in wealthy nations.

Low- and Middle-Income countries (LMICs)

In contrast, studies from LMICs including India, Kenya, and Rwanda focused more on informal coping mechanisms due to limited access to formal financial safety nets. Households in these regions frequently relied on strategies such as borrowing from informal lenders, selling assets, or depending on community support networks to manage financial shocks. Nkurunziza et al. (2023), for example, investigated shock-coping mechanisms in rural Rwanda and found that household characteristics (e.g., size, education level, and asset ownership) significantly influenced resilience. Their study also emphasized that the nature of the shock (sudden vs. recurring) shaped coping behaviors for instance, droughts or health emergencies forced families to liquidate assets, while income fluctuations led to increased reliance on social networks. Another key finding from LMIC research was the role of microfinance and community-based savings groups (e.g., ROSCAs) in enhancing financial resilience. However, some studies cautioned that excessive reliance on informal borrowing could lead to debt traps, particularly when interest rates were high.

Components of financial resilience

Financial resilience is a multidimensional construct shaped by a combination of economic, behavioral, social, and institutional factors. Understanding these components is essential for developing interventions that strengthen individuals’ and households’ ability to withstand financial shocks.

Economic resources

The foundation of financial resilience lies in economic resources, including stable income, savings, and manageable debt levels. Research consistently shows that individuals with higher and more predictable incomes are better positioned to absorb financial shocks, such as job loss or medical emergencies. Savings act as a critical buffer, allowing households to cover unexpected expenses without resorting to high-interest loans or asset depletion. However, disparities exist—low-income households often struggle to build savings due to living paycheck-to-paycheck, making them more vulnerable to economic disruptions. Effective debt management is another crucial aspect, as excessive debt (particularly high-interest or predatory loans) can erode financial resilience over time.

Financial knowledge and behavior

Financial literacy, which encompasses essential skills such as budgeting, saving, investing, and debt management, plays a pivotal role in fostering financial resilience. Research shows that individuals with strong financial literacy are more likely to create and adhere to budgets, build emergency funds, make informed borrowing decisions, and plan for long-term financial security. Behavioral factors, including self-control and future-oriented financial planning, further strengthen resilience. However, financial education alone is not enough; access to supportive financial systems and products is equally critical to ensure individuals can effectively apply their knowledge.

Social capital, defined as networks of trust, reciprocity, and institutional support, serves as an informal safety net during financial distress. Key forms of social capital include community savings groups, such as ROSCAs and chit funds, which provide interest-free liquidity in emergencies. Informal insurance networks, such as family or clan support, enable reciprocal assistance during crises, while digital social capital including crowdfunding and peer-to-peer lending offers rapid financial support through online platforms. Additionally, policy-led social capital, such as government welfare programs, provides public safety nets like unemployment benefits or food subsidies. Strong social ties reduce reliance on predatory lenders and help prevent distress sales of productive assets, further enhancing financial resilience.

Access to financial resources, including banking, credit, insurance, and digital payment systems, is another critical component of financial resilience. Financial inclusion ensures individuals have formal mechanisms to manage economic shocks. For instance, credit access can help smooth consumption during income disruptions, though unregulated borrowing may lead to over-indebtedness. Insurance products, such as health, crop, or property coverage, mitigate catastrophic financial losses but remain underutilized among low-income populations due to affordability and trust barriers. Meanwhile, digital financial services, including mobile money and fintech loans, improve accessibility but require robust consumer protection safeguards to prevent exploitation. Together, these elements—financial literacy, social capital, and access to financial resources—form a comprehensive framework for building resilience against financial shocks.

Strategies for enhancing financial resilience

Households employ a mix of proactive and reactive strategies to strengthen financial resilience, with approaches varying based on economic context. One key strategy is income stability and diversification, as relying on a single income source increases vulnerability. Households often engage in multiple income streams, such as combining wage labor with off-farm activities like side businesses or gig work. Investing in skills training also enhances earning potential, reducing financial fragility and alleviating stress-related illnesses linked to income volatility.

Another critical approach is savings and asset management. Building liquid savings whether in cash or mobile money ensures quick access to funds during emergencies. Investing in productive assets, such as livestock or tools, provides long-term security, though it carries the risk of distress sales if immediate liquidity is needed. These strategies contribute to faster shock recovery and help maintain access to essential services like healthcare.

Borrowing and financial assistance also play a role, though with trade-offs. Formal credit options, such as bank loans or microfinance, offer structured repayment plans but may exclude the poorest households. Informal loans from family or moneylenders provide flexibility but often come with high interest rates or social pressure. While borrowing can offer short-term relief, it may lead to long-term debt traps, potentially delaying essential expenditures like healthcare.

In times of financial strain, households often resort to reducing expenditures, cutting back on non-essentials such as leisure, education, or even nutritious food. While this provides immediate cost relief, it can have harmful long-term consequences, including child malnutrition, school dropouts, and overall human capital erosion.

Social networks serve as another vital resilience mechanism. Community support whether through loans, in-kind aid, or emotional backing helps preserve assets and mental well-being. Strong social ties reduce the need for distress asset sales and contribute to improved psychological health.

Finally, insurance and risk transfer mechanisms, such as health or crop insurance, can prevent catastrophic financial losses. However, low trust and affordability issues often hinder widespread adoption. When accessible, insurance mitigates large financial shocks and encourages preventive care utilization.

Policy and research implications

To enhance financial resilience, policies must be tailored to different economic contexts. In high-income countries (HICs), expanding financial education and regulating predatory lending can help households make informed decisions. In low- and middle-income countries (LMICs), strengthening social protection systems and promoting affordable insurance are crucial. Cross-cutting solutions should address behavioral barriers such as present bias through interventions like automatic savings nudges, ensuring households are better prepared for financial shocks. By combining these strategies, individuals and communities can build stronger, more sustainable financial resilience.

This framework highlights that financial resilience is not just about individual actions but also systemic support structures that enable equitable access to resources. Future research should explore intersectional vulnerabilities (e.g., gender, disability) and the role of technology in scaling resilience strategies.

Outcomes of financial resilience

Reduced financial fragility

Financial resilience strategies help reduce financial fragility, enabling individuals and households to better manage unexpected expenses and income shocks. This is often measured by the ability to cover a $2,000 emergency expense within a month.

Improved life satisfaction

Financial resilience is positively correlated with overall life satisfaction. Individuals who are financially resilient report higher levels of well-being and lower financial stress.

Enhanced financial stability

By adopting financial resilience strategies, individuals and households can achieve greater financial stability, reducing their vulnerability to economic shocks and improving their long-term financial health.

Discussion

The findings of this scoping review provide a comprehensive overview of the components, strategies, and outcomes associated with financial resilience in individuals and households. By synthesizing the existing literature, this review highlights the multidimensional nature of financial resilience and underscores its importance in navigating economic uncertainties and shocks. Below, we discuss the key findings in relation to the research questions, their implications, and areas for future research.

In high-income countries (HICs), resilience primarily relies on formal systems: 84% of US households use emergency savings, while 63% depend on government assistance during crises [44]. In contrast, low- and middle-income countries (LMICs) predominantly utilize informal strategies 77% of Kenyan households rely on community savings groups (chamas) [45] and 52% of Indian families depend on extended family networks when facing medical emergencies [46]. These divergent approaches reflect systemic disparities in safety net accessibility, with LMICs often compensating for weak institutional support through social capital, which carries distinct health implications [47].

Components of financial resilience

The review identified four primary components of financial resilience: economic resources, financial knowledge and behavior, social capital, and access to financial services. These components align with the findings of Salignac et al. (2019), who conceptualized financial resilience as a multidimensional construct. Economic resources, such as income stability and savings, were consistently highlighted as foundational to financial resilience [48].Without adequate economic resources, individuals and households are more vulnerable to financial shocks, such as job loss or unexpected medical expenses.

Financial knowledge and behavior emerged as critical enablers of financial resilience. Studies emphasized that individuals with higher financial literacy are better equipped to make informed decisions, such as budgeting, saving, and investing, which enhance their ability to withstand financial setbacks [49, 50]. In LMICs, literacy alone fails to improve resilience if structural barriers exist [51] for example, 68% of literate Kenyan farmers still took high-interest loans due to lack of banking access [52]. Social capital, including access to community and government support, also plays a vital role in buffering against financial shocks [9]. For instance, social networks can provide emotional and financial assistance during crises, as demonstrated in studies from low- and middle-income countries [53, 54]. Filipino community savings groups reduced health shocks by 23% [55]. 41% of Bangladeshi women faced social ostracism after failing to repay ROSCA dues [56].Finally, access to financial services, such as credit and insurance, was identified as a key component of financial resilience. Financial inclusion enables individuals to manage risks and recover from financial disruptions more effectively [57]. However, disparities in access to financial services, particularly among marginalized populations, remain a significant barrier to achieving financial resilience.

Strategies for enhancing financial resilience

The review identified several strategies employed by individuals and households to enhance financial resilience. These strategies can be broadly categorized into income-related strategies, savings and asset management, borrowing and financial assistance, and expenditure reduction.

Income-related strategies, such as income diversification and wage labor, were commonly reported as ways to mitigate the impact of income shocks [58].For example, households in rural Rwanda engaged in off-farm activities and planted drought-tolerant crops to stabilize their income during economic shocks (Nkurunziza et al., 2023). Similarly, savings and asset management were highlighted as critical strategies for building financial resilience. Studies consistently found that individuals with savings and liquid assets were better prepared to handle unexpected expenses [59].

Borrowing and financial assistance were also widely used strategies, particularly in low-resource settings. For instance, households in Burkina Faso relied on informal loans and community support to cope with the financial burden of illness (Sauerborn et al., 1996). However, reliance on high-interest loans or selling assets can exacerbate financial vulnerability in the long term, highlighting the need for accessible and affordable financial services.

Expenditure reduction was another common strategy, particularly during financial crises. Studies from high-income countries, such as the United States, found that individuals reduced spending on non-essential items, such as leisure and clothing, to manage financial stress (Zafar et al., 2013; Palli et al., 2021). While this strategy can provide short-term relief, it may also lead to reduced quality of life and long-term financial insecurity.

While strategies like income diversification and savings build resilience, downsides persist:

Strategy	Benefit	Risk/Downside
Borrowing	Covers emergency medical costs	Debt traps (200% APR loans in Malawi)
Expenditure cuts	Preserves cash flow	Child stunting (+ 11% in Indonesia)
Insurance	Prevents catastrophic spending	Low uptake (only 12% in rural India)

Outcomes of financial resilience

The review identified several positive outcomes associated with financial resilience, including reduced financial fragility, improved life satisfaction, and enhanced financial stability. Financial resilience was found to reduce vulnerability to economic shocks, as measured by the ability to cover unexpected expenses or maintain consumption levels during crises (Lusardi et al., 2011; Clark & Mitchell, 2022). For example, households with higher financial resilience were better able to manage the economic impact of the COVID-19 pandemic, as they had access to savings and social support networks [60].

Improved life satisfaction was another key outcome of financial resilience. Studies from Australia and Greece found that financially resilient individuals reported higher levels of well-being and lower financial stress (Jayasinghe et al., 2020; Palli et al., 2021). This suggests that financial resilience not only mitigates economic hardship but also contributes to broader psychological and social well-being [61].

Finally, financial resilience was associated with enhanced financial stability, as individuals and households were better able to plan for the future and recover from financial setbacks (Salignac et al., 2019; Kakde et al., 2024). However, the review also highlighted disparities in financial resilience, particularly among low-income and marginalized populations, underscoring the need for targeted interventions to promote financial inclusion and equity.

Implications for policy and practice

The findings of this review have important implications for policymakers, financial institutions, and practitioners. First, efforts to promote financial literacy and education should be prioritized, as financial knowledge is a key enabler of financial resilience [62]. Programs aimed at improving financial literacy, particularly among vulnerable populations, can empower individuals to make informed financial decisions and build long-term financial stability. Practitioners can benefit from the comprehensive financial resilience framework presented in this study. By understanding the key components, coping strategies and outcomes of financial resilience, health care providers, social workers and financial advisors will be able to better identify individuals’ strengths and vulnerabilities. This will enable the design of targeted interventions and support programmers that address not only financial difficulties but also the psychosocial consequences of financial stress. The framework can also guide the development of targeted educational and counselling programmes that promote the ability to effectively manage financial challenges and improve individuals’ overall well-being. These approaches are consistent with recent evidence supporting the need to integrate financial resilience into comprehensive care and social support services [63].

Second, expanding access to affordable financial services, such as credit and insurance, is critical for enhancing financial resilience [57]. Policymakers should focus on reducing barriers to financial inclusion, particularly in low- and middle-income countries, where access to formal financial services remains limited. Although expanding access to affordable financial services such as credit and insurance is essential to increasing financial resilience, it must be done with caution. Historical evidence from the 2008 global financial crisis shows that reckless lending to financially vulnerable individuals can exacerbate systemic risks and lead to widespread economic instability (Mian & Sufi, 2014). Therefore, implementing responsible lending policies, rigorous risk assessment, and comprehensive financial education are crucial to ensure that increased access to financial services leads to real financial stability rather than creating new vulnerabilities [64].

Third, incorporate literacy into school curricula (e.g., Brazil’s mandatory high school financial courses increased savings by 14% [65].Stand-alone workshops fail (only 8% of them produce behavior change [66].

Fourth, to avoid over-reliance on GDP-aligned metrics, adopt multidimensional indices (e.g., Mexico’s Social Vulnerability Index includes asset loss + mental health) [67].

Fifth, to take advantage of informal systems, digitization of community savings can be used. (Ghana’s Susu apps boosted participation by 30%) [68].

Finally, strengthening social safety nets and community support systems can provide a critical buffer against financial shocks [69]. Governments and non-governmental organizations should invest in programs that promote social capital and provide financial assistance to households in need.

Future research should explore the intersectionality of financial resilience, examining how factors such as gender, race, and socioeconomic status influence financial resilience. Longitudinal studies are also needed to better understand the long-term impacts of financial resilience strategies and outcomes. Finally, more research is needed on the role of technology and digital financial services in enhancing financial resilience, particularly in the context of rapid technological advancements and the increasing digitization of financial systems.

Limitations

While this scoping review sought to provide a comprehensive synthesis of financial resilience literature, several important limitations must be acknowledged. First, the restriction to English-language publications likely excluded valuable research published in other languages, particularly studies from non-Anglophone countries where financial resilience mechanisms may differ substantially. For example, informal risk-sharing systems like Latin American tandas or West African susu networks are often documented in local languages, and their exclusion may have biased our findings toward more formal, Western-centric models of financial resilience. This language barrier could be particularly consequential for understanding culturally specific resilience strategies in low- and middle-income countries.

Second, our focus on individual and household-level factors may have obscured the critical role of broader systemic and structural determinants of financial resilience. Macroeconomic conditions, labor market policies, healthcare financing systems, and historical inequities (such as racial wealth gaps or gender disparities in financial access) all shape financial resilience but were not systematically examined. Future research would benefit from a more explicit consideration of how these larger structural forces enable or constrain individual resilience strategies.

Third, the substantial heterogeneity in study designs, methodologies, and outcome measures across the included literature poses challenges for comparing findings directly. Studies ranged from large-scale quantitative surveys using standardized financial resilience metrics to small qualitative case studies of community-based coping mechanisms, with little consistency in how resilience was conceptualized or measured. This variation makes it difficult to draw definitive conclusions about which strategies are most effective across different contexts.

Additionally, our analysis may be affected by publication bias, as it predominantly included peer-reviewed academic literature while underrepresenting grey literature such as NGO reports, government evaluations, and working papers. These sources often contain valuable insights into local, on-the-ground resilience strategies that may not make their way into formal academic publications. For instance, evaluations of microfinance programs by development organizations frequently document health-related financial coping mechanisms that are less visible in journal articles.

Most notably, while this review aimed to explore financial resilience in relation to health outcomes, the majority of included studies focused primarily on economic rather than health-related dimensions of resilience. Only a small subset explicitly examined connections between financial resilience and health, such as how medical debt affects treatment adherence or how financial stress influences mental health. This gap reflects a broader disciplinary divide between economic and health research, where financial studies often neglect health outcomes and health studies frequently overlook financial determinants. As a result, while our findings offer important insights into financial resilience broadly, their applicability to health-specific contexts may be limited. Future research should more intentionally bridge this divide by integrating financial and health data to better understand their interconnections.

These limitations highlight important opportunities to strengthen future research on financial resilience through more inclusive language policies, greater attention to structural determinants, development of standardized measurement tools, systematic inclusion of grey literature, and dedicated focus on the financial-health nexus. Addressing these gaps will be essential for developing comprehensive, contextually grounded understandings of financial resilience that can inform both policy and practice.

This scoping review underscores that financial resilience comprising economic resources, financial knowledge, social capital, and access to services is not merely an economic issue, but a critical determinant of health equity. The evidence reveals that financially resilient individuals and households are better equipped to manage health shocks, maintain treatment adherence, and preserve mental well-being during crises. Yet significant disparities persist, particularly among marginalized populations who face intersecting barriers to financial and health security.

Three key policy priorities emerge

- Integrating Financial Resilience into Universal Health Coverage (UHC) Agendas.

Financial resilience must be embedded within UHC frameworks to prevent medical impoverishment—a situation where healthcare costs push households into poverty. Rwanda’s community-based health insurance (Mutuelles de Santé) demonstrates the effectiveness of this approach, reducing catastrophic health spending by 60% by pooling risks and ensuring affordable access to care. Similar models should be scaled in other low- and middle-income countries (LMICs), with subsidies for the poorest to prevent exclusion. Additionally, automatic enrollment mechanisms (e.g., linking health insurance to social registries) can expand coverage, while flexible payment plans for unexpected medical bills can prevent distress borrowing. Policymakers should also explore integrated social protection programs that bundle health insurance with cash transfers, ensuring that financial shocks do not force families to forgo treatment.

Targeted financial literacy programs for Health-Vulnerable groups

Financial literacy programs should prioritize high-risk populations, such as patients with chronic illnesses (e.g., diabetes, HIV/AIDS, or hypertension), where poor budget management can lead to treatment interruptions. For example, a diabetic patient struggling with medical expenses may ration insulin, worsening health outcomes and increasing long-term costs. Health-literate financial coaching delivered through clinics or community health workers can teach patients how to: Budget for recurring medical expenses (e.g., medications, check-ups), Access subsidies or patient assistance programs, and Avoid predatory loans that could exacerbate financial stress.

Digital tools, such as SMS reminders for bill payments or mobile apps tracking health expenditures, can reinforce these behaviors. In India, Self-Help Groups (SHGs) have successfully combined health education with micro savings, demonstrating how financial and health literacy can jointly improve resilience.

Formalizing informal support systems while mitigating risks

Informal financial networks such as Rotating Savings and Credit Associations (ROSCAs), burial societies, and community lending pools already serve as critical shock absorbers in LMICs. For instance, in Kenya, digitized ROSCAs (e.g., platforms like ChamaPesa) improve transparency and accessibility, allowing members to quickly mobilize funds for emergencies. However, without regulation, these systems can lead to over-indebtedness or exclusion of the most vulnerable. Policies should:

- Provide legal recognition to well-functioning informal groups, enabling them to access formal banking services, introduce safeguards (e.g., caps on interest rates in peer-to-peer lending), and Promote hybrid models, where informal groups partner with microfinance institutions or insurers to enhance stability.

By strengthening rather than replacing these grassroots mechanisms, governments can preserve existing social capital while reducing financial risks. For example, Ghana’s susu collectors (informal savings agents) have been integrated into mobile banking systems, increasing security without disrupting trust-based systems.

Conclusion

To build lasting financial resilience, a multi-system approach to financial-health resilience is essential. In other words, interventions must bridge health and economic systems. This includes embedding financial protections in UHC policies, tailoring financial education to health needs, and Formalizing informal safety nets with smart regulations. When households are shielded from medical impoverishment, empowered to manage health-related expenses, and supported by both formal and informal networks, they are far more likely to withstand financial shocks without sacrificing well-being. Policymakers, healthcare providers, and financial institutions must collaborate to ensure that resilience strategies are inclusive, adaptive, and sustainable.

Call to action for research

Future research must prioritize longitudinal studies in low- and middle-income countries (LMICs) to systematically examine how financial resilience strategies influence health outcomes across different life stages and economic shocks. These studies should track households over extended periods, capturing how interventions like emergency savings, insurance uptake, or social support networks affect medical treatment adherence, nutrition security, and mental health. A critical parallel need is the development of standardized metrics to assess the relationship between financial resilience and health outcomes, potentially building on existing frameworks like the WHO’s financial protection indicators which measure catastrophic health spending and impoverishment. Such standardization would enable cross-country comparisons and more robust evidence-based policymaking. Additionally, research must adopt an intersectional lens to understand how overlapping vulnerabilities - particularly gender, disability status, and racial/ethnic marginalization - create compounded financial-health disadvantages. For instance, studies should examine how women caregivers in rural areas or persons with disabilities in urban informal settlements experience unique barriers to financial coping mechanisms that subsequently worsen health disparities. These research priorities would generate actionable insights for designing targeted, equitable interventions that address both economic and health vulnerabilities simultaneously.

Achieving health equity requires recognizing financial resilience as a social determinant of health. Policymakers, health systems, and financial institutions must collaborate to build systems that simultaneously strengthen economic security and health outcomes because financial stability is, fundamentally, a prerequisite for population health.

Author contributions

LD and RJ had the main idea for the review. The search strategy and eligibility criteria were devised by LD, RJ, BN and VSG. RJ conducted the database searches. RJ and NG conducted duplicate, title and abstract and full text screening in accordance with inclusion criteria. RJ conducted data extraction, RJ and LD carried out the analysis and drafted the initial manuscript. All authors provided critical revision of intellectual content. All authors approved the final manuscript.

Funding

This study was funded by Tabriz Health Services Management Research Center and Tabriz University of Medical Sciences (NO: 72657).

Data availability

All data are available upon reasonable request from the corresponding author.

Declarations

Competing interests

The authors declare no competing interests.

Ethics approval

The study received ethical approval from Tabriz University of Medical Sciences (Ethical No: IR.TBZMED.REC.1402.663).

Consent for participate

Not applicable.