Project

Enhancing Gypsy/Travellers’ trust: using maternity and early years’ health services and dental health services as exemplars of mainstream service provision.

Goal: The main aim of the study is to explore which approaches to community engagement enhance Gypsy/Travellers’ trust in and use of health services, with a particular focus on maternity and early years health services (MEYHS) and child dental health services (CDHS). This is a four-stage, multi-method study comprising: reviews of the literature; a national online consultation to gather the views of a wide range of people involved in all aspects of healthcare, engagement and trust in relation to Gypsy, Traveller and Roma communities; four in-depth case studies in England and Scotland involving interviews and focus groups with Gypsy, Traveller and Roma mothers and health professionals; and cross-sectoral workshops to present policy options/recommendations derived from the study.

Methods: Case studies, Online consultation, Systematic reviews

Date: 1 June 2015 - 30 November 2017

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Project log

Alison Mcfadden
added a research item
Background: Gypsy, Roma and Traveller people represent the most disadvantaged minority groups in Europe, having the poorest health outcomes. This systematic review addressed the question of how Gypsy, Roma and Traveller people access healthcare and what are the best ways to enhance their engagement with health services. Methods: Searches were conducted in 21 electronic databases complemented by a focussed Google search. Studies were included if they had sufficient focus on Gypsy, Roma or Traveller populations; reported data pertinent to healthcare service use or engagement and were published in English from 2000 to 2015. Study findings were analyzed thematically and a narrative synthesis reported. Results: Ninety-nine studies from 32 countries were included, covering a range of health services. Nearly one-half of the presented findings related to primary healthcare services. Reported barriers to health service usage related to organisation of health systems, discrimination, culture and language, health literacy, service-user attributes and economic barriers. Promising engagement strategies included specialist roles, outreach services, dedicated services, raising health awareness, handheld records, training for staff and collaborative working. Conclusion: This review provides evidence that Gypsy, Roma and Traveller populations across Europe struggle to exercise their right to healthcare on account of multiple barriers; and related to other determinants of disadvantage such as low literacy levels and experiences of discrimination. Some promising strategies to overcome barriers were reported but the evidence is weak; therefore, rigorous evaluations of interventions to improve access to and engagement with health services for Gypsy, Roma and Traveller people are needed.
Alison Mcfadden
added an update
Poster presented at Lancet Public Health Science Conference, London, November 2017
 
Alison Mcfadden
added an update
There are a few places remaining at our two key national workshops that will help shape the recommendations of our research. At each workshop, the study findings will be presented and policy options and recommendations co-produced. If your work is related to health and social care in the UK and you have an interest in Gypsy, Roma and Traveller peoples' access and engagement with health services, please contact a.m.mcfadden@dundee.ac.uk for further information about the workshops.
The workshops will be held as follows:
Edinburgh, 14th September 2017, 10am - 3.30pm
Leeds 21st September, 10am - 3.30pm
 
Alison Mcfadden
added an update
All 4 case studies are underway.
Case study 1: English Gypsies and Irish Travellers in Leeds with Leeds Gypsy and Traveller Exchange (Leeds GATE)
Case study 2: Scottish Gypsy/Travellers in Fife with NHS Fife
Case study 3: Slovakian Roma in Sheffield with Darnall Wellbeing Project
Case study 4: English Gypsies and Irish Travellers in London with Southwark Traveller Action Group (STAG) and London Gypsy Traveller Unit (LGTU).
 
Alison Mcfadden
added a research item
Background Gypsy/Travellers have poor health and experience discrimination alongside structural and cultural barriers when accessing health services and consequently may mistrust those services. Our study aims to investigate which approaches to community engagement are most likely to be effective at enhancing trust between Gypsy/Travellers and mainstream health services. Methods This multi-method 30-month study, commenced in June 2015, and comprises four stages.1.Three related reviews: a) systematic review of Gypsy/Travellers’ access to health services; b) systematic review of reviews of how trust has been conceptualised within healthcare; c) realist synthesis of community engagement approaches to enhance trust and increase Gypsy/Travellers’ participation in health services. The reviews will consider any economic literature; 2.Online consultation with health and social care practitioners, and civil society organisations on existing engagement activities, including perceptions of barriers and good practice; 3.Four in-depth case studies of different Gypsy/Traveller communities, focusing on maternity, early years and child dental health services. The case studies include the views of 32–48 mothers of pre-school children, 32–40 healthcare providers and 8–12 informants from third sector organisations. 4.Two stakeholder workshops exploring whether policy options are realistic, sustainable and replicable. Case study data will be analysed thematically informed by the evaluative framework derived from the realist synthesis in stage one.The main outputs will be: a) an evaluative framework of Gypsy/Travellers’ engagement with health services; b) recommendations for policy and practice; c) evidence on which to base future implementation strategies including estimation of costs. DiscussionOur novel multi-method study seeks to provide recommendations for policy and practice that have potential to improve uptake and delivery of health services, and to reduce lifetime health inequalities for Gypsy/Travellers. The findings may have wider resonance for other marginalised populations. Strengths and limitations of the study are discussed. Trial registrationProspero registration for literature reviews: CRD42015021955 and CRD42015021950UKCRN reference: 20036
Alison Mcfadden
added a project goal
The main aim of the study is to explore which approaches to community engagement enhance Gypsy/Travellers’ trust in and use of health services, with a particular focus on maternity and early years health services (MEYHS) and child dental health services (CDHS). This is a four-stage, multi-method study comprising: reviews of the literature; a national online consultation to gather the views of a wide range of people involved in all aspects of healthcare, engagement and trust in relation to Gypsy, Traveller and Roma communities; four in-depth case studies in England and Scotland involving interviews and focus groups with Gypsy, Traveller and Roma mothers and health professionals; and cross-sectoral workshops to present policy options/recommendations derived from the study.