Re-orientating systematic reviews to rigorously examine what works, for whom and how: Example of a realist systematic review of school-based prevention of dating and gender violence

“(The SHEU survey) was very, very useful. It gave us reassurance we weren’t missing a trick. For example not many pupils in the sample year groups were taking illegal drugs, which re-enforced our opinions. But the survey also raised issues and flagged some things up. We discovered that some of our girls weren’t eating enough – the percentage of girls in our school not eating lunch the day before the survey was higher than the county average. There were other concerns too, specifically around cigarettes, alcohol and attendance.
The school used this data and took a number of actions to address it. More female peer mentors were put in place and the school asked NEXUS (the Extended Schools service) for help, so they developed a programme for girls which addressed their eating patterns, healthy eating, sex education and self-esteem issues.
We ran an anti-bullying group for Year 9 as a preventative measure, based upon data provided by our current Year 10 students.
The travel data revealed that a high number of pupils took the car to school so we involved the BIKE-IT scheme who ran assemblies, brought in their bikes (including one with a pedal-powered smoothie maker!), and raised awareness of health and green issues.
The information about how happy the students were with their lives raised some concerns as far fewer girls were as happy as the boys, so work was done around developing aspirations, role-models and self-esteem."        
 

 “The (SHEU survey) helped us to prioritise where we needed to be in terms of PSHE education. We delivered assemblies based on the evidence as well as curriculum development, and dealt with whole school issues – particularly in regard to pastoral care. The answers received to the question on the survey “Who are you most likely to approach if you needed help” worried staff as “teacher” was not a popular answer. Subsequently the staff asked themselves why this had happened and what needed to be done to address the issue. There was more emphasis on wider aspects of PSHE education delivery, which needed more attention.

To summarise, the (SHEU survey) allows the PSHE department to assess the impact of teaching and learning and modify future lessons accordingly. It allows our school to look at whole school issues such as the extent to which the pastoral care system is meeting the needs of our pupils. It helps us to do need analysis of our pupils. It helps to provide important evidence for SEF / the extent to which we are meeting wellbeing indicators / National Healthy School standards.”  

"You have made a fantastic contribution to children’s health education and promotion. I am personally grateful to you for helping to kickstart my research career." Prof. Neil Armstrong tribute to John Balding, presented at his retirement lunch, May 2005

"I would like to say how much we appreciated the work you and your team have put in to this project, a big thank you for the excellent reports that you have completed on our behalf." Assistant Director of Public Health

"Our use of the Health-Related Behaviour Questionnaire was commended as part of our accreditation for the National Healthy Schools Scheme." Headteacher

"You and the team have the evidence to show how young people's behaviour has or hasn't changed over time." 
Tribute from a Health Education Co-ordinator to John Balding, presented at his retirement lunch, May 2005

"Over the last twenty years you have achieved much. The surveys and subsequent reports have painted the clearest picture we have of what young people are doing and what they think." OFSTED 1998

Thank you for following up with schools the comments that caused concern. It is very sad to hear that some of our children have these thoughts and feelings and I am so grateful that you were able to make the schools aware of this so that they can attempt to offer some support.

This is another reason why I am so pleased that we have been able to work with you to offer this survey.

"We were talking about (the SHEU survey) data at our recent NSCoPSE Conference, for PSHE advisers and consultants. It would be really helpful if some of this powerful data and the trends could be shared in the consultation around the PSHE Review. Colleagues shared their very positive experiences of (the SHEU survey). It provides excellent evidence of behaviour change for children and young people and of the impact of PSHE and wider interventions."

"You have made a truly significant contribution to health education and health promotion of young people in, not only England, but all over the United Kingdom and beyond." Colleague from NHS Scotland paying tribute to John Balding, presented at his retirement lunch, May 2005

"The Unit produces an invaluable body of knowledge... providing exceptional information across time and throughout the country." Kelloggs

"The Unit has a unique historical and contemporary archive of young people." Prof. Ted Wragg 1938-2005

"Thank you very much, David, for another excellent survey.  We look forward to receiving our reports."

"We're very happy to commission another survey from you. Our colleagues in School Improvement are dead keen to work with us on this. During our last LA Inspection, we were flagged from our Tellus data as having a bullying problem. We could demonstrate with our SHEU data - which had a much better sample size and coverage of the authority - that we did not have the problem they suggested. The Inspectors went away happy and we are definitely surveying again with SHEU."

"The Unit is to be congratulated in preparing ... material of the highest standard and worthy of wide dissemination." National Association for Environmental Education

"The (named) Children and Young People's Partnership has benefitted from the results of the SHEU survey locally for many years now, and we should like to continue to do so in future."

"The Schools Health Education Unit has gained a reputation as one of the most reliable sources of information about young people's health." BBC

"Many thanks for a major contribution to the health of children in the UK and elsewhere over many years and putting in place the continuation of the Unit." Tribute from a Director of Public Health to John Balding, presented at his retirement lunch, May 2005

"The data from last time were spot-on and we have done lots of work with it. We are very keen to repeat the survey." Headteacher

"Just to say a huge thank you for all your efforts in helping us with the Health survey amongst pupils. It has provided us with significant data which will be used across the school to help us improve. It helped us to obtain a healthy schools standard as well. I hope we can make this an annual feature as we can track the changing health of our pupils." Headteacher

"We use the data to inform whole school practice: Pastoral programmes for target groups of pupils; Items for discussion with School Council; Information to help us achieve the Healthy School gold standard; To develop and dicuss with pupils our Anti-Bullying Policy; Targeted whole class sessions with the Police Community Support Officers; To share pupil perceptions of all aspects of their school life with parents, staff and governers." 

"...the only question to cause a problem was 'has everyone got a pen?" Supervisor's notes following a school survey

"Within the curriculum, we are part of the Healthy Schools programme - and the local, Director of Public Health Award. We cover many facets of health from emotional intelligence to safety education and our very strong, Anti-Bullying and Child Protection programmes. You can imagine our delight when the Local Authority and our school nurse made the following comments after we took part in the regional Schools Health Education Unit Survey: " Head Teacher.
“This was an amazing set of outcomes and really good evidence that (your school) is doing a wonderful job in prioritizing the health and well-being of its pupils … Well done to staff, governors and parents for all your work on this through the Director of Public Health award and other strategies. It is very clear that pupils feel happy, safe and involved at the school and your caring ethos shines through this data.”
Healthy Schools Coorduinator.

"As a Deputy Head in a large secondary school I was involved in taking part in a city wide health and wellbeing survey over a period of six years. Completing the survey every two years grew in importance year on year, with the final cycle having a major impact on our SDP, PHSE curriculum, Ofsted outcomes and governor understanding.
Over the six year period we moved from a small sample in two tutor groups filling in a paper survey to two year groups completing an online survey. The reports produced give graphical analysis of a wide range of issues. As a result of the survey we increased the number of PSHE workshop days for students to address issues such as smoking, drug and alcohol awareness, anti-bullying workshops. The surveys helped Governors make a positive informed decision to allow Brook Advisory Clinic nurses on site to support students.
As a result of taking part and using the evidence provided we were able to offer more support for students which had a direct impact on improved attendance and outcomes."

"The data for (us) are very useful ... This is especially important when evaluating the impact of interventions regarding alcohol or other areas, as the survey data are likely to provide an earlier indication than routine data sources."

"The survey reports have been used to inform commissioning at specific commissioning groups. They are also being used within our Extended Schools Clusters and to inform The Annual Public Health and the Joint Strategic Needs Assessment." Programme Manager - Young People

"The Health Related Behaviour Survey is an incredibly useful resource for (us) as it provides schools, with invaluable data which can inform curriculum content, methods of lesson delivery and empower schools to better meet the needs of their pupils."

Any comments on specific survey questions that may have caused difficulty?
Pupils at our primary school found the questionnaire very easy to understand and most of them completed the questions in less than 45min.

"Every school involved in the National Healthy School programme should start with an HRBQ survey." Health Education Co-ordinator

(Our) Senior team were very enthused with the rich source of data provided within the reports (and thought that the analyses including within the appendices section of the main reports were really interesting).

"I really appreciate the professional service which SHEU offers.  We have had a great experience working with Angela on the school surveys." 

"The system works and I find quite a lot of it useful in my work. I've also recommended it to others."

"You have often stood alone against the media who were often looking for the sensational headline. I have noticed an important change: the media now look out for and report very fairly and fully on the reports from the team." 
Tributes from a Health Education Advisor to John Balding, presented at his retirement lunch, May 2005

"As a result of the survey we reviewed and amended PSHE schemes of work, we are currently working on a "Green Travel Plan", a morning breakfast club was established and we further developed 6th Form mentoring."