Addi van Bergen

Cross-cultural validity of the Dutch version of the SEI-HS 111 5 Lastly, we classified the persons in our research based on their country of birth and that of their parents. This classification does not necessarily define their individual identity or represent meaningful social categories [50]. Gender, age, occupation, ethnic identity and educational level, may be more relevant in certain contexts than migration background. As more detailed knowledge becomes available, it becomes more difficult to make statements about immigrant groups in general [51]. CONCLUSIONS The results of this study support the cross-cultural validity of the SEI-HS in three major non-Western immigrant groups in the Netherlands. The findings suggest that the large differences in SE found between native Dutch and non-Western immigrant groups are real and not due to measurement bias. This raises serious concerns about the social inclusion of non-Western immigrants in the four largest cities in the Netherlands and its potential effect on health and wellbeing. Policy measures to reduce SE are urgently needed as well as more research into the mechanisms and risk factors of SE among immigrant groups and pathways to more social inclusion. Further research is necessary to examine the content validity of the normative integration dimension of the SEI-HS and rephrasing semantically problematic items. The interviews showed that the lived experience of socially excluded people may differ from the majority population. In general, it is advisable to involve people in adverse social circumstances in the development of health related measures. ACKNOWLEDGEMENTS The authors thank the Public Health Services ofAmsterdam, Rotterdam and The Hague and Jessica Bouwman-Notenboom of the Public Health, Municipality of Utrecht for making available the data used in this study. We also thank Carina Ballering (CB) for organising the interviews in Utrecht, Henriëtte Dijkshoorn and Renske Gilissen for facilitating the interviews in Amsterdam and The Hague, Maartje Aangeenbrug and Bouwine Carlier (BC) for their contribution to the qualitative data analysis, Anna Dogan, Stacey Oemraw, Anna Paauw, Nadia el Hannouche, Samia Bourakaa and Sana Aamiri for conducting interviews in Utrecht, The Hague and Amsterdam and finally Prof. Dr. Ria Reis for her advice on the interview guidelines. SUPPORTING INFORMATION S1 Tables A-C. Differential item functioning in SEI-HS items with respect to migrant background, A: Surinamese, B: Moroccan and C Turkish versus native Dutch S2 Table. Factor loadings items SEI-HS in adults of Surinamese, Moroccan and Turkish origin compared to the reference values in the general Dutch population S3 Appendix. Dutch version of the SEI-HS