Methods
6 Methods
Sampling Procedures for Telephone Interview/Written Questionnaires
The survey data for this study were collected primarily through a series of telephone interviews and a written questionnaire with personnel selected by using a random, structured sampling process (Brown, 1997). Based on previous work done at the University of Waterloo on smoking programs in schools, a sample of 116 communities was identified. Consideration was given to regional concentrations of the school population so that all schools in Canada had the chance of being selected to be part of the sample. The sample size was designed so that the results could be generalized to that level that ministries, school districts, and public health units in one province or territory can be compared to others or to the national level.
Subsequent to selecting the participating school districts, two schools in each district were randomly selected from among the list of the schools in those districts. The public health unit most closely associated with the school district was selected for the corresponding number of public health units. The public health nurses to be interviewed were identified either through inquiries with the public health unit or the school. The principal in each school was requested to identify a teacher who taught sexuality education including HIV/AIDS. An anonymous written questionnaire was subsequently sent to those teachers with a return-addressed envelope.
The response rates were as follows:
Based on a comparison with the very similar School Health Policies and Programs Study (SHPPS) in the US, which had a similar response rate from school districts of 82% from a national sample size proportionately five times less than this study, we believe these results achieve a reasonable basis for conclusions.
The survey was administered in the Spring of 1997, beginning with school and public health systems in March, adjourning for the summer break in June and recommencing in the Fall of 1997.
Difficulties were encountered in identifying the appropriate personnel to respond to the interview, particularly within the public health systems because of the restructuring that was taking place. A re-sampling of the primary unit, the school districts, was done to ensure that the levels of participation were achieved and that the regional, structured basis of the sample was maintained. This was necessary because of the number of original school districts that declined to participate.
Instrument Design and Development
Education and health ministry officials were consulted on the design of the study and the policy and program issues to be investigated.
An investigative framework (Shannon & McCall, 1997) was developed from a review of the criteria for effective, school-related health promotion and prevention. These criteria were used to guide the development of the study and instruments.
The questionnaires used in the telephone interviews were developed by the research team based on the SHPPS study and criteria for effective school-related HIV prevention and sexual health promotion. The interview outlines were field-tested prior to use as a part of the study.
It should be noted that a potential lack of clarity with one type of question was not identified in the field testing process. In several questions, we ask if an activity is done "regularly," "at least once in the past three years", "at least once in the past 4-10 years", "never done", "not the role" or "is planned to occur within two years". This format was developed to capture the changes that are occurring in both systems. Although the respondents did not have trouble choosing only one of these potential answers and the interviewers were asked to probe to ensure the most accurate response, it is possible that some respondents interpreted the question such that they chose "regularly" when indeed they have only done the activity once within the past two years.
The written questionnaire to the teachers was based on an earlier study of teacher development done by the CMEC (Mackinnon et al, 1994). That study was based on research on staff development. The research team for this study reviewed and modified the questions from the earlier study and the results for this study are comparable to that earlier work.
Copies of all of the survey instruments will be located at:
www.schoolfile.com/AIDSreport/questionnaires.htm.
Methods for Focus Groups
A total of eight focus groups were conducted with selected groups of students and parents to ascertain their perceptions of the programs and services available and delivered in their communities. Six groups, three with students and three with parents, were held in a urban-suburban community of Vancouver, in a rural-suburban community southwest of Montreal and in a rural community south of Halifax. Two other groups were held in the centre of Montreal with gay, lesbian and bisexual youth who already participating a sexual health program and with their parents. A total of 38 students and 19 parents participated in these eight focus groups.
The student and parent groups were selected from among the sample of schools surveyed as part of the larger study. Participants in the focus groups were selected by the principals and the researchers on a self-selected basis. The guide for the focus group interviews can be found at: www.schoolfile.com/AIDSreport/title.htm.
Difficulties were experienced at all four sites in recruiting parents to participate in the focus groups. Alternative methods for identifying parents had to be used in three sites.
Analysis of Data
The data from the telephone surveys and written teacher questionnaire were tabulated and re-weighted to correct for over-sampling of smaller jurisdictions. The Technical Report on this study provides the confidence intervals for these data.
The responses to the questions were grouped in accordance with the conceptual framework guiding the study. Five broad categories were used to report on the findings of the survey; policy-making and implementation, instruction, preventive health services, social support and physical environment.
The responses from the school systems and the public health systems were presented together on a series of selected topics to emphasize the shared responsibility for preventing HIV and STD and promoting sexual health. As well, the data are presented in a format that shows the responses from the three different levels within each system to illustrate how policies are being implemented.
The results of the focus groups were coded using standard content analysis procedures and the themes that emerged were integrated with the findings of the interviews and questionnaires.