Improving Roma Women’s Health in Greece: A Comprehensive Health Promotion and Prevention Program

Abstract Roma people remain one of the most vulnerable groups in Europe and in Greece, as they continue to face difficult living conditions and discrimination in access to health, social protection, employment and adequate housing. The health of Roma women is highly vulnerable, with high rates of pregnancy and maternal complications, chronic conditions and mental health problems reported. In response, a comprehensive health promotion and disease prevention programme has been implemented in different Roma settlements across Greece, with a focus on rural and isolated areas. The project aims to strengthen women's agency over their health and improve health literacy, health-related behaviours and outcomes by combining culturally sensitive education with access to preventive services, including cervical and breast cancer screening and HPV vaccination. Participatory methods are embedded throughout the project cycle. Focus groups were used to inform the development of training materials and communication tools, ensuring cultural relevance and alignment with the community's needs and concerns. These methods have also been central to process evaluation throughout the project implementation. The real-time process evaluation using participatory tools has guided important adaptations to recruitment strategies, service delivery approaches, and communication methods, especially around cancer screening and vaccination. These adjustments have significantly improved outreach and participation, demonstrating the value of incorporating community feedback into health intervention delivery. Projects targeting vulnerable groups are often challenging, as real-life and on-site conditions influence implementation. Integrating participatory methods into process evaluation helps ensure that approaches remain responsive and adapted to evolving needs.