USING E-TOOLS FOR SCHOOL HEALTH PROMOTION

Shobana Raghupathy

Sociometrics Corporation, 170 State Street, Suite 260, Los Altos, CA 94022, U.S.A.

Keywords: School health, Drug use monitoring, Evaluation.

Abstract: Our purpose is to outline the potential use of E-Tools for data collection and monitoring for school health

purposes. We discuss evidence on the feasibility of such E-Tools in school settings across the United States,

and will discuss issues of usability, confidentiality, and costs. Such E-tools can be extended to many school

health efforts, particularly areas of mental health, eating disorders and obesity. Drawing on our experience

developing such web-based assessments, we will also lay out design considerations for such E-tools that are

focused on drug prevention.

1 INTRODUCTION

The primary context for monitoring and preventing

adolescent drug use in the United States has been

through schools and other local educational agencies

(Ringwalt et al., 2002). Schools in the US are

required to provide drug prevention education, and

adopt drug-monitoring tools. It is often difficult,

however, for relatively small community and school-

based programs to sustain meaningful drug

evaluation systems. Problems include lack of staff

enthusiasm, insufficient funding, staffing and

expertise (Mantell et. al., 1997; Sedivy, 2000).

Teachers are expected to take on responsibilities

other than teaching even at a time when there are

increasing pressures on them to raise the academic

achievement levels of their students, and collection

and monitoring of data on substance use or other

health concerns are perceived as consuming valuable

time (Hallfors et al., 2000). E-tools that provide

online data collection and analysis—such as web-

based surveys-- provide promising opportunities for

drug abuse monitoring. Despite the growing

popularity of computer-assisted surveys, researchers

and practitioners working in the field of drug

prevention have generally been slow to adopt this

technology for data collection purposes mainly due

to a lack of awareness and/or availability of such

tools, as well as with the practical issues related to

such technologies. In this paper, we will provide a

brief overview of emerging trends in computer and

web-based data collection methods in public health

research that can fulfill these needs, and the

feasibility of applying such methods in schools and

community settings. Drawing from our own

experience in developing web-based assessments for

behavioral health, we will also lay out design

suggestions for online E-tools that are specifically

geared towards drug use monitoring and treatment.

Although our experience is largely US-based, our

paper has implications for other Western countries

as well.

2 FEASIBILITY OF WEB-BASED

ASSESSMENTS IN SCHOOLS

The increase in computer facilities in U.S. schools

makes it practically and financially feasible to

consider web-based computer-administered querying

for future alcohol, tobacco or drug surveys. Over the

past decade, access to computers and the Internet has

become almost universal in U.S. elementary schools.

Nearly 100% of public schools had access to the

Internet in 2005 with 97% of them using broadband

connections (Wells and Lewis, 2006). The

percentage of instructional rooms with access to the

Internet was 94 percent and the ratio of students to

instructional computers with online access was 3.8

to 1. There were no differences in access by

minority enrollment, school size, rural/urban setting

or socioeconomic status (Wells and Lewis, 2006).

Computer-assisted surveys have already been used

in a limited form in several recent national surveys

of youth sexual behaviour and substance use

including the National Survey of Adolescent Males,

Raghupathy S. (2011).

USING E-TOOLS FOR SCHOOL HEALTH PROMOTION.

In Proceedings of the Second International Conference on Innovative Developments in ICT, pages 99-102

DOI: 10.5220/0004472300990102

 SciTePress

National Household Survey on Drug Abuse, and the

National Survey of Child and Adolescent Well-

Being. More recently, substance abuse researchers

have been using Web-based surveys for collecting

data from elementary (McCabe et al., 2005; Wang et

al., 2005), secondary (e.g. Beebe et al., 1997; Boyd

et al., 2004, 2007; McCabe et al., 2004) and

postsecondary student populations (e.g. Eisenberg et

al., 2007; Kypri & Gallagher, 2003; McCabe et. al.,

2007a, 2007b; Miller et al., 2002; Pealer & Weiler,

2003). In a recent study, web-based surveys were

found to be an effective tool for collecting data from

Hispanic high school students located in remote,

rural areas (Cooper et al., 2006). It has been argued

that audio enhanced web-based surveys might be a

format that is more comprehensible to junior-high

and vocational high school students who might have

lower literacy skills than senior-high school students

(McCabe et al., 2004). Moreover, there is

overwhelming evidence that students prefer web-

based surveys to paper and pencil surveys, and

perceive more response anonymity (e.g. Case et al.,

2004; Hallfors et al., 2000; McCabe et al., 2002,

2004). The images associated with computer

administration are aligned more closely with

television images than those of the written word, a

preference often observed among adolescent

populations thereby increasing respondent

motivation for completing surveys (Beebe et al.,

1997). Web-based survey administration also seems

acceptable to school staff (Hallfors et al., 2000).

It is clear that web-based E-tools for school

health research has tremendous potential. As part of

a project funded by the National Institute of Drug

Abuse (NDA), the authors conducted focus groups

and telephone interviews with practitioners,

educators, teachers and district administrators from

across the U.S., to assess the feasibility of online

CASI administration in schools. Based on the

interviews and focus group discussions, we have

outlined some preliminary design considerations for

any online data collection and monitoring tool that

can be developed for measuring drug prevalence in

schools and for evaluating school-based drug

prevention efforts. The most optimal design for such

a tool would be one that allows for customized

survey development; web-based administration; and

downloadable data that eliminates the identity of

clients. In other words, any online data collection

system must be comprehensive and focus on all

three aspects of evaluation-- survey development,

survey administration and data analysis—in order to

fulfill the evaluation needs of schools and

communities across the United States.

3 USING WEB-BASED

ASSESSMENTS IN SCHOOLS

To monitor and prevent drug abuse, schools in the

United States often rely on local self-report surveys

(McCabe et al., 2004; Hallfors & Iritani, 2002b).

These self-report surveys are typically constructed

from commonly used outcome measures available

in the public domain. Currently, there are several

published instruments available for public use in

numerous websites maintained by the United States

National Institutes for Health. As a first step, any

online assessment tool must include an Instrument

Developer that will allow practitioners to pick

outcomes measures and construct a survey of their

choice. Such outcome measures can be pre-

programmed and stored in a “bank” of high quality,

commonly used questions and scales on a variety of

substance abuse and violence related topics.

Practitioners can then select the measures they are

interested in and create an online survey literally

within minutes by a simple selection process (such

as checkboxes).

The focus group discussions and telephone

interviews suggested that the most commonly used

drug prevalence measures were ones that have

undergone rigorous study into its psychometric

properties and that were most likely to be mandated

or approved by federal, and state funding agencies.

The most commonly used measures for drug

assessment purposes included the following:

-Core risk and protective measures compiled

by the National Institute on Drug Abuse

(www. Nida.nih.gov). These core measures

are drawn from various national surveys such

as the Student Survey of Risk and Protective

Factors that assesses students' attitudes,

perceptions, and behaviour regarding drug

use and violence, the Monitoring the Future

Survey, and the National Survey of Drug Use

and Health . Most of these measures are in

the public domain.

-State-specific school climate and youth risk

behaviour surveys such as the Oregon

Healthy Teen survey, which are mandated by

the Oregon Department of Education, or the

Kentucky Incentive for Prevention Survey.

Most of these state surveys are built from the

National Youth Risk Behaviour Survey (High

School) which includes sections on youth

resiliency measures, school safety and

connectedness.

Any instrument developer that eases survey develop-

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development will need to have several programming

safeguards in place to ensure that a novice user can

successfully create a scientifically valid evaluation

instrument. For example, if a user selects a question

from within a skip pattern or scale measure, the

entire block of questions will be added to the survey.

Because these questions are pre-programmed, users

cannot alter these questions in any way thereby

retaining their psychometrics properties.

Such an Instrument Developer online interface

can be developed by using a combination of HTML

and JavaScript with a custom-written CGI (common

gateway interface) program developed in Perl to

bridge the server-based question database with the

interface. Once the question selections have been

finalized by the user, the interface will send the

information from the HTML form to a database

using a CGI program written in the Perl scripting

language. Based on the specific user selections, the

Instrument Developer then automatically generates

an online survey that forms the basis of the CASI

interface.

A concern expressed by the focus groups and

interviewees related to survey confidentiality and

privacy. The concerns related to data storage and

security, as well as the easy visibility of survey

responses on closely spaced monitor screens. A

number of solutions were discussed. Participants

suggested that respondent privacy could be

enhanced by using monitor visors (that can range

from $20-$40 per piece) or computer privacy

screens. Participants were also asked about allowing

students to take their surveys from multiple access

points, particularly from their homes or other private

locations. The reaction was decidedly mixed in both

groups. Some felt that this would promote flexibility

and greater survey participation, while others felt

there would be more scope for misuse as it teachers

would be unable to monitor the respondents. Recent

studies do indicate that web-administration in an “on

your own setting” could lead to incomplete data

(Denniston et. al. 2010).

4 HELPING SCHOOLS DEVELOP

ONLINE ASSESSMENTS

Once a survey is created, students can self-

administer the questionnaire either in their computer

labs or from home. The data gathered will be

transmitted online and securely stored on the host

server. For users who prefer to conduct data analysis

using their own software, the interface should

include a function that downloads a copy of the raw

data that can then be imported into standard

statistical packages such as SPSS, SAS, Stata,

Minitab for offline analysis. It is imperative that the

downloaded data be made available without subject

identifiers in order to maintain confidentiality.

Data collected through such an online system

would reside on a secondary web server ensuring

maximum confidentiality and anonymity. At the

same time, the security of the data is of paramount

importance. Comprehensive security procedures will

need to be drafted for accessing the data; the

programming and files associated with the

Instrument Developer and ACASI will need to be

installed in secure sections of the server and not

available for viewing or download.

5 CONCLUSIONS

E-tools facilitating online data collection and

analysis can significantly enhance school health

research and practice. Such tools allow school staff

to save time and resources by using the computer

for a number of key evaluation tasks—especially

those that are burdensome, time-consuming and

tedious. And once developed, an online data

collection system would emerge as a more

affordable option compared to evaluation using

traditional data collection and monitoring methods.

ACKNOWLEDGEMENTS

National Institute on Drug Abuse.

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