Secondary Schools: Health Related Behaviour Questionnaire

Image   The Health Related Behaviour Questionnaire (HRBQ) was first developed in 1977 as an outcome of researches within the Department of Community Medicine at Nottingham University. Since then it has been used in thousands of school health surveys in secondary schools in the UK. It has also been used overseas. Across a period of more than 30 years the method surrounding its use, together with its content, have evolved against the demands of the users. In the early years these were mainly teachers, but now the medical profession has become more and more involved in shaping the content against the demands of national health programmesand targets including Every Child Matters. Similarly, from within schools there has been the pressure to produce information that can fit within health programmes and National Curriculum targets when fed back as results.

[Extract from questionnaire]

29 How many cigarettes have you smoked during the last 7 days?
Please write the number . . . . . . . . (If NONE, write 0)

30 If you have smoked recently, where did you get/buy your last cigarettes from?
Please write . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

31 Which statement describes you best?
0 = I have never smoked at all, not even a puff
1 = I have tried smoking once or twice
2 = I used to smoke, but I don't now
3 = I smoke occasionally (less than 1 cigarette a week)
4 = I smoke regularly but would like to give it up
 5 = I smoke regularly and don't want to give it up                            0  1  2  3  4  5

32 Do any of these people smoke on most days?
0 = No       1 = Yes

a Mother 0  1
b Father 0  1
c Brother (if no brother, circle 0) 0  1
d Sister (if no sister, circle 0) 0  1
e Close friend 0  1





Since its origin, the HRBQ has been regularly revised and improved. It contains the following sections:

1. Personal background Age, family structure, ethnicity, home background, self-esteem, feelings of control, personal safety, height and weight
2. Nutrition Lunch and breakfast, frequency of consumption of listed foods
3. Drugs Smoking, alcohol, other drugs
4. Hygiene, medication, dental Frequency of use of medication, relationship with GP, dental hygiene, health problems
5. Relationships, mental health, HIV 'Important others', problems and sources of support, HIV knowledge & precautionary intentions
6. Leisure and money Leisure activities, income, money spent, National Lottery, Instant scratchcards, money saved
7. Exercise Frequency of involvement, feelings about fitness & exercise, cycling training & safety, accidents

Sections 1-7 overlap substantially with the concerns of the national health programmes and targets:

Coronary Heart Disease (smoking,diet, exercise)
Mental health (problems, self-esteem)
Accidents, cancer (smoking, diet)
Sexual health (AIDS, relationships)

The Authority funding the survey will receive a bound volume of the combined results, together with a list and brief description of the additional available services, which are itemised here:

The Graphical Option, with the combined results returned in the form of histograms and pie charts instead of tables.
The Community Profile service, comparing the combined survey data with SHEU nationwide data, and recording differences of 5% or more.
The Draft Report service, for authorities wishing to circulate a comprehensive survey report.
The Collaborative Written Report, with more extensive text to help clarify issues arising from the results and to inform a wider audience within the community.
Databases to match their computing requirements.

The results are presented in tabular form and returned to individual schools as a bound volume with introduction, index and a copy of the questionnaire. As part of the service the school also receives the following:

After the Survey A substantial volume of information on the potential use of the returned material in schools and with staff, parents and governors. This collection of examples of good practice is the outcome of over 20 years of evolution and repeated use of the method in schools. The manual shows how specific questions link with National Curriculum requirements, and gives examples of the use of the data in health education programmes across the curriculum.
School Report This presents the principal findings from the survey, with commentary on selected questions.
Health Risk Appraisal The results of the Health Risk Appraisal calculations for individual boys and girls. PINs are used to feed back data to individuals, so protecting their identity. These results are contained within a bound document in which the basis for the calculation of the scores is carefully presented.

ADDITIONAL SERVICES have been developed to support schools. These include a wide range of opportunities for work across National Curriculum requirements, as follows:

The Graphical Option, a school's results returned in the form of histograms and pie charts instead of tables.
The Community Profile service, a comparison of the school's results with the average of all the schools taking part in the same survey. Any instances where the difference is 10% or more are detailed.
The Profile datafile: most of the school's HRBQ survey data on a diskette, 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 pupils. Links between behaviours, such as self-esteem and smoking, can be investigated.
Computer-readable tables of results to allow pupils to experiment with different forms of presentation.
Workshops, or compact and validated methods of introducing the data to pupils, parents, staff and health-care professionals.

Local Authorities' use has led to:
1. A computer database being set up for local interrogation. (The opportunity to link with Census Survey data is available.)
2. Report writing, based upon the results. SHEU has prepared many draft reports, which have then been revised in consultation with the customer and the final version printed and circulated.
3. The establishment of the behaviour levels of defined groups of young people at a particular time.
4. Priorities being identified or confirmed for intervention programme design.
5. Results linked directly to communities:

Schools (with their permission) To help concentrate money and resources where particular schools have most need of support.
GP practices To inform and direct the health care and provision for young people within the locality served by the practice or combination of practices.
Localities or neighbourhoods In order to attribute survey response patterns to the localities where young people live, and to retain anonymity and confidentiality, a method has been designed whereby the Local Authority allocates its own reference numbers to different electoral wards or boroughs. Alternatively, pupils supply a sufficient part of their home postcode to reveal the enumeration district in which they live, but no more. Collecting such information enables statisticians to analyse the information in larger combinations of localities.
6. Repeat surveys monitor changes influenced by intervention programmes.

Schools' use has led to:
1. Clarification of course timing
2. Material for use in course work
3. Prompts for course revision, renewal and innovation
4. Supportive evidence for co-operation with parents
5. Creation and consolidation of links between the school and support agencies, e.g.: Office of Public Health Youth services Health Promotion Units Recreational facilities for young people locally
6. Information for school doctor and nurse
7. Clarification of school policies, e.g.: Medication in school, School excursions, Sex education Drug education and Bullying

Please contact Angela Balding (Tel: 01392 667272) for details.