title: Sexual Health questions included in the Health Behaviour in School-aged Children (HBSC) Study: an international methodological pilot investigation.
abstract: This paper describes the methodological developments of the sexual health items included in the Health Behaviour in School-aged Children (HBSC) study since their mandatory inclusion in the study in 2002. The current methodological, ethical and pedagogical challenges in measuring young people's sexual health behaviours are discussed along with the issues associated with the sexual health items introduced to the HBSC study in 2002. The development and piloting of new cross-national items for use in the 2013/14 HBSC data collection are presented and discussed.
  
  
  
  An international pilot study was undertaken to determine the impact of these proposed changes. Questionnaires and classroom discussion groups were conducted in five pilot countries in 2012/2013 (France, Hungary, Ireland, Portugal and Romania) with a total of 612 school-aged children (age M = 15.55 years, SD = 0.95).
  
  
  
  The majority of participants in each country provided positive feedback about the appropriateness of the questions. Some small cross-national differences were found in the self-reported quantitative data relating to the appropriateness of the questions (χ2= 22.831, df = 9, p = .007, V = .117). Qualitative feedback suggests that for the vast majority of students the phrasing and age-targeting of the questions were considered appropriate. With the exception of a small number of respondents who commented on the clarity and/or personal nature of the content, no specific issues with the questions were identified.
  
  
  
  These findings provide guidance on the answerability (including the extent of missing and inconsistent data), understandability, acceptability (including in different cultures) and relevance of questions to potential participants. The findings from the pilot study suggest that in general, the questions are understandable, acceptable, and of a high priority to the target population, and that the simplification has significantly reduced the proportion of missing data. The new developments thus enhance the capacity of the questions to measure cross-nationally, sensitive aspects of young people's sexual behaviour. These questions were included in the 2013/2014 round of the HBSC survey and will continue to be used to monitor trends in adolescent sexual health and behaviours, and to inform and influence health services and health education policy and practice at local, national and international levels.
authors.affiliation: Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, UK. Youngh6@cardiff.ac.uk.
authors.forename: Honor
authors.identifier: 0000-0003-0664-4002
authors.initials: H
authors.lastname: Young
authors.affiliation: National Institute of Health Promotion, Budapest, Hungary.|Eötvös Loránd University, Institute of Psychology, Budapest, Hungary.
authors.forename: András
authors.initials: A
authors.lastname: Költő
authors.affiliation: Aventura Social - Faculdade de Motricidade Humana, Universidade de Lisboa, [University of Lisbon], Lisbon, Portugal.|ISAMB/Faculdade de Medicina da Universidade de Lisboa [Faculty of Medicine, University of Lisbon], Lisbon, Portugal.|FCT - Fundação para a Tecnologia e Ciência [Foundation for Science and Technology] (SFRH/BPD/110905/2015), Lisbon, Portugal.
authors.forename: Marta
authors.initials: M
authors.lastname: Reis
authors.affiliation: University of British Columbia, School of Nursing, Vancouver, Canada.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Saewyc
authors.affiliation: Université Libre de Bruxelles (ULB), Service d'Information Promotion Education Santé (SIPES), School of Public Health, Brussels, Belgium.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Moreau
authors.affiliation: Health Promotion Research Centre, National University of Ireland, Galway, Ireland.
authors.forename: Lorraine
authors.initials: L
authors.lastname: Burke
authors.affiliation: Child and Adolescent Health Research Unit, School of Medicine, University of St Andrews, St Andrews, Scotland, UK.
authors.forename: Alina
authors.initials: A
authors.lastname: Cosma
authors.affiliation: Addiction Switzerland, Research Department, Lausanne, Switzerland.
authors.forename: Béat
authors.initials: B
authors.lastname: Windlin
authors.affiliation: Health Promotion Research Centre, National University of Ireland, Galway, Ireland.
authors.forename: Saoirse Nic
authors.initials: SN
authors.lastname: Gabhainn
authors.affiliation: Service Médical du Rectorat de l'académie de Toulouse, UMR 1027 Inserm, Université Paul Sabatier, Toulouse, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Godeau
mesh_terms: D000293:Adolescent; D005260:Female; D005602:France; D015438:Health Behavior; D006266:Health Education / Q000379:methods*; D006801:Humans; D006814:Hungary; D007391:International Cooperation; D007494:Ireland; D008297:Male; D010865:Pilot Projects; D011174:Portugal; D060728:Reproductive Health / Q000592:standards / Q000706:statistics & numerical data*; D012383:Romania; D012574:Schools; D013334:Students / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires
keywords: Adolescent sexual behaviour; Adolescent sexual health; Missing data; Questionnaire design inconsistencies; Self-completion