MSc. Daniela Fiľakovská
Department of Health Psychology and Research Methodology, Faculty of Medicine, PJ Safarik University, Kosice, Slovak Republic
Within the RIVER-EU project, a series of qualitative studies were conducted to explore health system barriers to vaccination in selected underserved communities. In Slovakia, the study described barriers to human papillomavirus (HPV) vaccination among girls from marginalized Roma communities from the perspective of Roma girls, their parents, and professionals involved in HPV vaccination who serve this population.
Even though the research focused on the health system barriers, other barriers experienced by the marginalized Roma could not be ignored. Roma living in marginalized communities often experience discrimination, generational poverty, and limited access to education, employment, housing, and public services, including healthcare. Healthcare professionals often mentioned extremely low educational levels, resulting in low health literacy that impedes people to understand health-related information, including the meaning of prevention. During the interviews with researchers, one of the most discussed topics among the respondents was the lack of financial resources to cover out-of-pocket payments for healthcare, including travel costs to reach health services. The research also found that sex-related topics are still a taboo in the marginalised Roma communities and talking about it is associated with feelings of shame and embarrassment.
The health system barriers identified in Slovakia show that the health care system is not able to provide high-quality services to people with different needs. The Roma living in marginalized communities do not receive culturally and linguistically appropriate information which contributes to extremely low awareness of HPV, cancer and possible prevention strategies. Moreover, Slovakia faces a significant shortage of healthcare personnel. Many primary care providers are of retirement age, leading to the work overload and lack of capacity and motivation to address HPV vaccination.
Another substantial health system barrier to vaccination is limited coverage of vaccination expenses from health insurance. Currently, the HPV vaccination is fully covered only for 12 years-old boys and girls and most Roma living in social exclusion cannot afford paying for the expensive vaccine if they miss the one-year vaccination window. Furthermore, the process between the decision to vaccinate a child and the actual vaccination is complicated for people with lower literacy, given the number of steps that separate them. First, the general practitioner prescribes the vaccine, then pharmacy often needs to order the vaccine from the supplier, then next day parents need to pick up the prescribed vaccines in a pharmacy, maintain them in appropriate conditions (e.g., refrigerated), then bring the vaccine and the child to their doctor, give their consent to vaccinate and be physically present during the vaccination.
In addition, attitudes and behaviours of healthcare providers also constitute a barrier to vaccination. Many Roma complained about the neglect of care, double standard practices, inappropriate behaviour and communication, prejudices, and racism of health care providers. This in turn causes distrust, which often leads to avoidance of healthcare services and is reflected in low awareness of the importance of prevention. For example, respondents often mentioned negative attitudes towards healthcare and vaccination services, fear of vaccination and associated side effects.
The RIVER-EU research findings in Slovakia suggest that the health care system is not responsive to the specific needs of marginalized Roma and they perceive it as unfriendly. HPV is not viewed as a priority by marginalized Roma and health professionals working with them. The health care system fails to reach marginalized Roma with appropriate and understandable information about HPV and HPV vaccination. Together with a lack of capacities and motivation of health care providers to address these topics, it leads to a lack of awareness about HPV-related cancer and its prevention.
In 2023, RIVER-EU will select and implement a pilot project that addresses the identified health system barriers to HPV vaccination and empowers the marginalised Roma community in Slovakia.