Discrimination and Romani health: a validation study of discrimination scales among Romani women in Macedonia and Serbia

Objectives: Scales used to assess discrimination in public health research have rarely been validated outside of high income countries. Our objective was to validate the Experiences of Discrimination (EOD) scale and the Everyday Discrimination Scale (EDS) among 410 Romani women in Macedonia and Serbia. Methods: Romani female interviewers conducted interviews in 2012–2013. We used a multiple indicator multiple cause approach to test a one-factor model for each scale and to assess differential item functioning (DIF) by age, wealth, country, and education. We also measured associations between the EOD and EDS with smoking in the past year and psychological distress. Results: Three items of the EOD were conceptually irrelevant. Two items of the EDS were not conditionally independent. DIF was found by country for one item in each scale. After excluding these items, all scales exhibited good model fit and were associated with smoking (EOD beta = 0.40, 95 % CI = 0.18, 0.63; EDS beta = 0.33, 95 % CI = 0.12, 0.54) and psychological distress (EOD beta = 0.26, 95 % CI = 0.15, 0.37; EDS beta = 0.26, 95 % CI = 0.04, 0.47). Conclusions: Discrimination scales can be adapted for use among Romani women and are associated with both smoking and psychological distress.