The Meaning of Health, Well-Being, and Quality of Life Perceived by Roma People in West Sweden

Hassler S., Eklund L.

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.A cross-sectional, quantitative pilot study.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.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).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.

Crondahl K., Eklund L.

Huber M., Knottnerus J.A., Green L., Horst H.V., Jadad A.R., Kromhout D., Leonard B., Lorig K., Loureiro M.I., Meer J.W., Schnabel P., Smith R., Weel C.V., Smid H.

The WHO definition of health as complete wellbeing is no longer fit for purpose given the rise of chronic disease. Machteld Huber and colleagues propose changing the emphasis towards the ability to adapt and self manage in the face of social, physical, and emotional challenges

Gasper D.

The concepts of well-being and quality of life concern evaluative judgements. There is insufficient understanding in current literature that these judgements are made variously due to the use of not only differing values and differing research instruments but also differing standpoints, differing purposes, and differing theoretical views and ontological presuppositions. The paper elucidates these sources of differences and how they underlie the wide diversity of current conceptions.

Pascoe E.A., Smart Richman L.

Perceived discrimination has been studied with regard to its impact on several types of health effects. This meta-analysis provides a comprehensive account of the relationships between multiple forms of perceived discrimination and both mental and physical health outcomes. In addition, this meta-analysis examines potential mechanisms by which perceiving discrimination may affect health, including through psychological and physiological stress responses and health behaviors. Analysis of 134 samples suggests that when weighting each study's contribution by sample size, perceived discrimination has a significant negative effect on both mental and physical health. Perceived discrimination also produces significantly heightened stress responses and is related to participation in unhealthy and nonparticipation in healthy behaviors. These findings suggest potential pathways linking perceived discrimination to negative health outcomes.

Parry G., Van Cleemput P., Peters J., Walters S., Thomas K., Cooper C.

Objective: To provide the first valid and reliable estimate of the health status of Gypsies and Travellers in England by using standardised instruments to compare their health with that of a UK resident non-Traveller sample, drawn from different socioeconomic and ethnic groups, matched for age and sex.Design: Epidemiological survey, by structured interview, of quota sample and concurrent age–sex-matched comparators.Setting: The homes or alternative community settings of the participants at five study locations in England.Participants: Gypsies and Travellers of UK or Irish origin (n = 293) and an age–sex-matched comparison sample (n = 260); non-Gypsies or Travellers from rural communities, deprived inner-city White residents and ethnic minority populations.Results: Gypsies and Travellers reported poorer health status for the last year, were significantly more likely to have a long-term illness, health problem or disability, which limits daily activities or work, had more problems with mobility, self-care, usual activities, pain or discomfort and anxiety or depression as assessed using the EuroQol-5D health utility measure, and a higher overall prevalence of reported chest pain, respiratory problems, arthritis, miscarriage and premature death of offspring. No inequality was reported in diabetes, stroke and cancer.Conclusions: Significant health inequalities exist between the Gypsy and Traveller population in England and their non-Gypsy counterparts, even when compared with other socially deprived or excluded groups, and with other ethnic minorities.

Van Cleemput P., Parry G., Thomas K., Peters J., Cooper C.

Objective: To illuminate findings of the survey of the health status of Gypsies and Travellers by exploring their health-related beliefs and experiences.Design: Qualitative study of a purposive subsample from in-depth interviews using framework analysis.Setting: The homes or alternative community settings of the participants in five geographically dispersed study locations in England.Participants: 27 Gypsies and Travellers with an experience of ill health, purposively sampled from a larger population participating in an epidemiological survey of health status.Results: The experience of poor health and daily encounters of ill health among extended family members were normalised and accepted. Four major themes emerged relating to health beliefs and the effect of lifestyle on health for these respondents: the travelling way; low expectations of health; self-reliance and staying in control; fatalism and fear of death. These themes dominated accounts of health experience and were relevant to the experience. These themes add richness to the health status data and inform our understanding.Conclusions: Among Gypsies and Travellers, coherent cultural beliefs and attitudes underpin health-related behaviour, and health experiences must be understood in this context. In this group, ill health is seen as normal, an inevitable consequence of adverse social experiences, and is stoically and fatalistically accepted. The provision of effective healthcare and improvement of poor health in Gypsies and Travellers will require multi-agency awareness of these issues.

Harris R., Tobias M., Jeffreys M., Waldegrave K., Karlsen S., Nazroo J.

Accumulating research suggests that racism may be a major determinant of health. Here we report associations between self-reported experience of racial discrimination and health in New Zealand. Data from the 2002/2003 New Zealand Health Survey, a cross-sectional survey involving face-to-face interviews with 12,500 people, were analysed. Five items were included to capture racial discrimination in two dimensions: experience of ethnically motivated attack (physical or verbal), or unfair treatment because of ethnicity (by a health professional, in work or when gaining housing). Ethnicity was classified using self-identification to one of four ethnic groups: Māori, Pacific, Asian and European/Other peoples. Logistic regression, accounting for the survey design, age, sex, ethnicity and deprivation, was used to estimate odds ratios (OR) and 95% confidence intervals (CI). Māori reported the highest prevalence of "ever" experiencing any of the forms of racial discrimination (34%), followed by similar levels among Asian (28%) and Pacific peoples (25%). Māori were almost 10 times more likely to experience multiple types of discrimination compared to European/Others (4.5% vs. 0.5%). Reported experience of racial discrimination was associated with each of the measures of health examined. Experience of any one of the five types of discrimination was significantly associated with poor or fair self-rated health; lower physical functioning; lower mental health; smoking; and cardiovascular disease. There was strong evidence of a dose-response relationship between the number of reported types of discrimination and each health measure. These results highlight the need for racism to be considered in efforts to eliminate ethnic inequalities in health.

Diener E., Emmons R.A.

Five studies on the relation between positive and negative affect are reported. In Studies 1 and 2 we found that positive feelings were remembered as being nearly independent of negative feelings in the past year, but the two types of affect were moderately negatively correlated for the past month. In Studies 3 and 5, subjects completed daily mood reports for 70 and 30 days, respectively. In Study 4, subjects completed three-week, daily, and moment mood reports and also filled out reports when they experienced strong emotions. The principal finding was that the relation between positive and negative affect differed greatly depending on the time frame. The strongest negative correlation between the two affects occurred during emotional times. The correlation decreased in a linear fashion as the time span covered increased logarithmically. It appears that positive and negative affect are independent in terms of how much people feel in their lives over longer time periods. Researchers need to focus on the processes that underlie both positive and negative affect and that are responsible for producing their relative independence.

Diener E.

One area of positive psychology analyzes subjective well-being (SWB), people's cognitive and affective evaluations of their lives. Progress has been made in understanding the components of SWB, the importance of adaptation and goals to feelings of well-being, the temperament underpinnings of SWB, and the cultural influences on well-being. Representative selection of respondents, naturalistic experience sampling measures, and other methodological refinements are now used to study SWB and could be used to produce national indicators of happiness.

Pavot W., Diener E.

Wiking E.

Study objective: To analyse the association between ethnicity and poor self reported health and explore the importance of any mediators such as acculturation and discrimination.Design: A simple random sample of immigrants from Poland (n = 840), Turkey (n = 840), and Iran (n = 480) and of Swedish born persons (n = 2250) was used in a cross sectional study in 1996. The risk of poor self reported health was estimated by applying logistic models and stepwise inclusion of the explanatory variables. The response rate was about 68% for the immigrants and 80% for the Swedes. Explanatory variables were: age, ethnicity, educational status, marital status, poor economic resources, knowledge of Swedish, and discrimination.Main results: Among men from Iran and Turkey there was a threefold increased risk of poor self reported health than Swedes (reference) while the risk was five times higher for women. When socioeconomic status was included in the logistic model the risk decreased slightly. In an explanatory model, Iranian and Turkish women and men had a higher risk of poor health than Polish women and men (reference). The high risks of Turkish born men and women and Iranian born men for poor self reported health decreased to non-significance after the inclusion of SES and low knowledge of Swedish. The high risks of Iranian born women for poor self reported health decreased to non-significance after the inclusion of low SES, low knowledge of Swedish, and discrimination.Conclusions: The strong association between ethnicity and poor self reported health seems to be mediated by socioeconomic status, poor acculturation, and discrimination.

Lindseth A., Norberg A.

This study describes a phenomenological hermeneutical method for interpreting interview texts inspired by the theory of interpretation presented by Paul Ricoeur. Narrative interviews are transcribed. A naïve understanding of the text is formulated from an initial reading. The text is then divided into meaning units that are condensed and abstracted to form sub-themes, themes and possibly main themes, which are compared with the naïve understanding for validation. Lastly the text is again read as a whole, the naïve understanding and the themes are reflected on in relation to the literature about the meaning of lived experience and a comprehensive understanding is formulated. The comprehensive understanding discloses new possibilities for being in the world. This world can be described as the prefigured life world of the interviewees as configured in the interview and refigured first in the researcher's interpretation and second in the interpretation of the readers of the research report. This may help the readers refigure their own life.

Eid M., Diener E.

Subjective well-being (SWB) is an important indicator of quality oflife. SWB can be conceptualized as a momentary state (e.g., mood) aswell as a relatively stable trait (e.g., life satisfaction). Thevalidity of self-reported trait aspects of SWB has been questioned byexperimental studies showing that SWB judgments seem to be stronglycontext dependent. Particularly, momentary mood seems to have a stronginfluence on global SWB judgments. To explore the ecological validity ofthese conclusions a non-experimental longitudinal self-reportstudy with three occasions of measurement was conducted(N = 249). The associations between momentarymood ratings and global judgments of SWB (life satisfaction,satisfaction with life domains, frequency and intensity of emotions) aswell as personality ratings (self-esteem, optimism, neuroticism,extraversion) were analyzed in a multistate-multitrait-multiconstructmodel. This model takes (a) measurement error, (b) occasion-specificdeviations, and (c) stable interindividual differences into account. Itis shown that the variability in global SWB judgments and personalityratings is relatively small and much smaller than the variability inmood. Furthermore, the occasion-specific associations between moodstates, on the one hand, and global SWB and personality ratings, on theother hand, are relatively small and inconsistent. All global SWB andpersonality variables are more strongly related to mood on the traitlevel than on the occasion-specific deviation level. Therefore, incontrast to experimental studies, occasion-specific mood effects do notseem to be inherently important in ecological measurement settings.

Zeman C.L., Depken D.E., Senchina D.S.

Roma health issues are under-studied from a comprehensive, epidemiological perspective. The Roma peoples (including 'Travellers') have been living in and around Central and Eastern Europe for centuries, and may be one of the oldest systematically oppressed minority groups in Europe. This review examines the research literature in regard to the health and epidemiology of this group with the aim of examining the breadth and depth of the literature and reflecting on the primary and applied research needed to address the health needs of Roma groups.Internet, database and ancestral searches were conducted via such electronic databases as Medline and PubMed. Ancestral searches involved consulting previous literature reviews in select topical areas and obtaining all appropriate, primary literature. The time parameters of the search began with the year 1990 to current but was later expanded to 1985-2003 in order to capture slightly older published work.This paper describes what is known concerning Roma health via a review of the published studies, with special emphasis on population health and epidemiological studies. One hundred and twenty-nine articles are reviewed and discussed. The majority of research (50%) examines the genetic characteristics of this group.Surveillance and population health indices for this international minority population is scarce to lacking in the published literature. Concluding comments focus on the unique character of the study population and the need for scientific studies of Roma health issues and the cultural concerns which might affect them.

Oláh B., Bíró É., Kósa K.

BackgroundRoma are the largest and most disadvantaged minority in Europe, but there is few research on how mental health and social support of Roma people living in segregated settlements compares to the majority population. Our aim was to compare the subjective well-being, life satisfaction, mental status, and social support of representative samples of adults living in segregated settlements (colonies) and identifying as Roma with those of the general population in Hungary.MethodsA cross-sectional study was conducted with random samples of 417 individuals from the general Hungarian adult population (55.6% female, mean age = 43.89 ± 12.61 years) and 394 adults living in segregated settlements (colonies) (73.9% female, mean age = 42.37 ± 12.39 years). Demographic questions were used as well as the WHO Well-Being Index (WBI-5), the single item Life Satisfaction Scale, the 12-item version of the General Health Questionnaire (GHQ-12), and the Oslo Social Support Scale (OSSS-3).ResultsResidents of colonies reported significantly lower levels of subjective well-being and life satisfaction than the general population. The proportion of individuals at high risk for mental morbidity was more than twice as high among colony dwellers (16.4%) as in non-colony dwellers (7.6%). Similar unfavorable differences were seen at the expense of self-identified Roma compared to self-identified Hungarians but no difference was found in terms of social support either by type of residence or ethnicity. 32.2% of colony-dwellers self-identified themselves as Hungarian. Mental health assessed by principal component was directly determined by settlement type of permanent residence, age, educational attainment, employment, financial status, and social support but not ethnic identity.ConclusionThe study based on representative data shows that residents of segregated settlements are in worse mental health than those not living in colonies; that housing segregation is not limited to Roma people, and that housing conditions and financial status are major social determinants of mental health for which data must be collected to avoid using self-reported Roma identity as a proxy measure of socioeconomic deprivation.

Xavier S.M., Barbosa S., Correia A.F., Dindo V., Sequeira M., Maia T., Goes A.R.

Several migrant populations have been identified worldwide as high-risk groups for psychosis because of their experience of social adversity. Recent evidence suggests that the local contexts in which these populations live should be addressed in their complexity to take into account individual and larger societal environmental aspects. This study aimed to assess the lived experiences of a group of migrant Cape Verdean patients, who had been recently hospitalized for a first episode of psychosis in a mental health service on the outskirts of Lisbon, Portugal. The study used Photovoice, a qualitative participatory research method in which people's experiences are documented through photography. Six individuals were recruited, and five weekly sessions were conducted to collect data that were analyzed thematically. Emergent themes addressed two main categories of well-being and illness. Participant concepts of well-being were rooted in a definition of freedom encompassing cultural expression, conveyed by familiar environments and supporting communities. Cultural differences may be experienced as important obstacles for well-being and can be associated with feelings of oppression and guilt. Participants’ accounts focused on positive aspects of life despite illness and on personal concepts of recovery. The study findings contribute to knowledge of the dynamics of migrants’ social experience and underscore the importance of socially and culturally informed mental healthcare institutions.

Suavansri P., Pichayayothin N., Espinosa P.R., Areekit P., Nilchantuk C., Jones T.S., French J.J., Mam E., Moore J.B., Heaney C.A.

Well-being has long been recognized as a key construct in human history. Quantitative studies have been limited in their ability to uncover contextual and cultural nuances that can be leveraged to inform the promotion of well-being. The present study employed a qualitative approach informed by narrative inquiry to understand how individuals in a rapidly developing Asian country experience what it means to be well and what contributes to or detracts from their well-being. A purposeful sample of 50 Thai adults living in Bangkok shared their personal stories of times when they experienced high and low levels of well-being. Data were inductively coded and analysed to identify key domains of participants’ well-being and their inter-connections. The results reflect three layers of well-being. Social relationships (i.e., family, friends and acquaintances, and relationships at work or education) are at the center of well-being in Thailand, connecting and supporting a second layer of eight constituent domains of well-being (experience of emotions, sense of self, finances, self-care, demands and responsibilities, thoughts and feelings about the future, personal health, spirituality). The third layer is composed of the societal and physical contexts that are formative for well-being. Our findings suggest both universal and culturally unique components of well-being among Thai adults. Implications for the promotion of well-being in Thailand are discussed.

Gorbunova V., Gusak N., Klymchuk V., Palii V., Ustenko V., Kondur Z., Popenko V., Oates J.

Purpose The purpose of this paper is to explore senses of powerlessness and empowerment among Romani in Ukraine in relation to such social circles as the extended family, the Romani local community and the whole Ukrainian society. The main research interest is focused on situations and factors that make people feel powerless or empowered. Design/methodology/approach The study was conducted using a semi-structured interview method via telephone. Romani NGO experts approved the interview content. Trained Roma-facilitators were interviewers. Every interview was transcribed for further thematic analysis. Findings The most prominent empowerment factors for Romani people are located within their families and local communities, while the bigger society (Ukrainians themselves and Ukrainian public institutions) is a main source of powerlessness. At the same time, the rigid role of family and community expectations is seen as detrimental for both males and females. Originality/value The paper is original in terms of its topic (senses of powerlessness and empowerment among Romani in Ukraine as social determinants of mental well-being) and research strategy (engagement of Roma-facilitators as interviewers).

Winman T.

Throughout history, people have concerned themselves with how people can live and work together in an inclusive society that encourages cooperative and productive bonds. This question is highly rel...

Talmage C.A., Frederick C.

Quality of life has recently gained prominence in the urban affairs, development, and planning debates. A wide-range of factors have been linked to quality of life, including environmental health, commute times, arts and cultural amenities, school quality, housing availability, and economic concerns. The accessibility inherent in multimodal transportation is critical in the functioning of metropolitan areas. What has not been explored is the association between multimodal transportation and urban quality of life. In this paper, we adapt the method of urban sociologists, Harvey Molotch and Richard Appelbaum, to explore the association between multimodality and 12 measures of quality of life. We analyze 148 cities in the United States with populations over 50,000 that are more than 20 miles from other similarly sized cities. Our test measure is the percentage of workers who commute by some means other than a single-occupant vehicle. Using bivariate and multivariate analysis, this study shows a higher quality of life in counties and metropolitan areas with higher levels of multimodal commuting. These findings underscore the positive impact of sustainable transportation policies on quality of life and opens up new directions for research and policy in the built environment.

Eklund Karlsson L., Ringsberg K.C., Crondahl K.

Roma people all over the world have often been subject to prejudice, stigma, discrimination and oppression. Many Roma have little or no education, which in combination with other factors often leads to unemployment and marginalization. Based on a case study in Sweden, this paper proposes an approach that can be used in participatory projects aiming at improving the living situation of marginalized people. In such an approach, the Roma themselves would be the leaders in all activities concerning the group. The first aim of this paper is to describe how health literacy and work-integrated learning functioned as empowering tools for a Roma-led inclusion process within a participatory action research framework. The second aim is to discuss and reflect on the use of participatory action research in community work with Roma based on the experiences of the participatory action research participants. The findings indicate that work-integrated learning may be a worthwhile approach for increasing the individual empowerment and self-led social inclusion of vulnerable people. However, the obstacles of structural discriminatory nature hindered the project to reach its full potential in its intended emancipatory goals.

Bobakova D., Dankulincova Veselska Z., Babinska I., Klein D., Madarasova Geckova A., Cislakova L.

Roma are the most deprived ethnic minority in Slovakia, suffering from discrimination, poverty and social exclusion. Problematic access to good quality health care as result of institutional and interpersonal discrimination affects their health; therefore, factors which affect health care accessibility of Roma are of high importance for public health and policy makers. The aim of this study was to explore the association between health care accessibility problems and ethnicity and how different levels of social support from family and friends affect this association. We used data from the cross-sectional HepaMeta study conducted in 2011 in Slovakia. The final sample comprised 452 Roma (mean age = 34.7; 35.2% men) and 403 (mean age = 33.5; 45.9% men) non-Roma respondents. Roma in comparison with non-Roma have a more than 3-times higher chance of reporting health care accessibility problems. Social support from family and friends significantly decreases the likelihood of reporting health care accessibility problems in both Roma and non-Roma, while the family seems to be the more important factor. The worse access to health care of Roma living in so-called settlements seems to be partially mediated by social support. Interventions should focus on Roma health mediators and community workers who can identify influential individuals who are able to change a community’s fear and distrust and persuade and teach Roma to seek and appropriately use health care services.

Crondahl K., Eklund Karlsson L.

The basis for this article was a health promotion program based on participatory action research and work-integrated learning (WIL). Seven Roma people were employed and trained to work as local coordinators to empower the local Roma community by strengthening their participation in society and their sense of community, as well as to promote self-led integration. The study aimed to analyze the program from the Roma coordinators’ perspectives, focusing on perceived individual empowerment and perceptions of contribution to the common good and to community empowerment. The findings, based on qualitative data, primarily interviews with the Roma coordinators, indicated that the WIL approach, the participatory nature of the program, and the trust and support from the Roma colleagues and non-Roma facilitators were essential for the development of empowerment. Three main themes emerged that portrayed the participants’ psychological empowerment: strengthened Roma identity, a sense of power, and a sense of enculturated social inclusion.