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

Addi P L Van Bergen,Albert M Van Hemert,Stella J M Hoff,Erik J C Van Ameijden,Gozde Ozakinci

doi:10.1371/journal.pone.0098680

Abstract

IntroductionSocial 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.MethodsAnalyses 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.ResultsThe 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.ConclusionsOur 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.

Highlights

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
Social exclusion is a broad term that refers to the inability of certain groups or individuals to participate fully in society
The World Health Organization defines social exclusion as ‘‘dynamic multidimensional processes driven by unequal power relationships interacting across four main dimensions - economic, political, social and cultural - and at different levels including individual, household, group, community, country and global levels’’ [4]

Summary

Introduction

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. For example the loss of paid employment may lead to loss of social contacts and loss of income, which in turn may result in debts, poor housing, insecure living environment or reduced access to health care [6]. All these factors increase the risk of health problems directly or indirectly. Health risks tend to accumulate in socially excluded individuals and groups

Methods

Results

Conclusion