OBJECTIVES: The health status of segregated Roma is poor. To understand why segregated Roma engage in health-endangering practices, we explored their nonadherence to clinical and public health recommendations. METHODS: We examined one segregated Roma settlement of 260 inhabitants in Slovakia. To obtain qualitative data on local-level mechanisms supporting Roma nonadherence, we combined ethnography and systematic interviewing over 10 years. We then performed a qualitative content analysis based on sociological and public health theories. RESULTS: Our explanatory framework summarizes how the nonadherence of local Roma was supported by an interlocked system of seven mechanisms, controlled by and operating through both local Roma and non-Roma. These regard the Roma situation of poverty, segregation and substandard infrastructure; the Roma socialization into their situation; the Roma-perceived value of Roma alternative practices; the exclusionary non-Roma and self-exclusionary Roma ideologies; the discrimination, racism and dysfunctional support towards Roma by non-Roma; and drawbacks in adherence. CONCLUSIONS: Non-Roma ideologies, internalized by Roma into a racialized ethnic identity through socialization, and drawbacks in adherence might present powerful, yet neglected, mechanisms supporting segregated Roma nonadherence.

Department of Community and Occupational Medicine University Medical Center Groningen Groningen The Netherlands

Kosice Institute for Society and Health Faculty of Medicine P J Safarik University Kosice Slovakia Department of Community and Occupational Medicine University Medical Center Groningen Groningen The Netherlands Olomouc University Society and Health Institute Palacky University Olomouc Olomouc Czech Republic

Kosice Institute for Society and Health Faculty of Medicine P J Safarik University Kosice Slovakia Department of Health Psychology Faculty of Medicine P J Safarik University Trieda SNP 1 040 11 Kosice Slovakia Department of Community and Occupational Medicine University Medical Center Groningen Groningen The Netherlands Department of General Anthropology Faculty of Humanities Charles University Prague Czech Republic

Kosice Institute for Society and Health Faculty of Medicine P J Safarik University Kosice Slovakia Department of Health Psychology Faculty of Medicine P J Safarik University Trieda SNP 1 040 11 Kosice Slovakia Olomouc University Society and Health Institute Palacky University Olomouc Olomouc Czech Republic

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