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Outreach is important to improving Gypsy and Traveller health; new research findings

Helen Jones's picture
By Helen Jones |  August 11, 2014 |

Outreach is important to improving Gypsy and Traveller healthHealth outreach for Gypsy, Roma and Traveller Communities

Researchers from Northumbria University share the results from an evidence review.

Who we are and what we did.

Hello, we are a team of researchers at Northumbria University. We’d like to share the results of a project we recently completed that explored whether outreach is a good way of delivering health services to Gypsy, Roma and Traveller Communities.

Outreach is any service that is adapted and taken to groups who may experience barriers to accessing health care. We were interested in finding out which types of outreach work, when they work, and why. We hope that the results of this project will inform decisions about the types of outreach that are most useful to Gypsy, Roma and Traveller Communities in improving their health.

In order to help us to answer these questions, we searched for reports and articles written about Traveller Communities and outreach projects. We were also really pleased to talk to Gypsy, Roma and Traveller Community members and organisations, outreach workers, and health service providers. Their experiences and feedback helped us understand more about what makes outreach work, as well as test out and refine the results of the study.

What we found

While there were lots of reports on the health needs of Traveller Communities, there were very few about outreach projects to improve health and access to services.

We found that different outreach services could be provided by workers depending on their connections with the community. The amount of trust in outreach workers was an important influence on the success of outreach. Trust was developed as a result of history of working in the community, and pre-existing connections with the communities receiving outreach. Many Traveller Community members reported experiencing discrimination and this was an important context surrounding outreach interventions. 

Where outreach workers had not established trust with communities, it was imperative that they negotiated the focus of outreach work and responded to expressed needs in order to demonstrate their reliability and build trust over time. This often involved assisting community members with broader and more immediate concerns than those traditionally addressed by health workers (e.g. support finding accommodation). For outreach workers who were highly trusted and sometimes influential within communities, the need to negotiate the focus of the intervention lessened. Their position within and knowledge of the community often meant they were able to foster a greater level of engagement, promoting changes in beliefs, attitudes and behaviours towards health issues. However, community members we spoke to also reminded us that outreach workers are not automatically trusted as a result of their being from the community, and that there could be divisions within Traveller Communities, as in any other group.

Voluntary and community organisations with long-standing relationships with Traveller Communities were found to have a ‘trusted brand’ that facilitated early engagement, and which make them well placed to deliver outreach services. Through their links with wider statutory services, these organisations are also able to support community development.

The report of the domestic violence project undertaken by Leeds GATE was included in our study. This helped us to understand how community members can be influential in increasing awareness and facilitating discussion about sensitive issues, as well as how the established reputation of Leeds GATE as a trusted organisation enabled the project to run.

What do the results mean for policy and practice?

There is a need to be clear at the outset of designing and delivering outreach about the expected outcomes, and consideration given to the outreach workers best placed to achieve them. Where outreach is aiming to promote one off participation in an event or address the needs expressed by community members, the worker may not need to have an established relationship of trust. However, objectives of community development or changes in health attitudes or behaviours are more likely to be achieved if they build on established relationships of trust.

The development of trust takes time and requires sustained funding. There may also be a considerable time gap between engagement with outreach interventions and evidence of changes in health outcomes. Engagement with outreach interventions is an important outcome in itself, and should be considered alongside longer term health outcomes when considering the effectiveness of outreach programmes.

Acknowledgements: We wish to thank the Roma, Gypsy and Traveller Community members and organisations, outreach workers and health providers who assisted us with refining and interpreting the results, as well as our co-authors of the report: Mark Pennington, Angus Bancroft, Jean Adams and Susan Michie.

This project was funded by the National Institute for Health Research Public Health Research Programme (project number 10/3004/02)

Thanks very much for reading about the study,
Susan M Carr, Monique Lhussier, Natalie Forster, Deborah Goodall, Lesley Geddes

If you have any comments about the study or would like more information about it, please get in touch with us: Email: natalie2.forster@northumbria.ac.uk

Tel: 01912156498

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