Addi van Bergen

Chapter 5 110 level. The content of items 1-5 was derived from literature, life histories and interviews and judged by researchers and students [44]. Item 11 stems from a validated scale [45] that was translated into Dutch with back translation into English [22]. As far as we could establish, these items were not pre-tested among persons from disadvantaged social groups and/or low education or income. Despite the fact that the Normative Integration items were pretested with low- income and low-education participants, several issues with semantic and conceptual validity were encountered. The concept of normative integration touches on the moral underclass discourse, one of three models of social exclusion identified by Levitas [46]. The discourse focuses on the behavioural and attitudinal characteristics of the excluded and their imputed deficiencies. The Normative Integration scale developed by the SCP [20] reflects a fairly narrow spectrum of behaviours and attitudes that are relatively common in the general Dutch population. Our study showed that high scores on lack of normative integration do not necessarily reflect a lack of social commitment or anomie, but may reflect an inability to comply. For example, not helping your neighbours because you are handicapped yourself or not donating to good causes because you are in serious debt. One could argue that concept and social group are coming together here and that the failure to comply with given norms and values is part and parcel of the exclusion itself. From this point of view, the validity of the Normative Integration scale need not be jeopardised. High scores on the Normative Integration scale reflect high social exclusion, even though the interpretation of the concept and context may differ between respondents. Further research in the non- excluded group could shed more light on this issue. A strong point of our study is the use of a sequential explanatory mixed methods design for validation purposes. This approach is not very common. Usually, qualitative research precedes quantitative validation and not vice versa [47].Although uncommon, the approach has been used before. For example, Morren et al.[48] interviewed respondents with deviant response style behaviour and Carlier et al.[49] approached groups with high levels of non-response. In our case, the design allowed us to address reliability and validity issues that were uncovered in the quantitative survey. It also allowed to confirm the ability of the social exclusion index to identify a diverse group of socially excluded persons including perpetrators of domestic violence, persons leading very isolated lives, victims of violent incidents such as armed robbery or rape, people with drug addiction or aggression disorder, and someone just released from detention. There are some limitations to our study. The first limitation is related to the low response rate of the PHM especially among non-Western immigrant groups. Although the Public Health Services employed a large range of measures to increase participation of difficult to reach groups, a certain degree of selection bias e.g. for better integrated and educated immigrants, is inevitable. The great diversity within the qualitative research group gave us, however, confidence in the representativeness of the research outcomes. Another limitation is that the research was conducted only in urban areas.