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Filakovska Bobakova D, Chovan S, Van Laer S. Perceived Stress of Mothers, Harsh Discipline, and Early Childhood Mental Health: Insights from a Cross-Sectional Study in Marginalized Roma Communities. Int J Public Health 2024; 69:1606721. [PMID: 38464908 PMCID: PMC10920110 DOI: 10.3389/ijph.2024.1606721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/06/2024] [Indexed: 03/12/2024] Open
Abstract
Objectives: This study aims to compare the early childhood mental health of children from marginalized Roma communities (MRCs) in Slovakia with that of the majority and explore possible mediating pathways of mothers' perceived stress and harsh discipline practices. Methods: We used data from the first wave of the longitudinal RomaREACH study collected in 2021-2022. Two populations were included in the sample: 94 mother-child dyads from MRCs and 79 from the majority population (children aged 14-18 months). Data were analysed using linear regression, and mediation was tested using PROCESS Macro in SPSS. Results: Belonging to MRCs vs. the majority, perceived stress of mothers and harsh discipline were found to be associated with early mental health problems in children. Perceived stress of mothers partially mediates the relationship between belonging to MRCs vs. majority and harsh discipline and harsh discipline partially mediates the relationship between perceived stress of mothers and the mental health of children. Conclusion: Mothers from MRCs perceive more stress, which is associated with more frequent use of harsh discipline practices having a negative impact on the mental health of young children.
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Affiliation(s)
- Daniela Filakovska Bobakova
- Department of Health Psychology and Research Methodology, Faculty of Medicine, PJ Safarik University, Kosice, Slovakia
- Olomouc University Social Health Institute, Palacky University in Olomouc, Olomouc, Czechia
| | - Shoshana Chovan
- Department of Health Psychology and Research Methodology, Faculty of Medicine, PJ Safarik University, Kosice, Slovakia
- Graduate School Kosice Institute for Society and Health, PJ Safarik University, Kosice, Slovakia
| | - Stanislava Van Laer
- Department of Health Psychology and Research Methodology, Faculty of Medicine, PJ Safarik University, Kosice, Slovakia
- Graduate School Kosice Institute for Society and Health, PJ Safarik University, Kosice, Slovakia
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Filakovska Bobakova D, Chovan S, Bosakova L, Koky R, de Kroon MLA, Dankulincova Veselska Z. Desirable but not feasible: Measures and interventions to promote early childhood health and development in marginalized Roma communities in Slovakia. Front Public Health 2022; 10:942550. [PMID: 36276342 PMCID: PMC9580395 DOI: 10.3389/fpubh.2022.942550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 09/07/2022] [Indexed: 01/21/2023] Open
Abstract
Roma are the largest and most disadvantaged ethnic minority in Europe often facing generational poverty, and limited access to education, employment, housing, and various types of services. Despite many international and national initiatives, children from marginalized Roma communities face multiple risks and are being disadvantaged as early as from conception onward. We, therefore, aimed to identify measures and/or interventions targeting equity in early childhood health and development in marginalized Roma communities which implementation is considered to be urgent but not feasible. We used a group concept mapping approach-a participatory mixed research method-and involved 40 experts and professionals from research, policy and practice. From 90 measures and interventions proposed to achieve early childhood equity for children from marginalized Roma communities, 23 measures were identified as urgent but not feasible. These concerned particularly measures and interventions targeting living conditions (including access to income, access to housing, and basic infrastructure for families) and public resources for instrumental support (covering mainly topics related to financial and institutional frameworks). Our results reflect the most pressing issues in the area of equality, inclusion and participation of Roma and expose barriers to implementation which are likely to arise from public and political discourses perpetrating a negative image of Roma, constructing them as less deserving. Measures to overcome persistent prejudices against Roma need to be implemented along with the measures targeting equity in early childhood health and development.
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Affiliation(s)
- Daniela Filakovska Bobakova
- Department of Health Psychology and Research Methodology, Faculty of Medicine, PJ Safarik University, Kosice, Slovakia,Olomouc University Social Health Institute, Palacky University in Olomouc, Olomouc, Czechia,*Correspondence: Daniela Filakovska Bobakova
| | - Shoshana Chovan
- Department of Health Psychology and Research Methodology, Faculty of Medicine, PJ Safarik University, Kosice, Slovakia
| | - Lucia Bosakova
- Department of Health Psychology and Research Methodology, Faculty of Medicine, PJ Safarik University, Kosice, Slovakia,Olomouc University Social Health Institute, Palacky University in Olomouc, Olomouc, Czechia
| | - Richard Koky
- Department of Health Psychology and Research Methodology, Faculty of Medicine, PJ Safarik University, Kosice, Slovakia
| | - Marlou L. A. de Kroon
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands,Department of Public Health and Primary Care, Centre for Environment and Health, Catholic University Leuven, Leuven, Belgium
| | - Zuzana Dankulincova Veselska
- Department of Health Psychology and Research Methodology, Faculty of Medicine, PJ Safarik University, Kosice, Slovakia
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Anastasaki M, van Bree EM, Brakema EA, Tsiligianni I, Sifaki-Pistolla D, Chatzea VE, Crone MC, Karelis A, van der Kleij RMJJ, Poot CC, Reis R, Chavannes NH, Lionis C. Beliefs, Perceptions, and Behaviors Regarding Chronic Respiratory Diseases of Roma in Crete, Greece: A Qualitative FRESH AIR Study. Front Public Health 2022; 10:812700. [PMID: 35493388 PMCID: PMC9051233 DOI: 10.3389/fpubh.2022.812700] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/14/2022] [Indexed: 11/30/2022] Open
Abstract
Background The global burden of chronic respiratory diseases (CRDs) disproportionally affects Roma populations. Health interventions addressing CRD among Roma or other vulnerable groups often fail to be effective, as their implementation strategy misaligns with the local context. To design context-driven strategies, we studied CRD-related beliefs, perceptions, and behaviors among a Greek Roma population, focussing on asthma and COPD. Methods For this qualitative study in Crete, Greece, we used a Rapid Assessment Process. We conducted interviews and focus groups with purposively selected Roma community members (CMs), key informants (KIs) and healthcare professionals (HPs) serving the population. Data were triangulated using observations of households and clinical consultations. Key themes were identified using Thematic Content Analysis. The Health Belief Model, the Explanatory Model of Illness, and the Theory of Planned Behavior that are complementary is some aspects, guided our methodology with the several variables from them to be integrated to better understand CRD risk preventative behavior. Results We conducted six focus groups, seven interviews and 13 observations among 15 CMs, four KIs, and three HPs. Five themes emerged: (1) Poor CRD-awareness (smoking and household air pollution were perceived as harmful, but almost exclusively associated with acute rather than chronic symptoms); (2) Low perceived susceptibility to CRD (and CMs tended to ignore respiratory symptoms); (3) High risk exposure (smoking was common, and air pollution was perceived inevitable due to financial constraints); (4) Healthcare seeking (healthcare was sought only for persistent, severe symptoms, daily needs were a priority); (5) Perceived barriers/facilitators to care (health illiteracy, perceived discrimination and financial constraints were main barriers; established trust the main facilitator). Conclusion These five themes highlight that strategies to tackle CRD in the studied Roma setting require a multilevel approach: bridging awareness gaps at the population level, providing resources to enhance the adoption of healthy behaviors, and fighting discrimination at the societal level, whilst establishing trusted relationships at the local level. Similar methodologies to address local context may strengthen the implementation of effective interventions for similarly vulnerable and/or low-resource populations.
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Affiliation(s)
- Marilena Anastasaki
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
- *Correspondence: Marilena Anastasaki
| | - Egid M. van Bree
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Evelyn A. Brakema
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Ioanna Tsiligianni
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Dimitra Sifaki-Pistolla
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Vasiliki E. Chatzea
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Matty C. Crone
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Andreas Karelis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | | | - Charlotte C. Poot
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Ria Reis
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Niels H. Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Christos Lionis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
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Svobodova I, Filakovska Bobakova D, Bosakova L, Dankulincova Veselska Z. How to improve access to health care for Roma living in social exclusion: a concept mapping study. Int J Equity Health 2021; 20:61. [PMID: 33579295 PMCID: PMC7881662 DOI: 10.1186/s12939-021-01396-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 01/28/2021] [Indexed: 11/10/2022] Open
Abstract
Background Half of the people living in social exclusion in the Czech Republic are of Roma origin. The worse health of Roma could be partly explained by numerous barriers to accessing health care. Therefore, our study aimed to explore the perceptions of various stakeholders and experts who may have an impact on the inclusion of Roma and/or their access to health care on how to improve health care access for Roma living in social exclusion in the Czech Republic. Methods We conducted a concept mapping study and obtained data from 32 participants from health and social services, policymakers and others who were involved in different study phases (brainstorming, sorting, rating, interpretation). Results Out of 64 proposed measures sorted into six distinct clusters, 20 were rated as the most urgent and the most feasible and should be implemented with a priority to improve access to health care for Roma living in social exclusion. The proposed measures covered various topics, such as education and awareness of the target group as well as education and supervision of helping professionals, strengthening capacities and streamlining the health care system, health promotion and associated services and increasing the local and financial accessibility of health care. Overall, measures concerning the education and supervision of helping professionals were rated as both the most urgent and the most feasible. Individual priority measures targeted, for example, the health needs assessment of Roma living in social exclusion to set up interventions or to include topics such as participation, empowerment, cultural competence and communication training in the curricula of health care and helping professionals in postgraduate and continuing studies. Conclusions Stakeholders proposed a set of relevant and acceptable measures that may help improve access to health care for Roma living in social exclusion. The way they rated the proposed measures reflects both the current unfavourable mainstream and public discourse concerning Roma living in social exclusion and the most acute policy issues identified by several European and national bodies. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-021-01396-4.
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Affiliation(s)
- Ivana Svobodova
- Palacky University in Olomouc, Olomouc University Social Health Institute, Olomouc, Czech Republic.
| | - Daniela Filakovska Bobakova
- Palacky University in Olomouc, Olomouc University Social Health Institute, Olomouc, Czech Republic.,Department of Health Psychology and Research Methodology, University of Pavol Jozef Safarik in Kosice, Faculty of Medicine, Kosice, Slovak Republic
| | - Lucia Bosakova
- Palacky University in Olomouc, Olomouc University Social Health Institute, Olomouc, Czech Republic.,Department of Health Psychology and Research Methodology, University of Pavol Jozef Safarik in Kosice, Faculty of Medicine, Kosice, Slovak Republic
| | - Zuzana Dankulincova Veselska
- Department of Health Psychology and Research Methodology, University of Pavol Jozef Safarik in Kosice, Faculty of Medicine, Kosice, Slovak Republic
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Pavlikova B, Freel L, van Dijk JP. To Comply or Not to Comply: Roma Approach to Health Laws. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3087. [PMID: 32365484 PMCID: PMC7246461 DOI: 10.3390/ijerph17093087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 04/20/2020] [Accepted: 04/26/2020] [Indexed: 11/18/2022]
Abstract
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.
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Affiliation(s)
- Barbara Pavlikova
- Research Agency, 831 02 Bratislava, Slovakia
- Department of Labor Law and Social Welfare Law, Faculty of Law, Comenius University, 810 00 Bratislava, Slovakia
| | - Lenka Freel
- Department of Labor Law and Social Welfare Law, Faculty of Law, Comenius University, 810 00 Bratislava, Slovakia
| | - Jitse P. van Dijk
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, 9713 AV Groningen, The Netherlands
- Graduate School Kosice Institute for Society and Health, Faculty of Medicine, P.J. Safarik University in Kosice, 040 01 Kosice, Slovakia
- Theological Faculty, Olomouc University Social Health Institute, Palacky University, 771 11 Olomouc, Czech Republic
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Vincze F, Földvári A, Pálinkás A, Sipos V, Janka EA, Ádány R, Sándor J. Prevalence of Chronic Diseases and Activity-Limiting Disability among Roma and Non-Roma People: A Cross-Sectional, Census-Based Investigation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193620. [PMID: 31561641 PMCID: PMC6801756 DOI: 10.3390/ijerph16193620] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 09/24/2019] [Accepted: 09/25/2019] [Indexed: 12/27/2022]
Abstract
The lack of recommended design for Roma health-monitoring hinders the interventions to improve the health status of this ethnic minority. We aim to describe the riskiness of Roma ethnicity using census-derived data and to demonstrate the value of census for monitoring the Roma to non-Roma gap. This study investigated the self-declared occurrence of at least one chronic disease and the existence of activity limitations among subjects with chronic disease by the database of the 2011 Hungarian Census. Risks were assessed by odds ratios (OR) and 95% confidence intervals (95% CI) from logistic regression analyses controlled for sociodemographic factors. Roma ethnicity is a risk factor for chronic diseases (OR = 1.17; 95% CI: 1.16–1.18) and for activity limitation in everyday life activities (OR = 1.20; 95% CI: 1.17–1.23), learning-working (OR = 1.24; 95% CI: 1.21–1.27), family life (OR = 1.22; 95% CI: 1.16–1.28), and transport (OR = 1.03; 95% CI: 1.01–1.06). The population-level impact of Roma ethnicity was 0.39% (95% CI: 0.37–0.41) for chronic diseases and varied between 0 and 1.19% for activity limitations. Our investigations demonstrated that (1) the Roma ethnicity is a distinct risk factor with significant population level impact for chronic disease occurrence accompanied with prognosis worsening influence, and that (2) the census can improve the Roma health-monitoring system, primarily by assessing the population level impact.
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Affiliation(s)
- Ferenc Vincze
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, H-4028 Debrecen, Kassai St 26/B, Hungary.
- Doctoral School of Health Sciences, University of Debrecen, H-4028 Debrecen, Kassai St 26/B, Hungary.
| | - Anett Földvári
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, H-4028 Debrecen, Kassai St 26/B, Hungary.
- Doctoral School of Health Sciences, University of Debrecen, H-4028 Debrecen, Kassai St 26/B, Hungary.
| | - Anita Pálinkás
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, H-4028 Debrecen, Kassai St 26/B, Hungary.
- Doctoral School of Health Sciences, University of Debrecen, H-4028 Debrecen, Kassai St 26/B, Hungary.
| | - Valéria Sipos
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, H-4028 Debrecen, Kassai St 26/B, Hungary.
- Doctoral School of Health Sciences, University of Debrecen, H-4028 Debrecen, Kassai St 26/B, Hungary.
| | - Eszter Anna Janka
- Department of Dermatology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary.
| | - Róza Ádány
- WHO Collaborating Centre on Vulnerability and Health, Public Health Research Institute, University of Debrecen, H-4028 Debrecen, Kassai St 26/B, Hungary.
- Public Health Research Institute, University of Debrecen, H-4028 Debrecen, Kassai St 26/B, Hungary.
- MTA-DE-Public Health Research Group, Public Health Research Institute, University of Debrecen, H-4028 Debrecen, Kassai St 26/B, Hungary.
| | - János Sándor
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, H-4028 Debrecen, Kassai St 26/B, Hungary.
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Bosakova L, Madarasova Geckova A, van Dijk JP, Reijneveld SA. Increased Employment for Segregated Roma May Improve Their Health: Outcomes of a Public-Private Partnership Project. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16162889. [PMID: 31412549 PMCID: PMC6719200 DOI: 10.3390/ijerph16162889] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/04/2019] [Accepted: 08/07/2019] [Indexed: 12/02/2022]
Abstract
Increasing employment opportunities for segregated Roma might prevent major economic losses and improve their health. Involvement of the private sector in Roma employment, on top of intensified governmental actions, is likely to be a key to sustainable improvement, but evidence on this is scarce. Our aim was to determine the potential outcomes of such a partnership regarding increased employability and the resulting improved well-being and health. We therefore investigated a Roma employment project called Equality of Opportunity, run since 2002 by a private company, U.S. Steel Kosice, in eastern Slovakia. We conducted a multi-perspective qualitative study to obtain the perspectives of key stakeholders on the outcomes of this project. We found that they expected the employability of segregated Roma to increase in particular via improvements in their work ethic and working habits, education, skills acquisition, self-confidence, courage and social inclusion. They further expected as the main health effects of increased employability an improvement in Roma well-being and health via a stable income, better housing, crime reduction, improved hygienic standards, access to prevention and improved mental resilience. Social policies regarding segregated Roma could thus be best directed at increasing employment and at these topics in particular to increase their effects on Roma health.
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Affiliation(s)
- Lucia Bosakova
- Department of Health Psychology, Medical Faculty, P.J. Safarik University in Kosice, Trieda SNP 1, 040 11 Kosice, Slovakia.
- Graduate School Kosice Institute for Society and Health, P.J. Safarik University in Kosice, Trieda SNP 1, 040 11 Kosice, Slovakia.
- Olomouc University Society and Health Institute, Palacky University in Olomouc, Univerzitni 22, 771 11 Olomouc, Czech Republic.
| | - Andrea Madarasova Geckova
- Department of Health Psychology, Medical Faculty, P.J. Safarik University in Kosice, Trieda SNP 1, 040 11 Kosice, Slovakia
- Graduate School Kosice Institute for Society and Health, P.J. Safarik University in Kosice, Trieda SNP 1, 040 11 Kosice, Slovakia
- Olomouc University Society and Health Institute, Palacky University in Olomouc, Univerzitni 22, 771 11 Olomouc, Czech Republic
| | - Jitse P van Dijk
- Graduate School Kosice Institute for Society and Health, P.J. Safarik University in Kosice, Trieda SNP 1, 040 11 Kosice, Slovakia
- Olomouc University Society and Health Institute, Palacky University in Olomouc, Univerzitni 22, 771 11 Olomouc, Czech Republic
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
| | - Sijmen A Reijneveld
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
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