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.

Topics: 

Comments about SHEU

"SHEU data proved the best source of the kind of information we were looking for (...) to provide research support to the National Healthy Schools Programme." 

Department of Health

...Many thanks for all your work with this year’s survey. It’s already proving to be invaluable especially against the severe cuts in services that are looming.

Health Promotion Manager

"We are planning next year's programmes around this information." Health Education Adviser

Health Education Adviser

"I really think that the HRBQ is a wonderful piece of work in terms of getting useful information for so many different organisations in one go." Healthy Children's Research and Statistics Officer

Research and Statistics Officer

"The Schools Health Education Unit has been a unique inspiration to all of us. For me, as I have worked in the many different areas of the NHS, the SHEU, its principles and your determination have always been a cornerstone in what a health promoting service should be about."
PCT Performance Manager paying tribute to John Balding, presented at his retirement lunch, May 2005

PCT Performance Manager

I just wanted to write and tell you how much I enjoyed your talk at last week's conference.

Chief Executive, substance use charity

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

Health Improvement Specialist

"It's good to talk with you again - we used so much of those data and did so much with it in schools - we really got the place buzzing!"

Consultant in Public Health

"Thank you from my staff to you and all your staff. The speed of 'turn-around' of the questionnaires is outstanding in anyone's terms." Headteacher

Headteacher

"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

"We never make a move without looking at these excellent reports." Public Health Consultant

Public Health Consultant

"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

Health Education Co-ordinator

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

Teenage Pregnancy Manager

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.

Teacher

"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." Tribute from OFSTED to John Balding, presented at his retirement lunch, May 2005

OFSTED

"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."

Health Education Coordinator

"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

Health Education Advisor

"Many thanks to SHEU for your excellent professional support over the years."

PSHE teacher

I've just spent a really interesting half an hour reading through our ...survey (report). Always food for thought and a good way to look at how we can improve.

Headteacher

"We have never consulted our young people like this before. The survey makes a great contribution to our 'best value' planning." Sports Development Officer

Sports Development Officer

"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

Headteacher

"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."

Deputy Head Secondary School

"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

NHS Scotland

"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.

 

Headteacher & Healthy Schools Coordinator

"The credit goes to you for the fabulous information the survey yields!"

Assistant Director Schools and SEN

Please could our College be part of the SHEU survey this academic year? We did it in 2016 and 2017 and found it incredibly informative and it helped us shape our PSHE provision.

Assistant Principal

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

Kelloggs

I would be extremely interested to see the results as I know how useful this information has been to the other schools in the
borough

Headteacher

"I very much value the contribution the Health Related Behaviour Survey has made to the public health agenda and feel confident it will continue to do so." Tribute from a Director of Public Health to John Balding, presented at his retirement lunch, May 2005

Director of Public Health

"We would like to take part in the next ECM survey. We have found the data produced invaluable for supporting evidence in our SEF etc."

School Vice Principal

"...the most comprehensive health education survey."

Daily Telegraph

"The Schools Health Education Unit is the jewel in the crown of the Health Education Authority." Major General Sir John Acland 1928 - 2006

Major General Sir John Acland

"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

Prof Neil Armstrong

"The children found the survey very interesting and enjoyed doing it." Class Teacher

Class teacher

"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

Assistant Director of Public Health

I think the HRBQ is an absolutely wonderful, informative tool and I am keen to really encourage schools/other relevant partners (as appropriate) to utilise this invaluable data to encourage voice of the child, and subsequently contribute to shaping priorities and services.

Senior Health Improvement Practitioner (Children and Young People)

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

Supervisor's Notes

"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

OFSTED

"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." 

Learning Mentor

"The service you provide is of national significance." Health Development Agency

Health Development Agency

"Many thanks for all of the fantastic information that you have sent to me over the years, it has really helped me to plan relevant courses for my students to follow and to help me to focus on the needs of the students I teach."

PSHE teacher

(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).

Health Improvement Specialist (Children, Schools and Families)
Any comments on specific survey questions that may have caused difficulty

No problems. My children were fully briefed before the survey and they understood that they could miss questions if they did not want to answer them. We did not have any children with any concerns regarding the survey at all.

Any comments on the use of the web site No it was easy to use.
Any general comments on the exercise The children really enjoyed completing the survey, It has lead to many positive discussions about our health and how we all have slightly different experiences and home lives.

 

Class teacher

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.

Health and Wellbeing Adviser

"I have never looked at myself in this way before." Pupil

Pupil

"On behalf of all the health promoters in Scotland I would like to say a big thank to you and your colleagues for your excellent work over the years. This includes not only your survey work but your role as a visiting examiner in Scotland and adviser on course development."
Tribute from a Health Commissioner to John Balding, presented at his retirement lunch, May 2005

Health Commissioner

"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."

Local Authority Senior Adviser

"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

Headteacher

...our analyst here in Public Health- is beside himself with excitement about all the juicy data pouring in...he can't wait to get his hands on it!!!!
He is happier than I have seen him for years.

Public Health Principal

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

BBC

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

Healthy Schools Co-ordinator

"This week I have been working on a major strategy for service design -- it is easy to get solely focussed on hospitals, performance targets, and work force planning -- all very important; but at the same the needs of young people and how we need to work across agencies to address the health needs of today and tomorrow must be recognised. SHEU is founded to do just this."

PCT Performance Manager

"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

Director of Public Health

"I would like to say that this survey was very useful and made me realise things about PE and health that I had never realised before......Food at school is groovy, especially if your school does Jamie Olivers School Dinners. Viva apples and thanks for the survey." Female pupil, 13 yrs old

Female pupil, 13yrs

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

National Association for Environmental Education

"Thanks for presenting the survey to local schools this morning, I just wanted to thank you for such interesting and thought-provoking information.  
I’m really glad we were able to take part - the information (particularly headline data and differences) will support us to have some really interesting questions with the Year group as a whole about the sense they’re making of this; what they think it might mean in terms of changes they might make, and what they need to support them in this."

Deputy Headteacher

 “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.”  

Secondary School Head

"I would like to take this opportunity to thank you for your work regarding writing and compiling the sex education survey. The survey was well executed and the schools have found their individual reports very helpful. The results of the survey have enabled the Local Campaign Group to justify the need for young men's campaigns and given us invaluable insight as to the thoughts and experiences of this target group."

Teenage Pregnancy Strategy Manager

"I have valued greatly the work I have done with the team in Exeter, it has been a highlight of my years here." Health Promotion Specialist

Health Promotion Specialist

“(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."        
 

Deputy Head, Secondary School

We were all very impressed with the spreadsheet and can see that an incredible amount of work has gone into creating this!

Health Improvement Specialist

"One year (following the SHEU survey) responses from our Year 4 cohort caused us concern, so we put in place a number of team building, motivational projects. We then assessed their effectiveness by requesting the SHEU questionnaires for these pupils as Year 5's."

Learning Mentor

"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."

Personal and Social Development Consultant

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

Health Education Co-ordinator

"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."

Health Education Advisor

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

Prof Ted Wragg, 1938-2005

"Brilliant - thank you Angela. As always you and your team are so proficient at getting our requests dealt with so promptly - it is a real pleasure to work with such a great organisation."

Health Improvement Adviser

"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."

Consultant in Public Health Medicine

"This is an excellent way of keeping up to date belt and braces style."

School Drugs Advisor

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

"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."

Specialist Registrar in Public Health

"Your work in developing the Health Related Behaviour Survey was ground breaking and has continued to evolve." Tribute from a Director of Public Health to John Balding, presented at his retirement lunch, May 2005

I would just like to say thank you very much to Angela, yourself and all of the SHEU team for making the [survey] so successful. The survey has been well received and we are using data in new ways to help support work on local Public Health priorities.

Senior Public Health Specialist

"Please send an additional copy of our report - it is the most requested and borrowed item in the whole library." Health Promotion Unit

Health Promotion Unit