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Vera Nierkens Smoking in a multicultural society: developing a culturally sensitive questionnaire

Vera Nierkens Smoking in a multicultural society: developing a culturally sensitive questionnaire

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Page 1: Vera Nierkens Smoking in a multicultural society: developing a culturally sensitive questionnaire

Vera Nierkens

Smoking in a multicultural society: developing a culturally sensitive

questionnaire

Page 2: Vera Nierkens Smoking in a multicultural society: developing a culturally sensitive questionnaire

24 april 2006 Measuring determinants of smoking 2

The Netherlands and its immigrants

• Approximately 10% of non-Western background

• Of the 16 million people living in the Netherlands: – 316,000 from Morocco– 358,850 from Turkey– 329,500 from Surinam

• Turks and Moroccans: economic migrants• Surinamese: former Dutch colony

Page 3: Vera Nierkens Smoking in a multicultural society: developing a culturally sensitive questionnaire

24 april 2006 Measuring determinants of smoking 3

Percentage of smokers (adults)

0

20

40

60

80

100

T M S NL0

20

40

60

80

100

T M S NL

Men Women

Page 4: Vera Nierkens Smoking in a multicultural society: developing a culturally sensitive questionnaire

24 april 2006 Measuring determinants of smoking 4

Aim of the study

Why this studyTo little information about smoking behaviour available to develop anti-smoking programs

AimTo collect information about smoking and smoking cessation and its determinants among people aged 35 – 60.

Page 5: Vera Nierkens Smoking in a multicultural society: developing a culturally sensitive questionnaire

24 april 2006 Measuring determinants of smoking 5

Theoretical model

contextual factors

acculturation

education

beliefs smoking cessation

attitudes (advantages and disadvantages)

social influences

self efficacy

motivation

smo-king beha-viour

Page 6: Vera Nierkens Smoking in a multicultural society: developing a culturally sensitive questionnaire

6

Trial

Maintenance

Plans

Performance Skills

Behavior State

Precontemplation

Contemplation

Preparation

Motivation Factors

Attitude:Pros & Cons

Rational & Emotional

SocialInfluences:

NormsModellingPressure

Efficacy: RoutineSocial

SituationalStress

Behavioral factors

PredisposingFactors

Psychological factors

Biological factors

Social Cultural factors

InformationFactors

Risk Perception

Knowledge

Cues to Action

Intention State

Barriers

Ability Factors

Message

Source

Channel

AwarenessFactors

The I-CHANGE ModelDe Vries et al., 2004; 2005

Page 7: Vera Nierkens Smoking in a multicultural society: developing a culturally sensitive questionnaire

24 april 2006 Measuring determinants of smoking 7

Methods

Survey

To gain insight into the beliefs that may motivate smokers to quit among

385 Turks, 316 Moroccans and 1072 Surinamese

Developing questionnaires and pilot testing

Page 8: Vera Nierkens Smoking in a multicultural society: developing a culturally sensitive questionnaire

24 april 2006 Measuring determinants of smoking 8

Developing a questionnaire

1. Eliciting salient beliefs

2. Development of questionnaires

3. Pilot testing of the questionnaire

Page 9: Vera Nierkens Smoking in a multicultural society: developing a culturally sensitive questionnaire

24 april 2006 Measuring determinants of smoking 9

1. Eliciting salient beliefs

Focus group interviews• Recruitment of participants

– recruitment by key persons

– location of interviews: familiar to participants

• Ethnic matching

– native language

– feel free to talk: taboo

• Interpretation of qualitative results

• Appropriate theoretical background?

– classifying beliefs 97% classified

Page 10: Vera Nierkens Smoking in a multicultural society: developing a culturally sensitive questionnaire

24 april 2006 Measuring determinants of smoking 10

Results of the qualitative study

Similar to Dutchsmoking• relaxing effect• makes feel comfortable• increases health risksquitting• makes one proud• eating more • retraction symptoms

Different from Dutch• sign of modernization for

women• offering cigarettes sign of

kindness• different social influences• If smoking is not allowed

women smoke in secret

Page 11: Vera Nierkens Smoking in a multicultural society: developing a culturally sensitive questionnaire

24 april 2006 Measuring determinants of smoking 11

2. Development questionnaire

• Selection beliefs• Belief formulation: adaptation to preferences • Answer format: adaptation to ‘verbal answer’

– face to face interview!

• Translation– preparatory discussion with forward translator – afterwards: discussion with forward and back

translators– meaning of the translations!

Page 12: Vera Nierkens Smoking in a multicultural society: developing a culturally sensitive questionnaire

24 april 2006 Measuring determinants of smoking 12

3. Pilot testing

• Interview method – fluency in Dutch– educational level

• Final selection of the questions– differences between smokers and non-smokers– internal consistency– clarity of questions (number of missing values)– content validity– comparability with other groups

Page 13: Vera Nierkens Smoking in a multicultural society: developing a culturally sensitive questionnaire

24 april 2006 Measuring determinants of smoking 13

Results item selection (examples)

Included • Do you feel comfortable

(if you smoke)• If I smoke, I will be

ashamed• II I quit would be proud • If I quit, better for health• Social influences family

and friends

Excluded • If I smoke, I will not be

accepted • Social influence

colleagues, children, parents

• If I quit I get a better condition

• If I smoke I forget my problems

Page 14: Vera Nierkens Smoking in a multicultural society: developing a culturally sensitive questionnaire

24 april 2006 Measuring determinants of smoking 14

The result

• Three questionnaires including:– questions, formulation adapted to group– similar beliefs and some ‘culturally specific beliefs’

• Reliable scales for attitudes, social influences and self-efficacy (alpha between 0.66 – 0.95)

• Sufficient explained variance for Turkish and Moroccan men (66%)

Page 15: Vera Nierkens Smoking in a multicultural society: developing a culturally sensitive questionnaire

24 april 2006 Measuring determinants of smoking 15

Concluding remarks

• Combination of qualitative and quantitative methods

• Adapt methods; use key persons• Ethnic matching• Be open minded• Etic and emic beliefs• Translation: be aware of the meaning