Challenges and lessons learnt from conducting a health survey in an ethnically diverse population

Abstract

Aim: To document the challenges of developing and executing an interviewer-driven survey questionnaire in an ethnically diverse and deprived social housing area undergoing reconstruction in Denmark. Methods: The survey was initially planned to be conducted in three waves (before, during and after reconstruction of the housing area), based on a questionnaire covering health, wellbeing and social relations. The first two waves took place in 2018 and 2019 (invited n=~600 per wave) and the third wave will be conducted once the reconstruction is finalised. The approach to the third wave is under revision by the research team. The questionnaire was translated from Danish into the seven most common languages in the housing area. A bilingual interview team went door to door interviewing residents. Field notes were collected systematically during each wave to document the process. Results: The response rates were 35% ( n=209) and 22% ( n=132) for waves 1 and 2, respectively. There was an overall decrease in response rates between waves 1 and 2 for all language groups, but particularly for Arabic and Turkish-speaking men. The most frequently stated reasons for non-participation included illness and language barriers. The key lessons learnt were that overcoming linguistic and cultural barriers to conducting research among residents in this social housing area requires time and resources. Conclusions: Several challenges are associated with conducting a survey in ethnically diverse and deprived social housing areas. Documenting the challenges and learning from experience are both important, in order to include this hard-to-reach population in health research.

Undertaking graphic facilitation to enable participation in health promotion interventions in disadvantaged neighbourhoods in Denmark

“…Engaging residents in deprived neighbourhoods in HPIs is difficult due to a variety of factors, such as language barriers, socio-economic vulnerability, resistance towards ‘being told what to do’ and mistrust towards authorities. This population group is underrepresented in research overall ( Sydor, 2013 ; Bonevski et al , 2014 ; Nielsen et al , 2017 ; Srivarathan et al , 2020 ; Nygaard et al , 2021 ), and more knowledge is needed on how to engage such groups through new and innovative methods experienced as relevant to the participants. This includes methods to engage ethnic minorities in studies on their health behaviours and health experiences ( Mir et al , 2013 ).…”

The association between social integration and neighborhood dissatisfaction and unsafety: a cross-sectional survey study among social housing residents in Denmark

“…The survey questionnaire, 'Health, well-being and social relations in a changing neighborhood' , was designed to collect self-reported information on demography, socioeconomic position, social relationships, health behavior and illness [27,28]. The questionnaire employed validated instruments and items that have previously been applied in comparable study populations [27,28]. The baseline information was collected between September 2018 and January 2019 prior to the urban regeneration program [27].…”

“…The questionnaire employed validated instruments and items that have previously been applied in comparable study populations [27,28]. The baseline information was collected between September 2018 and January 2019 prior to the urban regeneration program [27]. The questionnaire was translated from Danish to the seven most prominent language groups among the residents (Arabic, English, Pashto, Polish, Turkish, Urdu and Vietnamese) by two independent translators who then agreed on the final version [27].…”

“…The questionnaire was administered in-person by trained bilingual interviewers among all residents aged 45 years and above identified through the Civil Registration System [27]. The target group of residents aged 45 years and above was selected based on the findings from a qualitative study in the social housing area [29].…”

“…There is a paucity of empirical studies investigating the importance of social integration for perceptions of the neighborhood environment among underrepresented population groups such as residents in disadvantaged neighborhoods. Such underrepresentation might impair the ability to address and understand mechanisms behind associations of social integration and neighborhood environment [27].…”