According to the general public in Slovakia, compliance with the law is problematic when it comes to Roma and health. Roma compliance with laws has not yet been studied. The aim of this is study was to explore the determinants of Roma behavior in the field of health laws. We used the concept of a semi-autonomous field proposed by Moore (1973) and the theory of planned behavior by Ajzen (1985). We found that Roma (non-)compliance with health laws was influenced by many different factors, such as beliefs, traditions, living conditions and culture. Group beliefs overrule national laws and also individual preferences, which tend to be subordinate to the group view. The less contact Roma from settlements have with non-Roma, the stronger their own rules are in the field of health. Roma health status is influenced by many factors: group beliefs and community traditions are stronger and overrule individual and state behavioral influence. A community-based participatory approach together with improvement of living conditions in cooperation with Roma is desirable.

Department of Community and Occupational Medicine University Medical Center Groningen University of Groningen 9713 AV Groningen The Netherlands

Department of Labor Law and Social Welfare Law Faculty of Law Comenius University 810 00 Bratislava Slovakia

Graduate School Kosice Institute for Society and Health Faculty of Medicine P J Safarik University in Kosice 040 01 Kosice Slovakia

Research Agency 831 02 Bratislava Slovakia

Theological Faculty Olomouc University Social Health Institute Palacky University 771 11 Olomouc Czech Republic

Zobrazit více v PubMed

Stewart M. Roma and Gypsy “Ethnicity” as a Subject of Anthropological Inquiry. Annu. Rev. Anthr. 2013;42:415–432. doi: 10.1146/annurev-anthro-092010-153348. DOI

Olesen C.L., Karlsson L.E. Roma Representation in Danish Roma Policy and Public Discourse—A Critical Analysis. Societies. 2018;8:63. doi: 10.3390/soc8030063. DOI

Alexiadou E.A. Ethnic Diversity and Access to Healthcare from a Human Rights Perspective: The Case of the Roma in Europe. Eur. J. Health Law. 2018;25:261–283. doi: 10.1163/15718093-12530367. DOI

Sándor J., Pálinkás A., Vincze F., Kovacs N., Sipos V., Kőrösi L., Falusi Z., Pál L., Fürjes G., Papp M., et al. Healthcare Utilization and All-Cause Premature Mortality in Hungarian Segregated Roma Settlements: Evaluation of Specific Indicators in a Cross-Sectional Study. Int. J. Environ. Res. Public Health. 2018;15:1835. doi: 10.3390/ijerph15091835. PubMed DOI PMC

Roma People: 10 Ways Europe’s Biggest Minority Faces Discrimination. [(accessed on 11 April 2020)]; Available online: https://www.reuters.com/article/us-global-roma-rights/roma-people-10-ways-europes-biggest-minority-faces-discrimination-idUSKCN1RK01Y.

Drazilova S., Janičko M., Kristian P., Schreter I., Halanova M., Urbančíková I., Geckova A.M., Mareková M., Pella D., Jarcuska P., et al. Prevalence and Risk Factors for Hepatitis B Virus Infection in Roma and Non-Roma People in Slovakia. Int. J. Environ. Res. Public Health. 2018;15:1047. doi: 10.3390/ijerph15051047. PubMed DOI PMC

Condon L., Bedford H., Ireland L., Kerr S., Mytton J., Richardson Z., Jackson C. Engaging Gypsy, Roma, and Traveller Communities in Research: Maximizing Opportunities and Overcoming Challenges. Qual. Health Res. 2019;29:1324–1333. doi: 10.1177/1049732318813558. PubMed DOI PMC

Islam S., Small N., Bryant M., Yang T.C., De Chavez A.C., Saville F., Dickerson J. Addressing obesity in Roma communities: A community readiness approach. Int. J. Hum. Rights Health. 2019;12:79–90. doi: 10.1108/IJHRH-06-2018-0038. DOI

Belak A., Geckova A.M., Van Dijk J.P., Reijneveld S.A. Why don’t segregated Roma do more for their health? An explanatory framework from an ethnographic study in Slovakia. Int. J. Public Health. 2018;63:1123–1131. doi: 10.1007/s00038-018-1134-2. PubMed DOI PMC

Janka E.A., Vincze F., Ádány R., Sándor J. Is the Definition of Roma an Important Matter? The Parallel Application of Self and External Classification of Ethnicity in a Population-Based Health Interview Survey. Int. J. Environ. Res. Public Health. 2018;15:353. doi: 10.3390/ijerph15020353. PubMed DOI PMC

Weiss E., Japie C., Balahura A.M., Bartoş D., Bădilă E. Cardiovascular risk factors in a Roma sample population from Romania. Rom. J. Intern. Med. 2018;56:193–202. doi: 10.2478/rjim-2018-0010. PubMed DOI

Ciaian P., Cupák A., Pokrivčák J., Rizov M. Food consumption and diet quality choices of Roma in Romania: A counterfactual analysis. Food Secur. 2018;10:437–456. doi: 10.1007/s12571-018-0781-8. DOI

Šedová L., Tothova V., Nováková D., Olišarová V., Bártlová S., Dolák F., Kajanová A., Prokešová R., Adámkova V. Qualification of Food Intake by the Roma Population in the Region of South Bohemia. Int. J. Environ. Res. Public Health. 2018;15:386. doi: 10.3390/ijerph15020386. PubMed DOI PMC

Olišarová V., Tothova V., Bártlová S., Dolák F., Kajanová A., Nováková D., Prokešová R., Šedová L. Cultural Features Influencing Eating, Overweight, and Obesity in the Roma People of South Bohemia. Nutrients. 2018;10:838. doi: 10.3390/nu10070838. PubMed DOI PMC

Second European Union Minorities and Discrimination Survey. [(accessed on 15 April 2020)];2016 Available online: https://fra.europa.eu/sites/default/files/fra_uploads/fra-2016-eu-minorities-survey-roma-selected-findings_en.pdf.

Robayo-Abril M., Millan N. Breaking the Cycle of Roma Exclusion in the Western Balkans. [(accessed on 15 April 2020)]; Available online: http://documents.worldbank.org/curated/en/642861552321695392/pdf/Breaking-the-Cycle-of-Roma-Exclusion-in-the-Western-Balkans.pdf.

Carlo A. We Need to Talk About the Rising Wave of Anti-Roma Attacks in Europe. [(accessed on 15 April 2020)]; Available online: https://www.independent.co.uk/voices/roma-antiziganist-romani-discrimination-italy-matteo-salvini-ukraine-a9024196.html.

George S., Daniels K., Fioratou E. A qualitative study into the perceived barriers of accessing healthcare among a vulnerable population involved with a community centre in Romania. Int. J. Equity Health. 2018;17:41. doi: 10.1186/s12939-018-0753-9. PubMed DOI PMC

Aiello E., Flecha A., Serradell O. Exploring the Barriers: A Qualitative Study about the Experiences of Mid-SES Roma Navigating the Spanish Healthcare System. Int. J. Environ. Res. Public Health. 2018;15:377. doi: 10.3390/ijerph15020377. PubMed DOI PMC

La Parra-Casado D., Mosquera P.A., Vives-Cases C., Sebastian M.S. Socioeconomic Inequalities in the Use of Healthcare Services: Comparison between the Roma and General Populations in Spain. Int. J. Environ. Res. Public Health. 2018;15:121. doi: 10.3390/ijerph15010121. PubMed DOI PMC

Vivian C., Dundes L. The crossroads of culture and health among the Roma (Gypsies) J. Nurs. Sch. 2004;36:86–91. doi: 10.1111/j.1547-5069.2004.04018.x. PubMed DOI

Millan M., Smith D. A Comparative Sociology of Gypsy Traveller Health in the UK. Int. J. Environ. Res. Public Health. 2019;16:379. doi: 10.3390/ijerph16030379. PubMed DOI PMC

Balint C. Assessment of the Interrelations between Health and Housing Conditions in a Hungarian Roma Settlement. [(accessed on 15 March 2020)];Deteurope. 2018 10 Available online: http://www.deturope.eu/index.php?navi=101&vol=29.

Kovac V., Gavurová B. Impact of infrastructure on mortality in marginalised and segregated communities in the Slovak Republic. Central Eur. J. Public Health. 2017;25(Suppl. 2):S44–S50. doi: 10.21101/cejph.a4959. PubMed DOI

Belak A., Veselska Z.D., Geckova A.M., Van Dijk J.P., Reijneveld S.A. How Well Do Health-Mediation Programs Address the Determinants of the Poor Health Status of Roma? A Longitudinal Case Study. Int. J. Environ. Res. Public Health. 2017;14:1569. doi: 10.3390/ijerph14121569. PubMed DOI PMC

Del S.P., Coates A.R., Milton J.G., Gómez-Salgado J., Ruiz-Frutos C. Ethnicity and health policy: Building equitable solutions in the face of ethnic inequalities. Rev. Esp. Salud Publica. 2018;92:e201809059. PubMed PMC

Kolvek G., Straussova Z., Majerníková M., Rosenberger J., Van Dijk J.P. Health Differences between Roma and Non-Roma in the Slovak Dialyzed Population. Int. J. Environ. Res. Public Health. 2018;15:360. doi: 10.3390/ijerph15020360. PubMed DOI PMC

Moore S.F. Law and Social Change: The Semi-Autonomous Social Field as an Appropriate Subject of Study. Law Soc. Rev. 1973;7:719–746. doi: 10.2307/3052967. DOI

Weber M. In: On Law in Economy and Society. Rheinstein M., editor. Simon and Schuster, a Clarion Book; New York, NY, USA: 1954.

Pek D. The Role of Semi-Autonomous Social Fields in the Transformation of Disputes with a Focus on Dispute Resolution (Naming, Blaming, Claiming) [(accessed on 20 January 2020)]; Available online: https://www.academia.edu/19522686/The_role_of_semi-autonomous_social_fields_in_the_transformation_of_disputes_with_a_focus_on_dispute_resolution_naming_blaming_claiming_.

Costa E., Giardini A., Savin M., Menditto E., Lehane E., Laosa O., Pecorelli S., Monaco A., Marengoni A. Interventional tools to improve medication adherence: Review of literature. Patient Prefer. Adherence. 2015;9:14. doi: 10.2147/PPA.S87551. PubMed DOI PMC

Godefroy R., Chaud P., Ninove L., Dina J., Decoppet A., Casha P., Hraiech S., Brouqui P., Cassir N., Julia D. Measles outbreak in a French Roma community in the Provence-Alpes-Côte d’Azur region, France, May to July 2017. Int. J. Infect. Dis. 2018;76:97–101. doi: 10.1016/j.ijid.2018.08.023. PubMed DOI

Howse R., Teitel R. Beyond Compliance: Rethinking Why International Law Really Matters. Glob. Policy. 2010;1:127–136. doi: 10.1111/j.1758-5899.2010.00035.x. DOI

Evangelista L.S. Compliance: A concept analysis. Nurs. Forum. 1999;34:5–11. doi: 10.1111/j.1744-6198.1999.tb00230.x. PubMed DOI

Ingram T.L. Compliance: A Concept Analysis. Nurs. Forum. 2009;44:189–194. doi: 10.1111/j.1744-6198.2009.00142.x. PubMed DOI

Playle J. Concepts of compliance: Understandings and approaches. Br. J. Fam. Plan. 2000;26:213–219. doi: 10.1783/147118900101194823. PubMed DOI

Stover R.V., Brown D.W. Understanding compliance and noncompliance with law: The contributions of utility theory. Soc. Sci. Q. 1975;56:363–375.

Rafii F., Fatemi N.S., Danielson E., Johansson C.M., Modanloo M. Compliance to treatment in patients with chronic illness: A concept exploration. Iran. J. Nurs. Midwifery Res. 2014;19:159–167. PubMed PMC

Trainor G. Importance of Compliance in Business. [(accessed on 2 December 2019)]; Available online: https://www.howtolearn.com/2012/08/importance-of-compliance-in-business/

Williams D. What Is Corporate Compliance and Why It’s Important. [(accessed on 2 December 2019)]; Available online: https://www.powerdms.com/blog/what-corporate-compliance-is-why-compliance-is-important/

What Is Legal Compliance? [(accessed on 2 December 2019)]; Available online: https://legal.thomsonreuters.com/en/insights/learn/what-is-legal-compliance.

What Is Compliance? [(accessed on 2 December 2019)]; Available online: https://www.int-comp.org/careers/a-career-in-compliance/what-is-compliance/

Kingsbury B. The concept of compliance as a function of competing conceptions of international law. Mich. J. Int. Law. 1998;19:345–372.

Guzman A.T. A Compliance-Based Theory of International Law. Calif. Law Rev. 2002;90:1823–1887. doi: 10.2307/3481436. DOI

Von Stein J. International Law: Understanding Compliance and Enforcement. Int. Stud. Encycl. 2010 doi: 10.1111/b.9781444336597.2010.x. DOI

Pavlikova B., Van Dijk J.P. The Framework Convention on Tobacco Control in Slovakia and in Finland: One law, two different practices? BMC Int. Health Hum. Rights. under review. PubMed PMC

Ajzen I. From Intentions to Actions: A Theory of Planned Behavior. In: Kuhl J., Beckmann J., editors. Action Control. Springer; Berlin/Heidelberg, Germany: 1985. pp. 11–39. (SSSP Springer Series in Social Psychology). DOI

Belak A. The Health of Segregated Roma: First-Line Views and Practices: A Case Study in Slovakia Using Ethnographic Methods. University of Groningen; Groningen, The Netherlands: 2019. 241p. DOI

Belak A., Geckova A.M., Van Dijk J.P., Reijneveld S.A. What Roma nonadherence is likely and what drives it? Reply to Broz and Nunes. Int. J. Public Health. 2019;64:805–807. doi: 10.1007/s00038-019-01250-z. PubMed DOI

Slovak Collection of Laws. [(accessed on 15 January 2020)]; Available online: https://www.slov-lex.sk/web/en.

Access to European Union Law. [(accessed on 15 January 2020)]; Available online: https://eur-lex.europa.eu/

Pathel R.H., Vaghela P.S. Proposed Theoretical Framework for Predicting Green Purchase Intention of Consumers An Extended Theory of Planned Behaviour. [(accessed on 2 December 2019)]; Available online: ttps://www.researchgate.net/publication/328047991_Proposed_Theoretical_Framework_for_Predicting_Green_Purchase_Intention_of_Consumers_An_Extended_Theory_of_Planned_Behaviour.

Ringold D., Orenstein M.A., Wilkens E. The International Bank for Reconstruction and Development. The World Bank; Washington, DC, USA: 2005. Roma in an expanding Europe: Breaking the poverty cycle.

Phelan J.C., Link B.G. Is Racism a Fundamental Cause of Inequalities in Health? Annu. Rev. Sociol. 2015;41:311–330. doi: 10.1146/annurev-soc-073014-112305. DOI

EUFRA A Persisting Concern: Anti-Gypsyism as a Barrier to Roma Inclusion. [(accessed on 20 January 2020)]; Available online: https://fra.europa.eu/sites/default/files/fra_uploads/fra-2018-anti-gypsyism-barrier-romainclusion_en.pdf.

Kende A., Hadarics M., Lášticová B. Anti-Roma attitudes as expressions of dominant social norms in Eastern Europe. Int. J. Intercult. Relations. 2017;60:12–27. doi: 10.1016/j.ijintrel.2017.06.002. DOI

Dressler W.W., Oths K.S., Gravlee C. Race and ethnicity in public health research: Models to Explain Health Disparities. Annu. Rev. Anthr. 2005;34:231–252. doi: 10.1146/annurev.anthro.34.081804.120505. DOI

Belak A., Geckova A.M., Van Dijk J.P., Reijneveld S.A. Health-endangering everyday settings and practices in a rural segregated Roma settlement in Slovakia: A descriptive summary from an exploratory longitudinal case study. BMC Public Health. 2017;17:128. doi: 10.1186/s12889-017-4029-x. PubMed DOI PMC

Vokó Z., Csépe P., Nemeth R., Kósa K., Kosa Z., Széles G., Ádány R. Does socioeconomic status fully mediate the effect of ethnicity on the health of Roma people in Hungary? J. Epidemiol. Community Health. 2009;63:455–460. doi: 10.1136/jech.2008.079715. PubMed DOI

Majdan M., Coman A., Gallová E., Ďuricová J., Kállayová D., Kvaková M., Bošák L. Assessment of the indoor environment and implications for health in Roma villages in Slovakia and Romania. Cent. Eur. J. Public Health. 2012;20:199–207. doi: 10.21101/cejph.a3719. PubMed DOI PMC

Kolarčik P., Geckova A.M., Orosova O., Van Dijk J.P., Reijneveld S.A. Predictors of health-endangering behaviour among Roma and non-Roma adolescents in Slovakia by gender. J. Epidemiol. Community Health. 2010;64:1043–1048. doi: 10.1136/jech.2009.092098. PubMed DOI

Young H.M., Lierman L., Powell-Cope G., Kasprzyk D., Benoliel J.Q. Operationalizing the theory of planned behavior. Res. Nurs. 1991;50:179–211. doi: 10.1002/nur.4770140208. PubMed DOI

Al-Swidi A., Huque S.M.R., Hafeez M.H., Shariff M.N.M. The role of subjective norms in theory of planned behavior in the context of organic food consumption. Br. Food J. 2014;116:1561–1580. doi: 10.1108/BFJ-05-2013-0105. DOI

Kósa Z., Széles G., Kardos L., Kósa K., Németh R., Országh S., Fésüs G., McKee M., Ádány R., Vokó Z. A Comparative Health Survey of the Inhabitants of Roma Settlements in Hungary. Am. J. Public Health. 2007;97:853–859. doi: 10.2105/AJPH.2005.072173. PubMed DOI PMC

Ham M., Jeger M., Ivković A.F. The role of subjective norms in forming the intention to purchase green food. Econ. Res. 2015;28:738–748. doi: 10.1080/1331677X.2015.1083875. DOI

Santiago-Portero M.C., Gómez-García J.M., Reig-Gómez H., Oltra-Durá T., Gascón-Cánovas J.J. Conocimientos, creencias y actitudes de la población gitana ante el cribado del cáncer colorrectal. Gac. Sanit. 2018;32:11–17. doi: 10.1016/j.gaceta.2017.08.007. PubMed DOI

Simpson D., Shah K. The Roma: A Thousand Years of Discrimination Continues in Europe, Advocates Say. [(accessed on 14 April 2020)]; Available online: https://edition.cnn.com/2013/10/21/world/europe/roma-discrimination/index.html.

Bandura A. Self-efficacy mechanism in human agency. Am. Psychol. 1982;37:122–147. doi: 10.1037/0003-066X.37.2.122. DOI

Schneeweis A. Constructing the Roma audience: Public health communication and intervention in contemporary Romania. Crit. Public Health. 2011;21:297–312. doi: 10.1080/09581596.2010.508102. DOI

Schneeweis A. Power, Gender, and Ethnic Spaces. J. Commun. Inq. 2016;1:88–105. doi: 10.1177/0196859915606975. DOI

Babinská I., Geckova A.M., Jarcuska P., Pella D., Mareková M., Stefková G., Veselská Z.D. Does the Population Living in Roma Settlements Differ in Physical Activity, Smoking and Alcohol Consumption from the Majority Population in Slovakia? Central Eur. J. Public Health. 2014;22:22–27. doi: 10.21101/cejph.a3897. PubMed DOI

Sárváry A., Kósa Z., Jávorné R.E., Gyulai A., Takács P., Sándor J., Sárváry A., Németh Á., Halmai R., Ádány R. Socioeconomic status, health related behaviour, and self-rated health of children living in Roma settlements in Hungary. Central Eur. J. Public Health. 2019;27:24–31. doi: 10.21101/cejph.a4726. PubMed DOI

Pappa E., Chatzikonstantinidou S., Chalkiopoulos G., Papadopoulos A., Niakas D. Health-Related Quality of Life of the Roma in Greece: The Role of Socio-Economic Characteristics and Housing Conditions. Int. J. Environ. Res. Public Health. 2015;12:6669–6681. doi: 10.3390/ijerph120606669. PubMed DOI PMC

Kolarčik P., Geckova A.M., Reijneveld S.A., Van Dijk J.P. The mediating effect of discrimination, social support and hopelessness on self-rated health of Roma adolescents in Slovakia. Int. J. Equity Health. 2015;14:137. doi: 10.1186/s12939-015-0270-z. PubMed DOI PMC

Bobakova D.F., Veselska Z.D., Babinska I., Klein D., Geckova A.M., Čisláková L., Team H.-M. Differences between Roma and non-Roma in how social support from family and friends helps to overcome health care accessibility problems. Int. J. Equity Health. 2015;14:37. doi: 10.1186/s12939-015-0165-z. PubMed DOI PMC

Hanssens L.G.M., Devisch I., Lobbestael J., Cottenie B., Willems S. Accessible health care for Roma: A gypsy’s tale a qualitative in-depth study of access to health care for Roma in Ghent. Int. J. Equity Health. 2016;15:38. doi: 10.1186/s12939-016-0327-7. PubMed DOI PMC

Bobakova D.F. Challenges for research, policy and practice in the field of Roma health. Int. J. Public Health. 2019;64:645–646. doi: 10.1007/s00038-019-01254-9. PubMed DOI

Ramos-Morcillo A.J., Leal-Costa C., Hueso-Montoro C., Del-Pino-Casado R., Ruzafa-Martínez M. Concept of Health and Sickness of the Spanish Gypsy Population: A Qualitative Approach. Int. J. Environ. Res. Public Health. 2019;16:4492. doi: 10.3390/ijerph16224492. PubMed DOI PMC

Miranda D., Ramírez M.G., Balcazar F.E., Suarez-Balcazar Y. A Community-Based Participatory Action Research for Roma Health Justice in a Deprived District in Spain. Int. J. Environ. Res. Public Health. 2019;16:3722. doi: 10.3390/ijerph16193722. PubMed DOI PMC

Othman A.K., Kiviniemi M.T., Wu Y.-W.B., Lally R.M. Influence of demographic factors, knowledge, and beliefs on Jordanian women’s intention to undergo mammography screening. J. Nurs. Sch. 2012;44:19–26. doi: 10.1111/j.1547-5069.2011.01435.x. PubMed DOI PMC

Sialubanje C., Massar K., Hamer D.H., Ruiter R.A.C. Understanding the psychosocial and environmental factors and barriers affecting utilization of maternal healthcare services in Kalomo, Zambia: A qualitative study. Health Educ. Res. 2014;29:521–532. doi: 10.1093/her/cyu011. PubMed DOI

Balozi M.A., Othman S.Z., Isa M.F.M. Mediation Effects of Subjective Norms on the Relationship between Career Advancement and Job Characteristics and Knowledge Sharing Behavior among the Tanzanian Healthcare Professionals. Gadjah Mada Int. J. Bus. 2018;20:187–203. doi: 10.22146/gamaijb.23740. DOI

Zhao Y., Ni Q., Zhou R. What factors influence the mobile health service adoption? A meta-analysis and the moderating role of age. Int. J. Inf. Manag. 2018;43:342–350. doi: 10.1016/j.ijinfomgt.2017.08.006. DOI

Martinez L.S., Lewis N. The Moderated Influence of Perceived Behavioral Control on Intentions Among the General U.S. Population: Implications for Public Communication Campaigns. J. Health Commun. 2016;21:1006–1015. doi: 10.1080/10810730.2016.1204378. PubMed DOI PMC

Dauvrin M., Lorant V. Cultural competence and social relationships: A social network analysis. Int. Nurs. Rev. 2017;64:195–204. doi: 10.1111/inr.12327. PubMed DOI

Abdikeeva A., Covaci A. The Impact of Legal Advocacy Strategies to Advance Roma Health: The Case of Macedonia. [(accessed on 1 February 2020)];Health Hum. Rights. 2017 19:99. Available online: https://www.hhrjournal.org/2017/12/the-impact-of-legal-advocacy-strategies-to-advance-roma-health-the-case-of-macedonia/ PubMed PMC

Belak A., Filakovska Bobakova D. Slovak approach to improvement of the national health-promotion interventions for segregated Roma. Eur. J. Public Health. 2018;28:cky218.183. doi: 10.1093/eurpub/cky218.183. DOI

Smoking is a Risk Factor for Generation Z, Too: The Evolution of the Attitudes