The etemic model of Gypsy Roma Traveller community vulnerability: is it time to rethink our understanding of vulnerability?

Abstract

Aim: To present a new etemic model of vulnerability.Background: Despite vulnerability being identified as a core consequence of health and health experiences there has been little research exploring the meaning of vulnerability as a concept. Yet being vulnerable is known to have dire physical/mental health consequences. It is therefore a fundamental issue for nurses to address. To date, the meaning of the term vulnerability has been influenced by the work of Spiers (2000Spiers ( , 2005. Spiers identified two aspects of vulnerability; the etic (external judgment of another persons' vulnerability and the emic (internal lived experience of vulnerability). This approach has led to a plethora of research which has explored the etic (external judgment) of vulnerability and rendered the internal lived (or emic) experience invisible. Consequences of this, for marginalised communities such as Gypsy Roma Travellers include a lack of culturally sensitive services compounding health inequalities. Design: Position paperMethod: Drawing upon a qualitative phenomenological research study exploring the lived experience of vulnerability from a Gypsy Roma Travelling community (published previously), this paper presents a new model of vulnerability. This etemic model of vulnerability values both external and internal dimensions of vulnerability and argues for a fusion of these two opposing perspectives. Conclusion and relevance to clinical practice:If nurses and other health and social care professionals wish to develop practice that is successful in engaging with Gypsy Roma Travellers then there is a need to both understand and respect their community. This can be achieved through an etemic approach to understanding their vulnerability achieved by eliciting lived experience alongside the appreciation of epidemiological studies. Doing so would enable the development and delivery of culturally sensitive services facilitating health access to this community. Only then, will their poor health status be successfully addressed.Keywords: Vulnerable, Gypsy, Romany, Irish Traveller, indigenous, marginalised, patient voice, mental health, nursing, healthcare. Summary Statement:What does this paper contribute to the wider global clinical community? The concept of vulnerability, whilst a crucial aspect of nurses' professional practice has had little examination to date. This paper provides a critical examination of vulnerability providing a timely contribution to ongoing debates regarding vulnerability.

Improving equity and cultural responsiveness with marginalised communities: Understanding competing worldviews

“…Like New Zealand Maori, Gypsy Roma Travellers tend not to access preventative health care, instead entering healthcare services much further down the illness trajectory. Yet when they do access health care, they are often faced with cultural barriers (Heaslip, Hean, & Parker, ), which result in fracturing the already fragile bond of trust between the practitioner and the community, as well as discrimination (Cemlyn, Greenfields, Burnett, Matthews, & Whitwell, ; Smith & Ruston, ), all of which contributes to the healthcare inequity they experience.…”

“…As such, marginalised communities require greater access to healthcare support in order to address the health inequities they experience. Yet this demand is not neces- (Szczepura, 2005), language (O'Donnell et al, 2016), structural and interpersonal discriminatory practices (Jones, 2000), and poor cultural responsiveness (Heaslip, Hean, & Parker, 2016b;Kings Fund, 2006;Smith & Ruston, 2013).…”

“…Many individuals from marginalised communities find accessing healthcare services challenging. Reasons for this can be multifaceted and include difficulty in accessing services due to physical ability (Heaslip, Hean, & Parker, ), structural barriers (O'Donnell, Tierney, O'Carroll, Nurse, & MacFarlane, ), poorer health literacy (Szczepura, ), language (O'Donnell et al., ), structural and interpersonal discriminatory practices (Jones, ), and poor cultural responsiveness (Heaslip, Hean, & Parker, ; Kings Fund, ; Smith & Ruston, ).…”

Are Gypsy Roma Traveller communities indigenous and would identification as such better address their public health needs?

“…37 and 38]. This discrimination occurs at all levels, including schools impacting on the educational achievement [30] of young Gypsy Roma Travellers, many of whom leave formal education at a younger age than their settled counterparts [16]; within healthcare practices [39] perpetuating health inequities; and in their day to day lives [8,20,27,37]. Clearly, it can be argued that Gypsy Roma Traveller communities could be identified as indigenous peoples under the distinctiveness and cultural difference criteria, however, what are the benefits of them being identified as such?…”

Problematizing the context and construction of vulnerability and risk in relation to British Muslim ME groups

“…Perceived insularity among certain groups viewed as holding markedly different practices to the majority are not of course, confined only to some British Muslims, but others, such as the European Gypsy Roma, British Romany and Traveller groups, have also been targets of government policies, nominally aimed at reducing underprivileged but where the effects are of imposing cultural norms that are alien to such groups (Heaslip, Hean, & Parker, 2016;Scullion & Brown, 2016). An example of cultural norms for Roma groups (which superficially echo some of the values of British Muslims as well as that of orthodox Jews), are those that many social workers might find questionable in terms of equality and empowerment.…”