Measuring the health and health behaviours of adolescents through cross-national survey research: recent developments in the Health Behaviour in School-aged Children (HBSC) study

Cross-national surveys have the potential to make a significant contribution to the study of adolescent health. The Health Behaviour in School-aged Children (HBSC) study was among the first international studies established in three countries in 1983 and growing to more than 40 countries for the seventh wave of fieldwork in 2005/06. The original aim of the study has remained largely the same since its inception, to increase understanding of adolescent health behaviours, health and well being in their social context and to collect high quality comparable data to achieve this. The challenges to producing valid and reliable data from cross-national, school-based research were recognised from the outset and reflected in the methodological development of the study. The paper sets out how these challenges were addressed, examining key aspects of the methodology, including study design, questionnaire content, data collection and file preparation. These methods are still in place, but HBSC has had to recognise the social and political change of recent years. The challenges that were recognised 20 years ago are magnified today, with the study embracing a variety of cultures across Europe and North America. As demand for HBSC data has grown from the scientific and policy communities, greater attention has been paid to scrutiny of the data produced, matched by a sharper focus on continuous improvement in data quality. Key developments of recent years are summarised in the paper, focusing on study organisation, review of the international Research Protocol, strengthening support for sampling, greater attention to translation and improvements in data processing and documentation. It is concluded that the HBSC study has evolved over the last 20 years and continues to do so, recognising the importance of data quality, but also the constraints of cross-national survey research. Looking to the future, some outstanding issues for consideration are touched upon, including the opportunities and challenges for expanding our knowledge on the possibilities for gathering cross-national and cross-cultural data, with the HBSC study being used to build capacity in understanding the health needs of young people in other regions of the world.