A participatory approach to increase HPV vaccination in marginalized Roma communities in Slovakia

BACKGROUND: Roma living in marginalized communities are among underserved groups facing limited access to vaccination services. The RIVER-EU in Slovakia aims to identify and tailor the intervention to address health system barriers to HPV vaccination faced by people from marginalized Roma communities. METHODS: Following principles of participatory action research, a wide spectrum of stakeholders was engaged to discuss the transferability of promising evidence-based interventions. Interviews and focus groups aimed to assess the suitability of interventions and identify barriers and facilitators for the transfer and implementation taking contextual characteristics into account. RESULTS: Key stakeholders included community members (parents and daughters), Roma health mediators, healthcare providers, policymakers, and representatives of the municipality, school, and public health authority. The most challenging was to engage community members as they had almost no information about the HPV vaccination. Building relationships and trust with communities require intensive cooperation with field services, time and energy. Engaging primary care providers was difficult due to their restricted capacities and work overload causing their motivation to engage in time-consuming collaborative processes to be low. Successful engagement of all stakeholders required concentrated efforts and specific strategies of the research team. CONCLUSIONS: Active participation of all those who will be affected by the intervention and those whose cooperation will be necessary for successful implementation requires to engage keep on board a number of stakeholders holding different opinions. Facilitating consensus about the design of tailored intervention requires intense communication and revisiting the ongoing integration of emerging ideas until the consensus is reached. It is a responsibility of a researcher to ensure that at the end of the process, all voices are heard and all needs are met.