Roma Health Research Articles

Tailoring intervention targeting HPV vaccination in marginalized Roma communities in Slovakia

Abstract Background Marginalized Roma communities (MRCs) are among underserved groups facing limited access to vaccination services and presumably low HPV vaccination rates. The most significant health system barriers to HPV vaccination include financial costs, lack of appropriate information and restricted capacities of healthcare providers. Two interventions identified as promising for implementation in the context of MRCs were discussed with a variety of stakeholders and community members to tailor intervention that would be well accepted and effective to increase HPV vaccination rates in MRCs. Methods The first intervention uses health promoters - trusted and trained community members to address cultural and language barriers and serve as a vital link between healthcare providers and community members. The second multilevel intervention is providing education, navigation, and vaccine access. Initial discussions were conducted with 23 stakeholders, and follow-up discussions were held with 16 stakeholders, including representatives of healthcare professionals, schools, local authorities, and community members. Results An intervention to be implemented in Slovakia focuses on the use of Roma health mediators who will provide parents and vaccine-eligible children (12-14 years old) from MRCs with information on HPV and HPV vaccination, invite them to educational sessions organized in community centres and at schools and navigate them through the vaccination process. The intervention also combines components such as videos and discussions with healthcare professionals, aligning with the needs and wishes of the target group. Conclusions This intervention will help to deliver reliable and understandable information on vaccination and enable people from MRCs to make informed decisions about vaccination. Roma health mediators will take the burden of providing information from overloaded healthcare providers and navigate community members through the vaccination process.

A retrospective, comparative analysis of A&E attendance paserns in Irish Traveller versus non-Traveller general practice patients.

Very little is known about Gypsy, Roma, and Traveller health, or access to and utilisation of health care. They are not coded in NHS data systems and there are multiple barriers including illiteracy, digital exclusion, and discrimination. To gain rare insight into Irish Traveller patients' emergency healthcare utilisation and outcomes. A retrospective general practice review of A&E attendances was performed from January to December 2017, comparing Travellers with the rest of the practice patient population. A search was done for all A&E attendance letters and related admissions. Blind review of the diagnosis and management were assessed by two reviewers for appropriateness of attendance at A&E. The frequency and recurrence of A&E attendances, referral pathway toA&E, location of A&E, and age distribution were compared. Traveller patients attending A&E were younger. There were fewer repeat attendances in the travelling community but proportionally more in the Traveller under-20-year-old cohort. Only 38% of A&E attendances in Travellers (56% non-Travellers) were deemed appropriate (χ2 7.16, P = 0.007). Only 20% of Travellers (36% non-Travellers) attending A&E were admitted to hospital (χ2 6.33, P = 0.01). Further, 93% of A&E attendances in Irish Travellers (75% non-Travellers) did not follow initial contact with either a GP or NHS 111 (χ2 9.86, P<0.002). Finally, 51% of Irish Travellers (6% non-Travellers) attended A&E departments distant to their registered GP practice (χ2 89.5, P<0.001). This work throws light on health service utilisation patterns by Irish Travellers. A&E attendances may have been more suited to a non-emergency setting and there may have been missed opportunities for contact with primary care or NHS 111, which may have an impact on continuity, onward referral, and quality of care.

Roma Community and Health Inequalities during the COVID-19 Pandemic in Romania

Roma Community and Health Inequalities during the COVID-19 Pandemic in Romania

A participatory approach to increase HPV vaccination in marginalized Roma communities in Slovakia

Abstract Background Roma living in marginalized communities are among underserved groups facing limited access to vaccination services. The RIVER-EU in Slovakia aims to identify and tailor the intervention to address health system barriers to HPV vaccination faced by people from marginalized Roma communities. Methods Following principles of participatory action research, a wide spectrum of stakeholders was engaged to discuss the transferability of promising evidence-based interventions. Interviews and focus groups aimed to assess the suitability of interventions and identify barriers and facilitators for the transfer and implementation taking contextual characteristics into account. Results Key stakeholders included community members (parents and daughters), Roma health mediators, healthcare providers, policymakers, and representatives of the municipality, school, and public health authority. The most challenging was to engage community members as they had almost no information about the HPV vaccination. Building relationships and trust with communities require intensive cooperation with field services, time and energy. Engaging primary care providers was difficult due to their restricted capacities and work overload causing their motivation to engage in time-consuming collaborative processes to be low. Successful engagement of all stakeholders required concentrated efforts and specific strategies of the research team. Conclusions Active participation of all those who will be affected by the intervention and those whose cooperation will be necessary for successful implementation requires to engage keep on board a number of stakeholders holding different opinions. Facilitating consensus about the design of tailored intervention requires intense communication and revisiting the ongoing integration of emerging ideas until the consensus is reached. It is a responsibility of a researcher to ensure that at the end of the process, all voices are heard and all needs are met.

The Participation of Pediatric Dentists in Oral Health Promotion and Education in Serbia.

To identify the involvement of Serbian paediatric dentists in oral health promotion and education, and to propose further actions for the improvement of these activities. This is an analysis of data collected by a cross-sectional, questionnaire-based survey of 445 dentists involved in the provision of dental health services to children at the primary healthcare level. We explored dentists' involvement in oral health education and promotion and the cooperation with other health professionals at the healthcare centre and the community level as well as their attitudes towards the importance of some factors influencing their work. Dentists estimate their cooperation with different services with ratings higher than 3 on the scale of 1 to 5. They reported the highest satisfaction in cooperation with paediatric services for preschool and schoolchildren (4.0±1.0). At the community level, they reported excellent cooperation with kindergartens (4.4±0.8), while collaboration with Roma health mediators (3.14±1.34) and nongovernmental organizations (2.5±1.4) received lower ratings. According to the average rating (4.7±0.7), dentists perceive the motivation of patients and/or their guardians for keeping good oral health as the factor with the highest importance for the quality of interventions they provide. Dentists involved in the provision of dental healthcare for children and adolescents in primary healthcare centres in Serbia participate in different oral healthcare education and promotion activities in the community, and highlight the importance of strengthening cooperation with healthcare and other professionals and services aimed at vulnerable population groups, both within the health sector and nongovernmental organizations.

Identifying a Human Rights Approach to Roma Health Vulnerabilities and Inequalities in Europe: From Concept to Action.

Roma communities across Europe still remain a neglected population group by way of the social and economic disadvantage that largely characterizes their lives. Roma communities continue to experience structural socioeconomic health inequalities on the grounds of their ethnic origin, alarmingly unveiling a pattern of systematic discrimination and ethnic marginalization. Without any doubt, such a highly worrying situation calls for States to incorporate Roma health rights within their law and policy agendas in a manner consistent with right to health requirements. Against this background, this paper seeks to identify an operational human rights framework for States as a driver for better informed policies and implementation as well as for Roma engagement in the deliberations about their life prospects. The paper argues that continuing, concerted, and proactive State engagement is required for effectively addressing the structural obstacles impeding Roma socioeconomic health rights realization and maximizing Roma opportunities for well-being.

Health system barriers to HPV vaccination in marginalized Roma communities in Slovakia

Abstract Background People from marginalized Roma communities often experience poverty, limited access to education, employment, housing, and health care (HC). The aim of the study was to explore the perceptions of people from marginalized Roma communities and health professionals regarding health system (HS) barriers to HPV vaccination. Methods A qualitative study was conducted in the Kosice region as a part of the RIVER-EU project. Semi-structured interviews with marginalized Roma parents (N = 18), children (N = 15), and health professionals (N = 18) were audio-recorded and thematic analysis of the transcripts was performed in MAXQDA. Findings Four main themes were identified regarding HS barriers: 1. Lack of information (lack of culturally and linguistically appropriate information, lack of information provision from HC providers, unreliable and conflicting information on the internet), 2. Restricted access to HC providers (lack of capacities, work overload, long wait in the waiting room, distance, traffic connection), 3. Financial and organizational barriers (limited coverage of vaccination expenses from health insurance, picking up prescribed vaccines in a pharmacy by parents, parental consent), 4. Attitudes and behaviours of HC providers (neglect of care, double standard, inappropriate behaviour and communication, prejudices, racism). Conclusions The reasoning and perception of several barriers to HPV vaccination differ among groups of respondents. Nevertheless, HPV is not viewed as a priority by both - marginalized Roma and health professionals. HS fails to reach marginalized Roma with appropriate information about HPV and HPV vaccination. Moreover, the lack of capacities and motivation of HC providers to address these topics lead to a lack of awareness. Organization and health insurance coverage of vaccination pose additional barriers to HPV vaccination.

The Italian Roma, Sinti and Travellers Health Project for equity in access to care

Abstract Issue In 2015, Italy approved the National Action Plan for Health for and with Roma, Sinti and Travellers (RSC); however, it is still not fully applied at a local level. The INMP (funded by the National Operational Programme for Social Inclusion), implemented the “Health Project - Promotion of strategies and tools for equity in access to health care for RSC”, aimed to support the implementation of the Plan by Local Health Authorities (ASL). Description The project lasted from March 2019 to December 2021. INMP worked with 7 ASL to design interventions and develop tools to address RSC health needs. The SODA (Strategic Options Development and Analysis) method as a participatory process aimed at identifying strategies and models for the execution of the Plan among relevant stakeholders was used. Moreover, RSC communities’ engagement strategies and a community-based Proximity Public Health (PPS) approach were adopted in designing and developing health promotion interventions. Results INMP performed 38 interviews with ASL health operators highlighting barriers and strategies in the local implementation of the Plan. Tools orienting to social and health services and health education materials for hard-to-reach groups were produced. A training course for 14 RSC facilitators and 5 training courses attended by over 200 NHS operators have been organized. ASL were supported in developing health promotion initiatives, based on the engagement of both local RSC communities and third sector entities. Lessons The project has enabled the ASL to develop local protocols for the implementation of the Action Plan. In line with this capacity-building activity, the project trained both health operators and RSC facilitators fostering the dissemination of the PPS culture in designing and providing care for hard-to-reach groups. Given the positive results obtained, INMP is still collaborating with both ASL and the Third Sector on additional activities related to the Project in 2022. Key messages

Vocational training of health mediators of primary care teams improves their sense of coherence

Abstract Background A Primary Care Model Programme had been implemented in Hungary between 2013-2017 in which group practices were established that employed - among others - nonprofessional health workers (health mediators, similar to community health workers) to facilitate access for the most disadvantaged population groups. The health of mediators, themselves mostly disadvantaged ethnic Roma, was monitored every odd year of the Programme. Methods A repeated cross-sectional health interview survey had been implemented inviting all health mediators who were employed at the time of the survey. The same questionnaire was used in all 3 surveys with items from the European Health Interview Survey 2009 and validated versions of other scales. Results Positive changes occurred in the health status of mediators during 5 years of follow-up. Significant improvement in mental health occurred among those who completed on-the-job vocational training. By 2017, significant increase in sense of coherence was observed among those who obtained vocational qualification as opposed to those who did not. The proportion of highly stressed mediators showed a significant increase among those with no vocational training. Improvement was detected in all mediators in health awareness, dysfunctional attitudes, psychological stress and smoking prevalence. Conclusions Significant improvement in mental status among those who obtained on-the-job vocational qualification were observed during follow-up of ethnic Roma health mediators in the programme in which they were equal members of the primary health care team. Employment of health mediators in primary care teams not only contributed to improving access to care for disadvantaged groups but also improved the mental health of mediators themselves. Key messages • Nonprofessional health mediators are important members of primary care teams servicing disadvantaged populations. • Significant improvement in mental status during 5 years of follow-up occurred among Roma health mediators who received vocational training and were equal members of primary health care teams.

On-the-job vocational training of nonprofessional ethnic health workers of a primary health care team improves their sense of coherence

Objectives A Primary Care Model Programme had been implemented in Hungary between 2013 and 2017 in which group practices were established that employed—among others—nonprofessional health workers (health mediators, similar to community health workers) to facilitate access for the most disadvantaged population groups. The health of mediators, themselves mostly disadvantaged ethnic Roma, was monitored every odd year of the Programme.Methods A repeated cross-sectional health interview survey had been implemented inviting all health mediators who were employed at the time of the survey. The same questionnaire was used in all 3 surveys with items from the European Health Interview Survey 2009 and validated versions of other scales.ResultsPositive changes occurred in the health status of mediators during 5 years of follow-up. Significant improvement in mental health occurred among those who completed on-the-job vocational training. By 2017, significant increase in sense of coherence was observed among those who obtained vocational qualification as opposed to those who did not. The proportion of highly stressed mediators showed a significant increase among those with no vocational training. Improvement was detected in all mediators in health awareness, dysfunctional attitudes, psychological stress and smoking prevalence. Conclusions Significant improvement in mental status among those who obtained on-the-job vocational qualification were observed during follow-up of ethnic Roma health mediators in the programme in which they were equal members of the primary health care team. Employment of health mediators in primary care teams not only contributed to improving access to care for disadvantaged groups, but also improved the mental health of mediators themselves.

Investigation of Healthcare Satisfaction of Roma Living in Camps or Urban Complex of Central Greece.

Background:Roma in Greece face multiple discrimination, particularly in the areas of housing, education, employment and health.Objective:The aim of this study is to explore the perceptions and beliefs of Greek Roma living both in camps and in urban neighborhoods for public health structures as well as to assess their satisfaction with health care services.Methods:The study sample consisted of 185 subjects (94 females and 91 males) with a mean age of 39.8 years (SD = 15.7). Of the people involved in the study, 80 come from the settlement of Larissa and 105 from the camp of Tyrnavos. A special survey questionnaire, “The scale of attitudes, feelings and satisfaction of Roma health services”, was used for collecting the data. The statistical analysis was carried out using the SPSS statistical program.Results:The statistical indicators of the sample, taken together, indicate a moderate trend towards a negative escalation of attitudes, feelings and satisfaction of health services. Based on the t-test results for independent samples, the average score on the Roma satisfaction scale of the Larissa settlement (M = -0,41, SD = 0,74) was not found to differ, statistically significantly, from the Roma population of the Tyrnavos camp (M = -0,61, SD = 0,94), t (182) = 1,680 (p = 0,095).Conclusion:The results of this study, despite its reasonable limitations, lead to a redefinition of some views regarding the attitude of the Roma towards the public health and care system, as well as the needs created.

The impact of the COVID-19 epidemic and anti-epidemic measures in the Roma neighborhood in Bulgaria

IntroductionCOVID-19 is becoming an indicator of inequality in societies. Due to the difficult socio-economic situation, Roma in Bulgaria face a higher risk of suffering and death due to COVID-19 than general population. The aim of the report is to analyze the impact of the epidemic of COVID-19 and the anti-epidemic measures applied among the Roma community in Sliven district, Bulgaria.Material and methodsAn exploratory qualitative study design was adopted, combining focus group discussion and qualitative interviews. One focus group with 8 representatives of the Roma ethnic group, and 7 in-depth interviews with specialists working with the Roma community were conducted in November 2020. Data were subjected to thematic analysis. 6 priority topics have been formulated and a hierarchical framework of codes has been built through free software. The experts, assessment of 13 university professors of public health was applied. The COREQ - checklist for reporting quality research was used.ResultsA segregated Roma community of about 20 000 people lives in the Nadezhda neighborhood in the town of Sliven. The impressions of the author from the in-depth conducted interviews with the specialists were compared with the summarized view of the experts, reflecting the information received from the Roma population in focus group. Matching the codes of the author and the experts in relation to 5 of the topics such as: work - work; fear - insecurity; healthcare - doctor; ‘closing the neighborhood' - police; despair, pessimistic views, deterioration of the epidemic situation - disease, misery, famine was found. No coincidences were found regarding future measures to reduce the negative effects of the COVID-19 crisis.ConclusionsThe measures taken against the spread of the pandemic further worsen the medical and social situation of the Roma ethnic group in Bulgaria. Our findings pointed to the importance of a multi-sectoral strategy to improve Roma health during and after a COVID-19.Key messages Due to the socio-economic situation, Roma in Bulgaria face a higher risk of suffering and death due to COVID-19 than general population and multi-sectoral strategy to improve Roma health is needed.According Roma ethnic group in Bulgaria the measures taken against the spread of the COVID-19 pandemic further worsen their medical and social situation and lead to disease, misery and famine.

Pautas de alimentación de la población gitana y la población general de España

ObjectiveThe NAOS (Nutrición, Actividad Física y Prevención de la Obesidad) strategy implemented by Spanish Ministry of Health proposes a range of healthy dietary guidelines. The objective of this article is to analyze the degree these nutritional patterns are monitored by the Roma population, compared to the rest of the population, compared to the total Spanish population. MethodsData from the 2012 National Health Survey and the 2014 Roma Health Survey were compared. Sex, age and socio-occupational scale were used as independent variables, applying a logistic regression analysis to assess their degree of influence. ResultsThere was less monitoring carried out by the Roma population of the dietary plans recommended by the Ministry of Health and differences of more of 20 percentage points were found in some of them. In both populations, age was the variable with the greatest influence, but even more so in the Roma population, while sex did not show statistical among Roma people. The follow-up data of these dietary patterns in the Roma population were lower in comparison with any of the socio-occupational groups of the rest of the population. ConclusionsThe Roma population is in a situation of inequality as regards the levels of adherence of the healthy dietary guidelines proposed by the Spanish NAOS strategy. The distance from these healthy eating habits is even greater among the younger Roma population.

Accessibility Difficulties, and Utilization of Healthcare Services Among Jordanian Roma with Chronic Diseases

Purpose: To examine factors that affect healthcare utilization among Roma population with chronic diseases in Jordan. It also explores behavior-seeking health care among them, their characteristics and ability to access healthcare. Design/Methodology/Approach: A cross-sectional descriptive survey performed, data collection done through in-person interviews using a structured questionnaire based on the Canadian Community Health Survey. Andersen’s behavioral model was implemented to examine the influences of predisposing, enabling, need, and outcome factors on healthcare utilization using binary logistic regression, and predictors for accessibility difficulties using multiple linear regression, Findings: 98.8% of the participants stated that they had difficulties in getting the care needed for diagnosis, treatment, or consultation, and 24.8% said that they didn’t utilize healthcare services last year. The number of chronic diseases and satisfaction level with the healthcare services significantly increase utilization, on the other hand; age, health insurance, resident location, number of chronic diseases and their duration as well as satisfaction with the healthcare are significantly affect accessibility difficulties to healthcare services. Practical implications: Provide mobile health units to reach remote settlements, that provide efficient healthcare services that met their health needs, and to be integrated with local health system. Societal implications: Efforts to involve Roma children in education. Establishing vocational training programs ended with employments. Establish sufficient and reasonable housing, to be side by side to the other population. Originality/value: This study is considered as the first to address the Jordanian Roma health status, utilization and accessibility to healthcare services, the end results help in suggesting different approaches to improve health and promote health equity.

Roma Health Mediators: A Neocolonial Tool for the Reinforcement of Epistemic Violence?

Scientific articles in medical journals regarding Roma have produced a type of problematic consensus narrative that is reinforced through its formulaic repetition. Roma health mediator (RHM) programs seem to have evolved from and currently be part of this consensus narrative. In this article I examine the potential use of RHMs, even if unintended, as a neocolonial tool for the reinforcement of epistemic violence against Roma, using a critical analysis of four empirical stories from the field. I explore the above hypothesis through critical reflexive anthropology, and postcolonial and intersectional studies, as well as by using elements of the self-ethnographic approach. I argue that the epistemic violence can be seen as resulting from the interplay between the Subject (i.e., health professional or researcher), the Object (i.e., Roma as “Other”), and the practices that result (i.e., discourse or consensus narrative production through the interpretation of the scientific data). I conclude with tools that could help reduce the epistemic violence against Roma within the health sector, suchas cross-disciplinary collaboration, participatory action research (PAR), (self-)reflection, critical theory, and the dialogic creation of scientific knowledge.

Self-Declared Roma Ethnicity and Health Insurance Expenditures: A Nationwide Cross-Sectional Investigation at the General Medical Practice Level in Hungary.

: IntroductionThe inevitable rising costs of health care and the accompanying risk of increasing inequalities raise concerns. In order to make tailored policies and interventions that can reduce this risk, it is necessary to investigate whether vulnerable groups (such as Roma, the largest ethnic minority in Europe) are being left out of access to medical advances. Objectives: The study aimed to describe the association between general medical practice (GMP) level of average per capita expenditure of the National Health Insurance Fund (NHIF), and the proportion of Roma people receiving GMP in Hungary, controlled for other socioeconomic and structural factors. Methods: A cross-sectional study that included all GMPs providing care for adults in Hungary (N = 4818) was conducted for the period 2012–2016. GMP specific data on health expenditures and structural indicators (GMP list size, providing care for adults only or children also, type and geographical location of settlement, age of GP, vacancy) for secondary analysis were obtained from the NHIF. Data for the socioeconomic variables were from the last census. Age and sex standardized specific socioeconomic status indicators (standardized relative education, srEDU; standardized relative employment, srEMP; relative housing density, rHD; relative Roma proportion based on self-reported data, rRP) and average per capita health expenditure (standardized relative health expenditure, srEXP) were computed. Multivariate linear regression model was applied to evaluate the relationship of socioeconomic and structural indicators with srEXP. Results: The srEDU had significant positive (b = 0.199, 95% CI: 0.128; 0.271) and the srEMP had significant negative (b = −0.282, 95% CI: −0.359; −0.204) effect on srEXP. GP age > 65 (b = −0.026, 95% CI: −0.036; −0.016), list size <800 (b = −0.043, 95% CI: −0.066; −0.020) and 800–1200 (b = −0.018, 95% CI: −0.031; −0.004]), had significant negative association with srEXP, and GMP providing adults only (b = 0.016, 95% CI: 0.001;0.032) had a positive effect. There was also significant expenditure variability across counties. However, rRP proved not to be a significant influencing factor (b = 0.002, 95% CI: −0.001; 0.005). Conclusion: As was expected, lower education, employment, and small practice size were associated with lower NHIF expenditures in Hungary, while the share of self-reported Roma did not significantly affect health expenditures according to our GMP level study. These findings do not suggest the necessity for Roma specific indicators elaborating health policy to control for the risk of widening inequalities imposed by rising health expenses.

Roma Health: An Overview of Communicable Diseases in Eastern and Central Europe.

The Roma are Europe’s largest minority. They are also one of its most disadvantaged, with low levels of education and health and high levels of poverty. Research on Roma health often reveals higher burdens of disease in the communities studied. This paper aims to review the literature on communicable diseases among Roma across Eastern and Central Europe. A PubMed search was carried out for communicable diseases among Roma in these parts of Europe, specifically in Romania, Bulgaria, Hungary, Serbia, Slovakia, the Czech Republic and North Macedonia. The papers were then screened for relevance and utility. Nineteen papers were selected for review; most of them from Slovakia. Roma continue to have a higher prevalence of communicable diseases and are at higher risk of infection than the majority populations of the countries they live in. Roma children in particular have a particularly high prevalence of parasitic disease. However, these differences in disease prevalence are not present across all diseases and all populations. For example, when Roma are compared to non-Roma living in close proximity to them, these differences are often no longer significant.

External classification for ethnicity in health survey to monitor Roma vs non-Roma differences

Abstract Background The Roma population of European countries is characterized by a poor and poorly described health status. The lack of detailed data on health loss among Roma can be partly attributed to legal limitations based lack of reliable methodology to effectively identify them. On the other hand, it is among factors responsible for restricted effectiveness of policy to narrow gap between Roma and non-Roma health status. Objectives We aimed to compare directly results from population based health survey on Roma vs non-Roma differences based on self-declared and observer-reported Roma classification. Methods In a population based health interview survey of random sample of 1849 subjects aged 18-64 years representing 965680 adults, both self-reporting and observer-reporting on Roma was applied. Data collection covered 52 indicators of morbidity, functional loss, health behavior, social capital, and use of health services. Health status differences between the self-declared Roma (N = 124) and the non-Roma (N = 1725) as well as the observer-reported Roma (N = 179) and non-Roma populations (N = 1670) were described by logistic regression models controlled for age, sex, education and employment. Results There was no significant Roma vs non-Roma difference in the respect of 33 indicators, and 14 indicators showed significant difference by both Roma definitions. Differences between the observer- and self-reported Roma ethnicity in statistical inference were observed for 7 indicators. In ascertaining significant Roma vs non-Roma difference, self-reporting was more effective for 2, and observer-reporting was for 5 indicators. Conclusions The application of observer-reported ethnicity classification cannot increase the practical value of health survey on Roma to non-Roma differences, compared to the self-reporting based approach. Therefore, the use of observer-reported Roma ethnicity in health surveys to improve the reliability of Roma specific indicators seems to be not justified. Key messages Application of external classification for ethnicity cannot increase the effectiveness of population based health interview survey in monitoring Roma vs non-Roma differences. The use of observer-reported Roma ethnicity in health surveys to improve the reliability of Roma specific indicators seems to be not justified.

Organizational Change in the Sphere of Health Protection of the Roma Community in Poland Seen From Different Perspective

Purpose: The intent of this study is to get insight into the different views on Roma health in Poland to improve health, access to healthcare and broaden the understanding of the limitations for the Roma inclusion in the mainstream of organizational behaviour of health and well-being institutions. Design/methodology/approach: The lack of institutional success up to date in the conduct of policies supporting the Roma on the path to an even standard of living, including health, suggests seeking new organizational approaches. To find the answers to these questions “What views do the Roma/Roma experts/Polish society have on Roma health?” qualitative research was done: six semi-structured openended interviews were conducted in the Roma community in Ochotnica Górna village in the Carpathian Mountains (across three generations), one structured and two semi-structured open-ended interviews with experts, observations of the living environments of the Roma interviewees and collection of newspaper articles as well as an analysis of different statistical data. Findings: The main insights that were provided by the views of Roma experts are the differences of approaches to health issues between Roma groups in Poland. The main insights that the newspaper articles give into the views of the society on Roma health are that the denigrating view on the Roma is still present in society, as some statements created a narrative of ‘othering’. This study also shows the change of views in time, as conformation to Romanipen principles is being relaxed among younger generations so their view on health and health care is changing. The policy in Poland that addresses the health issue of Roma is the National Roma Integration Policy 2014–2020, targeted to the whole Polish Roma population, homogeneously, although the target population is rather heterogeneous. This should be changed in the coming years. Research limitations/implications: A serious limitation in the research was the lack of willingness of both of the Roma people and Roma experts to participate in the study, and especially to share their insights on health, the protection of which follows the restrictive tradition of Romanipen. Generally, conducting research only in Ochotnica Gorna narrows the scope of this study to one particular village, even if the organizational solution is similar all over Poland. Originality/value: The value of the obtained results is increased by their uniqueness, as the separate issues of Roma health are not raised in Polish literature.

To Comply or Not to Comply: Roma Approach to Health Laws.

According to the general public in Slovakia, compliance with the law is problematic when it comes to Roma and health. Roma compliance with laws has not yet been studied. The aim of this is study was to explore the determinants of Roma behavior in the field of health laws. We used the concept of a semi-autonomous field proposed by Moore (1973) and the theory of planned behavior by Ajzen (1985). We found that Roma (non-)compliance with health laws was influenced by many different factors, such as beliefs, traditions, living conditions and culture. Group beliefs overrule national laws and also individual preferences, which tend to be subordinate to the group view. The less contact Roma from settlements have with non-Roma, the stronger their own rules are in the field of health. Roma health status is influenced by many factors: group beliefs and community traditions are stronger and overrule individual and state behavioral influence. A community-based participatory approach together with improvement of living conditions in cooperation with Roma is desirable.