BACKGROUND: Marginalized Roma communities (MRCs) in Slovakia experience longstanding exclusion from essential services, including healthcare. Roma women, in particular, face compounded vulnerabilities that contribute to unequal access and poorer health outcomes. Despite increasing attention to these issues, a deeper understanding of the lived experiences that shape healthcare access in MRCs remains necessary. METHODS: A qualitative study was conducted using semi-structured interviews with 13 Roma mothers living in MRCs and 13 professionals working in healthcare, public health, or policy, including six of Roma origin. Data were analyzed using consensual qualitative research and thematic analysis to identify significant access barriers. RESULTS: Roma women face multiple, often interconnected barriers to accessing healthcare, many of which are rooted in longstanding structural inequalities. These include distrust of the health system stemming from prior discrimination, difficulties in understanding health-related information and navigating the system, and financial hardship. On the side of healthcare providers, barriers involve shortages in the healthcare workforce, poor care coordination, and discriminatory attitudes. CONCLUSIONS: Improving access to healthcare for Roma women requires a comprehensive, multi-level strategy. Efforts should focus on building trust, improving communication, addressing financial and systemic obstacles, and investing in culturally sensitive primary care. Health promotion assistants play a crucial role in bridging the gaps between communities and healthcare providers. Culturally sensitive healthcare interventions and inclusive policies are essential to reducing health disparities and promoting equitable access. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-025-13482-2.

• Keywords
• Discrimination, Financial vulnerability, Health literacy, Healthcare access, Healthcare workforce, Marginalized Roma communities, Responsiveness of healthcare system, Roma women,
• Publication type
• Journal Article MeSH

BACKGROUND: Infant mortality rates are reliable indices of the child and general population health status and health care delivery. The most critical factors affecting infant mortality are socioeconomic status and ethnicity. The aim of this study was to assess the association between socioeconomic disadvantage, ethnicity, and perinatal, neonatal, and infant mortality in Slovakia before and during the COVID-19 pandemic. METHODS: The associations between socioeconomic disadvantage (educational level, long-term unemployment rate), ethnicity (the proportion of the Roma population) and mortality (perinatal, neonatal, and infant) in the period 2017-2022 were explored, using linear regression models. RESULTS: The higher proportion of people with only elementary education and long-term unemployed, as well as the higher proportion of the Roma population, increases mortality rates. The proportion of the Roma population had the most significant impact on mortality in the selected period between 2017 and 2022, especially during the COVID-19 pandemic (2020-2022). CONCLUSIONS: Life in segregated Roma settlements is connected with the accumulation of socioeconomic disadvantage. Persistent inequities between Roma and the majority population in Slovakia exposed by mortality rates in children point to the vulnerabilities and exposures which should be adequately addressed by health and social policies.

• Keywords
• Ethnicity, Infant mortality, Neonatal mortality, Perinatal mortality, Roma, Socioeconomic disadvantage,
• MeSH
• COVID-19 MeSH
• Ethnicity statistics & numerical data   MeSH
• Infant MeSH
• Infant Mortality * ethnology   trends   MeSH
• Humans MeSH
• Infant, Newborn MeSH
• Perinatal Mortality * ethnology   trends   MeSH
• Roma * statistics & numerical data   MeSH
• Socioeconomic Factors * MeSH
• Socioeconomic Disparities in Health MeSH
• Pregnancy MeSH
• Check Tag
• Infant MeSH
• Humans MeSH
• Male MeSH
• Infant, Newborn MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Geographicals
• Slovakia epidemiology   MeSH

BACKGROUND: This study aims to assess which measures could improve the healthy early childhood development of children from marginalized Roma communities and to identify priority measures. METHODS: Concept mapping approach was used, using mixed methods. In total 54 professionals, including social workers, educators, health care providers, municipality representatives, and project managers participated in our study. RESULTS: Four distinct clusters of measures targeting living conditions, public resources, healthcare and community interventions, and 27 individual priority measures of highest urgency and feasibility were identified. The cluster 'Targeting living conditions', was rated as the most urgent but least feasible, whereas the cluster 'Targeting health care', was considered least urgent but most feasible. Among the 27 priority measures, 'Planning parenthood' and 'Scaling up existing projects' had the highest priority. CONCLUSION: Our results reflect the public and political discourse and indicate significant barriers to implementation. Reducing inequalities in early childhood needs to be addressed through coordinated efforts.

• Keywords
• Early childhood development, Inequalities, Marginalized Roma communities,
• MeSH
• Child MeSH
• Humans MeSH
• Delivery of Health Care MeSH
• Child, Preschool MeSH
• Roma * MeSH
• Social Workers MeSH
• Health Status MeSH
• Health Personnel MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Child, Preschool MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

BACKGROUND: Half of the people living in social exclusion in the Czech Republic are of Roma origin. The worse health of Roma could be partly explained by numerous barriers to accessing health care. Therefore, our study aimed to explore the perceptions of various stakeholders and experts who may have an impact on the inclusion of Roma and/or their access to health care on how to improve health care access for Roma living in social exclusion in the Czech Republic. METHODS: We conducted a concept mapping study and obtained data from 32 participants from health and social services, policymakers and others who were involved in different study phases (brainstorming, sorting, rating, interpretation). RESULTS: Out of 64 proposed measures sorted into six distinct clusters, 20 were rated as the most urgent and the most feasible and should be implemented with a priority to improve access to health care for Roma living in social exclusion. The proposed measures covered various topics, such as education and awareness of the target group as well as education and supervision of helping professionals, strengthening capacities and streamlining the health care system, health promotion and associated services and increasing the local and financial accessibility of health care. Overall, measures concerning the education and supervision of helping professionals were rated as both the most urgent and the most feasible. Individual priority measures targeted, for example, the health needs assessment of Roma living in social exclusion to set up interventions or to include topics such as participation, empowerment, cultural competence and communication training in the curricula of health care and helping professionals in postgraduate and continuing studies. CONCLUSIONS: Stakeholders proposed a set of relevant and acceptable measures that may help improve access to health care for Roma living in social exclusion. The way they rated the proposed measures reflects both the current unfavourable mainstream and public discourse concerning Roma living in social exclusion and the most acute policy issues identified by several European and national bodies.

• Keywords
• Concept mapping, Czech Republic, Ethnicity, Health care access, Interventions, Policies, Roma, Vulnerable population,
• MeSH
• Healthcare Disparities MeSH
• Adult MeSH
• Health Services Accessibility * MeSH
• Culturally Competent Care * MeSH
• Cultural Competency MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Delivery of Health Care * MeSH
• Spatial Analysis MeSH
• Roma * MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Social Inclusion MeSH
• Social Isolation MeSH
• Concept Formation MeSH
• Health Policy MeSH
• Health Facilities MeSH
• Vulnerable Populations MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Geographicals
• China MeSH