Addi van Bergen

Cross-cultural validity of the Dutch version of the SEI-HS 107 5 felt rejected by their employer or by institutions like the tax office or the Employee Insurance Agency. Conceptually this interpretation belongs more to dimension 3 ‘Access to institutions’ than to ‘Social Participation’. In four cases the events or cases referred to were specific to the cultural group, for example forced marriage in case of a Turkish respondent. Contextuality also plays a role in item 6. The degree of contact that Moroccan, Turkish and Dutch respondents have with their neighbours is influenced by the migration background of these neighbours. According to a Turkish respondent they just say “ hi ” to the Dutch neighbours, but visit their Turkish neighbours regularly at home. The concept that is being measured, however, does not differ between the groups. DISCUSSION Our objective was to examine possible shortcomings in the cross-cultural validity of the SEI-HS that might explain the high prevalence of SE in adult immigrant groups found in the 2012 health monitor. The study was conducted among adults of Surinamese, Moroccan, Turkish and Dutch origin in the four largest cities in the Netherlands. The quantitative part of the study showed no cross-cultural validity issues. CFA confirmed the 4-factor structure of the SEI-HS in the three immigrant groups and none of the SEI-HS items exhibited problems with differential item functioning. Item scores did not differ significantly between respondents of Surinamese, Moroccan, Turkish origin and native Dutch respondents at the same level of SE. The qualitative part uncovered little differences in understanding and interpretation of items between the population groups, but some general methodological shortcomings were identified, especially in the normative integration dimension of the SEI-HS. The socially excluded respondents we interviewed did not always interpret the items as intended, due to unfamiliarity with words, complicated sentence structures and different connotations. Potential cultural biases were limited to the semantics of items 8,12 and 15 and contextuality of items 5 and 10. The interviews showed that particularly Moroccan respondents had problems understanding certain items. Rewording or rephrasing of semantically difficult items could be considered. In general, these findings underline the importance of offering assistance to respondents face-to-face or by phone in their own language (Berber or Arabic). Items 5 (I often feel rejected) and 10 (I have enough money to visit others) showed contextual differences that might threaten the cultural validity of the items. This was however not reflected in the quantitative analyses. Most validity issues were as noteworthy in native Dutch respondents as in Surinamese, Moroccan and Turkish respondents. This was not expected since all SEI-HS items originate from widely used and/or validated questionnaires [20-23]. The content of items 8-10 and 13-17 was derived from literature and interviews, judged by four focus groups and tested through individual cognitive interviews [20]. Efforts were made to include people with a higher risk of SE i.e. with low income and low educational