Researchers study HBSC survey to see which norms can be conveyed in health surveys

Since the 1980s, the physical and mental health of Swedish children and young people has been measured by way of surveys. One of these is the international "Health Behavior in School-aged Children Survey" (HBSC), which is taken by 11-, 13- and 15-year-olds every fourth year during a class in school.

Researchers Anette Wickström and Kristin Zeiler at Linköping University wanted to study the survey to see which norms can be conveyed in health surveys, something that has rarely been studied. The results have been published in the journal Children & Society.

"The study shows that survey questions on parents' occupation and financial situation create norms about how you should be and what you should own. Our interviews also show that some teenagers ask themselves if they should respond according to reality or in a way that protects themselves and the people they care about", says Anette Wickström, associate professor at the Department of Thematic Studies at Linköping University, who has previously studied norms and ideals in relation to health.

Survey raised thoughts they had not previously had

These surveys can be seen as a tool for finding out about the wellbeing of young people. But they can also be given a broader significance, as carriers of meaning and norms. This theoretical approach, from science and technology studies, is the one taken by the researchers.

By way of 51 interviews with 15-year-olds in three school classes, an understanding of how the teens view the surveys emerged.

According to the results of the study, some of them feel that the survey conveys a message about how people should live. The very existence of questions about having one's own room, and about the number of computers and bathrooms in the home, was perceived by some of them as a message that they should have these things. Similarly, they remarked that the survey questions about weight and body can give rise to negative thoughts that they previously had not had.

The survey also made them aware of differences, especially with regard to their families' financial situation. While some of them said the survey made them realise how fortunate they are, others said they felt afraid of appearing poor.

A growing field of research shows that a person's subjective idea of their socioeconomic status can affect their health more than their objective status does. In other words, it is more important for your health how you perceive your income and your status in society than how much you are actually paid.

The young people say that the survey raises issues of status. If we know that the subjective understanding of your social status can mean more for your health than the actual situation, we can ask how this type of question impacts the teenagers."

Anette Wickström, Associate Professor, Department of Thematic Studies, Linköping University

Motivating or guilt-inducing questions

The young people's experience of completing the survey differed. Some felt the survey was fun and informative, a "guide" to how you should live, which motivated them to set new targets.

Others said the survey was difficult to complete because it induced feelings of guilt, responsibility and inferiority. Some of them wondered about who is responsible for them feeling good. They felt the survey assumed that they themselves were ultimately responsible for - and could influence - their health. However their view was that largely, their health was reliant on external factors, things outside their control, such as deaths, abuse and conflict in the family.

Providing sensitive details in a classroom

The interviews also showed that it was difficult for the teenagers to complete the survey in privacy. Some reported that they tried to hide their questionnaire for fear of their classmates seeing it, while others said that questions and answers were discussed openly in the classroom.

Other interviewees spoke of the risk of being reminded of memories they didn't want to revisit while sitting amongst their classmates. Regarding the question of how old they were when they first had sexual intercourse, one girl commented: "If you've been abused and have never had sex voluntarily, how should you respond?" Anette Wickström explains that the results of the study are a reminder that surveys and questionnaires require constant reflection.

"Rather than thinking that some surveys should be stopped, we feel that we should apply our new-found knowledge when creating new surveys. You have to think about how they are designed, distributed, how questions and pre-defined responses are worded, and if schools can offer psychological support after the survey. And of course you should also reflect about whether questions about such sensitive topics should be included."