Measuring social exclusion in routine public health surveys: construction of a multidimensional instrument

• Published in: PloS one Vol. 9; no. 5; p. e98680
• Main Authors: van Bergen, Addi P L, Hoff, Stella J M, van Ameijden, Erik J C, van Hemert, Albert M
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 30.05.2014; Public Library of Science (PLoS)
• Subjects: Adult; Adults; Causation; Community health care; Construction methods; Correlation analysis; Data Collection; Data processing; Discriminant analysis; Economic policy; Economic research; Female; Health disparities; Health research; Health services; Health surveillance; Health Surveys; Humans; Indexes; Inequality; Male; Measurement; Measures; Medicine and Health Sciences; Mental health; Middle Aged; Netherlands; Nonlinear analysis; Odds Ratio; Policy analysis; Policy research; Polls & surveys; Property; Psychiatry; Public Health; Questionnaires; Research and Analysis Methods; Risk analysis; Risk factors; Social aspects; Social Distance; Social exclusion; Social research; Social science research; Social Sciences; Surveillance; Surveillance equipment; Surveillance systems; Surveys; Surveys and Questionnaires; Traditions; Netherlands
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0098680

Social exclusion is considered a major factor in the causation and maintenance of health inequalities, but its measurement in health research is still in its infancy. In the Netherlands the Institute for Social Research (SCP) developed an instrument to measure the multidimensional concept of social exclusion in social and economic policy research. Here, we present a method to construct a similar measure of social exclusion using available data from public health surveys. Analyses were performed on data from the health questionnaires that were completed by 20,877 adults in the four largest cities in the Netherlands. From each of the four questionnaires we selected the items that corresponded to those of the SCP-instrument. These were entered into a nonlinear canonical correlation analysis. The measurement properties of the resulting indices and dimension scales were assessed and compared to the SCP-instrument. The internal consistency of the indices and most of the dimension scales were adequate and the internal structure of the indices was as expected. Both generalisabiliy and construct validity were good: in all datasets strong associations were found between the index and a number of known risk factors of social exclusion. A limitation of content validity was that the dimension "lack of normative integration" could not be measured, because no relevant items were available. Our findings indicate that a measure for social exclusion can be constructed with available health questionnaires. This provides opportunities for application in public health surveillance systems in the Netherlands and elsewhere in the world.