Question development

Question development

A Health and Wellbeing Questionnaire Content Group was established in April 2018 chaired by NHS Health Scotland (now Public Health Scotland), with the remit to create a set of core questionnaires, together with an accompanying question bank, using questions from existing and established health and wellbeing surveys.  

The Content Group brought together expertise in health and wellbeing surveys, data users, representatives of the education sector and the health sector, and local authorities. Membership included:

• Education Scotland
• Local authorities
• HBSC International Coordinator
• Glasgow City Health and Social Care partnership
• School representation from Perth & Kinross & Aberdeenshire
• Director of the MRC/CSO Social & Public Health Sciences Unit
• NHS National Services Scotland
• Education Institute of Scotland (EIS)
• Association of Headteachers and Deputes in Scotland (AHDS)
• Director of Scottish Centre for Social Research (ScotCen)
• an Independent research consultant
• Scottish Government analysts from Health and Social Care, Learning Analysis Unit and Children & Families Analysis Unit.
• NHS Greater Glasgow and Clyde (provided an advisory role rather than a formal member of the Content Group).

This group was also supported by a wide range of Scottish Government policy colleagues who provided feedback and suggestions on the proposed set of questions relevant to their policy area in order to ensure that the language used was up-to-date and relevant. The Content Group operated jointly with these stakeholders. 

The Content Group, working with stakeholders, agreed a set of themes/topics, and within these, a set of age-appropriate questionnaires for use. It was recognised that a single data collection could not meet all data user needs, particularly with a subject as wide ranging as health and wellbeing.

Therefore, the Content Group was required to review the suggested questions for inclusion, and prioritise these based on:

• User need, noting local authorities and Scottish Government were key users of the data
• Age-appropriate questions
• Topics structured around the SHANNARI framework
• Key measures from SALSUS
• Using questions, where possible, from existing surveys – to replace existing data collections where appropriate, to provide time series as far as possible on key measures and to use existing (tested) questions
• The length of the questionnaire – required to be completed in a single class setting, and take into account the cognitive ability by age.

The draft National Improvement Framework for Scottish Education was launched in 2015, with health and wellbeing being one of the key priorities in the Framework. The information generated by an improved survey will be used for reporting on the National Improvement Framework beyond 2017.

While there were core questions included in each questionnaire, topics were asked appropriately by age. For example, questions on attitudes to school are asked of all stages, questions on caring responsibilities are asked of P7 and upwards, and questions on sexual health are asked of S4 – S6 pupils only. Table 3 sets out the topics included in the stage questionnaires. As different topics and questions are included as age appropriate, it was not possible to include all questions in all stages (where relevant) and meet the criteria of completing the questionnaire in a single class session. Therefore, some questions are only asked of key stages.

Table 3. Topics by stage questionnaire

Information on why topics and themes are included in the HWB Census is available in the published Topics document. The data collected is adequate, relevant and limited to the purpose identified in the DPIA in that it is sufficient to properly fulfil local authority and Scottish Government stated purpose (see chapter 7 UK GDPR and data protection).

The links below provide access to the questionnaire for each stage. These are the questionnaires as developed by the Scottish Government. As each local authority will conduct their own data collections, the survey questionnaires used locally may differ as local authorities have the flexibility to add or remove questions.
P5 questionnaire: Survey Preview Window (smartsurvey.co.uk)
P6 questionnaire: Survey Preview Window (smartsurvey.co.uk)
P7 questionnaire: Survey Preview Window (smartsurvey.co.uk)
S1 questionnaire: Survey Preview Window (smartsurvey.co.uk)
S2 questionnaire: Survey Preview Window (smartsurvey.co.uk)
S3 questionnaire: Survey Preview Window (smartsurvey.co.uk)
S4 questionnaire: Survey Preview Window (smartsurvey.co.uk)
S4 Substance Use questionnaire: Survey Preview Window (smartsurvey.co.uk)
S5 questionnaire: Survey Preview Window (smartsurvey.co.uk)
S6 questionnaire: Survey Preview Window (smartsurvey.co.uk)

Sexual health and relationships question development

Sexual health and wellbeing is an important aspect of the physical and emotional wellbeing of individuals. While teenage relationships can be positive and healthy, it is important that adolescents understand the concept of fully informed consent as a basis for any sexual relationship in order to reduce vulnerability to sexual exploitation.

The sexual health and relationship questions in the HWB Census, asked of pupils in S4-S6, provide evidence on the level of sexual experience young people in Scotland were having, as not all young people have penetrative sex.  However, for young young people who were, it is important to know if they were practicing safe sex. As the questionnaire is digital, only those young people for whom the questions apply to see the questions. For example, if a young person responds they have not had penetrative sex, they are not presented with the questions on safe sex.

Two other national surveys in Scotland ask questions about sexual experience to children and young people. Questions on sexual experience are asked to children aged 15 years in the HBSC, and to children aged 14 in the Growing up in Scotland Study Sweep 10. The Health and Wellbeing Census sexual experience question asked to children in S4 upwards aligns with the Curriculum for Excellence Relationships, Sexual Health and Parenting (RSHP) educational resource.

In September 2015, the Scottish Government published the Sexual Health and Blood Borne Virus Framework 2015–2020 update. It reported on the progress made since the original Framework published in 2011 which brought together policy on sexual health and wellbeing, HIV and viral hepatitis for the first time. The Scottish Government have since published the Sexual health and blood borne virus action plan: 2023 to 2026 which outlines the sexual health and blood borne virus (HIV, hepatitis C, hepatitis B) priorities for Scotland for 2023 to 2026, including young people. The Scottish Government strategy “Pregnancy and Parenthood in Young People (2016–2026)” sets out actions on pregnancy information and advice, and on mental health of teenage mothers.

Ethics

Surveys like this are not new and play a crucial role in ensuring children and young people have access to the help, advice and services they need. The HBSC survey, that has run in Scotland since 1990, has included questions on a range of health and wellbeing topics, including sexual health and wellbeing; substance use, alcohol consumption and smoking. Also, SALSUS has also provided a national (and local authority) picture of young peoples’ behaviours in relation to smoking (from 1982), drinking (from 1990) and drug use (from 1998). Such issues are routinely also included in pupil surveys in other countries across Europe, including in England and Wales.

The Government Social Research (GSR) professional guidance summarises the key principles which those commissioning or conducting social research for government need to uphold.

Following decisions on the topics and individual questions included in each stage questionnaire, an ethics review was undertaken. The Ethics Guidance for Scottish Government Social Researchers sets out the detail of the process. This process ensures that the project has been subject to an assessment of ethical issues before the final decision to commission the research is made. The ethical sensitivity checklist sets out the ethical sensitivities and risks and the appropriate actions recommended to manage the identified issues. As the HWB Census was identified as highly sensitive, the project was required to undergo an ethical peer review process, which provides a higher level of assessment and scrutiny.

The HWB Census questionnaires were ethically approved by the Scottish Government Ethics Peer Review Group in August 2019. The process applies to the survey as a whole, rather than for individual questions.

Digital collection

The options appraisal and feasibility study recommended digital data collection. This allows questionnaire routing to be designed into the questionnaire, so respondents are not presented with questions which do not apply to them, based on previous responses. For example, the experience of bullying questions are only asked of respondents who answer ‘yes’ to the question “Have you been bullied in the last year?”

​​​​​​​SmartSurvey was procured by the Scottish Government using the G-Cloud procurement framework set up by the Cabinet Office. The use of electronic survey platforms for data collection in the public sector is not a new development and does not constitute an innovative approach in itself. However, the use of this technology to enable each local authority to administer and gather its own Census data is new. As noted above, children and young people had to complete the census in a single class setting. They were not able to leave and re-enter the census questionnaire.  While the Scottish Government acts as the data processor of the IT platform, local authorities have their own sub-accounts to facilitate data collection at their end and are the data controllers of their local data collections.