A multi-method evaluation of a community initiative intended to improve the quality of healthcare in the Gypsy and Traveller communities

Abstract

Although small-scale initiatives have taken place attempting to address the inequality in health of Gypsies and Travellers, these have had little impact nationally, being isolated and lacking impartial evaluation. Consequently, healthcare access and health status of UK Gypsy/Travellers remains very poor. This thesis is a multi-method evaluation of a complex intervention designed to improve the healthcare of Gypsies and Travellers in Wrexham. An ethnographic method was used providing both 'insiders' and 'outsiders' perspectives. Participant observations and a series of interviews with Gypsy/Travellers and service providers were undertaken, together with a study of Gypsy/Travellers' coronary and mental health status. The combination and interaction of these studies provide an overall evaluation of the community health initiative. Gypsy/Travellers' culture, lifestyle, health beliefs and experiences of healthcare are described. Gypsy/Travellers hold a strong sense of cultural identity and their lives are governed by strict rules and cultural expectations. To break the rules risks being ostracised from the community. Family life is all important and religion is fundamental to Gypsy/Traveller lives. Also, they experience wide spread discrimination which results in defensive, mistrust of non- Gypsy/Travellers. Gypsy/Travellers' CHD and mental health status have been described. Results suggest that they engage in higher CHD risk behaviours than the general population and high levels of depression and anxiety were found. The community health initiative consisting of a full-time Project Health Worker who provides an outreach service by means of a mobile health unit is described. The aim is to increase access to healthcare and develop culturally acceptable methods to improve CHD health of this group. The strengths and weaknesses of the initiative are explored and the complex interactions between culture, health and the initiative are discussed. Finally, several key elements are identified which contribute to the success of the initiative and the continuation of the initiative is discussed