Survey Services In Schools
The Schools Health Education Unit has been involved in the collection of robust baseline data about young people’s health-related behaviour for over 25 years. It does this through surveys in schools using the Health Related Behaviour Questionnaire (HRBQ).
The resulting baseline data identify and confirm priorities for health needs assessment, intervention programmes, and health education planning. Behaviour changes can also be monitored over time and compared with local and national trends.
Breaking the data down by locality prompts curriculum review by the schools, promotes stronger links between schools and health authorities, and stimulates health promotion in the community.
Repeated use of the HRBQ allows intervention programmes to be monitored and evaluated.
This document is about the use of HRBQ survey findings from standard school surveys, but we also offer:
The resulting baseline data identify and confirm priorities for health needs assessment, intervention programmes, and health education planning. Behaviour changes can also be monitored over time and compared with local and national trends.
Breaking the data down by locality prompts curriculum review by the schools, promotes stronger links between schools and health authorities, and stimulates health promotion in the community.
Repeated use of the HRBQ allows intervention programmes to be monitored and evaluated.
This document is about the use of HRBQ survey findings from standard school surveys, but we also offer:
- 1. Customised surveys for particular needs.
- 2. Surveys linked to evaluative research.
1. Collaborative work with schools TOP
Surveying young people in schools
The work of the Unit is principally carried out in schools and funded by a variety of commissioners.
The initial aim of the Health Related Behaviour Questionnaire (HRBQ) used in these studies was to assist secondary schools in planning their curricula. It was not originally conceived as a research exercise, but rather as a device to assist local planning. It was first introduced in 1977; since then successive versions have been developed in consultation with teachers, health-care professionals and others concerned with the health education and welfare of young people.
By the end of 2005, more than 690,000 upper middle and secondary school pupils from more than 5400 schools had completed the questionnaire, then in its 22nd version. Many schools and district health authorities, and regional authorities, have been involved in repeat surveys.
The SHEU policy is to support effective health education programmes in schools by:
- helping them to secure the highest-quality information from their HRBQ survey; and
- showing them how the results may be used to the best advantage in curriculum planning and in the classroom.
Standard support materials for secondary schools
All users of the secondary HRBQ service receive the following support materials, which are described in separate leaflets:
- 1. The complete tabulated results, separated by gender and year group, in one or more bound volumes.
- 2. A ‘school report’, in which the school’s results for many widely-used questions are presented with commentary and comparison with other local or wider data.
- 3. A Health Risk Appraisal (HRA) score for every pupil taking part in the survey. This is derived from their answers to some key questions. The pupils’ identity is protected by a PIN.
- 4. The After the Survey manual, a guide to getting the maximum benefit from the survey results, based on many years of active involvement between SHEU and user schools.
Additional services available
In addition, schools may request several services, which are described in separate leaflets and the After the Survey manual. The most frequently sought is:
The Profiles datafiles: selections of the school’s HRBQ survey data on a floppy disk or email, for computer analysis in IT classes. The recorded behaviour of, for example, Year 10 boys and girls in their own school is more than interesting to the other pupils. Links between behaviours, such as self-esteem and smoking, can be investigated.
A version of HRBQ for primary schools
The primary version of the questionnaire was introduced in 1988, and was in its 11th version by the end of 2005. Suitable for children in the 7-11 age range, it addresses most of the topics covered in the secondary questionnaire at a level suitable for the younger children’s understanding. Questionnaire surveys covering secondary schools and their feeder primary schools have successfully bridged the gap between the two sectors.
2. HRBQ (secondary schools) TOP
The current version of the secondary-school HRBQ contains 7 sections, as follows:
- Section 1 (Personal background): Age, family structure, ethnicity, home background, self-esteem, feelings of control, height and weight.
- Section 2 (Nutrition): 5-a-day, drinking water, lunch and breakfast, frequency of consumption of listed foods.
- Section 3 (Drugs): Smoking, alcohol, other drugs.
- Section 4 (Health and Safety): Personal and dental hygiene, health problems, frequency of use of medication, relationship with GP, sun protection, crime and safety.
- Section 5 (Relationships, mental health, sexual health): ‘Important others’, problems and sources of support, STI and contraception knowledge.
- Section 6 (Leisure and money): Leisure activities, income, money spent, National Lottery and Instants, money saved.
- Section 7 (Exercise and accidents): Frequency of involvement, feelings about fitness & exercise, cycling, accidents.
- 1 Being healthy: (many topics)
- 2 Staying safe: Accidents, Crime, Sun Safety, Bullying
- 3 Enjoying and Achieving: enjoyment of school, useful lessins, GCSE expectations, plans after 16, satisfaction with life
- 4 Making a positive contribution: Leisure activities, caring and contributing
- 5 Economic well-being: GCSE expectations, plans after 16, income, money spent, lottery tickets, money saved.
These topics also overlap substantially with the concerns of the Saving Lives: Our Healthier Nation White Paper:
- Coronary Heart Disease (smoking, diet, exercise)
- Mental health (problems, self-esteem)
- Accidents, cancer (smoking, diet)
- Sexual health (STIs, relationships)
3. HRBQ (primary schools) TOP
Following the success of the secondary school HRBQ, a version suitable for primary schoolchildren was introduced in 1988. The primary-school HRBQ was in its 11th version at the end of 2005, and largely reflects the topics found within the secondary-school version. Many of the 50 questions are directly compatible, so maintaining continuity of the data across the age ranges. The questions are clearly laid out for easy completion within the following 12 sections:
| You and your home | Health |
| The food you eat | Feelings |
| Your money | Hygiene |
| 'Bullies' | Smoking |
| 'Stranger danger' | Alcohol |
| Leisure time | Growing up |
The section about ‘stranger danger’ is not paralleled in the secondary version.
In line with the secondary version, participating schools are provided with substantial support, both in the method of collecting good data and the After the Survey manual, which provides practical suggestions for using the results with staff, pupils, governors and parents.
'Pyramid' surveys between a secondary school and its feeder primary schools
Complementary surveys are sometimes used to link primary schools with the secondary school to which most of the primary-school children will transfer (see Section 8). The objective co-operation of the contributing schools is enhanced through staff and parent activities, through school doctor and school nurse liaison, and through planned continuity of health education programmes in the schools.
A model of ‘diagonal tracking’ is suggested in the following table:
4. Data broken down by locality TOP
Through discussion with schools, maps can be developed which enable the pupils to identify the code for their locality and write it on the questionnaire.
Health care is delivered at community level
Having collected geographical information data can then be analysed by locality. The charts below, taken from another survey, show the proportion of Year 10 pupils that recorded having tried an illegal drug at least once.
These proportions of each gender are broken down firstly by school and then by locality.
The upper diagram, showing data broken down by schools (which take pupils from more than one ward or borough), shows some variation in reported levels of experimentation with drugs. The second diagram shows a greater degree of variation in behaviour from one group of streets, forming a ward or borough, to the next. These data, and their implications, are discussed more fully in the SHEU annual 'Young People in ...' report.
5. Data broken down by school TOP
Data from the questionnaire can give many indications of the need for or effectiveness of services, for example:
Do you know where you can get condoms free of charge?
and
Is there a birth control (family planning) clinic for young people available locally?
Levels of asthma - diagnosed and undiagnosed
In other areas of the questionnaire there are indicators for planning, for example management of asthma. It is widely accepted that asthma may be undiagnosed, so that symptoms typical of asthma may remain untreated. The chart below suggests that levels of under-diagnosis may vary from one school’s community to another. The percentages of young people are shown, with their schools’ identity numbers along the bottom. In this particular health authority, data from each school show that the number of young people reporting possible asthma symptoms (derived from a question about breathlessness and ‘wheezing’) exceeded the number reporting that they had used asthma medication during the previous week However, it will be noted that the school with the lowest level of medication (57) is not the school with the lowest level of reported symptoms (47). Which school should be the most concerned?
6. Data services for different Public Health levels TOP
Strategic Health Authority level
We can supply survey commissioners with their own database in an appropriate software format, for example as an SPSS system file. The data can then be interrogated locally for clarification of particular issues, such as the distribution of asthma, or levels of smoking. The data can also be linked to other information available to health authorities or collaborating organisations, such as census information related to electoral boundaries.
Primary Care Trust
Schools’ data can readily be re-grouped to match PCT, LHCC, or LHG boundaries, and use of the HRBQ can provide a vivid ‘profile’ of the young people in the group’s area:
| Profile for Janwick PCT | |||||
| All | Year 8 | Year 10 | |||
| Male | Female | Male | Female | ||
| P2: Two adults at home | 75.8 | 76.9 | 77.4 | 72.6 | 73.3 |
| P4/5: Large family (6+) | 12.5 | 13.2 | 13.9 | 14.5 | 8.5 |
| D2: Smoked last week | 13.2 | 5.8 | 4.3 | 15.4 | 27.1 |
| D4: Self-labeled smoker | 11.0 | 4.1 | 2.6 | 12.8 | 24.6 |
| D5: Smoking in family home | 20.2 | 13.2 | 20.0 | 24.8 | 22.9 |
| H12: Seen doctor in last 6m | 52.9 | 52.9 | 48.7 | 57.3 | 52.5 |
| H4: Seen dentist in last 6m | 68.4 | 67.8 | 71.3 | 62.4 | 72.0 |
| H14/15: Often have asthma symptoms | 8.3 | 9.1 | 10.4 | 1.7 | 11.9 |
| H10: Asthma medication last week | 12.3 | 14.0 | 10.4 | 10.3 | 14.4 |
| H11: Painkiller medication last week | 20.8 | 12.4 | 24.3 | 14.5 | 32.2 |
The profile of the PCT, LHCC, or LHG can be used to set the agenda locally by itself, or be studied alongside statistics from other local PCT's, etc., or even from the whole county, as shown here.
| The percentage that smoked at least 1 cigarette during the last 7 days | ||||
| PCT | County | |||
| Year Group | 7 | 9 | 7 | 9 |
| Males | 1.0 | 12.1 | 2.6 | 11.9 |
| Females | 2.2 | 25.4 | 2.3 | 17.4 |
GP practice level
GP practice codes can be collected during surveys, and the combined data about the young people in their care can be made available to the practices represented. Information about a wide range of health-related behaviours can be helpful when talking with those young people who ‘report sick’; around 50% of boys and girls aged 12-15 consistently record that they have been to see their GP within the last three months, a figure which has on occasion been checked through local practice records.
Practices may also be interested in supporting the cost of an HRBQ survey, if the data arising from it are expected to be derived from a sufficiently large and representative number of young people registered with the practice.
7a. Trends in one commissioning authority TOP
A common practice is for PCTs to carry out a survey in two year groups, with a follow-up survey two years later. A chart such as the one shown below makes it easy to see if any differences in the behaviours reported by young people of the same age and gender have occurred in the two years since the first survey was carried out.
A comparison between county smoking data in 2003 and 2005
ln this example, which shows the percentage of Year 9 and 11 pupils that smoked at least one cigarette during the previous week, it is seen that there were more smokers in each of the four age/gender groups in 2005 (rear) than in 2003 (front).
The sampling frame also enables a cohort-like analysis to be carried out, since the Year 9 pupils sampled in 2003 were in Year 11 in 2005.
The arrow shows the large increase in smokers within the same groups after two years.
A graphical presentation like this is very useful for presentation in public reports.
7b. A 15-year survey programme in one commissioning authority TOP
Health care is delivered at community level
Surveys were carried out in this particular area in 1988, 1990, 1992, 1995, 2000 and 2003 and changes in the recorded levels of young smokers (based on the percentage that smoked at least one cigarette during the previous week) are shown in the upper chart. They show an overall increase in the percentage of ‘smokers’ among the Year 8 and 10 respondents. The lower set of columns represents the percentages for the same year groups, in the same calendar years, obtained from our annually-published Young People reports. It can then be discovered how closely the general area trends match those seen in the much larger annual sample.
Smoking levels 1988-2003 in local authority data
Smoking levels 1988-2003 in SHEU databank samples
8. Pyramid project TOP
Primary and secondary schools share their data and planning
The notion of the pyramid project is to survey children in a secondary school and the associated feeder primary schools. This provides an immediate ‘mirror view’ of the pupils’ current health-related behaviour patterns, attitudes and beliefs across an age range which spans the transfer between primary and secondary school.
There are both short-term and long-term outcomes built into a pyramid survey. The participating schools get a new perspective on their curriculum content, as well as a range of new coursework material. Health and education authorities can assess current and future needs and review their funding and provision.
Immediate benefits of a pyramid survey include:
- the data provided by the pyramid survey are of great interest to all parties involved;
- the secondary school receives a preview of its future intake’s health-related behaviour;
- the primary schools receive insights into the possible future behaviour patterns of their youngsters;
- staff from all linked schools are able to plan a coordinated approach in their health education programmes.
A typical Pyramid model
The upper years of the feeder primary schools, and Years 8 and 10 of the associated secondary school, are sampled. Repetition at 2-year intervals creates a Year 6-8-10 cohort study.
This is one of a series of documents describing the work of the SHEU in detail.