Evaluating the cross-cultural validity of the Dutch version of the Social Exclusion Index for Health Surveys (SEI-HS): A mixed methods study

Autoři: Addi P. L. van Bergen aff001;  Annelies van Loon aff003;  Matty A. S. de Wit aff003;  Stella J. M. Hoff aff004;  Judith R. L. M. Wolf aff005;  Albert M. van Hemert aff002
Působiště autorů: Staff Department, Public Health Service Hollands Midden, Leiden, The Netherlands aff001;  Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands aff002;  Department of Epidemiology, Health Promotion and Care Innovation, Public Health Service of Amsterdam, Amsterdam, The Netherlands aff003;  Department of Income and Social Security, The Netherlands Institute of Social Research|SCP, The Hague, The Netherlands aff004;  Impuls, the Netherlands Center for Social Care Research, Radboud University Medical Center, Nijmegen, The Netherlands aff005
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224687



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.


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.


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 interviews uncovered some methodological shortcomings, but these did not substantially impact the observed excess of social exclusion in immigrant groups.


The present study provides evidence in support of the validity of the SEI-HS in adults of Surinamese, Moroccan and Turkish background and confirms the major social exclusion of these immigrant groups in the main cities in the Netherlands. Policy measures to enhance social inclusion and reduce exclusion are urgently needed.

Klíčová slova:

Cross-cultural studies – Dutch people – Health surveys – Netherlands – Public and occupational health – Qualitative studies – Semantics – Conceptual semantics


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Článek vyšel v časopise


2019 Číslo 11