Table 2 Recommended Actions to improve primary health care responses to violence against Romani women
Cluster | Statement | Importance | Feasibility |
|---|---|---|---|
Actions to enhance health professionals’ capacity to respond to battered Roma women | |||
1. Foster a relationship of trust with health professionals | Ensure confidentiality for women who decide to seek help | 5,91 | 5,7 |
Facilitate the accompaniment of women who are in situations of abuse if they want to file a report to help minimize risks, advise them, give them support, generate trust and facilitate referrals to other professionals | 5,32 | 4,27 | |
Help women see that the health professionals are going to be there for them, and not tell them that they have to file a report or coerce them | 5,2 | 4,55 | |
Talk with the women so that they know that they can get away from the violence and that their relationship with their partner isn’t healthy | 4,94 | 3,91 | |
2. Professional practices to promote respectful treatment and improve detection | Give unprejudiced and equal treatment to everyone | 5,37 | 4,52 |
Be attentive to non-verbal communication, fear and submissiveness | 5,34 | 4,64 | |
Adapt language in the consultation so that it is easy to understand | 5,31 | 5,06 | |
Be attentive to indirect indicators, such as injuries in hidden sites, and children missing a lot of school | 5,31 | 4,76 | |
Understand the cycle of violence and acquired defenselessness and don’t assume that it is useless to make an effort because they will just go back | 5,12 | 4,15 | |
Be attentive to the psychosocial indicators of gender violence, which are very high in Roma women | 5,06 | 4,55 | |
Don’t take quick action without thinking through the repercussions that the interventions can have | 4,86 | 4,33 | |
Be attentive to hyper-frequent visits by Roma women | 4,69 | 4,3 | |
Understand their limits in the tolerance of violence | 4,37 | 3,91 | |
Be aware of the barrier to reporting posed by the informal cultural tradition in the Roma community that custody be given to the father | 4,21 | 4,18 | |
6. Enhance health staff’s knowledge and skills for providing culture and gender-sensitive care | Improve and expand training in gender-based violence for all staff in the health centers, including administrative and reception staff, to know how to provide security and support in cases of abuse | 5,6 | 4,42 |
Establish mandatory training for health professionals starting from the university regarding vulnerable groups | 5,49 | 4,15 | |
Provide sensitivity training about the social situation and Roma culture (dress, roles, etc.) to eliminate prejudices and stereotypes about this population | 5,29 | 4,27 | |
Hold clinical rounds about prejudices and gender-based violence for health professionals – doctors and non-doctors | 5,26 | 4,67 | |
Develop training about inter-personal intervention techniques (questions, attitudes) to be able to reach the women better | 5,14 | 4,82 | |
Provide education about how the women experience intimate partner violence, how they suffer and how they express it | 5,14 | 4,18 | |
Involve Roma associations in the training of staff in the health centers | 4,37 | 3,45 | |
Actions to strengthen primary health care’s responses at the institutional level | |||
3. Strengthen coordination with Roma associations and other sectors | Promote coordination with education to put prevention first: work with gender equality in the school, including education on sexism and gender roles | 5,49 | 4,79 |
Coordinate with people who work with Roma associations as social educators and social workers | 5,24 | 4,79 | |
Foster institutional support and the involvement of managers to develop relationships with Roma associations and carry out activities together | 5,23 | 4,15 | |
Make a list of the social resources available in the nearby area where they can be referred or can go for consultation | 5 | 5,36 | |
Facilitate the inclusion of communication with associations in the professional duties of the doctor so that they can dedicate part of their time to this | 4,69 | 3,21 | |
Coordinate with specialists (e.g. mental health, obstetrics) to detect cases during delivery care | 4,6 | 4,24 | |
Coordinate with Roma health mediators from other cities so that they are not from the family of the aggressor | 4,53 | 3,36 | |
4. Enhance resources for follow up on detected cases | Coordinate with pediatrics when gender-based violence cases are detected to monitor the effects in the children | 5,6 | 5,33 |
Offer the women resources that are available even if they have not filed a report– shelters, legal support, economic help, etc. | 5,51 | 4,15 | |
Inform the women about what resources they have and how to access them | 5,49 | 5,12 | |
Reinforce the role of the social worker in the detection of cases | 5,17 | 5 | |
Develop programs and protocols that take into account the unique characteristics of this collective group | 5 | 4,7 | |
Reinforce the figure of the community nurse | 5 | 4,48 | |
Hire professional Roma women to work with affected women | 4,86 | 4,36 | |
Institutional measures, such as hiring more staff, to make it possible to extend consultations by a half hour when cases are detected | 4,69 | 2,88 | |
Stabilize staffing, so that they stay in the same neighborhoods and don’t have temporary contracts, to generate trust | 4,63 | 2,61 | |
Actions to strengthen primary health care’s responses at the community level | |||
5. Facilitate women’s participation in activities and actions | Encourage Roma women to use antenatal health care and education services, and thus increase opportunities to detect violence during pregnancy | 5 | 4,45 |
Start therapy groups for women in the centers where they are referred | 4,97 | 3,97 | |
Facilitate Roma women’s access to health centers, providing alternative entry points to primary health care | 4,65 | 3,55 | |
Encourage the training of Roma health professionals (nurse, social worker) | 4,53 | 2,79 | |
Promote home visits | 4,11 | 3,67 | |
7. Strengthenawareness in the Roma community | Provide training to Roma health agents and the Roma community associations on gender-based violence | 5,4 | 4,21 |
Work to develop the autonomy of Roma women | 5,37 | 4,21 | |
Carry out trainings and workshops with participation from social services and Roma associations about empowerment, self-esteem, interpersonal relationships, and prevention of gender-based violence | 5,34 | 4,61 | |
Outreachclinics to bring primary care providers closer to the Roma populations | 4,89 | 4,18 | |
Make health center’s activities about gender-based violence more attractive for Romani women | 4,8 | 3,64 | |
Promotional materials (like posters and brochures) about prevention and awareness of gender-based violence adapted to the Roma reality | 4,44 | 4,61 | |
8. Develop community-level action to prevent violence | Promote Roma women’s participation in the design of interventions or programs for prevention of gender-based violence | 5,49 | 4,24 |
Promote community health projects with activities and interventions about empowerment in vulnerable neighborhoods with Roma population | 5,43 | 4,42 | |
Work with Roma health mediators | 5,29 | 4,42 | |
Work with male Roma health mediators to transmit different values to the men | 5,26 | 3,52 | |
Involve health professionals from all health centers in community health programs for prevention of gender-based violence | 5,09 | 3,61 | |
Carry out activities with the Roma population to improve their trust in health staff | 4,97 | 3,79 | |
Involve key actors from the Roma community (respected people, artists, athletes, professionals, social activists, the church) to make prevention campaigns | 4,89 | 4,12 | |