Pasos para el proporcionamiento

Using a questionnaire has a number of advantages over interviewing participants directly, especially when collecting data form a large number of participants. Questionnaires are meant to be easy to understand, they can be completed in a limited period of time, and are cost effective in terms of assessment and financial resources. It is also possible to conduct straightforward statistical analysis on the data, which are presented in a concise fashion, focused on the areas of interest to the researcher.

6.2.1. SALSUS (baseline)

Part of the intention of the present study was to build on and complement the findings of The Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS; 2004), which is undertaken by the Child and Adolescent Health Unit. SALSUS is a large-scale survey of young people in Scotland investigating their attitudes to smoking, drinking and drugs and the prevalence of these behaviours in this population.

SALSUS is conducted biennially for the government in Scotland and started in 1982 with the collection of data on smoking behaviour. Drinking behaviour was first examined in 1990 followed by drug use in 1998. In 2002 the survey examined lifestyle, social factors and substance use in S2 (aged 13 years) and S4 (aged (15 years), which was repeated in 2004 (n=7,062) and most recently in 2006 (n=23,180).

The SALSUS itself provides a detailed and comprehensive picture at both a national and local level of the frequency of smoking, drinking and drug use and the social context of the young people completing the questionnaire, including family structure, affluence and friendships. The frequency with which the SALSUS is carried out permits comparison across time and allows for exploration of trends, for example looking at the impact of health education messages on teenage behaviour.

Data collection in SALSUS is primarily through closed questions. The participant is guided step by step through the questionnaire from one question to the next as in the example provided below. The questions do not necessarily have to run in a sequential fashion, but they do adhere to asking about the same topic. The reader is asked to provide and answer from the responses available.

SALSUS Question 30 (2004)

During the last 7 days, how much beer, lager and cider have you drunk? Please don’t count drinks labelled low alcohol

Have not drunk beer, lager or cider in the last 7 days Less than half a pint

Respondents are directed to the next question depending on which box they tick. For example ticking the first two boxes leads respondents to Q33:

During the last 7 days how much shandy have you drunk? Have not drunk shandy in the last 7 days Less than half a pint

Half a pint or more

Whereas ticking the last box on Q30 leads to the next question:

Question 31. Write in the boxes below, the number of pints, half pints, large cans, small cans and bottles of beer, lager and cider drunk in the last 7 days.

Pints Half pints Large cans Small cans

The questionnaire developed for the present study was directly informed by the SALSUS. Initial question formatting was based on examples in the SALSUS. This was to ensure the use of well-validated questions, and where the topics are not covered in SALSUS, a well-validated question format. The following examples are taken from the questionnaire developed for this study:

If you have consumed alcohol, have you ever had enough alcohol where you felt

you were no longer in control of your actions?

□

□

If you answered yes to the prior question, have you ever done anything you

regretted or would have done differently while under the effects of alcohol.

□

□

In addition to these SALSUS-style questions, the questionnaire developed for this study also contained vignettes requiring participants to present a narrative response, for example:

A. Lisa had never tried alcohol before, but her friends persuaded her to try some wine that was stored in their parent’s house. She realised that after drinking one glass she was feeling pretty tipsy, and even though she did not want to have more she had two more glasses which made her very drunk. Based on your experience or your knowledge of a similar situation, what would happen next and why?

The format of these questions was informed by the MEPS scenarios used in the previous two studies (Chapters 4 and 5). However, instead of presenting a desired resolution to the social problems, this study used open-ended questions requiring participants to reflect upon personal experience or use personal knowledge in developing a response. Participants are required to engage with the question by writing their response rather than ticking a box. The vignettes are designed to establish situations that the participants may or may not have been encountered previously, but can reasonably be

expected to have some knowledge about, if not first hand, then through other channels such as peers, school or television.

Through the use of vignettes the present study hoped to add to the quantitative findings from SALSUS on the percentage occurrence of different behaviours by exploring something of the way in which young people make decisions about risky situations. The questions ask the participants to provide information that they know or have about the topic at hand. Alongside the SALSUS topics - smoking, drinking alcohol and drug use - the questionnaire also covers two other areas associated with risk-taking: sex and gambling. Two further sections were included to expand the scope of the study to other challenging situations young people encounter. The first of these explores relationships with family and peers with a view to investigating the participants’ perspectives on these. The second examines issues around eating behaviour, which is included both as an issue of concern in adolescence but also to tap into adolescent thinking and understanding about mental health, alongside issues raised with alcohol and drug use.

SALSUS not only provides a well-validated scale as a foundation for the quantitative portion of this questionnaire. It also provides a measure of validity for the data collected with the new questionnaire, as it is possible to compare the percentage responses on key questions on both questionnaires. This in turn is important for establishing the validity of the qualitative questions.

6.2.3. Pilot study

The questionnaire was piloted on a total of 55 volunteers between the ages of 13 and 18, some of whom were recruited from the St Andrews’ Scottish History and Creative Writing Summer programme and others who attended a local high school. Informed consent was obtained from all participants over 16 and from their parents for those under 16 years of age. The pilot study comprised two phases.

Phase 1. The first phase aimed to identify what the participants thought the questions meant, and whether there were any misinterpretations due to language or format, as well as gauging the adequacy of the length of the questionnaire. A total of 15 teenagers took part in this qualitative portion of the pilot study. Participants were asked to explain what they thought the questionnaire was actually asking of them and whether the questions themselves had any relevance to their daily life. Any discrepancies and suggestions from the participants were noted down, and changes were made accordingly before the second phase was carried out. The only substantial issues raised by the participants were the length of the questionnaire and that some of the questions appeared to be asking them for information they had already provided earlier. Open-ended questions that appeared redundant were exchanged for new questions broaching a different angle on the same topic. For example, a question talking about pregnancy was switched for a question talking about condom use during intercourse. This first pilot phase also demonstrated that the length of the questionnaire was excessive. Instead of presenting two open ended questions per topic, the number was reduced and two separate

versions of the questionnaire created, each with one question on each of the seven topics. Half an hour was set as a target time for completing the questionnaire.

Phase 2. This second pilot phase was completed by 40 participants, with the aim of testing the internal consistency of the questions (Table 6.1). As a result of this two questions were modified. In one the term “slumber party” was modified because of continuous misunderstanding of the term itself, and a question was shortened as there was more than one way to interpret it.

Table 6.1. Reliability of Phase 1 with Phase 2 Pilot data.

Topics Items before 2nd

phase of pilot Items after 2nd phase of pilot Cronbach’s Alpha of the remaining items Smoking 8 6 .79 Drinking 2 2 .82 Gambling 8 6 .85 Personal Choices (Sex) 4 4 .76 Friendships 3 3 .75 Eating 2 2 .71 Drugs 4 3 .75

Questionnaire A and Questionnaire B were developed, each with a quantitative section for each topic and a vignette. Having two separate questionnaires allowed the researcher to counterbalance the presentation of the questions. The order of the

questionnaire was also reversed between questionnaire A and questionnaire B, accounting for any possible order effects that could present themselves.

6.2.4. Description of Final Version of Questionnaire A and Questionnaire B

There were two distinct, yet structurally identical versions of the questionnaire, version A and version B. While all the closed questions remained the same for both versions, the order of the topics was reversed in version B to counterbalance the design as well as to remove any order of presentation bias. Questionnaire A introduces smoking first and finished with gambling. Questionnaire B commenced with Gambling and concluded with smoking (Figure 6.1.).

Figure 6.1. Set up of Questionnaire Study, Version A and Version B

The open-ended question for Questionnaire B was also different from that of Questionnaire A. A total of two questions were developed for each topic. One question was presented in version A, the second question was presented in version B. Please refer to the diagram below showing the similarities and differences of the set up of the questionnaire. A B Closed Questions Closed Questions SAME TOPIC Order TOPIC Order Reversed SAME Open Question Open Question SAME

Structure of the Questionnaire

On the frontispiece of the questionnaire (A & B) there was a total of four paragraphs which set out the following: a) Purpose of the Study, b) Confidential nature and anonymity of the questionnaire, c) Request to consider the questions thoroughly and to express personal thoughts and not those others may hold (to avoid Social Desirability Bias), and d) Request to read the simple instructions for each topic and an appeal to answer all questions as well as they knew how.

On the second page participants were asked to fill in their gender, provide current year of schooling (e.g. S2) for logistical purposes and their age in terms of year of birth and month of birth. If this information was not filled in, then the questionnaire itself was invalidated.

On the third page the actual questionnaire began. The closed response questions (yes / no) were presented first in order to allow the participant to consider the risk behaviour itself. This allows for the vignette, open-ended question that follows to have an appropriate introduction where the participant can reflect on the risk behaviour itself. By introducing the topic in this manner, there is an element of self-assessment that can occur. The participant is indirectly being asked to think about his behaviour and following this is then asked to provide what steps he/she would take from personal experience or knowledge regarding the risk behaviour presented (Table 6.2.).

Table 6.2. Number of Closed Questions and Open Questions in Questionnaire

SALSUS

Inspired Questions

Total

Closed Questions

Total Open Questions A and B Drinking 2 4 2 Smoking 3 3 2 Drug Taking 3 3 2 Gambling 0 2 2 Sexual Behaviour0 2 2 Eating 0 3 2 Friendships 0 2 2 Total 8 19 14

After the closed questions were presented, there was one open question for each of the two questionnaires. For each topic there was either Question A, or Question B. Each topic had two separate open-ended questions, both probing similar yet distinct aspects of the topic itself. Each of the small vignettes concluded with: “Based on your experience or your knowledge of a similar situation, what would happen next and why? Each of the open-ended questions asked concluded with the same sentence, providing a structural link between all of the open-ended questions. The initial portion of the questions related to a real life situation that the participants may or may not have come across, but of which they may have distinct knowledge about. Participants were asked explicitly to use knowledge or their experience to respond to the vignette in order to tap into real life problem solving and decision-making.

6.3 Method 6.3.1 Participants

A total of six hundred and five young people were recruited to take part in the study from four high schools in Dundee in the East of Scotland.

Participants were recruited using a judgment sampling strategy. The Dundee School population was the most socio-economically diverse school system that could cater to a study this size in the vicinity of St Andrews. A judgement was made that Dundee Schools could provide a close approximation of what the general Scottish population was like in terms of decision-making processes.

6.3.2 Recruitment Ethical Approval

Ethical approval for the project was received from the School of Psychology at the University of St Andrews. Permission to approach high schools in Dundee was granted by the Dundee City Council Education Department. On receipt of this approval approaches were made to the Head Teachers of all 12 high schools in Dundee for permission to run the questionnaire study. Three out of the 12 schools agreed to participate.

6.3.3. Schools

School 1 (n= 256)

School 1 forms part of the Dundee City Council schooling system, but is located on the edge of the city. School 1 is a non-denominational school, and at the time of this

study had approximately 900 students on its roll. As a measure of socio-economic tendency within the school, the percentage of pupils entitled to a free-school meal at School 1 was obtained for 2004, 5.2%. The national average for Dundee is 20%, and for Scotland was 13.2% in Scotland. The percentage for this school fell sharply below the national average, suggesting that parents stood on solid socio-economic ground (Dundee City Council, 2004). The measure, though imperfect, allowed for a rough categorization of participant socio-economic status.

Her Majesty’s Inspectorate (HMI) of Education rated the overall quality of the curriculum of School 1 as very good. The overall quality of attainment at all levels was good as well. Of particular relevance to this study the HMI found that pastoral welfare was good. PSE and Social Education classes were judged successful in teaching key aspects of relationships, health education, sexual health, and decision-making. The overall quality of staff support was found to be very good.

School 2 (n= 128)

School 2 included religious teaching and serves part of west and central Dundee. The school roll was approximately 900 at the time of the study. In terms of the socio- economic make up of the school population, free school meals fell in line with the national average during this particular school year. In this school (2004), the average was 14.3%, with the average in Dundee being 20%, and the national average 13.2%.

The general attainment of this school was rated as fair to weak by the HMI, and achievement in standard grades was slightly below the national average. A strong religious ethos was imparted to the students, particularly through music and after school

activities. An appropriate Social Education and PSE program was in place, though overall the teaching levels varied quite dramatically. The PSE covered a range of topics, including personal safety, drugs, personal relationships, and careers, as reported on the HMI report for that school year.

At the time of the study this school was housed in a temporary structure as the school building was undergoing redevelopment. Heavy construction work and relocation hampered recruitment, as older and younger participants were located on separate campuses. This resulted in a narrow recruitment of students from this school.

School 3 (n= 211)

School 3 is a non-denominational school situated in the West of Dundee. At the time of this study, approximately 815 students were enrolled. The percentage of students who were entitled to free meals was above average (23%), placing the students in a more impoverished socio-economic bracket than pupils attending schools 1 and 2. The city average for Dundee is 20%, and for Scotland 13.3%. Pupil attendance was also below average at school 3.

School 3 had a poor reputation within Dundee although a recent survey of parents had elicited positive views about the school and a belief that its reputation was slowly improving. HMI noted learning and teaching were weak overall, though other aspects of the school such a leadership, pastoral care, and curricular guidance were rated as satisfactory to good. In particular, it was found that the PSE programme covered an appropriate range of topics including healthy lifestyles, substance abuse, personal relationships, and citizenship.

The general attainment of this school were rated only as fair to weak by the HMI, and achievement in standard grades was slightly below the national average. A strong religious ethos was imparted among the students, particularly through music and after school activities. An appropriate Social Education and PSE program was in place, though overall the teaching levels varied quite dramatically. The PSE covered a range of topics, including personal safety, drugs, personal relationships, and careers.

6.3.4. Opt In /Opt Out

Head Teachers of the schools involved gave permission for participants to “opt out” of the study rather than “opt in”, which would have meant that individual parental permission would have been necessary for the study to be conducted. Parents were aware that the study was to be conducted and could ask for their child to be excluded if they were not of age to consent. Further to parental approval via the “opt-out” system, all pupils were given the option to opt out of the study or not complete the questionnaire if they did not want to. Participants were encouraged to do other work if they did not want to complete the questionnaire itself, which took approximately 25 minutes. It was agreed by the Head Teacher of each school that logistically speaking it would be easier that the questionnaire itself were to be seen as part of the Social Education curriculum rather than as a separate item during the school day. Consent forms and letters for parents to “opt in”