Pupil focus groups
Focus groups were conducted both with pupils who had received the SHAHRP classroom component of STAMPP and with pupils who received EAN. Focus groups were conducted with two research aims in mind: first, to determine the degree to which participants in the classroom curriculum engaged with, enjoyed and perceived that they benefited from participation; and, second, to ascertain to what extent control participants who received EAN engaged with, enjoyed and perceived that they benefited from participation. Focus groups were chosen for several reasons: they provided a quick and convenient way to collect data
from several participants concurrently;84participants prompted each other to consider the issue to a
greater extent and subsequently responded to other opinions, leading to greater discussion;85they
provided an opportunity for participants to feel more comfortable discussing an issue in a group setting
than in one-to-one interviews;84,86and, finally, they did not discriminate against participants who had
difficulties with reading or writing.84
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Purposive sampling was used to ensure that both participating study geographies were represented, and that there was an equal representation of sex, intervention and control participants and those attending different school types (grammar vs. secondary). All schools approached agreed to participate. A total of 16 schools in NI and Scotland participated: eight intervention and eight control schools (representing 15% of the schools involved in the trial).
A contact teacher in each school selected what they considered to be a representative sample of their school
year 10 or S3 pupils (aged 13–14 years) for participation. A total of 129 pupils participated in the focus
groups [male, n= 62 (48%); female, n = 67 (52%)], with a mean of eight participants per group. Group size
ranged from 6 to 12 pupils. Participants did not receive any compensation for their involvement. The focus groups were completed in May/June 2014 when intervention students had completed both phases of the SHAHRP. They took place in a quiet classroom during school time, and the mean duration was 34 minutes. As per the questionnaire surveys, informed parental consent was obtained through each school prior to participation in the focus groups. Participants were also asked to sign an informed consent form on the day of the focus group.
A series of open-ended questions was developed in order to stimulate discussion, to minimise any bias87
and to ensure consistency between the focus groups. An introductory question was used to set the pupils at
ease and to build rapport between the researcher and the participants (‘When you hear the word alcohol,
what do you think of?’). Intervention participants were then asked to respond to prompts about phases 1
and 2 of the SHAHRP curriculum. A sample question would be‘What was your overall impression of part 2?’.
Control participants were asked to comment on EAN in their schools. Both intervention and control participants were asked to answer questions in relation to learning about alcohol in school more generally,
for example:‘Did you find it easy or difficult to discuss these issues with your teacher?’ The researchers
used prompts throughout the focus group discussions in order to clarify answers or to explore and obtain details about a specific issue that may have arisen. This helped to ensure that detailed responses giving the
participants’ true opinions were collected. For the discussion schedule, refer to Appendix 6. The discussions
were digitally recorded and transcribed verbatim by a professional stenographer.
The transcribed focus groups were analysed using thematic analysis as defined by Braun and Clarke.88
This procedure involved six steps: (1) familiarisation, (2) generating initial codes, (3) searching for themes, (4) reviewing themes, (5) defining and naming themes and (6) producing the report. The analysis was conducted by the same researchers who conducted the focus groups using both the software package NVivo version 10 and manual coding. Meetings were held between the researchers over a 4-week period to discuss areas of consensus and discrepancy, and to review and revise emerging themes.
Online survey of teachers
Online self-report questionnaires were completed by teachers who had facilitated the classroom
intervention and by teachers who had facilitated EAN. The questionnaires were designed to ascertain the
intervention teachers’ perceptions of the SHAHRP intervention. The questionnaires were also designed to
gather information about both the intervention and control teachers’ experience of alcohol and health
education delivery in general.
Two different online self-report questionnaires were developed for intervention and control teachers. All included items were bespoke and designed by the investigators. The questionnaires for both intervention and control teachers contained the following items:
l Demographic information: this included the participants’ name, location (i.e. NI or Glasgow/Inverclyde),
school name, sex, age, teaching experience and subject specialisation.
l Questions on experience of delivering general health and alcohol education in school: the participants
were asked whether or not they had ever delivered or organised general health or alcohol education or talks in school. They were also asked to indicate whether or not they had ever attended external training about alcohol. The teachers could choose from two response options: yes or no.
l Questions on who was best placed to provide alcohol advice: the participants were asked to indicate who they believed was best placed to provide advice to students about alcohol. A range of options was
provided [i.e.‘you, as a teacher’, ‘a doctor/GP (general practitioner)’, etc.]. Each option was answered
on a six-point Likert scale from‘strongly disagree’ to ‘strongly agree’.
l Open-text response: respondents were asked about their views on alcohol, health and other prevention
activities in school.
A series of additional statements was included in order to gather information about the intervention
teachers’ perceptions of SHAHRP. The participants were asked to indicate if SHAHRP engaged, and was
enjoyed by, pupils; whether or not SHAHRP was suitable for the age of the pupils; whether or not the activities were easy to follow and if the resources supported its delivery; and whether or not SHAHRP was easy to accommodate in the curriculum and if it fitted in with school strategy. A sample statement was: ‘SHAHRP engaged the interest of pupils’. All statements had a four-point Likert response option, from ‘strongly disagree’ to ‘strongly agree’. High scores on these statements indicated that participants had provided a positive evaluation of SHAHRP. The participants were also given the opportunity to provide open-text statements on their personal evaluation of both phases of SHAHRP.
Statements were also included to gather information about the intervention teachers’ thoughts on the
future delivery of SHAHRP. The statements ranged from whether or not they would continue to deliver SHAHRP if it was proven to be effective to whether or not it was likely that there would be senior
management support delivery of SHAHRP in the future. A sample statement was:‘There is likely to be
curriculum time to deliver SHAHRP in the future’. Statements were answered on a four-point Likert scale
from‘strongly disagree’ to ‘strongly agree’. High scores on these statements indicated a more positive
outlook on the future delivery of SHAHRP. Participants were again invited to provide open-text statements on the challenges and opportunities facing delivery of SHAHRP in the future.
Teachers were invited to participate via an announcement on the school’s noticeboard or by e-mail. The
notice provided information about the study survey and included a web link to the survey (intervention or control). E-mails with equivalent text were also sent to the contact teacher in each school (intervention or control), and it was requested that they circulate the e-mail to all teachers who had delivered alcohol education within their school. The questionnaire took between 5 and 7 minutes to complete. The data were collected between February 2015 and July 2015. The data were exported to IBM SPSS version 21.0 and analysed using a variety of descriptive techniques.
Please note that, because of space constraints, only data pertaining to the delivery of the SHAHRP, additional exposure to alcohol interventions and EAN are reported here. Additional information collected will be reported in follow-up publications.
Interviews with senior school staff
Head teachers and/or senior school staff (hereafter senior staff) in intervention and control schools participated in individual interviews. The purpose of this work was to obtain a better understanding of
how STAMPP complemented (or otherwise) the school’s existing response to alcohol and to identify some
of the challenges facing future delivery.
Purposive sampling was used to ensure that senior staff from both participating study sites (NI and Scotland) and trial arms (intervention and control) were represented. The participation of a representative sample ensured that data saturation was achieved and that a variety of perspectives was accounted for. The interviews were conducted either face to face or by telephone, and were conducted between September and October 2015. Interviews were recorded and then transcribed by a professional stenographer. Ethics approval was obtained separately from the main trial from Liverpool John Moores University (reference number 14/EHC/015).
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Semistructured interview guides based on a series of open-ended questions were developed in order to
stimulate discussion, minimise any biases87and ensure consistency between the interviews. Different
interview guides were developed for senior staff in intervention and control schools (see Appendix 6). The interviews in intervention and control schools included questions about their experience of alcohol use and alcohol education within their schools, the future dissemination of the STAMPP trial results and the potential future delivery of STAMPP in their schools. The interviews in intervention schools also included questions about their motivation to participate in, and their experience of, STAMPP delivery and the STAMPP trial. The interviews in control schools included questions about their motivation to participate in and their experience of the trial. The interviews were analysed using the procedures recommended by Braun and Clark,88and involved six steps: (1) familiarisation, (2) generating initial codes, (3) searching for
themes, (4) reviewing themes, (5) defining and naming themes and (6) producing the report. Interviews with external stakeholders
Stakeholders in NI and Scotland also participated in individual interviews. Stakeholders included employees of the Department of Health, Social Services and Public Safety Northern Ireland (DHSSPSNI) and the Public Health Agency (PHA) in NI, and included employees of Glasgow Psychological Services, Inverclyde Psychological Services and Glasgow Education Services in Scotland. The purpose was to attain a better understanding of how STAMPP fits in with local current and planned intervention and service delivery strategies and priorities, how STAMPP might complement current approaches and what the most important considerations are when thinking about opportunities for future implementation.
Purposive sampling was used to ensure that stakeholders from both participating study sites (NI and Scotland) and trial arms (intervention and control) were represented. The interviews were conducted either face to face or by telephone, and were conducted between September and October 2015. Interviews were recorded and then transcribed by a professional stenographer. Ethics approval was obtained from Liverpool John Moores University.
The interviews with stakeholders included questions about alcohol education in general and how STAMPP
compared with other approaches to alcohol use and how it fitted in with their organisations’ alcohol or
health policy and strategic priorities. The support that these agencies would or would not provide for future delivery was also addressed. The interviews were analysed using the procedures recommended by
Braun and Clark.88
Findings
Focus groups with pupils
The results are presented across four themes, namely learning outcomes, materials, mode of delivery and delivery style. These themes were defined prior to the analysis of the data and were used to analyse the
intervention and control participants’ views on their alcohol education. A full description of the analysis
and coding methodology applied to the interviews is available from the authors on request.
Learning outcomes
The intervention participants were positive in tone about the education they had received and felt that participation in the programme was beneficial. They identified a number of alcohol-specific topics that they learned about as a result of taking part in the intervention, and analysis of responses revealed that elements from all 10 lessons in the programme were commented on and discussed. The topics discussed
included‘units of alcohol’, the related alcohol content of drinks and ‘drinking guidelines’, the ‘effects’
and‘consequences’ of alcohol use, media portrayal of alcohol and ‘real-life situations’ in which alcohol
consumption occurs. In contrast, the participants in the control group held negative views about EAN. They felt that not only was EAN rarely delivered, but any education that they did receive was about things that
they already knew. The education was subsequently described as lacking structure, not engaging, boring and repetitive:
It’s really repetitive. We get it a lot every year, and it’s basically just the same information every single year, and it’s all negative views.
Female, control group, Scotland
It, sort of, gave you an insight into the units of alcohol, like, in each drink and shows how they can vary and affect your system differently.
Female, intervention group, NI
During the focus groups, intervention participants engaged in in-depth discussions on learning about topics, such as the consequences and effects of alcohol use, which were strong themes in the intervention curriculum. They indicated that this information would help them in making decisions about alcohol consumption both at the present time and in the future. For some, the realisation that the information presented could affect future decision-making offset the possible criticism of participating in a scenario-based project on a topic that they (or some of their friends) were not currently engaged in (i.e. alcohol use). In contrast, although those in the control group indicated that topics, such as the consequences and effects of alcohol use, were addressed during EAN, their discussions were not in-depth and they did not address how the possession of this information might be beneficial either at the present time or in the future:
Plus, like, for later in life, it’s giving them information of alcohol and they can decide, because they
know the facts about it. So they’re able to decide, knowing the facts, whether they want to drink or
not, they know the facts and the consequences it’s going to have on them.
Male, intervention group, NI
. . . they basically teach us don’t do it at this age because it will have consequences, extreme
consequences that will come back at you in the future . . .
Female, control group, Scotland
The intervention participants also engaged in in-depth discussions on learning about‘units of alcohol’.
They identified the resulting benefits from learning about this issue, such as knowing about how amount consumed broadly relates to behavioural outcomes. They also appreciated learning about real-life situations involving alcohol. They could relate to this information from their own experiences and/or from stories that they had heard from others. The project taught them about how to deal with certain situations and ensure
their own and other people’s safety in a drinking context. The workbook for phase 2 in particular was
commended for providing this information and in the opinion of many this made the project more relevant: I quite liked the bit about the real-life situations because then you could, like, put it into real-life context. And then if you were ever put in a situation like that, you could know how to deal with it, and all.
Male, intervention group, NI
However, a small number of criticisms emerged concerning the‘real-life’ situations that were presented.
One participant felt that the information was repetitive; another felt that the real-life situations presented were too extreme and unrealistic; and another felt that the situations were not age-appropriate and instead were focused on the drinking experiences of older people. These same criticisms were evident among those in the control group, but to a much greater degree. These participants felt that younger
drinkers’ social behaviour and consumption levels were portrayed negatively and inaccurately and that the
education received was not age appropriate:
I know they cover when you drink when you’re older, but underage drinking, they could, kind of,
cover in that, because there’s not much about that.
Male, intervention group, Scotland
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It was well extreme. Like, no one our age is going to drink to that extent, like. The one on the video, like, had probably about a litre of vodka.
Male, control group, NI
The intervention participants mentioned some alcohol-specific topics that they felt should have been contained in the programme but were not. These topics included information on alcoholism, the effects of
alcohol on elderly people and more examples of‘real-life’ situations that were relevant to people their own
age. In relation to the real-world relevance, there was some criticism that the specific scenarios presented might be more relevant for those already engaged in drinking. It should be noted that each of these recommendations were made on only a single occasion.
Materials
The intervention materials discussed were the workbooks and CDs for phases 1 and 2; the EAN materials discussed, which differed from school to school, were workbooks, other written materials such as handouts and/or videos.
The intervention participants held a positive attitude towards the NI-adapted SHAHRP workbooks. They felt that completing these helped them to learn about alcohol and to remember the facts they had learned. Although mentioned less frequently, the design of the workbooks, the inclusion of activities and
challenges and the relatively small amount of writing required were also discussed positively. In contrast, EAN workbooks and other materials were negatively appraised and failed to engage the participants:
I think it’s better when you’re, like, writing out in a book because you take it in more, as opposed to
sitting there and, like, reading it.
Female, intervention group, Scotland
We’re so used to books, you, kind of, just ignore them now.
Female, control group, NI
Despite the positive appraisal, there was some criticism of the intervention workbooks. Some participants indicated that they disliked having to do any writing and would have preferred more discussion and
activities. In some cases, it was felt that having to write made the project seem similar to just another lesson. Similarly, during the control focus groups, and to a much greater degree, the participants called for less reliance on written materials and for greater utilisation of interactive materials such as videos and games:
Well, in a way, you know, there could have been, like, more physical activities instead of, like, always doing it in the book.
Male, intervention group, NI
It’s more books and, like, what we already know, rather than stuff we can ask about and, like, videos
and stuff.
Female, control group, NI
The intervention participants discussed the similarities and differences between the phase 1 and 2
workbooks. It was broadly agreed that alcohol-specific topics such as‘units of alcohol’ and ‘consequences
of alcohol use’ were addressed in both. However, it was also widely accepted that differences between the