Comparison of the Number and Reasons for Self-Perceived Barriers to Accessing Primary Health Care Services Between Roma and Ethnic Albanians

Distribution of background characteristics in a sample of Albanian adults who reported barriers to accessing primary health care services in 2024 (N = 533).

Albanian (N = 444)	Other (N = 89)^a	P^c
Sex:
Men	215 (40.3)^b	159 (35.8)	56 (62.9)	< 0.001
Women	318 (59.7)	285 (64.2)	33 (37.1)
Age-group:
18–39 years	228 (42.8)	203 (45.7)	25 (28.1)	0.003
40–59 years	168 (31.5)	128 (28.8)	40 (44.9)	0.003
≥ 60 years	137 (25.7)	113 (25.5)	24 (27.0)
Place of residence:
Urban/periurban areas	463 (86.9)	374 (84.2)	89 (100.0)	< 0.001
Rural areas	70 (13.1)	70 (15.8)	0 (–)
Marital status:
Married	334 (62.7)	264 (59.5)	70 (78.7)	< 0.001
Other	199 (37.3)	180 (40.5)	19 (21.3)
Education:
Low	161 (30.2)	85 (19.1)	76 (85.4)	< 0.001
Middle	180 (33.8)	171 (38.5)	9 (10.1)	< 0.001
High	192 (36.0)	188 (42.3)	4 (4.5)
Economic situation:
Good	39 (7.3)	38 (8.6)	1 (1.1)	< 0.001
Average	324 (60.8)	296 (66.7)	28 (31.5)	< 0.001
Bad	170 (31.9)	110 (24.8)	60 (67.4)
Self-perceived health:
Very poor/poor	59 (11.1)	36 (8.1)	23 (25.8)	< 0.001
Average	159 (29.8)	139 (31.3)	20 (22.5)	< 0.001
Good/excellent	315 (59.1)	269 (60.6)	46 (51.7)
Disability:
No	391 (73.4)	335 (75.5)	56 (62.9)	0.018
Yes	142 (26.6)	109 (24.5)	33 (37.1)
Chronic conditions:
No	348 (65.3)	305 (68.7)	43 (48.3)	< 0.001
Yes	185 (34.7)	139 (31.3)	46 (51.7)

Legend:

a Other ethnicities included the following: Roma (n = 57), Egyptian (n = 30), and Gorani or Macedonian (n = 2).

b Absolute numbers and their respective column percentages (in parentheses).

c P-values from Fisher's exact test.

Table 2.

Distribution of number and perceived reasons for barriers to accessing primary health care services among study participants, by ethnicity (N = 533).

Albanian (N = 444)	Other ethnicities (N = 89)^a	P^c
Cost	121 (27.3)^b	20 (22.5)	0.430
Long waiting time	105 (23.6)	15 (16.9)	0.210
Distance	81 (18.2)	23 (25.8)	0.108
Poor service quality	75 (16.9)	14 (15.7)	0.877
Lack of information	68 (15.3)	13 (14.6)	0.998
Transportation	55 (12.4)	5 (5.6)	0.068
Lack of trust	44 (9.9)	1 (1.1)	0.003
Cultural barriers	4 (0.9)	30 (33.7)	< 0.001
Health reasons	24 (5.4)	5 (5.6)	0.998
Language barriers	5 (1.1)	23 (25.8)	< 0.001
Don't know where to go	13 (2.9)	1 (1.1)	0.483
Stigma	8 (1.8)	1 (1.1)	0.999
Other barriers^d	102 (23.0)	6 (6.7)	< 0.001
Unspecified barriers	10 (2.3)	7 (7.9)	0.013

Albanian (N = 444)	Other ethnicities (N = 89)^a	P
Mean (±SD) number of barriers	1.6±1.0	1.8±0.9	0.004^e
Number of barriers:
1 barrier	271 (61.0)^f	41 (46.1)
2 barriers	111 (25.0)	24 (27.0)	0.002^c
3 barriers	43 (9.7)	21 (23.6)
≥ 4 barriers	19 (4.3)	3 (3.4)
Number of barriers:
1 barrier	271 (61.0)	41 (46.1)	0.010^c
≥ 2 barriers	173 (39.0)	48 (53.9)

Legend:

a Roma (n = 57), Egyptian (n = 30), and Gorani or Macedonian (n = 2).

b Absolute numbers and their respective percentages (in parentheses).

c P-values from Fisher's exact test.

d As specified by participants, “other barriers” included higher expectations than those met by the current services offered in the public PHC services in Albania.

e P-value from Mann-Whitney test.

f Absolute numbers and their respective column percentages (in parentheses).

Table 3.

Association of the number of perceived barriers to accessing primary health care services with ethnicity; results from general linear models and binary logistic regression.

Model	Mean^a	95%CI^a	P^a
Model 1^b
Albanian	1.61	1.52–1.70	0.042
Other ethnicities	1.84	1.64–2.05
Model 2 ^c
Albanian	1.62	1.53–1.72	0.074
Other ethnicities	1.83	1.63–2.04
Model 3 ^d
Albanian	1.62	1.52–1.71	0.087
Other ethnicities	1.82	1.61–2.02
Model 4 ^e
Albanian	1.64	1.51–1.76	0.097
Other ethnicities	1.87	1.64–2.10
Model 5 ^f
Albanian	1.69	1.55–1.83	0.111
Other ethnicities	1.91	1.68–2.14

Model	OR^g	95%CI^g	P^g
Model 1 ^b
Albanian	1.00	reference	0.010
Other ethnicities	1.83	1.16–2.90
Model 2 ^c
Albanian	1.00	reference	0.015
Other ethnicities	1.79	1.12–2.86
Model 3 ^d
Albanian	1.00	reference	0.020
Other ethnicities	1.75	1.09–2.82
Model 4 ^e
Albanian	1.00	reference	0.022
Other ethnicities	1.97	1.10–3.50
Model 5 ^f
Albanian	1.00	reference	0.028
Other ethnicities	1.93	1.07–3.48

Legend:

a Mean values and their respective confidence intervals (95%CIs) and p-values from the general linear models.

b Model 1: crude/unadjusted.

c Model 2: adjusted for sex (men vs. women).

d Model 3: adjusted for sex and age (18–39 years, 40–59 years, ≥ 60 years).

e Model 4: adjusted for all sociodemographic factors [sex, age, marital status (married vs. single/divorced/widowed), education (low vs. middle/high), and economic situation (bad vs. average/good)].

f Model 5: adjusted for sociodemographic factors and health profile [self-perceived health status (very poor/poor, average, good/excellent), disability (yes vs. no), and chronic conditions (yes vs. no)].

g Odds ratios (ORs: “≥ 2 barriers” vs. “one barrier only” to accessing primary health care services) and their respective 95%CIs and p-values from binary logistic regression analysis.

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DOI: https://doi.org/10.2478/sjph-2026-0002 | Journal eISSN: 1854-2476 | Journal ISSN: 0351-0026

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Language: English, Slovenian

Page range: 5 - 15

Submitted on: Nov 4, 2025

Accepted on: Jan 5, 2026

Published on: Mar 1, 2026

Published by: National Institute of Public Health, Slovenia

In partnership with: Paradigm Publishing Services

Keywords:

Access to health services,

Albania,

Barriers,

Ethnic differences,

Primary health care,

Roma and Egyptian minorities

Related subjects:

Medicine,

Clinical medicine,

Hygiene and environmental medicine

© 2026 Alvi Naum, Albana Gjyzari, Gentiana Qirjako, Katarzyna Czabanowska, Ervin Toçi, Genc Burazeri, published by National Institute of Public Health, Slovenia
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 65 (2026): Issue 1 (March 2026)