A practical validation process for questionnaires in the field of health education and health promotion in schools

International audienceFrom an epistemological point of view, Potvin and Jones (2010), describe health promotion research as being applied by nature, producing knowledge about the conditions, practices and processes that makes changes possible and consider that research process should be health promoting itself. Creswell (2013) characterise a research by its philosophical assumptions (paradigms), strategies of inquiry and research methods. Do research in health education and promotion (HEPR) refers to only one (participatory) or more paradigms? Is there a specific set of research strategies and methods (mixed methods) for health promotion research? In fact, unlike others research fields (such as social psychology, sociology…) HEPR is not rooted in a particular theoretical and methodological framework. The research is about understanding practices rather than testing theories. In health education and health promotion, what is essential is not the framework but rather the practices/action and the people (individual, groups and institutions … stakeholders) who carry them out. The researcher can’t be outside of the action but is essentially an actor within it. A “neutral position” is not an option. The HEPR has two goals that must be addressed: creation of new knowledge “epistemic” and social transformation “transformative”. In our view HEPR is by definition epistemic and transformative. One must ask then whether these two goals are compatible in research. This kind of tension between two different aims is not exclusive to HEPR. It also operates in fields of research such as: political science, engineering science, social research and educational research in general… In all of these sciences research must firstly address themselves to actual practices. HEPR is also characterised by a willing engagement with complexity, a multidisciplinary approach and a specific ethical framework in relationship to the position of the stakeholders which are not “objects” but also “subjects” of the research process.In this communication we will discuss the impact of the epistemological status of HEPS on quantitative data collection. Questionnaires are routine tools to collect quantitative data, especially in psychology (Bjorner & Rugulies, 2010), psychometrics scales are commonly used to measure variables in specific and clearly defined areas. The validation process is based on classical methods (Falissard, 2008). In HEPS, depending on the research project, that questionnaires could be used but other kind of questionnaires are often build with the stakeholders, take into account the complexity and thus are multidimensional. These tools could explore people’s views, practices, lifestyle, background information about contexts… In addition, the validation, as a part of the whole research project, has to be feasible (amount of time, resources and competencies requested) and to take place in the participatory approach. The validation of such questionnaires is a complex process. This communication will take a stock of the different approaches used for the validation of a questionnaire and will suggest a practical model taking into account the nature of HEPR.Three main fields to explore in a validation process are questionnaire’s reliability, its validity and its sensitivity to change (Sauvé, 2005). Reliability aims to verify that the questionnaire is reproducible, i.e. if results are similar when the questionnaire is applied in the same conditions (Marx and al., 2003). Sensitivity to change test the ability of the questionnaire to detect changes, over time in general. Validity seeks to evaluate if questionnaire measure what it is supposed to measure. There are different points in validity: the face validity (appearance of the questionnaire: understanding by stakeholders, social acceptability in the context for which the questionnaire have been developed, compatibility with the values of the community…), the content validity (relevance and completeness of items), the construct validity (consistency of the underlying dimensions of the questionnaire) (Cronbach, 1951; Bjorner & Pejtersen, 2010), predictive validity (capacity to predict real results), concurrent validity (compare results with those obtain with another tool). Finally, when questionnaire have to be used in several language, a translation with an adaption to context and a back translation by people who speak the two languages is needed.Classical methods have been developed to explore each of these criteria; but they are particularly adapted for psychometric questionnaire which examine few dimensions (Falissard, 2008). The complex structure of a questionnaire makes the validation more difficult to perform. For example, reliability of a multi-items scale can be explored by a traditional test-retest, which compare answers of two collects of data one the sample, or with internal consistency, seeing that question of the same dimension are a kind of repetition. Internal consistency is easier to use, because it ask only one collect of data instead two for test-retest. Unfortunately, in HEPR questionnaire, exploring reliability by internal consistency is rarely possible because of the its structure.Moreover, it is not always possible to assess all the criteria. For example, compare results with those already obtained with another validate tools need that tool exists. It’s is more difficult in the field of health education because it’s a more recent field than psychology or quality of life in medicine area.In addition, it is noted that there isn’t a consensus between fields of psychology and medicine (Bouletreau and al., 1999). Indeed, they don’t always use the same terms and methods to explore the same criterion (Falissard, 2008), making a supplementary difficulty for those who are not familiar with validation.Based on this analysis, we have developed a step by step practical method (Jourdan, 2015) for different contexts, different research and especially underprivileged settings. The method is accompanied by a tool for stakeholders community to make the validation process and its pertinence understandable by the communities.This communication is to purpose a methodology to assess reliability, validity and sensibility to change in questionnaire validation process in the field of HEPR. It will be illustrated by an example, a questionnaire related to home-school collaboration developed and used in both Finland and France

Parents and Teachers’ Views on Health Guidance and Education in Finland and in France

International audienceAs the Commission on Social Determinants of Health (2008) presents, concerns about health and disease are not only the responsibility of the health sector. Actions toward equal and healthier lives must happen in daily environments of people and be supported by policies and programs, as well as in local communities. (CSDH, 2008.) School-aged children’s health is largely determined by the most important surrounding environments, home and school. Although home is the first educational setting for children, schools have a substantial role in influencing children’s health and on balancing the inequalities among children (WHO, 1986, 2012; Tang et al., 2008).Collaboration between the home and school is an essential part of schools’ daily work, and its advantages have been confirmed by numerous studies (e.g., Sormunen et al., 2011). The evidence for the importance of active collaboration between home and school is strong, and the children are able to benefit from joint support academically, socially, emotionally, and in various ways related to healthHealth problems of children have been partially changed over time. In daily life, the children seem to fall short of the recommended hours of sleep, and the use of electronic media in purpose of entertainment or social interaction is high. Problems with daily health habits, e.g., related to lack of sleep, sugar and fat-based nutrition and low physical activity are inevitably leading a large number of children to overweight and obesity, and even to chronic diseases and mental health problems. Furthermore, headaches, tension, restlessness, and difficulty on concentrating are symptoms experienced in particular by school-aged children (Mäki et al., 2010). Smoking and alcohol consumption, as well as social exposure to drugs, are additional concerns among youth (Raisamo et al., 2011). These concerns, among others, give parents and schools new challenges to confront and new tasks to fulfill. As Smit and Driessen (2005) conclude and suggest, education and child rearing should become more integrated activity at home and at school, as well as education and upbringing should be seen as a joint task and responsibility of these environments.This study aims to investigate the components and level of home-school relationship related to health. Data on parents and teachers’ views on collaboration between home and school will be collected in Finland and in France in spring 2015. Since this study is in its preliminary stage, no country comparisons will be made, but instead, the phenomenon inside two countries will be examined.The research questions are:How do parents and teachers view the health-related collaboration between home and school in Finland?How do parents and teachers view the health-related collaboration between home and school in France?MethodA quantitative survey for Finnish fifth grade pupils’ (age 10-11) parents and class grade 1-6 school teachers, and for French fifth grade pupils’ (age 10-11) parents and all school teachers will be conducted. The pilot study has been executed in September 2014, and the data collection will be performed in January 2015 (Finland) and in March 2015 (France). Total of 52 schools will participate in the study in Finland, and 40 schools in France. Both questionnaires used for data collection were developed on the basis of scientific literature and national documents. They were tested and validated. After translation, adaption to national context and back translation, pilot studies were performed among 126 parents and 28 teachers in Finland and 306 parents and 39 teachers in France. Face validity was tested by interviewing teachers and parents who already had filled questionnaires. Reliability was assessed by a test-retest. Content validity was evaluated by the judgment of expert of the field, by literature and with the help of structure forms questionnaire (which tested whether the questionnaires were comprehensive, understandable, and contained valid and sufficient content); acceptability and discriminating power of items were studied with a descriptive analysis, in seeking a level of missing value and floor and ceiling effects. Questionnaire structure was studied with explanatory factorial analysis and internal consistency was tested with Cronbach’s alpha. The data will be analyzed by descriptive statistics to find out the current situation in both countries. With bivariate and multivariate analyses, specific attention will be paid to find out whether background variables, such as parents’ education, occupation, the status of employment, or family form, and teachers’ work experience, age, or gender are related with health education and collaboration views and experiences. Also the profile of schools (rural, urban, small, big, privileged, under-privileged), will be examined.Expected OutcomesPreliminary findings from pilot phase in France underline that majority of families were satisfied with general home-school collaboration (85%). However, even if 70% of families reported that they discuss regularly with teacher in a global way, only 42% discussed about their child’s health and well-being. Furthermore, more than 50% of parents thought that health education responsibilities were shared between families and schools. However, for fields the most linked with intimate sphere (e.g., hygiene, eating, sexuality, drugs), a significant proportion of families reported that they were their own role (between 30% and 41% versus less than 14% for other fields). In Finland, 75% of parents were satisfied with collaboration between home and school. Majority of parents (84%) experienced discussing with their child’s teacher as easy, but similarly as in France, less than half of parents (41%) discussed about child’s health and well-being with the teacher. The data from spring 2015 surveys related to parents and teachers’ responses will be presented on following areas: 1) Parents’ views on their own / home health guidance and health traditions, 2) Parents’ views and experiences on school health education, 3) Parents’ views on health-related collaboration between home and school, and 4) Teachers’ views and actions on health education and guidance at home and at school. As expected outcomes, the findings will give lot of new information on how teachers and parents experience their collaboration related to health. That information can be utilized at schools and disseminated to parents. Additionally, the findings will offer important and useful knowledge also for the policy level by showing the country-specific as well as European-level findings, which can be used to recognize and develop the role of the educational sector in health equity efforts

Lasten ja nuorten terveys ja hyvinvointi – tiedonhankinta ja -tarve kunnallisessa päätöksenteossa

Tutkimuksen tarkoituksena oli kuvata millaisia tiedonhankintakanavia kuntien lautakunnissa käytetään ja millaista tietoa lautakuntien luottamushenkilöt ja viranhaltijat kokevat tarvitsevansa lasten ja nuorten terveyteen ja hyvinvointiin liittyvissä politiikkatoimissa. Tutkimusaineisto (n=13) kerättiin laadullisilla teemahaastatteluilla ja analysoitiin induktiivisella sisällönanalyysilla.Tulosten mukaan pääasiallisina tiedonhankintakanavina käytettiin valtion ja julkisen sektorin sekä kolmannen sektorin organisaatioita, mediaa ja verkostoja. Luottamushenkilöt ja viranhaltijaterosivat toisistaan sekä tiedonhankinnan että tiedon tarpeen suhteen. Luottamushenkilöt luottivat tiedonhankinnassa suuressa määrin viranhaltijoiden valmisteluun ja esittelymateriaaliin,eikä muun omatoimisen tiedonhankinnan katsottu kuuluvan keskeisesti luottamushenkilön tehtäviin. Viranhaltijat puolestaan hankkivat tietoa monista eri lähteistä. Luottamushenkilöidenja viranhaltijoiden työskentelyssä ja päätöksenteossa yhdistyivät virallinen ja epävirallinen tieto. Terveyteen ja hyvinvointiin liittyvän tiedon välittämisessä tulisikin hyödyntää monipuolisiatiedonvälityskanavia ja -menetelmiä, jotta informaatio tavoittaisi poliittiset päättäjät

Monimenetelmätutkimus terveystieteissä

Monimenetelmätutkimus yhdistää määrällisen ja laadullisen metodologian. Tieteenfilosofisena suuntauksena monimenetelmätutkimus pohjautuu enimmäkseen pragmatismiin, korostaen tiedon käytännöllistä luonnetta. Monimenetelmätutkimus on saavuttanut vakiintuneen aseman usealla tieteenalalla ja sitä käytetään enenevästi myös terveystieteissä tutkimuskysymysten monimuotoisuuden vuoksi

Online discussions mirroring family life during pregnancy

Objective The aim of this study was to find out what aspects of their parenthood parents revealed, and how they expressed their thoughts concerning maternity care services on an online communication forum. Background The 'Information Society' offers a growing variety of health services as part of public primary health care via the internet. Little is known about the contents produced online by pregnant families, and how they reflect on both family life and maternity care services. Methods The data for this study were obtained from online discussions between families (n=21) in Net Clinic, an internet-based service designed for public maternity care. The data included experiences of family life during pregnancy, childbirth and parenting, and was analysed by inductive content analysis. Results While maturing into parenthood, both women and men recognised the uniqueness of their new role and wanted to prepare for safe childbirth. Online communication in the home environment nourished new social networks among families who were expecting their first, second or third child. In addition, families reflected on maternity care services on the Net Clinic's communication forum. This provided realistic feedback to maternity care professionals. Conclusions Today, the relationship between clients and professionals is inevitably changing. More online services and advocacy are needed if families are to have access to online health services. The role of professionals is diversifying from being authorities to supporting and facilitating clients' individual self-care. Based on direct client feedback, the quality of maternity care can be improved

Self-assessment as a resource for health education: results of 7-day continuous data collection of 10-11–year old children’s health habits

International audienceSelf-assessment as a resource for health education: results of 7-day continuous data collection of 10- 11 –year old children’s health habits Objectives: Children are digital natives; they live in a world shaped by technology. The use of personal data collected by smartphones may raise ethical issues, but also can be viewed as a powerful tool for education, enabling working with children. This study examines how health routines are realized among 10-11 -year old schoolchildren and what ethical issues may occur in taking part of this kind of an educational research process. Methods: Twenty children participated in the study. Data were collected via smartphones or tablets through health game application during seven consecutive days. Each day the children answered to 12-14 questions concerning their daily health routines. The process and data analysis were made in order to understand 1) the relationship the children have to such apps, 2) the potential of mobile apps in health education, and 3) the possible trends in children’s daily health routines. The ethical questions actualized in several phases of the study. Results: Children used the application easily. According to preliminary findings, children’s behaviours can be divided at least in three categories. First group of children, for example, washed their teeth twice a day, ate healthy, and had a sufficient amount of sleep at night. Second group generally had healthy habits, but they did not follow certain routines daily. Third group of children had daily habits that may become health threats, if they are not specifically addressed. The potential use of these personal data in school health education will be discussed in the presentation. Conclusions: Monitoring children’s health behaviours during a short period brings potentially valuable insights into their health habits. It can be used as a resource for health education if it takes into account the fact that children’s health and well-being are influenced by a complex interplay of biological, environmental, cultural, and social factors