Barriers to primary health care: perspectives of marginalized Roma women and healthcare professionals

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.