Conocimientos, creencias y actitudes de la población gitana ante el cribado del cáncer colorrectal / Knowledge, beliefs and attitudes of the Roma population regarding colorectal cancer screening

Objetivo: Identificar los factores predisponentes, inhibidores y facilitadores que pueden afectar a la participación en los programas de cribado del cáncer colorrectal en la población gitana. Método: Estudio cualitativo exploratorio mediante técnica de grupo focal. Se realizaron tres grupos focales de hombres y tres de mujeres, con un total de 16 hombres y 18 mujeres participantes de población romaní, de 50-69 años de edad, de la provincia de Alicante. Se realizó un análisis del discurso con el modelo PRECEDE como marco de análisis. Resultados: Se identificaron diversas barreras a la participación, como la aversión de la población gitana a hablar de cáncer, el rechazo a anticipar un diagnóstico que puede provocar sufrimiento de la persona y su entorno familiar, escaso conocimiento de la enfermedad y del programa preventivo, rechazo hacia la recogida y manejo de las muestras, miedo y vergüenza ante la posible colonoscopia, aceptación de la voluntad divina, dificultades de comprensión y lectura, y percepción de estar discriminados por su etnia en el ámbito sanitario. Sin embargo, se identificaron factores predisponentes a la participación en el programa de cribado, como la predisposición favorable a recibir información pertinente a través de vías más apropiadas, así como su confianza en el consejo profesional. Conclusión: La predisposición a recibir la recomendación de participar en los programas de cribado colorrectal y una información comprensible de los profesionales sanitarios permiten entrever posibles estrategias de aproximación a este colectivo. Esto podría contribuir a la mejora de la participación de la población gitana en el programa de cribado de cáncer colorrectal y abrir nuevas vías para promover conductas preventivas (AU)

Objective: To identify predisposing, inhibitory and facilitating factors that may affect participation in colorectal cancer screening programs in the Roma population. Method: Qualitative and exploratory study by focus group technique. Three focus groups of men and three groups of women were carried out, with a total of 16 men and 18 women from the Roma population, aged 50-69 years, from the province of Alicante. A discourse analysis was performed with the PRECEDE model as an analysis framework. Results: Several barriers to participation were identified, such as the aversion of the Roma population to talk about cancer, refusal to anticipate a diagnosis that can cause suffering to the person and their family, poor knowledge of the disease and the preventive programmes, refusal to collect and handle samples, fear and shame about the colonoscopy, acceptance of divine will, difficulties in understanding and reading, and the perception of being discriminated by their ethnicity in the health sector. However, predisposing factors to participate in the screening programme also were identified, for example willingness to receive relevant information through more appropriate pathways, as well as their confidence in professional counselling. Conclusion: A willingness to receive the recommendation to participate and understanding information from health professionals have been identified. This will enable us to envisage potential strategies for approaching this population group. This could contribute to improved participation of the Roma population in colorectal cancer screening programmes and to open up new ways to promote preventive behaviours (AU)

Expectativas y experiencias de uso de las mujeres gitanas mayores ante los servicios sanitarios de atención primaria / Expectations and user experiences of older Roma women with health services in primary care

OBJETIVO: Conocer las expectativas y las experiencias de uso de las mujeres gitanas mayores ante los servicios sanitarios de atención primaria (AP). DISEÑO: Estudio cualitativo fenomenológico. Uso de grupos focales (4-9 mujeres/grupo) y entrevistas semiestructuradas. Registradas en audio. Realizadas entre marzo y noviembre de 2011. Emplazamiento: Estudio realizado en Úbeda y Linares (España). Participantes y contexto: Mujeres gitanas de más de 50 años. Muestreo intencional con criterio de segmentación de edad y zona de residencia. Captación a través de líderes comunitarias. MÉTODO: Proceso de análisis cualitativo de contenido: codificación, triangulación, obtención y verificación de RESULTADOS: Apoyado con el software Nvivo 8. RESULTADOS: Se realizaron 3 grupos focales y 4 entrevistas, incluyéndose 23 mujeres. Las expectativas ante la AP se dirigen exclusivamente a su médico, siendo invisibles otros profesionales. Quieren una relación con su médico basada en la confianza. En sus experiencias de uso de la AP conviven 3 tipos de uso: acuden a sus citas, demandan atención solo ante patología aguda y no acuden a citas y revisiones. Existen elementos socioculturales relacionados con la accesibilidad. CONCLUSIONES: Las mujeres gitanas mayores plantean sus expectativas y experiencias en los servicios de AP alrededor del binomio enfermedad/médico. Esperan una atención basada en la confianza y con una alta instrumentalización. Se observa un discurso con signos de cambio dirigidos hacia una participación más activa y reivindicativa en los servicios de AP

OBJECTIVE: To know the expectations and user experiences of older Roma women with health services in primary care (PC). DESIGN: Phenomenological qualitative study. Using focus groups (4-9 women/group) and semistructured interviews. Audio recorded from March to November 2011. LOCATION: Performed in Úbeda and Linares (Spain). Participants and SETTING: Roma women over 50 years. A purposive sample stratified by age and area of residence was carried out. Woman were recruited through community leaders. Method: Process of qualitative content analysis: coding, triangulation, obtain and verify RESULTS: Supported whit the software Nvivo 8. RESULTS: Three focus groups and four interviews were conducted, including 23 women. The expectations for the PC are focus exclusively on their physician, being invisible other professionals. They look for a relationship with their physician based on trust. In their user experience with the PC coexist three types of user: who goes to their appointments, demands attention only in acute disease and does not attend appointments and reviews. There are socio-cultural factors related to accessibility. CONCLUSIONS: Older Roma women set their expectations and experiences with health service in PC around the binomial disease/physician. Expect attention based on trust and a high instrumentalization. A speech with signs of change directed towards a more active and demanding participation in PC services is observed

Context variations and pluti-methodological issues concerning the expression of a social representation: the example of the gypsy community

Within the social representations’ field of research, the «mute zone» hypothesis considers that some objects are characterized by counter normative content that people usually do not express in standard conditions of production. Within the framework of this approach, this study aims to explore the variations in the expression about the Gypsy community following the manipulation of different contexts and the issues associated with a pluri-methodological approach of data analysis. Indeed, two methodologies have been combined. The participants were asked to express themselves in public or in private. In addition, the identity of the experimenter was also manipulated as she presented herself as a Gypsy or not. Then, through a set of analyses based on a methodological triangulation approach, we were able to observe a recurrent modulation of the participants’ answers. These analyses highlighted a greater incidence of the expression of counternormative elements when the context of expression was private and especially when the experimenter did not present herself as a Gypsy (p < .01, ηp² = .06). These results will be discussed in terms of the contribution of the methodologies employed and their comparison within the framework of the study of counternormative content (AU)

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Healthier lives for European minority groups: school and health care, lessons from the Roma.

On average, the Roma in Europe can expect to die 10 years earlier than the rest of the population, given the health conditions they experience. EU-funded research has informed on successful actions (SA) that when implemented among the Roma provide them new forms of educational participation which have a direct impact on improving their health status, regardless of their educational level. The findings from this research, unanimously endorsed by the European Parliament, have been included in several European Union recommendations and resolutions as part of the EU strategy on Roma inclusion. To analyze these SA, as well as the conditions that promote them and their impact on reducing health inequalities, communicative fieldwork has been conducted with Roma people from a deprived neighbourhood in the South of Spain, who are participating in the previously identified SA. The analysis reveals that these SA enable Roma people to reinforce and enrich specific strategies like improving family cohesion and strengthening their identity, which allow them to improve their overall health. These findings may inform public policies to improve the health condition of the Roma and other vulnerable groups, one goal of the Europe 2020 strategy for a healthier Europe.

Policies to improve the health and well-being of Roma people: the European experience.

The Roma constitute the largest ethnic minority in the European Region. The many policy initiatives designed over the past two decades to tackle their adverse social conditions in Central and South Eastern Europe, where the Roma population is concentrated, have had limited success. This paper reviews what is being done to improve the health and social situation of Roma communities in the Region and identifies factors that may limit the effectiveness of these policy initiatives. Strong political commitment, measures to overcome prejudices against Roma, inter-sectoral policy coordination, adequate budgets, evidence-based policies, and Roma involvement can be identified as key preconditions for improved health outcomes and well-being. However, developing a sound evidence-based approach to Roma inclusion requires removing obstacles to the collection of reliable data and improving analytical and evaluation capacity. Health policies seeking to reduce health inequalities for Roma people need to be aligned with education, economic, labour market, housing, environmental and territorial development policies and form part of comprehensive policy frameworks allowing for effective integration.

The forest behind the bar charts: bridging quantitative and qualitative research on Roma/Tigani in contemporary Romania.

Rughinis discusses three controversial issues with regard to surveys of the Romani population: ethnonym use, self-identification versus hetero-attribution of Romani ethnicity, and the use of variables in reference to Romani settlements. She uses data sets from ten surveys of Romanian Roma between 2000 and 2008 as well as the 2002 Romanian Census to compare two types of samples, and to explore the consequences of several research choices for the quality of the data. In addition to specific methodological issues, Rughinis addresses the relevance to such surveys of qualitative research in Romani communities.

Negotiating the "state of exception": Gypsies' encounter with the judiciary in Germany and Italy, 1860-1914.

The tensions between judicial and executive authorities regarding so-called Gypsies in fin de siècle Germany and Italy reveals an inherent contradiction between the universalist dictates of the modern Rechtsstaat and the requirements of building a national state free of perceived outsiders. The frustration of executive authorities with judicial authorities who insisted on protecting the universalist individual enshrined in law pushed executive authorities to utilize the 'state of exception' to achieve their vision of the national community. Rather than choosing to create illiberal laws that would expressly exclude Gypsies from the national body, and would resolve the tension with the judiciary, authorities in Germany and Italy instead chose to go around the law by treating Gypsies as an exception not subject to the law. The state of exception not only deprived those labelled as Gypsies of a method of resistance, since many were able to use unwilling courts to protect them from over-zealous executive authorities, but also created a group of stateless people, persecuted and lacking basic human rights.

The education of Romany health and social assistants in the Czech Republic.

AIM: This paper presents the Czech national pilot project - the first educational course of Romany health and social assistants for community work with the Romany population in excluded communities. BACKGROUND: The Romany people are the biggest minority in the Czech Republic. The number is ever increasing because of the migration from South-East Europe. At the same time, the health and social problems of the Romany population are rising, too. To begin to address some of the health problems of this population, a pilot community project entitled Romany Health and Social Assistant was implemented in the years 2002-2004 in Ostrava. Ostrava is the third largest city and has the largest Romany population. Based on the outcomes of this project and as part of the national project SASTIPEN - Reduction of Health Inequalities in the Romany Community, the systematic education of selected Romany health and social assistants was carried out in 2005-2007. CONCLUSIONS: These trained Romany assistants are now working in the regions of the Czech Republic where inhabitants live in large Romany communities. The project evaluation was based on a questionnaire investigation of 170 clients living in Romany communities and on the statements of Romany health assistants. They found positive outcomes in several areas: obtaining information on health, motivation to healthy lifestyle, concrete changes in lifestyle and boosting trust towards doctors. Following the end of the project and its evaluation, an educational course will be accredited and certified, and the education of Romany assistants will be widespread across the whole country.

The health needs of the Slovak Roma community in Sheffield.

Since Slovakia joined the European Union in 2004, Sheffield has seen a steady increase in the arrival of migrant workers and their families to the city. Most of these families are from a Roma background, marginalised within Eastern Europe and the subjects of recognised health inequalities in their country of origin. As newcomers to the UK, they have had no previous experience of the health visiting service or primary care provision. The impact of their migration on health services has been significant. As a vulnerable group, they consume a disproportionate amount of universal services. An understanding of their background and of their socioeconomic position in the UK is essential in determining their health needs. Attempts to address these effectively require good communication with both the public and voluntary sectors and the involvement of the community itself.

Extermination of the Gypsies in Estonia during World War II- popular images and official policies.

A discussion of Nazi anti-Gypsy policy in Estonia needs to center on local interpretation and implementation of RSHA and RKO orders. Contradictions between various German instructions, which often discriminated among sedentary and itinerating Gypsies, created a state of confusion that increased chances for survival. Since in Estonia Sonderkommando 1a of the German Security Police exercised oversight rather than itself carrying out atrocities, the destruction of the Gypsy community in Estonia proceeded at a pace slower than elsewhere in Eastern Europe. Interested in exploiting slave labor, the German Security Police in Estonia did not consider liquidation of the Gypsies a priority. Acculturated to traditional anti-Gypsy prejudices and burdened by their own wartime travails, the majority of Estonians remained indifferent when Estonian police deported Gypsies.

Gypsies and Jews under the Nazis.

This article compares the fate of the Gypsies under the Third Reich to that of the Jews, arguing that, despite parallels, the treatment each group underwent differed fundamentally. The Nazis never formulated a plan for a "Final Solution" to the Gypsy problem analogous to that for the Jews. Compulsory sterilization affected only a relatively small portion of the Gypsy population, and killings that did take place were carried out to achieve Nazi solutions to specific local situations. Numerous sources, especially recently discovered local police files, show that large numbers of "racially pure" and "socially adjusted" Gypsies were exempted from deportation to the Gypsy family camp in Auschwitz and were allowed to survive the war.