Abstract
Background The recently developed Social Exclusion Index for Health Surveys (SEI-HS) revealed particularly strong social exclusion in non-Western immigrant groups compared to the native Dutch population. To qualify such results, cross-cultural validation of the SEI-HS in non- Western immigrant groups is called for. Methods A sequential explanatory mixed methods design was used, employing quantitative data from the Netherlands Public Health Monitor along with qualitative interviews. Data from 1,803 adults aged 19 years or older of Surinamese, 1,009 of Moroccan and 1,164 of Turkish background and 19,318 native Dutch living in the four largest cities in the Netherlands were used to test the factorial structure of the SEI-HS and differential item functioning across immigrant groups. Additionally, 52 respondents with a high score on the SEI-HS and from different background were interviewed on the item content of the SEI-HS and subjective feelings of exclusion. For each SEI-HS item the semantic, conceptual and contextual connotations were coded and compared between the immigrant groups and native Dutch. Results High levels of social exclusion were found in 20.0% of the urban population of Surinamese origin, 20.9% of Moroccan, 28.7% of Turkish and 4.2% of native Dutch origin. The 4-factor structure of the SEI-HS was confirmed in all three immigrant groups. None of the items demonstrated substantial differential item functioning in relation to immigration background. The PLOS ONE | November 5, 2019 1 / 15 OPEN ACCESS Citation: van Bergen APL, Loon Av, de Wit MAS, Hoff SJM, Wolf JRLM, van Hemert AM (2019) Evaluating the cross-cultural validity of the Dutch version of the Social Exclusion Index for Health Surveys (SEI-HS): A mixed methods study. PLoS ONE 14(11): e0224687. journal.pone.0224687 Editor: Wen-Jun Tu, Chinese Academy of Medical Sciences and Peking Union Medical College, CHINA Received: June 6, 2019 Accepted: October 19, 2019 Published: November 5, 2019 Copyright: © 2019 van Bergen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: The data underlying the quantitative results are owned by the Public Health Services of Amsterdam, Rotterdam, and The Hague and the Public Health, Municipality of Utrecht. Requests for data may be directed to Public Health Service of Rotterdam, Gezondheidsmonitor@rotterdam.nl. Data from the interviews cannot be shared publicly because of privacy concerns. The participants did not consent to have their full transcripts made publicly interviews uncovered some methodological shortcomings, but these did not substantially impact the observed excess of social exclusion in im