Romani girls matter: developing a participatory action research protocol for reproductive justice

Citation: Soto-Ponce, B.; Garcia-Ramirez, M.; Jiménez, L. Romani Girls Matter: Developing a Participatory Action Research Protocol for Reproductive Justice. Healthcare 2023,11, 755. https:// doi.org/10.3390/healthcare11050755 Received: 7 February 2023 Revised: 27 February 2023 Accepted: 1 March 2023 Published: 4 March 2023 Copyright: © 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). healthcare Protocol Romani Girls Matter: Developing a Participatory Action Research Protocol for Reproductive Justice Belen Soto-Ponce 1,* , Manuel Garcia-Ramirez 1and Lucía Jiménez 2 1CESPYD, Department of Social Psychology, University of Seville, 41018 Sevilla, Spain 2Department of Developmental and Educational Psychology, University of Seville, 41018 Sevilla, Spain *Correspondence: [email protected] Abstract: Despite the last few decades’ advances towards social and gender justice, reproductive decisions are still a source of oppression for many European Romani women and girls. This protocol aims to propose a model to empower Romani women and girls’ reproductive decisions, inspired by Reproductive Justice—the recognition of women and girls’ ability to make safe and free decisions about their bodies and reproduction. Through Participatory Action Research, 15–20 Romani girls and their families, two Romani platforms, and key agents from a rural and an urban context in Spain will participate. They will (1) contextualize Romani women and girls’ inequities, (2) build partnerships, (3) implement Photovoice and advocate for their gender rights, and (4) assess the initiative’s related changes, using self-evaluation techniques. Qualitative and quantitative indicators will be collected to assess impacts among participants, while tailoring and assuring the quality of the actions. Expected outcomes include the creation and consolidation of new social networks, and the promotion of Romani women and girls’ leadership. For this, Romani organizations must be transformed into empowering settings for their communities, spaces where Romani women and girls assume responsibility of the initiatives, being these tailored to their real needs and interests, and guaranteeing transformative social changes. Keywords: Romani girls; reproductive justice; participatory action research; Photovoice; sense of mattering 1. Introduction Health inequities suffered by European Romani women are regularly linked to their early reproductive decisions (RD) [ 1 – 3 ]. Known as the largest European ethnic minority group, it is estimated that 11 million Romani are living on the European continent. They are a young population; partly because they tend to have many children, and partly because they have a life expectancy 15 years lower than the rest of the population [ 4 ]. Even with the great advances that Europe has made in gender justice, today, many Romani women and girls (RWG)—just as centuries ago—are living in the margins of society [ 5 ]. RWG’s reproductive decisions have been clearly affected by antigypsyism policies, such as those that forced Romani women’s sterilizations in many European countries [ 6 ]. Moreover, other antigypsyism mechanisms convert RD into sources of structural oppression, including substandard housing conditions, unresponsive healthcare, violence and stigma, scarce education from early childhood, and vast obstacles to accessing a regular labor market. These mechanisms push some Romani girls to view their womanhood as being linked to marriage, rearing children, caregiving and housekeeping, and they end up viewing these as the only way to matter to their families and communities [7–10]. Huge efforts have been carried out in attempts to overcome gendered inequities. Often, these have been based on the assumption that solutions would come from RWG’s access to sex education, reproductive literacy, contraceptive measures, and family planning services [ 11 ]. Although the initiatives were based on scientific evidence and agreed upon by Healthcare 2023,11, 755. https://doi.org/10.3390/healthcare11050755 https://www.mdpi.com/journal/healthcare Healthcare 2023,11, 755 2 of 16 academics, policymakers, and service providers, they have not only been unable to reverse the issues, but they have sometimes aggravated them. In fact, instead of achieving the expected results, these initiatives have been rejected by Romani communities [ 11 , 12 ]. Strong evidence highlights that this rejection is due to the weak response to the urgent challenges that RWG confront daily; the lack of harmony with their cultural practices, traditions, and spirituality; and the disregard of Romani strengths developed to face adversity over centuries [ 13 – 15 ]. The lack of recognition of these issues as relevant dimensions to address Romani gendered inequities can be catalogued as slow violence [ 16 ]—understood as diverse and invisible acts entangled in societal, institutional, and community dynamics, such as discrimination, neglect, and marginalization of Romani communities—that perpetuates oppression and inequalities [ 17 ]. These processes lead to the development of new efforts mainly based on ethnocentric patterns, which end up ignoring the roots of RWG’s suffering, and consequently, lack of Romani communities’ support. Such failures uncover the wicked nature of Romani reproduction inequalities, understood as inequities over which there is little agreement on their causes and the best way to address them, and that defy the capacity of any one organization to solve them [ 18 , 19 ]. The limited trust RWG have towards promoters of these initiatives (organizations, institutions, researchers) has provoked their withdrawal, even making them more refractory to future initiatives and feeding feelings of abandonment in the most isolated communities [ 14 , 20 ]. These examples show that Romani women—especially younger ones—were unable to progress in the understanding of the causes of their own suffering, perceiving themselves as entitled to define their life goals, as well as to find and weave alliances within their families and communities to advocate for their rights [21]. As in other health-based wicked inequities (e.g., obesity, tobacco use, COVID vaccination), to overcome reproductive inequities of RWG, there is need for innovative actions in which they become aware about the unfair conditions they, their families, and communities suffer; increasing intra- and intergenerational complicity and solidarity among women; and creating safe community settings for themselves. This article describes a Participatory Action Research protocol, inspired by Reproductive Justice, as the most suitable approach to build safe spaces that facilitate RWG’s empowerment towards their own reproductive decisions. 1.1. Reproductive Justice for Romani Women and Girls Reproductive Justice (RJ) highlights that RWG’s wellbeing is connected to empowering them to freely make decisions in all their life domains including—but not limited to—their bodies, sexuality, and reproduction, which can be achieved only if they have the necessary resources, as well as sufficient economic, social, and political power [ 22 , 23 ]. On the one side, RJ posits that women and girls must be able to take informed decisions regarding their own lives and aspirations. On the other, it also implies that they must enjoy guaranteed access to resources that facilitate the pursuit of those decisions completely, freely, and safely, while allowing them to obtain recognition and influence [ 24 ]. Reproductive justice arises in the context in which the inequalities suffered by humanity and its environment have paved the way for new proposals driven by new actors claiming legitimacy to new rights. This is the case with structural racism [ 25 ], gender equity [ 26 ], environmental justice [ 27 ], displaced people’s justice [ 28 ], LGTBQ + rights [ 29 ], and indigenous justice [ 30 ], among others. All of the above highlight that current inequities are the result of the intersection of multiple oppressions at multiple levels which manifest as a unique expression in the suffering of silenced and emerging individuals and collectives in their local contexts and communities. Based on the previous assumptions, an RJ approach for RWG highlights some key points. First, Romani girls should be provided with opportunities from the beginning of their lives to separate their mattering from the female traditional roles (i.e., marriage, childrearing, parenting, caregiving) while offering them alternatives and safe corridors to imagine and explore new and free aspirations. Second, it should provide tools and Healthcare 2023,11, 755 3 of 16 competencies to analyze the influence of power structures inside and outside their communities on their RD, and how these could be reproducing sociocultural structures that oppress them. Third, all RWG must have real opportunities to design their lives around their experiences and find and weave sufficient allies to accompany them, give guidance, protection, and emotional support. Fourth, they must have the tools to evaluate their experiences, make decisions, choose new allies for new targets, and have the strength to self-evaluate and know the impact of their actions on the environment. 1.2. Reproductive Justice and Participatory Action Research Participatory Action Research (PAR) is especially relevant to accomplish the above strategies linked to the RJ approach. PAR should offer an ideal scenario to bring stakeholders interested in overcoming RWG inequities together, while the roles are redefined and distributed, power is balanced and shared among participants, and decisions are ultimately taken by RWG [ 21 , 31 ]. However, although PAR initiatives usually state that their purpose is to advance social justice, they often end up concentrating their efforts on providing assistance, capacity building, or ameliorative interventions [ 14 ]. A good example of this has been many initiatives designed and implemented to cope with the turbulences suffered by RWG communities during the COVID pandemic [ 32 ]. Far from offering resources to them to face new challenges and take advantage of new opportunities (e.g., digitalization of their younger ones’ activities), they have pushed them into households and have been unable to prevent them from taking on harsh housework. Online schooling has been an inaccessible pipe dream for many Romani girls; many will never return to school [33]. Some dimensions must be present for PAR to overcome the previously mentioned barriers and become RJ-inspired. RWG must lead the processes that shape the community context, the underlying determinants of inequities and the strengths they have to confront them. While RJ seeks the legitimization of RWG as political actors, PAR must provide opportunities for them to have time and space to recognize and perceive themselves as having the capacity to decide and influence [ 34 , 35 ]. PAR must ensure actions aimed at disentangling the complexity of communities so as not to repeat the same power asymmetries they combat. For example, it is not possible to overcome the conditions of inequality suffered by RWG without taking into account the impact that secularly established and sacralized traditions and customs has had on them [36]. In addition to the former challenge, RWG are often represented in PAR initiatives through community leaders and organizations. Are these representatives free of conflict of interests so that we can ensure that the actions they decide on address the needs of the women and not those of their organizations? RJ calls for ensuring that RWG have “presence, voice, and influence” [ 37 ] (p. 1973) in initiatives that affect their lives so that policy decisions are truly theirs. However, this is not a simple task. RWG suffer dramatic consequences of social inequalities and lack the skills to occupy effective positions in the political arena. The same mechanisms of oppression that co-opt their life projects prevent them from transcending their conditions of alienation, so that it is impossible for women who uncritically accept life patterns rooted in traditional gender roles to imagine alternative life projects. In contrast, a critical vision implies understanding the power dynamics that over time construct the world we know and in which we navigate in our daily lives [ 38 , 39 ]. RJ posits that PAR should aim to facilitate this journey toward constructing a critical view of everyday life and personal experiences [25,40–42]. Building a critical vision of their own realities demands that evaluation components must be placed at the heart of developed initiatives, so that RWG are impelled to (1) identify problems and goals that are important for them; (2) analyze, understand, and prioritize those that are more relevant; (3) choose and decide what actions need to be taken to achieve their proposed goals; and (4) take stock of the contribution of those actions towards their goals, while planning future steps to assure their real impact [ 43 ]. Through evaluation, RWG can use their voices to decide what is important to them, while also ensuring accountability of the actions implemented through the initiatives developed. Healthcare 2023,11, 755 4 of 16 Evaluation components can then become empowering methods for RWG to lead their own initiatives and, as a result, to lead their own life decisions. In summary, RJ impels PAR to build a new Romani womanhood assuming that they are new political actors who have new rights (e.g., civil, political, social, cultural) and need new scenarios for taking new actions (e.g., blogging, protesting, resisting, organizing) to inhabit new spaces in Romani communities [44,45]. Adopting a Reproductive Justice-based Participatory Action Research approach in promoting RWG reproductive decisions is consistent with a mature and sophisticated understanding of generating evidence when supporting children, young people, and families [ 46 ]. From this understanding, the development of evidence-based practices requires the best scientific evidence from applied science in combination with agreed professional experience. Moreover, what is critical in this approach is the reformulation of the “client with preferences” that are considered in the classical definition of evidence into “subjects of rights”. Recognizing intervention participants as rights owners involves establishing relationships between results and rights, a culturally sensitive approach, and placing the voices of children, young people, and families in the center [47]. 1.3. Aim The aim of this paper is to describe a Reproductive Justice Participatory Action Research protocol to empower Romani girls’ reproductive decisions, following the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidelines [48]. This protocol is framed within a strategic framework to implement three initiatives that were funded at Spanish national and regional levels, to advocate for policies and social empowerment to overcome the disparities that RWG suffer. At the national level, call for proposals focused on developing solutions to the challenges of Spanish society; specifically, this initiative aimed to respond to challenges in the field of social psychology and feminist studies, which addressed the study of norms, prejudices, conflict, discrimination and social influence in various social contexts. At the regional level, call for proposals were also aimed at promoting knowledge oriented to the challenges of Andalusian society; in this case, the challenge of health and social well-being of marginalized groups. These call for proposals were framed within the objectives and challenges of the Horizon 2020, focusing on empowering vulnerable groups on the social determinants that limit their well-being. RWG are one of the central axes of many scientific initiatives since the persistent failure in improving their social inclusion in Spain and other European countries. Therefore, this protocol aims to respond to those priorities included within the funding strategies. 2. Materials and Methods 2.1. Study Design This initiative follows PAR; specifically, participants will define their own goals and actions to be taken, in order to achieve those. In the first phase, they will assess problems, needs and assets of their communities, reflecting on their life conditions. They will then determine the actions to be implemented in order to advocate for their rights in their own terms (i.e., preparing exhibits to share on their communities). Lastly, they will evaluate the intervention and its results, taking part in data collection and its analyses [ 49 – 51 ]. Steps to be taken are described below. The design follows a quasi-experimental evaluation multi-site approach with parallel groups (intervention and comparison groups) and two evaluation moments (pre-test and post-test), including process, implementation, and outcome indicators [ 52 ]. The comparison group will not participate in any of the proposed steps nor sessions. They will only participate in baseline and endline interviews, where qualitative and quantitative data will be collected. Healthcare 2023,11, 755 5 of 16 2.2. Study Settings This initiative will be carried out in different settings and facilities located around Romani local communities (e.g., civic centers, schools, streets, city council buildings, etc.) in the regions of Andalucía and Comunidad Foral de Navarra, in southern and northern Spain, respectively. In each region, partnerships and shared resources among local communities, civil society groups, local institutions, and research teams—including researchers from the University of Seville and the Public University of Navarra—will facilitate the proper implementation of the initiative. 2.3. Participants and Recruitment At an individual level, 15–20 Romani girls and their families will be involved in the initiative in each of the local neighborhoods. For the intervention group, the inclusion criteria for Romani girls will be girls who: (1) are between 10 and 14 years old; (2) selfidentify as Romani; (3) have no children; (4) are not pregnant; (5) are attending school; and (6) have untapped leadership potential and ability to work together. These data will be gathered through baseline interviews with Romani girls and their families, including questions regarding sociodemographic data, teamwork skills, and leadership potential. The exclusion criteria will be: (1) having comorbidities or health conditions that could bias the implementation or results of the intervention; (2) those who can commit to attending the sessions or being involved in the project only sporadically; and (3) those for which the intervention can increase risks of adverse events. The comparison group will be composed of Romani girls from similar contexts, with comparable family socio-economic statuses, and in the age range of the girls who will receive intervention. At organizational level, this initiative will include platforms that have strong influence within local Romani communities (Gaz Kalo and Yilo). They will oversee the transferring of their learned knowledge and previous experiences serving local Romani communities to facilitate the implementation of this study, as well as maximize the initiative’s impacts at community, institutional, and policy level. At a community level, contexts and neighborhoods entail diverse Spanish local contexts with high at-risk Romani populations, including marginalized rural contexts (i.e., Mancomunidad de San Adrián, in Comunidad Foral de Navarra) and marginalized urban contexts (i.e., the Torreblanca and Polígono Sur neighborhoods, in Seville). 2.4. Intervention: An Overview RJ-based PAR will be co-designed, implemented, and evaluated along with Romani girls through group sessions within a psychosocial intervention facilitated by Romani women from their local communities. The intervention will be tailored by members of Romani grassroots organizations—specifically, GazKalo and Yilo, already working with participant Romani communities in Mancomunidad de San Adrián and Seville—and academic researchers from each context (researchers from Pamplona, Comunidad Foral de Navarra and researchers from Seville, Andalucía). To achieve this, self-evaluation strategies at organizational, community, and individual levels will be placed at the center of the four RJ-based PAR dimensions (see Table 1) in order for RWG to adopt leading roles in decision-making processes regarding the definition of their aims, actions to be taken, and expected outcomes. Healthcare 2023,11, 755 6 of 16 Table 1. Reproductive justice participatory action research for Romani girls’ mattering. Individual Organizational Community Contextualizing Romani women and girls’ inequities Girls’ life satisfaction, sense of mattering, and agency linked to gender roles. Social convoy based on family ties Mapping organizational settings and narratives, practices, and community influence Life narratives to identity experiences of oppression, resistance, and resilience Building partnerships, alliances, and solidarity Building complicity and alliances between girls, peers, and significant adults Building local coalitions and collaborative capacity with key stakeholders at multiple levels Identifying community assets and influential members within the community Photovoice as an innovative way of doing things Photovoice to envision aspirations and resources to achieve them, planning activities to advocate for their rights Ensuring RWG leadership within organizations, facilitating Photovoice and advocacy activities, and adapting evaluation processes Maximizing the dissemination and impact of advocacy processes at community, institutional, and policy levels Expected changes, outcomes, and impacts Girls and women’s reproductive justice-based mattering, agency, and life satisfaction. Enlarged social convoy Romani women facilitators’ increased recognition in the community, and leadership to design actions, implement, and evaluate initiatives Romani associations as empowering community settings for RWG, radiating influence and leading transformative policy changes based on Romani strengths 2.4.1. Contextualizing Romani Women and Girls’ Inequities Contextualizing Romani girls’ inequities entails mapping Romani adolescents’ psychosocial dimensions linked to gendered identity roles (i.e., satisfaction with life, sense of mattering at family, school, and community levels, and socio-political agency), as well as their personal social support networks. At a community level, RWG’s life narratives will be mapped to identify strengths and the mechanisms of oppression that co-opt their RD. At an organizational level, programs, good practices, and materials developed to tackle RWG’s inequities will be mapped, including organizations’ influence. Narratives to identify empowering settings for its members and Romani communities will be collected. 2.4.2. Building Partnerships, Alliances, and Solidarity Adolescent girls will collaboratively consolidate existing alliances with their mothers (and families) and expand their community social ties and networks. Building partnerships, alliances, and solidarity also implies identifying influential Romani women from local communities to adopt the role of facilitators. Simultaneously, shared knowledge between organizations, academic researchers, and RWG will be developed to create trust and facilitate the understanding of cultural norms. Local coalitions will be built, including key stakeholders and policymakers interested in and with expertise on these matters, to support and disseminate RWG’s actions. 2.4.3. Photovoice as an Innovative Way of Doing Things Romani girls will participate in Photovoice group sessions in order to build critical strengths based on reproductive justice. This process includes identifying and reflecting on their life conditions and those of their communities, interacting with other Romani women role models and building new alliances and support networks, taking photographs regarding their dreams and the resources they need to achieve them, categorizing them to build collective knowledge and strengths, and preparing photo exhibits to advocate for those goals, aspirations, and rights at local, institutional, and policy levels. Romani women facilitators will lead Photovoice implementation along with Romani girls, adopting coleading roles in decision-making processes and co-assessing its implementation. RJ-based PAR, evaluation, and advocacy capacity will be built among organizations, to ensure the quality, real impact, and sustainability of the actions. Healthcare 2023,11, 755 7 of 16 2.4.4. Expected Changes, Outcomes and Impacts Lastly, regarding impact, changes, and outcomes, qualitative and quantitative indicators will be collected to assess the initiative’s related impact and changes among RWG, Romani grassroots organizations, and their communities. 2.5. Participants Timeline The first four months will be required to map evidence, and to prepare the intervention, developing and adapting guidelines with Romani grassroots organizations, and building local coalitions and collaboration with local communities’ key stakeholders. During the third and fourth month, Romani women facilitators’ recruitment and training will start with a 20-h workshop. This will be followed by the Photovoice process with Romani girls, which will last 6 months. Endline data collection and analysis will ensue in the subsequent 2 months. 2.6. Data Collection Methods Participating girls, significant adults, Romani women facilitators, grassroots organizations, and relevant stakeholders will all contribute to data collection in collaboration with researchers. Romani girls will establish their own goals, processes, and outcomes for all the actions that will be implemented. Afterwards, they will proceed to assess themselves in terms of the implementation of their set goals, action plans, and aspired outcomes. This way, data will be collected, having in mind the intervention steps proposed above (see Table 1; i.e., contextualizing inequities, building partnerships, innovative ways of doing; and expected changes, outcomes, and impacts). External indicators as control mechanisms will be included to guarantee that the decisions that are being made are tailored to local contexts while their quality is ensured. The RJ-based PAR’s process and implementation evaluation will entail the degree on which planning and logistical activities were considered and adapted by partners to set up and run the intervention effectively [ 53 ]. Special focus will be set on assessing how and how many Romani girls and facilitators were identified and selected; how many sessions were organized; which actions were implemented or not, and why; Romani girls’ satisfaction with the process; how they were involved in actions; how they were trained and their permanence was guaranteed. Specific tools will allow us to collect qualitative and quantitative data at individual, organizational, and community levels (see Table 2). To implement Photovoice as an innovative strategy, several Likert scales and open-ended question forms will collect Romani girls’ attendance and significant events within each session. At organizational level, similar forms will collect Romani women facilitators’ perceptions of the Photovoice process while taking stock of each implemented activity in order to maintain the quality of actions through the whole process. To build partnerships, alliances, and solidarity, diverse tools measure social networks (e.g., social convoy at individual level), identify alliances and influential members within the community, and consolidate local coalitions throughout the process (e.g., Local Coalition Ambassador checklist at community level). Table 2. Process and implementation evaluation indicators. Tool General Characteristics Content Individual level Wrap-up notes Open-ended questions Significant event(s) and satisfaction of Romani Girls in the Photovoice sessions Romani girls’ attendance sheets (ad hoc) Quantitative scales to assess participation Through 4-point Likert scales, overall participation/adherence level Healthcare 2023,11, 755 8 of 16 Table 2. Cont. Tool General Characteristics Content Organizational level Local Coalitions’ attendance (ad hoc) Quantitative scales to assess attendance of activities Through 4-point Likert scales overall participation level for each member attending each activity individually Quality Assurance Checklists on evaluation capacity (ad hoc) Self-assessment tool to measure Romani women facilitators’ decision-making, leadership, and evaluation capacity Eleven open questions for Romani women facilitators to reflect on their work to help them build their skills and continuously improve in leading the sessions, analyzing the skills and knowledge they have acquired, and areas where they might need additional support Romani women facilitators’ meeting notes Quantitative scales to assess sessions’ emotional climate, and collect girls’ reactions Date, agenda points, discussed topics, and decisions made, as well as overall emotional climate of the session through 4-point Likert scale Facilitation Skills (ad hoc) Self-assessment questions to collect facilitators’ reflections A 10-point Likert scale through 3 items on facilitation skills and 5 open ended questions about areas where they might need more support Action Plan Forms (ad hoc) Open-ended questions that will help the facilitators and Romani girls to map out and plan Eight open-ended questions aimed at designing the actions, participants, setting the date, location, and goals for the activity/initiative and outlining each step that needs to be taken, anticipate barriers and strategies to mitigate them Community level Local Coalition Ambassador checklist (ad hoc) Open-ended questions to identify relevant policymakers, leaders, and service providers Date of meeting/conversation, name(s) of person(s), organization, position of the person, involvement in the project, and follow up actions to disseminate and build networks to support Romani girls’ activities Advocacy Plan and attendance sheets (ad hoc) Open-ended questions to collect attendance, and decisions made during activities Number of exhibitions and other advocacy activities developed, number and position/role of people reached and involved within the activities Outcome evaluation will assess the results and impact of RJ-based PAR among participants (i.e., Romani girls, facilitators, and Romani grassroots organizations) (see Table 3). In order to contextualize RWG’s inequities and measure Photovoice’s impact, baseline and exit interviews will be carried out among Romani adolescent girl participants and their significant adults (which should be audio-recorded), including qualitative and quantitative data. The comparison group will have the same interviews. Special focus will be placed on evaluating the personal networks of girls, the number of exhibitions organized, and their impacts on the community, and the evolution of Romani girls’ mattering linked to reproductive justice. Concerning organizations, among other aspects, facilitators’ capacity to lead small work groups with Romani girls and conflict-resolution skills will be measured. At a community level, semi-structured interviews will be conducted to map life-stories, community narratives, and community assets. Desk reviews will be developed to identify organizational practices and influence at community and policy levels. Healthcare 2023,11, 755 9 of 16 Table 3. Outcome evaluation indicators. Tool General Characteristics Content Individual level Social Convoy [54]Semi-structured interviews to assess personal networks Includes three levels—i.e., inner circle (closest people), middle circle (people they care about, but not so close) and outer circle (weak ties) Societal Mattering Scale [55] A 4-point Likert scale to measure girls’ sense of mattering Eighteen items to measure mattering in their community and school (e.g., “The people in my community value me as a person”) and nine items to measure mattering within family contexts (e.g., “The people in my family value me as a person”) Life Satisfaction Scale [56]A 7-point Likert scale to measure satisfaction with life Five items (e.g., “I am satisfied with my life”) Policy Control Subscale [57]Quantitative scale to measure Romani girls’ policy control Four items (e.g., “Youth like me have the ability to participate effectively in community activities and decision making”) Relevance of Identity Roles Scale (ad hoc) A 4-point Likert scale to measure relevant roles for Romani Girls Eight items (e.g., “How important to you in obtaining your life goals is finishing high school”) Baseline and endline interviews with Romani girls and their families Semi-structured interviews (ad hoc) Twenty open-ended questions regarding family context, interests, analytical skills and leadership abilities (e.g., What types of games do you like to play with your friends? Who is the one who decides what to play?). Organizational level Baseline and endline interviews with Romani facilitators Semi-structured interviews (ad hoc) Twenty-five open-ended questions re. information on Romani women facilitators’ community work experience with minors Baseline and endline interviews with members of the organization Semi-structured interviews (ad hoc) Organization members’ experience, and motivation towards organizations’ goals. Organizational opportunities for members to participate, core activities or adaptation to local contexts Desk reviews Collection of materials to map community influence and assets Good practices and organizations’ recognition and influence at community, institutional, and policy levels Community level Map life-stories and community narratives [39,58] Stakeholders and recipients’ semi-structured interviews Organizations radiating influence to local communities as well as stakeholders and policymakers’ perceptions of organizations’ social impact at local and institutional levels Map community assets [59] Organization and stakeholders’ semi-structured interviews Numbers of services and resources used at local communities, type of services used, satisfaction with each service, frequency of use, access barriers, and other desired resources Healthcare 2023,11, 755 16 of 16 73. Jiménez, L.; Hidalgo García, M. 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