The PATHS survey: a participatory-informed, multilingual instrument for assessing tobacco and nicotine-related knowledge, attitudes, and behaviours among people with a migration background in Switzerland.

Introduction: Research on tobacco and nicotine use among people with migration backgrounds is characterised by methodological limitations, including a predominant focus on behavioural outcomes, limited integration of knowledge and attitudes, and a lack of participatory approaches. Standard population surveys further restrict linguistic accessibility and often fail to capture the complexity of migration-related experiences, thereby limiting the interpretability of observed health inequalities. We thus aimed to develop a multilingual, participatory survey instrument assessing knowledge, attitudes, and behaviours (KAB) related to tobacco and nicotine use among people with migration backgrounds in Switzerland. Methods: The Perspectives and Attitudes Towards Health and Smoking (PATHS) survey was developed following the WHO framework for knowledge, attitude and practice surveys, informed by Cognitive Aspects of Survey Methodology (CASM) and KAB frameworks. We applied a participatory-informed approach with iterative community consultations across all development phases, including evidence mapping, survey design, translation, and pilot testing. We adapted and extended validated items from international and national surveys (e.g., WHO GATS, Swiss Health Survey). We translated the instrument in collaboration with community partners and iteratively refined through partner feedback. Results: The final instrument comprises 136 items covering the different KAB domains, sociodemographic characteristics, and multidimensional migration-related variables. It operationalises migration background beyond categorical indicators, incorporating factors such as migration history, legal status, language use, and reasons for migration. Community input informed content expansion, wording simplification, and the inclusion of visual aids. Pilot testing indicated good feasibility (10-15 min completion time; ~80% completion rate). A community-based dissemination strategy was established, supported by multilingual materials and a network of 53 partner organisations. Conclusion: The PATHS survey demonstrates how participatory, multilingual approaches can enhance the inclusiveness and explanatory power of survey-based research. This methodology provides a transferable framework for studying health behaviours in diverse populations.