Conducting school-based health surveys with secondary schools in England: advice and recommendations from school staff, local authority professionals, and wider key stakeholders, a qualitative study | BMC Medical Research Methodology

Participants were key stakeholders working in young people’s health. Participant characteristics, including job role and employer organisation type, are presented in Table 1. School locations included urban (n = 4), rural (n = 4) and coastal (n = 3). Free school meal eligibility status (used as a proxy for socioeconomic status) at participating schools ranged from 1.3% to 50.1%. The 2022 English average free school meal eligibility is 22.5% [51]. The Ofsted rating of participating schools varied and included outstanding (n = 2), good (n = 5), and requires improvement (n = 2); two were new schools and had not yet received an Ofsted rating.

This section provides summaries for each theme and sub-theme produced, with exemplar quotes. Table 2 presents an overview of the three main themes, and corresponding sub-themes, developed. The data presented below was collected as part of a wider study which involved a school-based health survey, however in some instances participants discussed opinions and preferences regarding school-based health research more broadly.

Recruitment & Retention

This theme captured participants experiences and recommendations for how to maximise schools’ engagement with health research more broadly, and centres on understanding schools’ drivers and individual contexts. Three sub-themes were apparent in the data: Priorities & Values; Contextual Challenges: Local Authorities vs. Academy Trusts; and Recruitment Recommendations.

Priorities & Values

This sub-theme reflects the tension that exists between academic criteria and health and well-being. Stakeholders noted that schools are often focused on academic achievement and attendance, despite many stating that their school culture centres around health and well-being. Schools have limited resources (e.g., time and money) which are typically allocated towards curriculum learning.

“Obviously their priority is attainment and attendance because that is their bread and butter and that’s what schools do. But we know that schools want to support mental health and well-being” (KS 1).

School staff highlighted that when a university is reputable it acts as a motive for engagement in health research. Moreover, school staff and local authority professionals explained that schools may want to be recognised for investing time in student health and well-being.

“I think also…being able to showcase them as a school. Because I think some schools really want to be celebrated for the work they do. And I think now, especially maybe the academies as well, they’re always looking at ways that they can show why parents should send their kids to that school, why kids should want to come.” (LA1).

Contextual Challenges: Local Authorities vs. Academy Trusts

A challenge in England is the separation of the school system into local authority-maintained schools and academies, who act independently. Stakeholders, local authority professionals, and school staff discussed the relationships between local authorities, schools, and academies and whether they thought this would impact a school signing up to school-based health research.

“I think, getting into schools has become a lot more challenging just because of how they’re set up and the academy structure. It used to be that you could go through the local authority and have a quite straightforward way of getting into schools because they were quite linked up with what they were doing. I think now that…has broken down and… it’s very much up to the individual schools, or certainly the academies, whether they want to engage or not.” (KS 6).

An overall message was that gaining approval from the entity providing support to a school, whether that be an academy trust or local authority, may be important when it comes to a school’s decision to participate in research. However, while approval from an academy trust was considered particularly important for recruiting an academy, local authority-maintained schools differed in their relationships with their local authority and opinions regarding how this influenced recruitment. Some schools work closely with their local authority and look to them for recommendations regarding health programmes, practices and research to get involved in. Other schools are more disconnected from their local authority and suggested that approaching the school directly would be most effective for recruitment to research.

“I think going through the local authority can be the slower process just because they’re so busy. Especially our one, it seems to be very understaffed at the moment so it can be difficult to receive communications such as this from them, so…going straight to the senior leaders is a better way.” (SC 6).

Recruitment Recommendations

Participants offered advice on effective recruitment of schools, including which member/s of staff to contact, the preferred methods of contact, and when during the academic year schools are most likely to engage in research. School staff and key stakeholders recognised the difficulty in recruiting schools due to staff turnover/changing roles, the differing levels of investment in health and well-being from senior leadership, and the lack of time and resource for schools taking on additional projects. Schools discussed the importance of senior leadership support as they make the final decision on participation, but detailed that making initial contact with a member of staff invested in health/well-being (e.g., mental health and well-being coordinator, PSHE lead) may be beneficial, as they can encourage senior leadership to participate.

“Whereas you never know do you. If you’re sending it to the head, the head might be, ‘Oh, I’m not getting involved in this’, but actually the person who is the expert, shall we say, might think, ‘Well actually, that is a really good thing. That would really help me with what I’m doing.’ So, they might just think that the obvious way in is through the head, because otherwise it is a bit of a faff for yourselves, getting hold of the right person.” (SC 5).

There was consensus that the preferred method of contact involves receiving an initial email with details of the study and then a follow up email and/or call over the following few weeks. Additionally, one member of school staff highlighted that recruitment efforts were most likely to be successful if initial contact with the school is made in the period following summer exams, as staff are planning the curriculum for the following year and have more flexibility to incorporate a research study into the school timetable. Although school staff differed in opinion regarding the time of year that schools are most likely to accommodate research, there was a consensus that the start of the school year (September) and the summer term (June-July) was least likely due to a focus on integrating new students and exams, respectively.

“So from…about April time, it’s Year 11 exams. I think probably September time it’s integrating the new Year 7 s, so probably, I think, January would be a good time [for participation in data collection], probably avoiding more towards the end of the year.” (SC 9).

Practicalities of Data Collection in Schools

This theme centers around practical advice from school staff, local authority professionals, and wider key stakeholders on collecting survey-based health data in school and was split into three subthemes: 1) Complexities of Consent; 2) Working Flexibly with Schools and 3) Researcher-in-the-Room.

Complexities of Consent

School staff provided varied views on the consent process, particularly regarding whether parents/carers needed to provide consent for their child to participate as well as the child providing individual consent, and whether this differed among age groups. There was a concern that some students may not fully understand the research project and/or what would be required of them, and therefore would not be able to make an informed decision. As such, some school contacts felt that parental/carer consent (as well as child consent) should be obtained, particularly as they are the legal guardian/s while the students are under 16 years of age. However, other school contacts felt that it should be exclusively the student’s choice whether they participate in research if they are secondary-school age.

“The parent might say no and then the student might say yes. I think for under 16 s particularly, I think the parent one trumps the student one. Only because they’re legal guardian. If they’ve read through the documentation, they might not be happy, whereas a student who might not understand fully what it is and they want to do it, I guess you’d have to go with the parental decision.” (SC 6).

“I would say that your average secondary school age pupil should be able to give informed consent… Ethically I don’t see a problem with that.” (SC 13).

One member of school staff expressed different views on consent, depending on whether they were speaking as a staff member or parent.

“As a parent, and I’ve got a Year 9 daughter, I think she’d be more than capable of making a decision about what to ask her questions on. It is slightly different with Year 8. I think it would be important to let parents know that that’s what you’re doing.” (SC 13).

Although there were some differences in opinion regarding child versus parent/carer and child consent, there was consensus among school staff regarding parent/carer opt-out versus opt-in methods for school-based health surveys. An opt-out method in this instance would involve all children being automatically enrolled to a study and a parent/carer having to contact the school/researchers to opt their child out of the study if they do not want to participate. In contrast, an opt-in method would involve parents/carers having to contact the school/researchers to enroll their child in a study. School staff agreed that the opt-out method is preferable to the opt-in method, due to efficiency. Moreover, they expressed a preference for researchers to manage this process in order to reduce burden on schools.

Working Flexibly with Schools

School staff had different preferences around the logistics of conducting surveys in schools. This included which lesson/s to use for data collection, as well as the amount of curriculum time data collection requires. Several agreed, however, that if the research project is health-based then fitting data collection into personal, social, health, and economic (PSHE) lesson time felt the most appropriate and least disruptive. The overarching message from schools was that the researchers must be flexible in their approach to schools based on their individual preferences and must not expect schools to adapt to meet research demands. While reflecting on data collection for survey-based research, one participant expressed a preference for being able to book data collection sessions flexibly and sporadically over a number of weeks, at times which would best suit the school, their students and the timetable.

“If you were to say to me, ‘Here’s my team of three people. You’ve got them for two weeks,’ and I’d be like, ‘I want them here, here, here, here, here,’ which is annoying because it’s really sporadic. It’s like three hours on a Thursday afternoon, but in terms of if you’re asking me what’s best for my students…that’s what’s best for them.” (SC 1).

Researcher-in-the-Room

The majority of schools had a preference for in-person, researcher-led survey data collection. They felt that having a researcher present encourages interest and engagement in the research and ensures consistency in data collection procedures. However, one school contact said that they did not see the benefits of a researcher leading data collection if it involved a protocol they were familiar with (i.e., administering a survey), particularly if a member of school staff still needed to be present in the lesson to manage registering students and behaviour. School staff felt that response rates would be much lower if data collection was completed online at home (as opposed to in person) and may exclude certain students (e.g., disadvantaged students, those with special education needs [SEN]), and lead to response bias.

“I think having researchers there is massively beneficial, because I think it gets the students excited, because it’s like, “Oh, this is something different, I have not seen yourself before”. They’re almost a little bit more invested, paying a little bit more attention. And I think obviously going into a bit more detail, maybe explaining- because obviously you’re running it and it’s your project, you’ve got that bit more understanding as to why we’re doing what we’re doing” (SC 7).

“We get a much, much lower uptake when we’re accepting things remotely. I know that you probably would lose some groups. So, a lot of SEN students might not feel confident doing it without a bit of support. Maybe some of our disadvantaged students wouldn’t do it. I know that girls tend to complete homework more than boys. I think you would lose…your data would become quite skewed.” (SC 8).

Collaboration from Design to Dissemination

This theme refers to the importance of working closely with schools and young people throughout all stages of the research process, there were two subthemes: 1) Schools Shaping Research and 2) Student Voice.

Schools Shaping Research

Stakeholders emphasised the importance of listening to school needs and seeking to understand schools’ experiences of participating in research. One school contact felt that for research to be effective researchers needed to have a comprehensive understanding of the education sector. Moreover, participants felt that researchers should seek guidance from school staff when shaping research study materials and during dissemination.

“The one thing that I would say is it needs to come from a standpoint of understanding the educational sector. Oh, I’m not trying to be patronising, but sometimes we’ve had information given to us by organisations which is all very well intentioned, but they’re not teachers, and actually understanding how the information can be presented to students or what is appropriate is very different.” (SC 4).

Student Voice

School staff, local authority professionals, and wider stakeholders advised involving young people in the research project, from the set-up of the study through to dissemination of findings. Participants felt that young people should be involved in decision making processes and the design of research materials, so that they are able to express their needs, priorities, and preferences. Additionally, one stakeholder suggested training young people to support researchers with research data collection to empower students in the research process. This was thought to be mutually beneficial, as students would develop research skills and researchers would have support with data collection, as well as greater buy-in from students.

“Let us co-own [research] with young people in schools and let us really make these decisions together about what we collect and how…give them chance to vote on priorities…then I think you have got the buy in from them.” (KS 7).

By combining the themes, subthemes and context from participant quotes, Fig. 1 provides an overall visual representation of conducting school-based health surveys.