Sense of coherence and self-reported health among Roma people in Sweden--a pilot study

Living in Roma Settlements in Greece: Self-Perceived Health Status, Chronic Diseases and Associated Social Determinants of Health

We aimed to assess the self-perceived health status and the presence of chronic diseases of adult Roma living in settlements in Greece, and to explore associated social determinants of health. Data were derived from the Hprolipsis Health Survey. Multivariable regression models were applied. In total, 534 adults, 287 women, and 247 men were recruited from twelve Roma settlements in four prefectures. Although 62% of the participants perceived their health status as good/very good, about half of them had been diagnosed with at least one chronic disease. Several structural and intermediary social determinants of health were found to be significantly associated with the health outcomes; prefecture, settlement type, sex, age group, living with a partner, presence of depression symptoms, food insecurity, and alcohol consumption were associated with self-perceived health status; settlement type, sex, age group, presence of anxiety symptoms, food insecurity and number of persons living in the house with the presence of a chronic disease. This is one of the few studies assessing the self-perceived health status and presence of chronic diseases in Roma settlements in Greece and investigating the associated social determinants of health in the world. Community-based participatory action research and health literacy programs are needed to mitigate health inequalities in Roma settlements.

A Salutogenic Perspective on End-of-Life Care among the Indigenous Sámi of Northern Fennoscandia

There is limited empirical data about both health and end-of-life (EoL) issues among the Indigenous Sámi of Fennoscandia. We therefore aimed to investigate experiences of EoL care and support among the Sámi, both from the Sámi community itself as well as from more formalized health and social care services in Sweden. Our primary data source is from focus group discussions (FGDs) held at a Sámi event in 2017 with 24 people, complemented with analysis of previously collected data from 15 individual interviews with both Sámi and non-Sámi informants familiar with dying, death and bereavement among Sámi; "go-along" discussions with 12 Sámi, and individual interviews with 31 Sámi about advance care planning. After initial framework analysis, we applied a salutogenic model for interpretation, focusing on a sense of community coherence. We found a range of generalized resistance resources in relation to the Sámi community, which appeared to support EoL care situations, i.e., Social Organization; Familiarity with EoL Care, Collective Cultural Heritage; Expressions of Spirituality; Support from Majority Care Systems; and Brokerage. These positive features appear to support key components of a sense of community coherence, i.e., comprehensibility, meaningfulness and manageability. We also found relatively few, but notable deficits that may diminish the sense of community coherence, i.e., lack of communication in one's own language; orientation, familiarity and/or agreement in contacts with formal health and social care systems; and/or support from extended family. The results suggest that there is a robust basis among Sámi for well-functioning EoL care; a challenge is in developing supportive interactions with the majority health and social care systems that support and complement these structures, for partnership in developing care that is meaningful, comprehensible and manageable even in potentially difficult EoL situations.

Design and Development of a Viral Hepatitis and HIV Infection Screening Program (Hprolipsis) for the General, Greek Roma, and Migrant Populations of Greece: Protocol for Three Cross-Sectional Health Examination Surveys

BACKGROUND

Although infectious diseases are globally on the decline, they remain a major global public health problem. Among them, the hepatitis B virus (HBV) or hepatitis C virus (HCV) and HIV infection are of primary interest. Valid prevalence data on these infections are sparse in Greece, especially for vulnerable populations.

OBJECTIVE

This study aimed to present the design and methods of Hprolipsis, an integrated viral hepatitis and HIV screening program administered to adults (≥18 years) from the general, Greek Roma, and migrant populations. Its aims were to estimate the prevalence of HBV, HCV, and HIV; assess infectious disease knowledge level; design, implement, and assess population-specific awareness actions; and offer individual counseling and referral when indicated and HBV vaccination to susceptible Roma and migrants.

METHODS

Multistage, stratified, random sampling based on the 2011 Census was applied to select the general population sample, and nonprobability multistage quota sampling was used for Roma and migrant sample selection. Trained personnel made home (general population) or community (Roma and migrants) visits. Collected blood samples were tested for Hepatitis B surface Antigen, Hepatitis B core Antibody, Hepatitis B surface Antibody, Hepatitis C Antibody, and HIV 1,2 Antibody. The surveys were conducted during May 2013 and June 2016. To estimate an HCV prevalence of 1.5% with 0.3 precision, the required general population sample size was estimated to be 6000. As migrants constitute 10% of the whole Greek population, the migrant sample size was set to 600. A feasible sample size of 500 Greek Roma was set.

RESULTS

In total, 6006 individuals from the general population (response rate 72%), 534 Greek Roma, and 612 migrants were recruited. Blood test results are available for 4245 individuals from the general population, 523 Roma, and 537 migrants.

CONCLUSIONS

Hprolipsis is the first nationwide survey on HBV, HCV, and HIV. Its results will enhance our understanding of the health needs and disease burden of these diseases in the 3 studied populations. Its implementation provided useful recommendations for future studies, particularly in vulnerable populations.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/13578.

Multiple struggles in fighting violence against women: implications among Romani women leaders in Spain

Background: Violence against women (VAW) is a central issue in gender studies and one that has united feminist activists from around the world. But this does not mean that this struggle is singular: indeed, one can say that there are many, diverse and sometimes even contradictory struggles occurring throughout the world.

Objectives: To identify and analyze the different struggles faced by women from Roma organizations in Spain in relation to VAW and their work with affected women.

Methods: Twelve semi-structured interviews were conducted among women actively involved in Roma associations in different Spanish cities, in 2015. An inductive thematic analysis was used to analyze the empirical materials.

Results: Our analysis resulted in three themes that captured different struggles that women from Roma organizations have faced: ‘between persistence and rupture of restrictive gender norms’, ‘invisibility and normalization of violence against women’ and ‘willingness and trust in daily work with women’. The activities related to VAW carried out by the interviewed women were more related to their personal initiatives and abilities than to strategies proposed by the organizations they work for.

Conclusions: The results show the need to support the initiatives of Romani women and their own struggles related to identity. This is what makes them true promoters of social change and, more specifically, change related to gender relations both within and outside of their communities.

Vision and Hearing Health Inequities in the Roma population: A National Cross-Sectional Study in Spain

We analyzed vision and hearing health status in the Spanish Roma population compared with the general population and its influence on mental health and social participation. We conducted a Cross-sectional study on Roma population (n = 1.167) compared to general population in Spain (n = 21.007). We analyzed the use of optical and hearing aids, vision and hearing limitations and associations with mental health, diagnosed depression and social participation; through prevalence, odds ratio adjusted by age (AOR), Chi square independence test and contrast of proportions (p < 0.05). The Roma population are more likely to present vision limitations-far sight AOR = 3.76 (3.13-4.55), near sight AOR = 3.18 (2.33-4.35)-, hearing difficulties-AOR = 1.41 (1.15-1.72)-, and lower use of corrective aids than the general population. These findings were associated with poor mental health and lower social participation (p < 0.01). Vision and hearing limitations affect unequally in Spain. Addressing avoidable vision and hearing impairment among Roma population is needed to reduce health inequities.

The Relation Between Discrimination, Sense of Coherence and Health Varies According to Ethnicity: A Study Among Three Distinct Populations in Israel

Self-reported experiences of discrimination and sense of coherence (SOC) have been found to be associated with health. A face-to-face survey of Long Term Jewish Residents (LTJR), Arabs and former Soviet Union (fSU) immigrants in Israel was performed. Respondents reported their physical and mental health, self-reported experiences of discrimination, SOC and socioeconomic status. Multivariable logistic regressions and bootstrapping path analyses were performed. Discrimination was associated with health after adjusting for all other variables. SOC was also associated with health. SOC did not mediate the strong association between discrimination and health among Israeli LTJR, but was a significant mediator among Arabs and fSU immigrants. Discrimination seems to have a direct effect on health only among the majority and not among minority populations. High levels of SOC may reduce the negative effects of discrimination on health by serving as a coping resource, however only among minorities.

Is the Definition of Roma an Important Matter? The Parallel Application of Self and External Classification of Ethnicity in a Population-Based Health Interview Survey

The Roma population is typified by a poor and, due to difficulties in ethnicity assessment, poorly documented health status. We aimed to compare the usefulness of self-reporting and observer-reporting in Roma classification for surveys investigating differences between Roma and non-Roma populations. Both self-reporting and observer-reporting of Roma ethnicity were applied in a population-based health interview survey. A questionnaire was completed by 1849 people aged 18–64 years; this questionnaire provided information on 52 indicators (morbidity, functionality, lifestyle, social capital, accidents, healthcare use) indicators. Multivariate logistic regression models controlling for age, sex, education and employment were used to produce indicators for differences between the self-reported Roma (N = 124) and non-Roma (N = 1725) populations, as well as between observer-reported Roma (N = 179) and non-Roma populations (N = 1670). Differences between interviewer-reported and self-reported individuals of Roma ethnicity in statistical inferences were observed for only seven indicators. The self-reporting approach was more sensitive for two indicators, and the observer-reported assessment for five indicators. Based on our results, the self-reported identity can be considered as a useful approach, and the application of observer-reporting cannot considerably increase the usefulness of a survey, because the differences between Roma and non-Roma individuals are much bigger than the differences between indicators produced by self-reported or observer-reported data on individuals of Roma ethnicity.

Risk factors for multiple suicide attempts among Roma in Hungary

In recent years, suicide rates in Hungary have been among the highest in the European Union. Attempted suicide rates in the Roma population are 2-3 times higher than in the non-Roma population. Since individuals making multiple attempts have a higher pro-bability of eventual death by suicide, and there are limited data on suicidal behaviour of the Roma population, the aim of this study was to explore the sociodemographic and psychological background factors of multiple suicide attempts in the Hungarian Roma population. Semistructured interviews were conducted with 150 individuals admitted to hospital toxicology departments, who made suicide attempts by deliberate self-poisoning, 65 of whom were multiple attempters. Detailed information regarding the current attempt and previous suicidal acts was recorded. Patients also completed the Shortened Beck Depression, the Beck Hopelessness Questionnaire, and the Social Support Questionnaire. Independent samples t-tests were used to evaluate differences in psychological variables between the Roma ( N = 90) and non-Roma ( N = 60) groups. Stepwise linear regression and odds ratios analyses were performed to identify potential background factors of multiple suicide attempts. There was a significantly higher level of previous suicidal events among the Roma in the sample population (3.53 vs. 0.84, p < .001). Roma ethnicity was found to be a strong predictor of multiple suicide attempts. Current major depression, hopelessness, and diagnosed mood disorder were identified as significant risk factors of repeated attempts. Smoking (OR = 5.4), family history of suicide (OR = 4.9), and long-term unemployment (OR = 4.6) were additional risk factors among Roma patients. A thorough understanding of the ethnicity-specific risk factors for multiple suicide attempts could facilitate the development of effective intervention and postvention programmes.

Health-related quality of life of a very special population: monks of Holy Mountain Athos, Greece

PURPOSE

The investigation of Health-Related Quality of Life (HRQOL) of Orthodox Christian monks who live at the Holy Mount Athos in Greece, and its correlation with demographic characteristics and Sense of Coherence (SOC-13).

METHODS

A cross-sectional study was designed. The seven monasteries and five scetes with the largest number of monk population were invited to participate. Two monasteries and 1 scete gave their permission for the study. The final monks sample was formed by 166 monks from 215 who participated to the study. HRQOL was assessed using the SF-12 and Sense of Coherence the SOC-13 scales that were completed by monks from May to August 2012. Μultiple linear regression analyses were conducted to explore the association of the HRQOL subscales with the demographics and SOC-13.

RESULTS

The mean age was 45.5 ± 13.0 years; 83.7% lived in communal monasteries, and the mean number of years in monasticism was 18.4 ± 12.1. The mean value of their Physical Component Summary (PCS) score was 47.3 ± 5.3, which is lower than in the general Greek men population, while their Mental Component Summary (MCS) score was 56.4 ± 5.8, which is higher than in the general Greek men population. The mean value of SOC-13 was 65.7 ± 6.5. Positive association for PCS appeared for place of living (β = 5.43, SE = 1.27, p < 0.001) and negative association for age (β = -0.16, SE = 0.03, p < 0.001) while for MCS for number of years in monasticism (β = 0.07, SE = 0.06, p = 0.023) and sense of coherence (β = 0.47, SE = 0.06, p < 0.001).

CONCLUSIONS

The results indicated that monks had better mental health but worse physical health compared to the general Greek male population. More studies are required to validate the above findings.

'You likes your way, we got our own way': Gypsies and Travellers' views on infant feeding and health professional support

BACKGROUND

Gypsies and Travellers are known to have poor health status and access to health services, even in comparison with other ethnic minority groups. People from this stigmatized ethnic group are rarely consulted about their health needs or health service provision. Optimal infant feeding in the first year of life has the potential to improve lifelong health.

OBJECTIVE

The aim of this study was to explore mothers and grandmothers' views on feeding in the first year of life, including the support provided by health professionals.

METHODS

Semi-structured interviews were conducted with a purposively selected sample of 22 mothers and grandmothers of English Gypsy, Irish Traveller and Romanian Roma ethnicity between November 2011 and February 2012 in a city in south-west England.

RESULTS

Few women perceived themselves as requiring help from health professionals in infant feeding, as acceptable and accessible support was available from within their own communities. Roma mothers described a tradition of breast-feeding and appropriately timed weaning, while English Gypsies and Irish Travellers customarily practised less healthy infant feeding. When mothers requested support, health service provision was often found inadequate.

CONCLUSION

Exploring the views of Gypsies and Travellers is important to gain insight into the provision of health services for this marginalized ethnic group. This study has implications for policy and the practice of health professionals, in indicating the customary feeding behaviours of some Gypsy and Travellers, and highlighting areas meriting culturally sensitive health promotion.

Quality of Life and Patient Satisfaction with Family Practice Care in a Roma Population with Chronic Conditions in Northeast Slovenia

OBJECTIVES

Health-related quality of life (HRQoL) measures a patient's subjective experience of his or her health status. We aimed to show how the presence of chronic diseases and satisfaction with family physicians (FPs) were associated with the HRQoL of a Roma population.

METHODS

A cross-sectional study was carried out in May 2011 on a representative sample of 650 Roma living in Prekmurje, Slovenia. The EQ-5D questionnaire was used for measuring the HRQoL of the Roma. Demographical data, 12 groups of diseases diagnosed in the last 12 months and satisfaction with FPs were included in the questionnaire.

RESULTS

The response rate was 88.3% 574), of which 56.4% were female, and the average age of the participants had a mean value of 40.2±12.7 years. The presence of cardiovascular problems with risk factors for them or presence of musculoskeletal disorders were strongly associated with the presence of pain (Cramer's V = 0.40 and 0.46 respectively). There was a strong association between the presence of mental disorders and anxiety and depression (Cramer's V = 0.58). The average satisfaction with the family physician was 3.9 (mean±1.10) on a five-point Likert scale. There was no significant association between HRQoL and satisfaction with the family physician.

CONCLUSIONS

Roma with chronic mental health problems had the lowest HRQoL in the Roma population. More attention should be paid to this subgroup of Roma in family medicine, and interventions should be provided. High satisfaction with their FPs is not associated with the observed quality of life variables.

Sense of coherence and depressive symptoms among low-income Bedouin women in the Negev Israel

BACKGROUND

Higher sense of coherence (SOC) has been associated with lower depression in Western societies; however, it is not clear whether this association manifests similarly in non-Western cultural contexts.

AIMS

To examine the associations between different levels of SOC and depressive symptoms (DS) among indigenous-minority Arab Bedouin women in Israel and explore possible explanatory variables for this association.

METHODS

We conducted face-to-face interviews with 464 women (aged 18-49 years). DS was measured based on the Center for Epidemiologic Studies Depression Scale. We used the SOC-13 questionnaire and conducted path analysis using Structural Equation Modeling to examine the contribution of two levels of SOC (low/high) to predict DS beyond psychological resources and socioeconomic position.

RESULTS

The mean score of SOC was 3.42, standard deviation (SD) = 1.15. While high SOC (mean = 4.38, SD = 0.66, range = 3.5-6.38) was positively and significantly associated with DS (r = 0.46), SOC was not associated (r = 0.02) with DS in the low SOC group (mean = 2.4, SD = 0.56, range = 1-3.42).

CONCLUSIONS

Relationships between high versus low SOC and DS among Bedouin women differ from those found in Western societies. This raises questions about the use of SOC as a universal tool in different cultural contexts.

Revisiting the evidence on health and health care disparities among the Roma: a systematic review 2003-2012

OBJECTIVES

To conduct a systematic review of the epidemiological and health service utilization literature related to the Roma population between 2003 and 2012.

METHODS

Systematic review of empirical research related to Roma health and health care utilization published between 2003 and 2012 identified through electronic databases (PsycInfo, Medline, Google Scholar). Methodological rigor was evaluated using a six-point set of design criteria.

RESULTS

We found evidence for lower self-reported health and significantly higher mortality risk for Roma compared to non-Roma, and greater prevalence of health risk factors for Roma children, including environmental risks, low birth weight, and lower vaccination coverage. Studies of non-communicable and infectious disease remain insufficient to make firm conclusions on disparities. Barriers to care include lack of documentation and affordability of care, though more studies on health care utilization are needed.

CONCLUSIONS

Roma youth and adults are in need of programs that reduce health disparities and their increased mortality risk. Reducing exposure to risk factors such as smoking, obesity, and poor living conditions may be a target for interventions. More intervention studies and rigorous evaluations are needed.

Sense of coherence and self-reported health among Roma people in Sweden--a pilot study

Objectives

The Roma people have been known in Europe for a 1000 years, during which they have usually been the subject of discrimination and oppression leading to isolation, powerlessness and poor health. The objective of this study is to investigate the sense of coherence (SOC) in relation to self-reported health among a group of Roma people in southwest Sweden.

Study design

A cross-sectional, quantitative pilot study.

Methods

A questionnaire was constructed based on the Short-Form Health Survey (SF-12) and Antonovsky's Sense of Coherence Scale (SOC-13) and was distributed among Roma people in southwest Sweden (n = 102). Self-reported health was summarised in a physical score (PCS) and a mental score (MCS). Comparisons were made with a general Swedish majority population and a Sami population.

Results

The health scores were significantly lower among the Roma people compared to Swedes – PCS: Roma 46.0 (Swedes 52.0) and MCS: Roma 47.5 (Swedes 52.6). The SOC score for the Roma people (54.4) was significantly lower than that of the Swedes (65.2) and Sami (65.0).

Conclusions

The low SOC with the Swedish majority society is a strong indication of the marginalisation and exclusion of the Roma people from mainstream society. Low scores in self-reported health among the Roma people also establishes the serious health risks the Roma people are experiencing through their present life situation.