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The Health Promotion Needs and Preferences of Gypsy Travellers In Diversity in Health and Social Care 2007;4:167–76 # 2007 Radcliffe Publishing Research paper The health promotion needs and preferences of Gypsy Travellers in Wales Irena Papadopoulos PhD MA BA DipNEd DipN RGN RM NDN Cert RNT Head of the Research Centre for Transcultural Studies in Health Margaret Lay BA(Hons) RMN RGN Cert Counselling Skills Research Fellow, Research Centre for Transcultural Studies in Health Middlesex University, London, UK ABSTRACT Gypsy Travellers suffer high levels of racism, socio- more open to health promotion activities, and some economic deprivation, unemployment and illiter- wished to engage in their design and delivery. acy, the poorest life expectancy in Europe and poor Participants preferred health promotion provided access to health promotion. Astudy of the health locally. Culturally competent health promotion promotion experiences, needs and preferences of practitioners who can be flexible and willing to work Gypsy Travellers in Wales was undertaken obtaining on Gypsy Travellers’ terms are needed, as are changes data from five focus groups formed from a con- in health and social policy to improve their socio- venience sample of 18 Gypsy Travellers living on economic conditions and reduce health inequalities. authorised caravan sites in Wales. Findings indicate that these Gypsy Travellers see improvement in socio- Keywords: cultural competence, Gypsy Travellers, economic conditions as a primary need. Women were health promotion Introduction Gypsy Travellers in Britain today are a diverse constel- Monmouthshire and Wrexham local authorities which lation of different groups, including Romany Gypsies did not participate in the count; Statistical Directorate, and English, Scottish, Welsh and Irish Travellers. National Assembly for Wales, 2006). Although there is no one culture common to all these Gypsy Travellers suffer gross health inequalities and groups, they share an ancient tradition of nomadism have the lowest life expectancy levels of all Europeans and an ‘oral tradition’ of passing on knowledge. (Krushelnyck, 2003). Crawley (2003) estimated that According to the Commission for Racial Equality on average Gypsy and Traveller women in Britain live (CRE) the Romany Gypsies have lived in Britain since 12 years less and men 10 years less than the general the 16th century and were the earliest group of Gypsy population. Arecent exploration of the health status Travellers in Britain (CRE, 2004). Because of their and health needs of Gypsy Travellers in England con- nomadic lifestyles and a lack of systematic ethnic cluded that: monitoring, the number of Gypsy Travellers can only be estimated; in Britain there may be as many ‘There is now little doubt that health inequality between ... Gypsy Traveller population in England and their non- as 300 000 (CRE, 2004), although other estimates Gypsy counterparts is striking, even when compared with place this figure much lower at between 90 000 and other socially deprived or excluded groups ...’ (Parry et al, 120 000 (Office of the Deputy Prime Minister, 2003). 2004, p.9). The number in Wales – where the study described in this paper took place – is unknown (Welsh Assembly It is likely that such health inequalities also exist Government, 2003). However, in July 2006 a caravan amongst Gypsy Travellers in Wales. Despite such count showed that there were around 722 Gypsy and glaring health inequalities there has been little research Traveller caravans in Wales located on 57 sites (excluding regarding the specific health problems and needs of 168 I Papadopoulos and M Lay Gypsy Travellers, or the behaviours that may contrib- as healthy eating and taking exercise and activities ute to them (Aspinall, 2005). that encourage the uptake of disease prevention and The National Assembly for Wales, which was es- health protection activities. Disease prevention includes tablished in 1999 following devolution from British measures such as immunisation, various health screening governance, and the Welsh Assembly Government, interventions, smoking cessation programmes and so which is accountable to the National Assembly, are on. Health protection includes policies such as clean responsible for a number of policy areas that impact air, seat belts, and water fluoridation. The overlapping on the health of Gypsy Travellers. These include econ- domains of these three constructs emphasise their omic development, education and training, the en- interrelatedness, and the many social and health vironment, health and health services, highways, agencies that need to work together to promote health. housing, social services and transport (www.direct. gov.uk/en/Gtgl1/GuideToGovernment/DevolvedAnd LocalGovernment/DG_4003265). The Welsh Assembly Government has a statutory duty to promote equality Methodology of opportunity, and Gypsy Travellers have the full protection of the Race Relations Act (Welsh Assembly Aculturally competent approach to the study was Government 2003). adopted to ensure participants’ cultural traditions Amajor programme of reform and improvement to were recognised and respected. As a group view of healthcare in Wales was outlined in 2001 in Improving the areas under study was desired, and as their oral Health in Wales: a plan for the NHS with its partners tradition required an oral data collection method, (Health Service Strategy Team, 2001). The Inequal- focus groups were used. Arelationship of trust, ities in Health Fund was also set up in 2001 to tackle empathy and respect is needed between researchers inequalities in health and inequities in access to and participants (Papadopoulos, 2006), and as Gypsy services (Health of Wales Information Service, 2004). Travellers often distrust authorities, focus group facilitators were used who were known to the partici- pants and who understood their culture. This decision The studyand its aims was taken following consultation with Gypsy Traveller It was against this backdrop in 2002 that the Welsh leaders and local key health professionals. The focus Assembly Government’s Health Promotion Division, groups were undertaken in the participants’ own Office of the Chief Medical Officer commissioned and environment at times suitable to them. To maintain funded the authors to undertake the Health ASERT confidentiality the socio-demographic details of each Programme Wales study (Asylum Seekers, Ethnic participant were obtained individually prior to each minorities, Refugees and Travellers). This study aimed focus group discussion. to ascertain the health promotion experiences, needs The facilitators underwent rigorous training pro- and preferences of Gypsy Travellers, new age travel- vided by the researchers to help reduce the potential lers, minority ethnic groups and asylum seekers/refu- effects of familiarity and the power imbalances be- gees in Wales, to inform the commissioning body’s tween them, as well as informing them about the policy and programme development and other Welsh study. Assembly Government departments. Only the Five focus group discussions were held in 2003 with findings relevant to Gypsy Travellers are discussed in a total of 18 Gypsy Traveller participants. These were this paper. Findings relating to the whole study group tape recorded with their permission. Since all partici- are available in the study report (Papadopoulos et al, pants spoke fluent English all focus groups were 2007). conducted in English (see Box 1). Health promotion Identifying and recruiting the participants Health promotion is taken by the authors to be a complex concept beset with definitional and philosoph- Aconvenience sample of Gypsy Traveller participants ical idiosyncrasies. However, we found Tannahill’s for the focus groups was identified and recruited by (1985) model of health promotion, with its three the focus group facilitators using a networking/snow- interrelated and overlapping constructs of health ball approach. This involved requesting people who education, health protection and disease prevention, had agreed to participate to enlist other suitable to be a useful framework in guiding the study. Health participants. To facilitate attendance at the focus groups, education comprises activities aimed at the develop- participants were paid expenses and provided with ment of positive health attributes in individuals, such child care when needed. Health promotion needs of Gypsy Travellers in Wales 169 Box 1 Topic list for focus groups Table 1 Referencing system for focus The following focus group topic list was devel- group quotation oped with the help of the advisory group to meet the aims of the study: Abbreviated quote Name of group reference . participants’ health-promotion needs . access to and utilisation of health information WET1 Welsh English . problems accessing information Travellers (group 1) . health-promotion materials available to them . health-promotion and information approaches WET2 Welsh English they were aware of and/or preferred Travellers (group 2) . preferences regarding who should conduct IT Irish Travellers health promotion with their communities and where WT Welsh Travellers . suggestions for culturally appropriate health ET English Travellers promotion. Ethical considerations Findings The researchers gained ethical approval from the University School of Health and Social Science Re- Socio-demographic characteristics of search Ethics Committee and the appropriate Welsh the studyparticipants local research ethics committees. Fifteen female and three male (n = 18) Gypsy Travel- Written information and verbal explanation,
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