An evaluation of asthma education project targeting the Traveller and Roma community

Abstract

Objective:The aim of this evaluation was to determine the cultural and educational appropriateness of a pilot asthma education programme developed for the Traveller and Roma community in Ireland. Design: A participatory multi-stakeholder and qualitative approach. Setting: Prevalence and inadequate control of asthma have been found to be high among members of the Traveller and Roma community. Barriers to health care among these groups have been reported. A trainthe-trainer approach was undertaken to build capacity among Traveller Community Health Workers around specialist asthma knowledge. Method: A total of 29 Traveller community health care workers completed and graduated successfully with a certificate of attendance. Interviews were undertaken with key stakeholders (n = 8) and focus groups (n = 24) with participants. Results: The train-the-trainer approach was shown to be an effective, transferable and cost effective strategy to building capacity to outreach specialist asthma education to a wider population. There was a very positive response to the programme among the stakeholders, facilitators and the participants generally. Participants felt confident in their ability to teach other health care workers about what they had learned during the programme. Conclusion: The cascade provided by the pilot work offers an economical approach to building capacity and outreach specialist asthma knowledge to Community Health Workers and to families affected by asthma in the Traveller community. The use of energisers and the approach to local evaluation should be adapted to respond to the requirements of the group. It is recommended that regular evaluation and reporting of outcome indicators be undertaken.

Healthy People, Healthy Community: Evaluation of a train-the-trainers programme for community health workers on water, sanitation and hygiene in rural Haiti

“…In order to reach high-need families, Kore Fanmi CHWs and JHAs act as links between the community and the formal health system. The programme's pyramid structure also has a substantial 'cascade' effect (Brady and Keogh, 2016), as the 96 JHAs directly interface with approximately 15,000 vulnerable families in three communes of southeast Haiti (see Figure 1). The first week of the training programme was the didactic training portion in which instructors from the sponsoring NGO and corporate partner taught WASH content to 22 Kore Fanmi supervisors and invited volunteer CHWs from local organisations.…”

“…As the project has grown, it has adopted a tiered, 'train-the-trainer' (TTT) model, which aims to be (1) efficient, as a small number of trainees can pass knowledge on to a number of others; (b) sustainable, since the trainees receiving the most intensive training are expected to take on greater organisational leadership as their expertise grows; and (3) culturally relevant, as the trainers are members of the local community and may serve as 'cultural filters' of content (Knettel et al, 2017), ensuring that it is applicable to the local context. Because of these strengths, the TTT model has received substantial support in under-resourced and hard-to-reach populations (Besculides et al, 2011;Brady and Keogh, 2016;Orfaly et al, 2005). In Haiti, a past TTT programme effectively improved knowledge of techniques for hand washing and water sanitisation in an effort to prevent cholera transmission (Rajasingham et al, 2011).…”

“…In order to reach high-need families, Kore Fanmi CHWs and JHAs act as links between the community and the formal health system. The programme’s pyramid structure also has a substantial ‘cascade’ effect (Brady and Keogh, 2016), as the 96 JHAs directly interface with approximately 15,000 vulnerable families in three communes of southeast Haiti (see Figure 1).…”

Exploring the Barriers: A Qualitative Study about the Experiences of Mid-SES Roma Navigating the Spanish Healthcare System

“…In general, the study’s findings are aligned with the existing evidence of discrimination against Romani women in healthcare systems in Europe, specifically in maternity care [ 20 ]. Nonetheless, all these investigations emphasize the central importance of social support from the family to address healthcare accessibility problems [ 24 , 25 , 26 ], accentuating the active role that women play in leading the improvement of their family and community’s living conditions [ 27 ], which is also identified in other social groups when facing difficult situations [ 28 , 29 , 30 ].…”

“…All in all, the lack of cultural sensitivity in healthcare systems is often fed by the intolerance, prejudices, and stereotypes of some healthcare personnel towards all non-white clients, accentuated in the case of the Roma people as a result of long-lasting discrimination [ 14 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 ]. Although some efforts have been dedicated to exploring the barriers that the Roma community face in accessing the healthcare system in Spain [ 32 ], more research specifically addressing how these barriers are embodied, and looking at the cases not only of those who are in the most vulnerable social positions, but also of those who have stable socioeconomic positions and higher cultural capitals, can help us to better understand how anti-Roma sentiments underlie society, and specifically, the health-care system.…”