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

2. 24 april 2006Measuring 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

3. 24 april 2006Measuring determinants of smoking 3 Percentage of smokers (adults) MenWomen

4. 24 april 2006Measuring 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.

5. 24 april 2006Measuring determinants of smoking 5 Theoretical model contextual factors acculturation education beliefs smoking cessation attitudes (advantages and disadvantages) social influences self efficacy motiva tion smo- king beha- viour

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

7. 24 april 2006Measuring 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

8. 24 april 2006Measuring determinants of smoking 8 Developing a questionnaire 1.Eliciting salient beliefs 2.Development of questionnaires 3.Pilot testing of the questionnaire

9. 24 april 2006Measuring 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 beliefs97% classified

10. 24 april 2006Measuring determinants of smoking 10 Results of the qualitative study 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

11. 24 april 2006Measuring 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!

12. 24 april 2006Measuring 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

13. 24 april 2006Measuring 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

14. 24 april 2006Measuring 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%)

15. 24 april 2006Measuring 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