SURVEY INTO THE HEALTH-CONSCIOUS BEHAVIOUR OF ROMA WOMEN IN BORSOD- ABAÚJ-ZEMPLÉN COUNTY CLOSING RESEARCH REPORT for the OFFICE OF THE CHIEF MEDICAL OFFICER within the framework of the project „improving the working conditions of health visitors working in Roma communities”, under ID number HU12-0001-PP1-2016, financed by the Norway Grants made by PSYMA HUNGARY KFT Budapest, March 2017 Closing Research Report Contents Introduction............................................................................................ 4 The purpose of the research ................................................................... 4 Research tools ...................................................................................... 5 2. Demographic situation, social background ...............................................12 2.1. The social and economic situation of Roma women .............................13 2.2. Child birth, family planning .............................................................19 3. Health behaviour, health awareness .......................................................26 3.1. The theoretical model of health behaviour .........................................26 3.2. The main elements of the theoretical model of health behaviour ............28 3.3. The manifestations of health behaviour .............................................30 4. Sources of health information (communication) .......................................35 4.1. Communication channels ................................................................35 4.2. Health visitors as information source ................................................40 4.3. Health development and health protection programmes .......................47 5. Health condition..................................................................................53 5.1. Presumed health ...........................................................................54 5.2. Restrictions ..................................................................................55 5.3. Mental health ................................................................................56 5.4. Overweight/obesity ........................................................................57 6. Risky health behaviour.........................................................................60 6.1. Smoking ......................................................................................60 6.2. Alcohol consumption ......................................................................64 6.3. Drug consumption .........................................................................65 7. Lifestyle ............................................................................................67 7.1. Workout .......................................................................................67 7.2. Nutrition ......................................................................................69 7.3. Slimming diet ...............................................................................73 8. Healthcare services .............................................................................75 8.1. Visiting the doctor .........................................................................75 8.2. Using health services .....................................................................76 8.3. Medication habits...........................................................................80 8.4. Unequal access to health services ....................................................82 9. Public health screenings .......................................................................86 9.1. Mammography ..............................................................................86 9.2. Cervical screening .........................................................................89 9.3. Cervical screening by health visitors .................................................94 9.4. Factors preventing participation in public health screenings ................ 105 10. Management summary ..................................................................... 111 2 Closing Research Report 11. Professional policy recommendation for the more active participation of roma women in public health screenings .......................................................... 114 12 Annexes ......................................................................................... 119 3 Closing Research Report Introduction The purpose of the research In the first quarter of 2017, Psyma Hungary Public Opinion Research Ltd. conducted research – upon request by the Office of the Chief Medical Officer - into the health conditions, the health awareness and the health behaviour of Roma women. The research was financed by the Norwegian Fund, within the framework of the project entitled „Improving the working conditions of health visitors working in Roma communities”, under ID number HU12- 0001-PP1-2016. The research surveyed the health awareness and the health behaviour of Roma women from various aspects and in several cross-sections. One of the major objectives of the project was to improve the special, preventive and health educational tasks of health visitors, with special attention to effectively influencing the health behaviour. The research touched upon several topics within the factors that determine the health condition (lifestyle, risk factors, using the healthcare system etc.), and we tried to survey these topics in order to be able to provide feedback to the health visitors who (also) work in Roma areas. An important part of the survey is covered by the screenings controlled and supervised by the Office of the Chief Medical Officer (mammography and cervical screenings): checking the frequency and intensity of attending such screenings, mapping the possible reasons for attendance or failure to attend etc. Based on these results, we tried to draw conclusions on how the willingness of Roma women to attend public health screenings could be 4 Closing Research Report improved. We also attempt to provide professional recommendations through our own tools. These conclusions often affect the area of communication as well, i.e. how the screening-related communication could be enhanced. Upon the start of the research, we presumed that specific means of communication may be required in presenting the patterns of health-conscious behaviour to disadvantaged social strata. It is an evident objective of the survey to significantly improve the health culture and the attitude of Roma women as well as to enhance their rate of participation in health development and disease prevention programmes. Research tools The research consisted of two parts: a quantitative and a qualitative part: In the quantitative research phase we conducted a questionnaire-based survey among adult (18+) Roma women living in Borsod-Abaúj-Zemplén county. The sample covered 1000 persons. The research was carried out through the PAPI technique, i.e. the interviewers used traditional, printed questionnaires. Then the questionnaires were processed by computer, and after the logical check of the raw data file we produced the empirical database that was applied through the analysis. The research itself was conducted through quota-based sampling combined with random elements. In this case, quota-based sampling means that the Principal pre-determined the internal sample structure upon the start of the research. It was the Principal’s request that the Roma population should be surveyed at settlements of different sizes (level of development and 5 Closing Research Report infrastructure). The survey focused on four settlement types: Miskolc, the county seat town, two towns with more than 20,000 residents (Ózd and Kazincbarcika), settlements with 3000-19,999 residents as well as settlements with fewer than 3000 residents. The quota was set up with the same population in the four territorial sub-groups. Another main dimension of selecting the respondents was age. Here, a threefold breakdown of age was specified. The quota paid special attention to the 18-29 age group, mainly because the work of health visitors is especially focused on women who belong to this age group. (The characteristic features of the surveyed population, for example, having children at an early age – for this reason health visitors are in also contact with pregnant women aged 15-16 – would also have justified to involve an even younger age group in the sample, but we only interviewed adult-age persons with a view to data protection.) In addition to the younger generation, the 30-55 age group also has a dominant role in the quota, while the elderly group (aged 56+) carries a lower weight. The latter group has fewer participants not only because health visitors evidently maintain fewer contacts with them but also because the rate of the elderly is very low within the Roma (female) population due to the characteristic age tree. Below we give details on the distribution of the sample framework prescribed in the research. Sample distribution according to the requested quotas (persons) women aged 18- women aged 30- 56+ total 29 55 county seat 100 100 50 250 town 20,000-150,000 100 100 50 250 3000-19,999 100 100 50 250 fewer than 3000 100 100 50 250 total 400 400 200 1000 6 Closing Research Report 31 out of the 358 settlements of the county were involved in the research. (The list of the surveyed settlements can be found in annex 1.) The selection was clear and evident at the large settlements (Miskolc, Ózd, Kazincbarcika). According