Well-being of children and young people – School Health Promotion study

Quality description

Relevance of statistical data

The statistics published by the Finnish Institute for Health and Welfare (THL) provide information on the well-being and health of children and young people, their experiences of school attendance and studies, their participation, access to help and how well services respond to their needs by region. The statistics are based on an overall sample produced from the School Health Promotion study covering all of Finland. The first data collection for the School Health Promotion study conducted by the Finnish Institute for Health and Welfare every two years was in 1996. The results of the Welfare of children and young people – School Health Promotion study 2023 statistical report are based on data collection carried out in the School Health Promotion study in the period 2006–2023.

The role of the Finnish Institute for Health and Welfare is to follow the health and welfare of the population. The School Health Promotion study implements this task among children and young people. The data are utilised at the Finnish Institute for Health and Welfare in developing school and student health care, for instance. Educational institutions utilise the data produced by the School Health Promotion study in the evaluation and development of the promotion of welfare at the school community and pupil and student welfare, and in the instruction of health education. Municipalities utilise the results in welfare management, for instance, in the context of preparing a welfare strategy, a child and youth policy programme or a child welfare plan. At the national level, the results of the School Health Promotion study are used for purposes such as the monitoring and assessment of the implementation of policy programmes, strategies and different laws.

Methodology

The statistics are based on a biennial School Health Promotion study. The School Health Promotion study is implemented as a census survey whose target group comprises pupils in grades 4 and 5 (since 2017), and pupils in grades 8 and 9 (since 2006), and 1st and 2nd year students in upper secondary schools (since 2006) and 1st and 2nd year students in vocational institutions (since 2008). At the general upper secondary level, the survey is intended for students completing a curriculum for young people, and in vocational upper secondary education, for students under the age of 21 who are completing a vocational upper secondary qualification.

In 2023, the School Health Promotion study was carried out in educational institutions as an anonymous, independently completed online survey. Pupils and students filled out the survey in classes or groups during the school day. The teacher handed out the answer IDs to the pupils or students and supervised as they answered the survey. One lesson period had been scheduled for responding. Responding to the survey was voluntary for pupils and students. The study included separate survey forms for four different school levels, which could be answered in Finnish, Swedish, English, Russian or Northern Sámi. Short forms in plain language were also available in Finnish and Swedish and these were used both for grades 4 and 5 and for grades 8 and 9 of basic education and for students in vocational education and training. The educational institution decided who would respond to the form in plain language. The educational institutions informed the guardians in advance of the survey, and they were given the opportunity to prohibit the participation of their child if they were under the age of 15.

In 2023, the data for the School Health Promotion study were collected from grades 4 and 5 of basic education during the period 1 March–14 April, from grades 8 and 9 of basic education and from general upper secondary schools during the period 3 April–12 May and from vocational institutions during the period 1 March–12 May. 

In 2023, there were 95,523 respondents from grades 4 and 5 of basic education, 87,147 from grades 8 and 9 of basic education, 44,862 from upper secondary schools and 19,215 from vocational institutions. Respondents to the form in plain language (n = 13,335) are not included in the data presented in this statistical report, as the form in plain language was very short and the format of the questions was slightly different from the forms in standard language.

In the data for 2023, 48.9 per cent of the respondents in grades 8 and 9 of basic education were aged 15, 32.2 per cent 14, and 17.7 per cent 16 years. Of the upper secondary school students, 17-year-olds formed the largest group (48.4 %) and were followed by 16-year-olds (34.5 %) and 18-year-olds (16.0 %). Of students in vocational education and training, 42.7 per cent were aged 17, 36.0 per cent 16, and 15.3 per cent 18 years. The age is based on the year and month of birth reported by the respondents. The students in grades 4 and 5 of basic education were not asked about their year of birth.

In 2023, 6.1 per cent of respondents in grades 4 and 5 of basic education, 5.8 per cent of respondents in grades 8 and 9 of basic education, 6.2 per cent in general upper secondary school and 5.6 per cent in vocational institutions were of foreign background (revised on 9th September 2024). The survey included questions on the respondent's country of birth and their mother's and father's country of birth. The respondents reporting that both their parents, or their only parent, were born abroad, were perceived as respondents with a foreign background.

Responses to online forms were collected through the THL form service. Only those who clicked the Submit button at the end of the questionnaire will be included in the data compiled. The survey data is enriched with sample data that provides information about the respondent's educational institution and the municipality where the educational institution is located.

Respondents to the School Health Promotion study had the opportunity to give feedback on the survey. The end of the form included the following section: "You may give feedback on the survey here if you wish:” (Open field with no character limit). 94,059 children and young people answered left feedback. 

Feedback responses were viewed using natural language software. In the examination, the ten most frequently mentioned words were: hyvä, pitkä, kysely, kiva, kysymys, paska, tietää, tehdä, turha, vastata (translated: good, long, survey, nice, question, shit, know, do, unnecessary, answer). Correspondingly, the adjectives were: hyvä, pitkä, kiva, turha, huono, outo, mukava, tylsä, tärkeä, henkilökohtainen (good, long, nice, unnecessary, bad, strange, comfortable, boring, important, personal). The more detailed analysis of feedback responses will continue, and the results will be utilised in the development of forms.

The Finnish Institute for Health and Welfare undertakes as a public authority to store and process the data complying with its secrecy obligation and data protection legislation. All persons involved in collecting and processing the data have a duty of non-disclosure. Before data collection for the School Health Promotion study, the research plan is evaluated by the institutional review board of The Finnish Institute for Health and Welfare (THL).

During the period 2006─2011, data collections for the survey were conducted in even-numbered years in Southern Finland, Eastern Finland and Lapland and in odd-numbered years elsewhere in mainland Finland and in Åland. Since 2013, the School Health Promotion study has been implemented once every two years simultaneously across the entire country. Due to the data collection method, the examination of the results from the period 2006─2011 combines the research years 2006‒2007, 2008‒2009 and 2010─2011 to ensure that the results are as comparable as possible with research years 2013, 2015, 2017, 2019, 2021 and 2023.

Correctness and accuracy of data (revised on 9th September 2024)

The statistics are based on the data reported by the respondents themselves. Some of the answers may have embellished, concealed or, on the other hand, exaggerated information, for example, in the case of sensitive questions. In a time series or a regional comparison, the significance of such error sources can be assumed to remain approximately similar.

When examining data collected from young people, the possibility of implausible answers must also be considered. In the School Health Promotion study, they were investigated based on both content and answer technique.

In 2019–2023, the aim was to identify respondents from the School Health Promotion study data who, in certain questions, answer to extreme options that are impossible in terms of content. In 2023, respondents who reported that they cannot see, hear, walk, learn, remember, or concentrate at all, and that they never eat breakfast, school lunch, evening meal, evening snack or snacks during the school week were excluded as implausible from the user data of 8th and 9th grades in basic education, upper secondary schools, and vocational institutions (n=419).

Those who gave implausible answers based on content were not removed from the total data in previous years, but those respondents who reported never brushing their teeth and that they had had two or more accidents during recess, physical education lessons, other classes and on the way to school during the school year were excluded from the results by origin. In 2023 no separate exclusions based on content were made to the results by origin.

The quality of the data of the School Health Promotion study can also be examined based on content by comparing the answers given with Statistics Finland's data. In spring 2024, it was discovered that there are even more people born in certain countries of birth in the School Health Promotion study data than according to statistical data in the whole country combined. That’s why we started to examine implausible respondents from the data also based on answer technique.

In the School Health Promotion study’s data of students in grades 8 and 9 in comprehensive school, in year 1 and 2 in general upper secondary schools and vocational institutions implausible answers were investigated by examining response behaviour in matrix questions in 2019, 2021 and 2023. Matrix questions with at least five lines on the questionnaires for each survey year were used in the examination. Among them, questions that were intended for all respondents and have been asked at all three school levels were included.

The first examination is based on edge answers to matrix questions, i.e. that the respondent has selected the first answer option on the left in each row or the last answer option on the right in each row. Depending on the matrix, the left or right edge can most often be considered an "abnormal" edge with relatively few responses. In turn, the answers of the "non-abnormal" edge of the matrix are quite common and the answers can be considered usual.

When examining edge answers in matrices, one point is given for each matrix answered to an abnormal edge. Those who left one row blank are taken into account so that the blank row is completed for examination with the answer most commonly selected by the respondent in that matrix. If a respondent has left more than one row unanswered in the matrix, they cannot get a point for it.

The second examination is based on the identification of diagonal answer patterns of the same matrix questions. In the diagonal answer pattern, the answer starts at one edge of the matrix and proceeds diagonally row by row. The answer can start either at the top right or left.

Most respondents do not answer diagonally in any matrix. In individual matrices, diagonal answering can be considered plausible. Responding based on diagonal patterns is significantly less common than responding to an abnormal edge of the matrix.

You get one point for each diagonally answered matrix. To get a point, the respondent must have answered every row of the matrix.

Based on the examinations, it was found that a small proportion of students in the 8th and 9th grade in comprehensive school and students in the 1st and 2nd year in general upper secondary schools and vocational institutions who responded to the School Health Promotion study have abnormal response behaviour to matrix questions. Abnormal edge answers or diagonal answer patterns in a couple of matrix questions may indicate a real phenomenon and do not yet show pattern in the answer behaviour. Only when the same pattern is repeated from one matrix to another can the credibility of the respondent be questioned.

The proportion of respondents with foreign background in the data increased the more points the respondent received based on abnormal response behaviour. When the respondent scored at least five points due to the abnormal edges of the matrix, the proportions differed considerably from the averages of the data at all school levels. The same happened when there were at least four diagonal answer patterns.

Since the questions used to form the origin variable are not included in the implausibility examinations, it can be concluded that those respondents who have answered implausibly in matrix questions have also not answered truthfully to questions about origin.

Based on the above-mentioned examinations, those respondents who answered to an abnormal edge in at least five matrices or a diagonal response pattern in at least four matrices were excluded from the results by origin. The share of those excluded from results by origin was 0.7 per cent (n=1033) in 2019, 1.2 per cent (n=1847) in 2021 and 1.3 per cent (n=1923) in 2023.

The quality of the data can also be assessed by examining the share of respondents who did not respond to individual questions. In 2023, pupils in grade 4 and 5 of basic education tended to leave 1-3% of the questions intended for everyone unanswered. The share of missing answers among pupils in grades 8 and 9 of basic education until halfway down the form, excluding individual questions, was 1–3% but increases to 4–6% after this and to 6–8% at the end of the form. The share of missing answers on the forms completed by general upper secondary school students was 1–2% all the way to the last quarter of the survey and then increases to 2–3%. As a rule, the share of missing answers among students in vocational institutions until halfway down the form is 1–3% but increases to 4–5% after this and to 6–7% at the end of the form. The number of missing answers in forms filled out by grades 4 and 5 of basic education and by students in general upper secondary school is relatively small on the form in its entirety, so these do not affect the quality of the data. On the other hand, respondents to the rest of the form in grades 8 and 9 of basic education and vocational institutions may be selected.

Groups that did not participate in the study include children and young people who were absent from school on the day of the survey due to such issues as illness, travel or unpermitted absence, who have severe functional disabilities or who are home-schooled, as well as young people in preparatory education for programmes leading to an upper secondary qualification.

As for grades 4 and 5 of basic education, there was one municipality that did not provide any responses in 2023. For grades 8 and 9 of basic education and for general upper secondary schools, responses were received from all municipalities that had pupils or students in the grades or years concerned. Eight of the municipalities that had been sent questionnaire materials aimed at vocational institutions provided no responses at all.

Coverage of the data 

The data for the School Health Promotion study 2023 covered 77% of all pupils in grades 4 and 5 of basic education, and 70% of the pupils in grades 8 and 9 of basic education in Mainland Finland and Åland. In general upper secondary schools, the data covered 68% of all students who started their studies in the general upper secondary education syllabus for young people or a foreign qualification in 2021 and 2022. In vocational institutions, the data covered 28 per cent of all students under the age of 21 who started their vocational upper secondary qualifications in 2021 and 2022. The lower coverage of the data on vocational institutions should be taken into account when comparing the results.

When examined by wellbeing services counties, the coverage varied between 66% and 85% for pupils in grades 4 and 5, between 57% and 79% for pupils in grades 8 and 9, between 60% and 87% for general upper secondary school students, and between 15% and 57% for students in vocational education and training. 

Timeliness and promptness of published data

The School Health Promotion study is carried out every two years. Total sampling enables information production at the level of wellbeing services counties and municipalities.

The data will be published within approximately four months of the end of data collection. The results are available to be used as support for decision-making immediately at the start of the school year.

Availability, transparency and clarity of the data

The regional and municipality-specific results of the School Health Promotion study are published as indicators in the interactive the Health and well-being of children and adolescents environment (Tableau) and in the THL statistical cubes (thl.fi/kouluterveyskysely/tulokset, in Finnish and Swedish). Also, the distribution of responses for questions used in calculating indicators are published in the data cubes. Some of the indicators are also published in the Finnish Institute for Health and Welfare 's statistics and indicator bank Sotkanet (sotkanet.fi). Sotkanet provides information directly to welfare reports through an open interface. The results of an indicator will not be published in the Health and well-being of children and adolescents environment (Tableau), data cubes or Sotkanet, if the number of respondents is less than 30; for rare phenomena (less than five cases), there must be at least 60 respondents.

Results of School Health Promotion study are also reported in the Statistical yearbook on social welfare and health care, Tobacco statistics, and the Yearbook of Alcohol and Drug Statistics.

Comparability of statistical data

The preparation of the School Health Promotion study takes into account comparability with national and international studies focused on children and young people as well as THL’s other questionnaire surveys concerning population.

The results of the School Health Promotion study are reported as indicators. Some of the indicators are based on one and other on several questions. The development history of the questions is taken into account in forming time series of the indicators. The core questions included on the questionnaires remain unchanged. If there is cause to suspect that a change in the results has resulted from changes in the manner of measurement (such as the reformulation of a question or the place of a question on the form), the time series will be interrupted or this will reported as a new indicator.

Starting from 2013, data collection for the School Health Promotion study has progressed from paper forms to online forms so that only online forms were used in 2021. This change has primarily not been observed to have a significant impact on the results of the indicators. 

The 2023 results from the different wellbeing services counties can be considered comparable thanks to the high number of respondents. In 2015, the data collection conducted with the online questionnaires was plagued by technical problems, which resulted in an uncommonly small response rate. Therefore, the results per wellbeing services county and municipality for 2015 have been hidden in the electronic reporting system.

Clarity, integrity and cohesion

The School Health Promotion study questionnaires contain permanent and changing sections. Questions on the welfare and health of pupils and students and on the availability of services are permanent parts of the survey. Annually changing questions can be used to further explore a certain topic from topical phenomena.

Most of the questions in the permanent sections remained unchanged in the 2023 survey. In 2023, questions surveying symptoms and pains and questions related to social competence and free-of-charge contraception were added to the forms.

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