Many things depend on the power of conversation – including vaccine equity. A reliable way to foster unity and close the inequality gap is to form strong relationships with underserved populations.
In Slovakia, the Roma community continues to face high levels of social exclusion, discrimination, and inequalities – all of which lead to a severe distrust with those from outside. Such barriers present a significant challenge when reaching the Roma people, particularly when raising awareness around healthcare initiatives such as increasing the uptake of the HPV vaccine.
But how can effective communication strategies bridge the gap?
Breaking down barriers
It is thought that the Roma community is the largest minority ethnic group in the European region (WHO, 2017). This community is complex, comprising of many different populations. As health practitioners, it is essential that we keep communication at the heart of our work, by listening and understanding the needs of this group through cultural appreciation and anti-bias approaches. By doing so we can work with underserved groups to break down the health system barriers and protect the healthcare rights of these communities.
One of the key messages of the World Health Organization’s European Immunization Week 2023 is vaccination communication. By encouraging open conversations around vaccination between parents, guardians, and health professionals, not only does it help to build trust but can also motivate individuals to follow vaccine recommendations and schedules.
As a project that aims to remove health system barriers to vaccination services – to improve the overall coverage of MMR and HPV vaccines in Europe – the RIVER-EU project has undertaken communication workshops in all target countries to better evaluate and understand local context and current project situations in each area; most recently in Slovakia working with the Roma people.
How can we effectively find answers to questions about immunisation that really impacts this community. Questions such as what other approaches could be taken regarding HPV vaccination? How can we work with target groups to support this change? How can we implement these changes?
In Slovakia, the communications team worked with UPJŠ to identify the goals, key messages, and communication channels needed to effectively communicate with the Roma people and other stakeholders.
Collaboration is key. Collaborating with the community and other organisations such as Healthy Regions (Organizácia Zdravé regióny) – a contributory organization of the Ministry of health who specialises in providing equal access to public health for the Roma community – can help with research efforts and community mobilisation.
Healthy Regions is already carrying out campaigns to raise awareness on the importance of vaccination as part of primary prevention to protect against cervical cancer. However, working with the Roma community is just one part of the chain of change.
Healthcare professionals have a strong influence when it comes to the dissemination of healthcare advice, particularly around the vaccination process.
It is vital that patients feel secure and confident when seeking healthcare. However, distrust between the healthcare system and patients continues to be a significant problem and this is especially true amongst the underserved Roma communities.
“The most important things for me are trust and a feeling of security having the healthcare provider explain to me what is going to happen and knowing that you are safe.”
A Roma girl testimony, Slovakia
Attitudes and behaviours including prejudices, inappropriate behaviour and racism have a profound impact on breaking down barriers in health systems, leading to distrust and neglect of care.
Building such trust requires empathy, active listening, and patience. Unfortunately, due to increasing pressures faced by health professionals across Europe, it can be difficult for doctors to establish a genuine relationship with their patients. This becomes even more challenging when there are cultural and linguistic differences. Regrettably, failing to be sensitive towards a patient’s needs or providing insufficient information can have a significant impact on people’s lives.
Health professionals need to be educated on the importance of culturally sensitive community care to increase vaccination uptake within the Roma community. Having an in-depth understanding of the societies and communities in which we operate enables us to build strong relationships with underserved communities to meet their values, needs and desires and protect their healthcare requirements. A lack of empathy skills can lead to a complete rejection of the healthcare system.
Increasing HPV vaccination in the Roma communities
Access to adequate healthcare is a universal right that all individuals deserve. However, due to long-standing structural problems, not all people can receive the care they are entitled to.
Considering this, the UPJŠ team has identified key community leaders and organisations that can help mobilise the Roma community and ensure a successful implementation of interventions. By working closely with the community, training healthcare professionals, and addressing concerns about vaccination with effective messages that can lead to actions, it is possible to increase the uptake of the HPV vaccine among marginalised Roma communities in Slovakia.
Working with the community enables us to gain an insight into each perspective, value, and motivation, leading to the creation of effective and tailored messaging – this is particularly important when communicating with parents, adolescents, health providers or health mediators.
What drives and motivates communities, particularly underserved communities, such as the Roma people, ensures that we, as health practitioners can understand and attune content that resonates with specific values and help promote better health outcomes.
Though, it may be difficult to see all the benefits and impacts of building herd immunity in the population at first glance, what is known is that having healthy communities can lead to a better quality of life for everyone and help build a more resilient and prosperous society.
Research conducted by the RIVER-EU communications outreach team, illustrated that many of the health system barriers are due to a lack of effective communication and consequently dissemination of health-related information is difficult to achieve. To meaningfully engage with underserved communities across Europe, healthcare professionals must be careful to not further marginalise access to healthcare, but instead consider the needs of the Roma people and other underserved communities by working with them in collaboration with key stakeholders, such as the Pavol Jozef Safarik University (UPJŠ), to raise awareness around vaccination.
Field visit participants:
- Ekaterina Gómez
- Eleonora Mesiano
- MSc. Daniela Fiľakovská Bobáková
- MSc. Lucia Bosakova
- MSc. Jana Plavnická
- MSc. Zuzana Dankulincova
- Dr. Ingrid Urbancikova
- Bc. Emilia Gajdosova