Assessing child-well-being: perspectives and experiences of

Health Behaviour in School-Aged Children (HBSC) Study

A World Health Organization Cross-National Study

Professor Candace Currie HBSC International Coordinator

Child and Adolescent Health Research Unit (CAHRU)University of Edinburgh

Assessing health related child well-being: the HBSC experience

• Why do we do it? and who is ‘we’?• What do we do, how do we do it?• What have we learned?

• How have indicators of child wellbeing been selected?

• How does selection relate to policy interests/ needs of policy makers?

The HBSC experience

Who is ‘we’?

• ‘Health Behaviour in School-Aged Children: WHO Collaborating Cross-National Study (HBSC)’

• HBSC began in 1982 as a scientific collaboration between researchers in 3 European countries

• Now 43 participating countries and national teams from Europe and North America

• HBSC international research network has > 280 participating researchers

• Most national teams have university base • WHO Euro is study partner

Growth of HBSC study: countries by survey year

1983/1984 1985/1986 1989/1990 1993/1994 1997/1998 2001/2002 2005/6

1. England2. Finland3. Norway4. Austria5. Denmark

1. Finland 2. Norway 3. Austria 4. Denmark 5. Belgium 6. Hungary 7. Israel 8. Scotland 9. Spain10. Sweden11. Switzerland12. Wales13. Netherlands

1. Finland 2. Norway 3. Austria 4. Belgium (French) 5. Hungary 6. Scotland 7. Spain 8. Sweden 9. Switzerland10. Wales11.Denmark12. Netherlands13. Canada14. Latvia15. N. Ireland16. Poland

1. Finland 2. Norway 3. Austria 4. Belgium (French) 5. Hungary 6. Israel 7. Scotland 8. Spain 9. Sweden10. Switzerland11. Wales12. Denmark13. Canada14. Latvia15. Northern Ireland16. Poland17. Belgium (Flemish)18. Czech Republic19. Estonia20. France21. Germany22. Greenland23. Lithuania24. Russia25. Slovakia

1. Finland 2. Norway 3. Austria 4. Belgium (French) 5. Hungary 6. Israel 7. Scotland 8. Sweden 9. Switzerland10. Wales11. Denmark12. Canada13. Latvia14. Northern Ireland15. Poland16. Belgium (Flemish)17. Czech Republic18. Estonia19. France20. Germany21. Greenland22. Lithuania23. Russia24. Slovakia25. England26. Greece27. Portugal28. Ireland29. USA

1. Finland 2. Norway 3. Austria 4. Belgium (French) 5. Hungary 6. Israel 7. Scotland 8. Spain 9. Sweden10. Switzerland11. Wales12. Denmark13. Canada14. Latvia15. Poland16. Belgium (Flemish)17. Czech Republic18. Estonia19. France20. Germany21. Greenland22. Lithuania23. Russia24. England25. Greece26. Portugal27. Ireland28. USA29. tfyr Macedonia30. Netherlands31. Italy32. Croatia33. Malta34. Slovenia35. Ukraine

1. Finland 2. Norway 3. Austria 4. Belgium (French) 5. Hungary 6. Israel 7. Scotland 8. Spain 9. Sweden10. Switzerland11. Wales12. Denmark13. Canada14. Latvia15. Poland16. Belgium

(Flemish)17. Czech Republic18. Estonia19. France20. Germany21. Greenland22. Lithuania23. Russia24. England25. Greece26. Portugal27. Ireland28. USA29. tfyr Macedonia30. Netherlands31. Italy32. Croatia33. Malta34. Slovenia35. Ukraine36. Luxemburg37. Turkey38. Slovakia39. Romania40. Iceland41. Bulgaria

The HBSC experience

What do we do?

• Lead and develop a cross-national study on health of young people

• Contribute to scientific evidence base on adolescent health and its determinants

• Disseminate research findings to policy and practice as well as scientific audiences

• Inform health promotion in schools, families and local communities

The HBSC experience

Why do we do it?

• To collect cross-nationally comparable data on health related behaviours and understand cross-national differences

• To understand:

– health behaviours as part of adolescent lifestyles

– social and environmental factors that influence health behaviours & health and well-being

The HBSC experience

Why do we do it?

• Scientific endeavour - multi-disciplinary interests of researchers – explaining health of young people

• Public health interest - health monitoring/ social determinants of health

• Commitment to child health improvement

The HBSC experience

How do we do it? HBSC is organised on democratic principles with agreed Terms of Reference

National team responsibilities - working at a national level to:

• obtain funding• conduct the survey according to study protocol, • disseminate national study findings

– working collaboratively to develop international study: • methodological improvement• scientific development• inform policy and practice

The HBSC experience

How do we do it?

• National team rights include access to international data file (if national datafile is accepted as meeting high quality control standards)

• Rules: regarding data use and publications

The HBSC experience

How do we do it?

Study cycle – 4 years with overlapping key stages• Research protocol development• Survey in each participating country• Data file submission to international databank• International datafile construction, checking and cleaning

and export to national teams, further period of datafile checking

• International report preparation and other policy outputs• Scientific publications

The HBSC experienceWhat have we learned?

• Quality of data is paramount– Survey item validation including translation– Survey administration– Data management– Training and capacity building

• Science needs to pay attention to policy interests but also needs to drive policy interests

• Importance of a scientific conceptual framework and study aim to inform scientific content

• HBSC cannot do everything! – limitation to length of q’aire, topic areas that do not fit with conceptual framework, and inappropriate for age group

The HBSC experience

How have indicators of child wellbeing been selected?

• Scientific process working in context of broad conceptual framework of study

• Development of indicators conducted at level of scientific Focus Groups working in two broad areas:– Social determinants– Health & well-being and health/ risk behaviours

The HBSC experience

How have indicators of child wellbeing been selected?

• Around the main social domains of adolescent lifestyles/ social determinants

– Socioeconomic indicators– Indicators of family structure and relationships– Indicators of school environment and relationships– Indicators of peer relationships– Indicators of local area/ social capital

The HBSC experienceHow have indicators of child wellbeing been

selected?

• Around the main dimensions of adolescent health & well-being/ health related behaviour

– Positive health including self-reported health, life satisfaction, mental well-being, body image, etc

– Risk behaviours including tobacco, alcohol and drug use, sexual behaviour, violence

– Health behaviours including eating habits, physical activity, etc

The HBSC experience

How does selection of indicators relate to policy interests/ needs?

– At an international level: HBSC Policy Development Group and partnership with WHO play a crucial role in guiding policy related elements of HBSC work including selection of indicators

– At a national level: national teams decide on content of non-mandatory part of survey questionnaire to address national policy interests

The HBSC experienceHow does selection of indicators relate to policy interests/

needs?

• Impact of policy outputs and knowledge exchange activities also guides the selection of indicators:

– citation of HBSC international and national reports and peer reviewed publications in national and international policy documents/ strategies

– use of published HBSC data in reports of other organisations such as UNICEF Innocenti Centre, EC

– WHO-HBSC policy forums which examine impact of HBSC on practice and policy development

– HBSC input to WHO Euro Child and Adolescent Health Strategy

The HBSC experience

How does selection of indicators relate to policy interests/ needs?

– Feedback from policy guides selection of future indicators: allows HBSC to identify gaps and new areas for development

– Participative approaches with young people may be used to guide future indicator development – most policy now aiming to address views of young people

HBSC data access

• Published data made available in reports and papers – findings replicated and used in secondary analysis

• Limited access to data files except where area of interest is adjacent but not overlapping with current scientific activity or where collaboration can be achieved

• Discussions will take place at forthcoming HBSC Assembly meeting in June to consider opportunities, limitations and risks associated with development of future data access systems

Future challenges for HBSC indicator development

• To develop perspectives and indicators for other aspects of young people’s health & well-being and related determinants including cultural and environmental factors

• To be effective in bringing the agenda of young people and their health to research and policy agendas through HBSC development