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. 2018 Dec;63(9):1123-1131.
doi: 10.1007/s00038-018-1134-2. Epub 2018 Jun 16.

Why don't segregated Roma do more for their health? An explanatory framework from an ethnographic study in Slovakia

Andrej Belak  1   2   3   4 , Andrea Madarasova Geckova  5   6   7 , Jitse P van Dijk  5   8   7 , Sijmen A Reijneveld  8
Affiliations

Why don't segregated Roma do more for their health? An explanatory framework from an ethnographic study in Slovakia

Andrej Belak et al. Int J Public Health. 2018 Dec.

Abstract

Objectives: The health status of segregated Roma is poor. To understand why segregated Roma engage in health-endangering practices, we explored their nonadherence to clinical and public health recommendations.

Methods: We examined one segregated Roma settlement of 260 inhabitants in Slovakia. To obtain qualitative data on local-level mechanisms supporting Roma nonadherence, we combined ethnography and systematic interviewing over 10 years. We then performed a qualitative content analysis based on sociological and public health theories.

Results: Our explanatory framework summarizes how the nonadherence of local Roma was supported by an interlocked system of seven mechanisms, controlled by and operating through both local Roma and non-Roma. These regard the Roma situation of poverty, segregation and substandard infrastructure; the Roma socialization into their situation; the Roma-perceived value of Roma alternative practices; the exclusionary non-Roma and self-exclusionary Roma ideologies; the discrimination, racism and dysfunctional support towards Roma by non-Roma; and drawbacks in adherence.

Conclusions: Non-Roma ideologies, internalized by Roma into a racialized ethnic identity through socialization, and drawbacks in adherence might present powerful, yet neglected, mechanisms supporting segregated Roma nonadherence.

Keywords: Adherence; Ethnographic study; Health inequality; Roma health; Slovakia.

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Conflict of interest statement

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Figures

Fig. 1
Fig. 1
Local-level mechanisms supporting segregated Roma nonadherence reasoning and practices, Slovakia, 2004–2014
See this image and copyright information in PMC

Comment in

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