title: Measuring social exclusion in routine public health surveys: construction of a multidimensional instrument.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Municipal Health Service Utrecht, Utrecht, The Netherlands; Leiden University Medical Center, Department of Psychiatry, Leiden, The Netherlands.
authors.forename: Addi P L
authors.initials: AP
authors.lastname: van Bergen
authors.affiliation: The Netherlands Institute of Social Research|SCP, The Hague, The Netherlands.
authors.forename: Stella J M
authors.initials: SJ
authors.lastname: Hoff
authors.affiliation: Municipal Health Service Utrecht, Utrecht, The Netherlands.
authors.forename: Erik J C
authors.initials: EJ
authors.lastname: van Ameijden
authors.affiliation: Leiden University Medical Center, Department of Psychiatry, Leiden, The Netherlands.
authors.forename: Albert M
authors.initials: AM
authors.lastname: van Hemert
mesh_terms: D000328:Adult; D003625:Data Collection; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D016017:Odds Ratio; D012929:Psychological Distance; D011634:Public Health; D011795:Surveys and Questionnaires