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Smoking in a multicultural society: developing a culturally sensitive questionnaire

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

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Smoking in a multicultural society: developing a culturally sensitive questionnaire

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

  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 Measuring determinants of smoking

  3. Percentage of smokers (adults) Men Women Measuring determinants of smoking

  4. Aim of the study Why this study To little information about smoking behaviour available to develop anti-smoking programs Aim To collect information about smoking and smoking cessation and its determinants among people aged 35 – 60. Measuring determinants of smoking

  5. Theoretical model beliefs smoking cessation attitudes (advantages and disadvantages) social influences self efficacy contextual factors acculturation education motivation smo-king beha-viour Measuring determinants of smoking

  6. Predisposing Factors MotivationFactors Ability Factors Behavioral factors Plans Psychological factors Attitude: Pros & Cons Rational & Emotional Performance Skills Biological factors Social Cultural factors Social Influences: Norms Modelling Pressure Intention State Behavior State Awareness Factors Precontemplation Trial Efficacy: Routine Social Situational Stress Knowledge Contemplation Cues to Action Maintenance Preparation Risk Perception Information Factors Message Barriers The I-CHANGE Model De Vries et al., 2004; 2005 Channel Source

  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 Measuring determinants of smoking

  8. Developing a questionnaire • Eliciting salient beliefs • Development of questionnaires • Pilot testing of the questionnaire 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 Measuring determinants of smoking

  10. Similar to Dutch smoking relaxing effect makes feel comfortable increases health risks quitting 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 Results of the qualitative study 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! 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 Measuring determinants of smoking

  13. 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 Results item selection (examples) 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%) 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 Measuring determinants of smoking

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