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Young people who are being bullied – do they want general practice support?

Young people who are being bullied – do they want general practice support? Background: Childhood bullying is a major risk factor for health, education and social relationships, with effects persisting into adulthood. It affects half of all children at some point, with 10–14 % experiencing bullying that lasts for years. With the advent of cyberbullying, it can happen at all times and places. There have been calls for GPs to take a more active role in identifying and supporting young people who are being bullied. This paper explores young people’s and parents’ opinions about whether general practice should be involved in identifying and supporting young people who are being bullied. Methods: Two hundred six young people (85.9 % female, mean ± sd age 16.2 ± 3.2 years) and 44 parents were recruited through established bullying charity websites and their social media channels to complete an online questionnaire comprising multiple-choice questions and unlimited narrative responses. Questionnaire responses were analysed by age and gender using descriptive statistics. A descriptive analysis of the narrative responses was undertaken and key themes identified. Results: Young people (90.8 %) and parents (88.7 %) thought it was important for GPs to be better able to recognise and help young people who are being bullied. Most recognised the link between bullying and health. The doctor’s independence was seen as advantageous. Young people preferred completing a screening questionnaire to disclose experience of being bullied than being asked directly. They expressed concerns about how questions would be asked and whether information would be shared with parents/guardians. Parents were supportive of the use of a screening questionnaire, and most expected their child’s disclosure to besharedwiththem. Conclusion: Young people and parents recruited through anti-bullying websites and social media would welcome greater GP involvement in identifying and supporting young people who are being bullied and their families, provided it is offered in a caring, compassionate and confidential manner. Keywords: General practice, Bullying, Children, Parents, Questionnaire, Internet Abbreviations: CAMHS, Child and Adolescent Mental Health Services; GP, General Practitioner; NICE, National Institute of Health and Care Excellence; RCGP, Royal College of General Practitioners; UK, United Kingdom; WHO, World Health Organisation; YP, Young Person Background both minority ethnic and white youths reporting compar- Bullying is a systematic abuse of power characterised by able levels of victimisation [4]. Although often perceived repeated psychological or physical aggression with the as a school-based problem, bullying is increasingly intention to cause distress to another person. Over half community-based. Social networking sites and smart- of young people (55 %) report having recently been phones have brought with them a new phenomenon – bullied [1], with 10–14 % experiencing chronic bullying cyber-bullying, which can happen at all times and in all lasting for more than six months [2]. Bullying occurs at places [5]. Recent figures show that 15 % of 15 year similar rates across all socio-economic strata [1, 3] with olds in the UK have experienced cyber-bullying. Girls are more likely to experience psychological, emotional and cyber-bullying, whereas boys are more likely to be * Correspondence: e.j.scott@warwick.ac.uk Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK physically bullied [1]. Full list of author information is available at the end of the article © 2016 The Author(s). Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Scott et al. BMC Family Practice (2016) 17:116 Page 2 of 9 Childhood bullying is a major risk factor for health, that include primary care and mental health services [19]. educational attainment and social relationships. Bullied This has been echoed by NICE who include the evaluation children are twice as likely as non-victims to suffer from of bullying as a risk factor and the development of anti- psychosomatic problems, such as headaches, abdominal bullying strategies in several of its guidance documents, pain, sleeping problems, poor appetite and enuresis [6]. including depression [20] and weight management in They are at increased risk of psychiatric disorders young people [21] which specifically mention general including depression, eating disorders, self-harm and practice. The Anti-Bullying Alliance, in collaboration with suicidal behaviour [7, 8]. They also have high rates of the Royal College of General Practitioners, marked Anti- poor academic performance resulting from absenteeism Bullying Week 2015 with the publication of guidance and worries at school [9, 10]. Over 16,000 young people notes for GPs [22]. in the UK aged 11–15 years are estimated to be absent Despite the calls for greater health service involve- from state school with bullying as the main reason, and ment, the extent to which young people and their fam- a further 78,000 are absent where bullying is one of the ilies see bullying as a health issue relevant to general reasons given [11]. The adverse consequences of child- practice is unknown. This paper reports on work explor- hood bullying continue into adulthood leading to sub- ing the views of young people and parents about GPs stantial health and wider societal costs. This includes taking a more active role in identifying and supporting difficulties with employment and social relationships, young people who are being bullied. and mental health consequences such as general anx- iety disorder, panic disorder, agoraphobia, depression, Methods and suicidal acts [12]. Recruitment General Practitioners (GPs) in the UK can offer sup- Four national UK-based bullying charities (Anti-Bullying portive counselling either within the practice or from a Alliance, BeatBullying, Bullies Out, Kidscape), which third sector agency specialising supporting young offer support to young people aged 11-25years, posted people or bullying. They also have access to a range of brief information on their websites, Facebook pages and other resources as recommended by the Royal College twitter feeds, inviting young people who had experienced of General Practitioners (RCGP) [13]. If bullying is af- bullying to complete a brief survey. A hyperlink was pro- fecting the young person’s education, the GP can refer vided to a page on the University’s website where more them to the educational psychology service or to Chil- detailed information about the study was given, together dren and Adolescent Mental Health Service (CAMHS) with a link to a confidential survey page. if there is evidence of severe mental health issues. In There was no direct contact between researcher and addition to this, GPs are optimally placed to identify participant. Parental consent was not obtained for the and treat the physical and psychological consequences young people participating. Clicking the link given in the of bullying outlined above. Talking to someone about invitation from the charity and then completing the on- bullying is the first step to getting help, but up to 40 % line survey after reading the age appropriate information of children never disclose bullying to their parents [14]. supplied about how their responses would be used, was Hence, the opportunity to discuss bullying with a considered to be implied informed consent. The reason healthcare professional may provide an important av- for not seeking parental consent was to ensure that po- enue to break the silence and initiate help. tential participants who have not disclosed the fact that Given the impact on health, children who are being they are being bullied to a parent were not unfairly ex- bullied are likely to have greater need for health care cluded from the survey. There are many reasons that than their non-bullied peers. Although research to con- young people may not tell their parents that they are be- firm the extent to which this leads to more frequent ing bullied and it is particularly important that their attendance at general practice is lacking [15], previous opinions on other sources of support are heard. Our in- work with school nurses has confirmed that there is a stitutional ethics review board approved this approach positive correlation between self-reported health symp- and the rationale behind it. toms (e.g. poor sleep, frequent headache) and frequency A parallel request was made for parents of children of bullying experienced [16, 17]. In the UK, school who had been bullied to complete a similar survey. No nurses do not typically consult with every student in active effort was made to recruit parent-child dyads. Par- the school every year. In countries, however, such as ental participation was not contingent on their child also Denmark, where an annual consultation is routine, stu- completing the questionnaire and no information was dents who are being bullied are more likely to report collected to match parent and child participants. Com- positive effects of their dialogue with the school nurse pletion of the survey, after reading the introductory in- and to initiate additional visits to the nurse [18]. The formation about how their responses would be used, was WHO has called for society-wide inter-agency approaches considered implied informed consent. Scott et al. BMC Family Practice (2016) 17:116 Page 3 of 9 The study received ethical approval from the Univer- be significant. All data analysis was conducted using sity’s BioSciences Research Ethics Committee. IBM SPSS Statistics 22. Free text responses were downloaded verbatim from the online survey output and initially collated by which Data collection survey question elicited the comment. The lead author For young people, the survey comprised three multiple familiarised herself with the responses before undertak- choice questions with free text space under each ques- ing a descriptive analysis of the data. As this was ex- tion. The questions were intended to stimulate interest, ploratory work, an inductive approach was taken. The with topics covering the perceived importance of GP data was subjected to a process of complete coding and involvement in identifying and supporting children who candidate themes identified. These themes were then re- are being bullied, and whether they would be comfort- fined, redundant themes removed and further themes able with (a) their GP asking about bullying and (b) added as identified during subsequent readings of the completing a screening questionnaire which included data. The relationship between the themes and partici- questions on bullying, in the waiting room prior to see- pants’ responses to the multiple choice questions was ing the GP. The questions and answer options are pre- considered during analysis. As some themes were com- sented in full in Table 1. mon to more than one question, the data was collapsed The parental survey had eight questions, three of and the findings presented by theme. which related to the bullying experienced by their child. The remaining questions covered the perceived import- Results ance of greater GP involvement, feelings about their Participant characteristics child being asked to complete a screening tool for bully- Two hundred and six young people (85.9 % female, ing, whether they thought their child would be honest mean ± sd age 16.2 ± 3.2 years) and 44 parents (88.6 % about bullying if the GP asked and their experience of female, aged 25–58 years) participated. The majority discussing bullying with their own GP. The questions (55.4 %) of young people were aged 13–16 years (see and answer options are presented in full in Table 2. Fig. 1), and there was no difference in gender distribu- Age and gender were collected for participants in both tion by age (p= .142). surveys. Most parent participants (86.4 %) were certain that their The questions in both surveys were initially developed child had been bullied, the others were less sure. Parents in consultation with representatives from the Anti-Bully- reported a wide range of types of bullying experienced by ing Alliance and Kidscape. The response options were their child (see Table 2) with school bullying (86.4 %) be- refined with input from local parents and young people ing the most common. In the majority of cases (90.9 %) with experience of bullying. There was no formal pilot the child was aged 16 years or younger at the time. test phase. Data analysis Quantitative data For the multiple choice questions in both surveys, re- All multiple choice questions received a 100 % response sponse frequencies were tallied. Chi-square tests were (see Tables 1 and 2). For young people, there were no dif- conducted to explore any differences in response by age ferences in responses to any question by age (all p >.495) or gender, with a p-value of less than 0.05 considered to or sex (all p >.119). Table 1 Young people’s responses to the multiple choice questions Q1: How important do you think it is for GPs to be better able to recognise and help young people who are affected by bullying? Very important Quite important Not Sure Not very important Not important at all n = 109, 52.9 % n = 78, 37.9 % n = 11, 5.3 % n = 7, 3.4 % n = 1, 0.5 % Q2: As a young person, how would you feel if a GP asked you about experiences of being bullied if you were attending the GP for an everyday problem such as a headache or tummy ache? Would you feel comfortable with this? Yes, completely Yes, a bit Not sure Not very much Not at all n = 36, 17.5 % n = 72, 35.0 % n = 50, 24.2 % n = 36, 17.5 % n = 12, 5.8 % Q3: We are thinking of asking young people to complete a questionnaire while in the waiting room when they visit the doctor to ask about their current health. This would include some questions about their experience of being bullied. Would you feel comfortable answering such a questionnaire in the waiting room? Yes, completely Yes, a bit Not sure Not very much Not at all n = 100, 48.5 % n = 68, 33.0 % n = 15, 7.3 % n = 17, 8.3 % n = 6, 2.9 % Scott et al. BMC Family Practice (2016) 17:116 Page 4 of 9 Table 2 Parents’ survey responses Q1: Has your child ever been bullied? Yes No Unsure n = 38, 86.4 % n = 4, 9.1 % n = 2, 4.5 % Q2: If you answered yes to Q1, what type of bullying was it? You may choose more than one option School Outside school Cyber Emotional Physical Psychological Other n = 38, 86.4 % n = 18, 40.9 % n = 11, 25.0 % n = 20, 45.5 % n = 14, 31.8 % n = 13, 29.5 % n = 2, 4.5 % Q3: Was your child aged 16 years or younger? Yes – primary school Yes - secondary school Yes – both schools Yes – age not given No n = 10, 22.7 % n = 10, 22.7 % n = 4, 9.1 % n = 20, 45.5 % n = 2, 9.1 % Q4: Do you think it is important that GPs should be better able to recognise and help young people being affected by bullying? Very important Quite important Not Sure Not very important Not important at all n = 31, 70.5 % n = 8, 18.2 % n = 5, 11.3 % n =0 n =0 Q5: How would you feel if your child was asked to complete a questionnaire while in the doctor’s waiting room which covered questions about their current health including their experience of being bullied? Positive – would expect child Positive – would not expect Not Sure Negative – I don’t think this to share answers child to share answers is appropriate n = 24, 54.5 % n = 12, 27.3 % n = 3, 6.8 % n = 5, 11.4 % Q6: If your child was being bullied do you think they would report this during a visit with a doctor if asked? Yes, definitely Yes, maybe Not sure No, probably not No, definitely not n = 6, 13.6 % n = 18, 40.9 % n = 9, 20.5 % n = 9, 20.5 % n = 2, 4.5 % Q7: What kind of problem do you see bullying as? You may choose more than one option School Health Neither Other n = 33, 75.0 % n = 23, 52.3 % n = 1, 2.3 % n = 17, 38.6 % Q8: Have you ever discussed with a GP any incidents of bullying of your child and its consequences? Yes – GP helpful Yes – GP not helpful No Not yet, but am considering n = 7, 15.9 % n = 9, 20.5 % n = 26, 59.1 % n = 2, 4.5 % Note: parents were able to select more than one type of bullying so percentages will not add up to 100 % Involvement of GPs bullying (n = 2), family problem (n = 2), a self-esteem Most young people thought it important (very im- problem (n = 1), “a fact of life” (n = 1). portant52.9%;quite important37.9%)for GPstobe Over a third of parents (36.4 %) had discussed the better able to recognise and help young people who bullying of their child and its consequences with their are affected by bullying. Likewise, most parents also GP, but less than half had found it helpful. believed this to be important (very important 70.5 %; quite important 18.2 %). Just over half of the young people described feeling Screening for bullying comfortable (completely comfortable 17.5 %; quite com- When asked about completing a health questionnaire, fortable 35.0 %) with their GP asking about bullying if which included questions about bullying, before seeing a they attended the surgery for a problem such as a head- GP, the vast majority of young people would feel com- ache. A quarter, however, would not be comfortable be- fortable doing this (completely comfortable 48.5 %; quite ing asked (not very comfortable 17.5 %; not at all comfortable 33.0 %). A few were unsure (7.3 %) and comfortable 5.8 %) and the remaining 24.2 % were un- some were not comfortable with this idea (not very com- certain. This pattern of responses was similar across all fortable 8.3 %; not at all comfortable 2.9 %). age ranges (p= .495). The vast majority (81.8 %) of parents were positive Most parents recognised bullying as a school and/or about the idea of their child being asked to complete a health problem, with a significant proportion (38.6 %) screening questionnaire that included questions on identifying additional or alternative routes of the prob- bullying. Most would expect their child to show them lem, i.e. social/community problem (n = 8), cyber- their answers. Scott et al. BMC Family Practice (2016) 17:116 Page 5 of 9 Fig. 1 Age distribution of young people completing the questionnaire Qualitative data “A medical problem may well be the first sign of In total, young people provided 232 free text comments bullying … it would be helpful if GPs were more aware with a further 56 from parents. Most were quite brief (10– of how prevalent bullying is and included it in any 20 words) but others were notably longer (up to 700 assessment of the child.” (Parent #43, female, aged 52) words). Analysis identified four themes: Awareness of the link between bullying and health; The appropriateness of The appropriateness of GP involvement GP involvement; Confidentiality and the presence of par- Whilst both young people and parent participants were ents; and, Practical issues surrounding screening. overwhelmingly in favour of GPs being better able to identify and support young people who are being bullied, Awareness of the link between bullying and health they also expressed a number of reservations. A very Most young people and parents demonstrated under- small minority felt that tackling bullying was outside the standing that bullying can be a cause or contributory doctor’s remit and should remain the responsibility of factor in both physical and mental ill-health throughout teachers and parents. the comments they provided. In many cases they spoke Both young people and parents thought GPs being re- from experience and included personal examples. A mi- moved from the school setting was an advantage. The nority, however, appeared unaware of bullying as a po- doctors’ independence from both the family and school tential risk factor for common health concerns: was considered beneficial and likely to allow a more ob- jective assessment of the child and situation. In addition “I don’t really see the link between GP and bullying. to this, young people felt it would be easier to talk to a If I go in with a tummy ache or headache I would just more independent adult: want to get in there get medication and then come out.” (Young Person #85, female, aged 14) “…it may be easier to talk to someone that they know probably doesn’t know the people they are talking Experience of approaching the GP for support with about and that they won’t tell them.” bullying-related health problems was variable. GPs were (Young Person #20, female, aged 14) perceived to lack understanding of bullying and its links to physical and mental health. Parents were par- Over half of the parents surveyed thought that if their ticularly critical: child was being bullied that they would probably tell the Scott et al. BMC Family Practice (2016) 17:116 Page 6 of 9 doctor, if asked, and those leaving comments identified children would disclose bullying in their parent’spresence. the doctor’s approach to questioning as being key to fa- Many young people expressed a preference for parents/ cilitating disclosure. Parents and young people agreed carers not to be present during discussions about bullying. that they would be more likely to report bullying if they Most parents, however, expected their child’s disclos- understood why the doctor was asking (i.e. the link be- ure to be shared with them and some expressed a desire tween bullying and health). Other key factors were GP to be the first person to help their child. Others gave a sensitivity and offering reassurance: more balanced view about providing support to the child: “As long as they were friendly and genuine I would quite happily talk about problems if someone was “Would hope that my child would share info with me, there to listen. I wouldn’t talk if it was spoken about in but it is important that they know it would be a generic way like a check mark against their daily confidential if they wish.” (Parent #43, female, 52) tasks.” (YP #176, female, 22) Practical issues surrounding screening Young people felt the most significant barrier to dis- Participants identified a number of practical issues re- closure was the feeling that they didn’t have an estab- garding the use of a screening questionnaire to identify lished relationship with their GP. They expressed young people who are being bullied including delivery concern about their lack of connection with their doctor format and venue. There was a strong preference among and the difficulties this may present in feeling safe talk- young people for initially answering questions about ing to them: bullying in a paper or online questionnaire rather than verbally face-to-face: “You might not even want to tell an adult you trust, let alone one that you don’t really know” “I think this would be a more suitable and effective (YP #138, female, 13) way of approaching this topic … it’s easier to write things down than speak to someone” Other concerns expressed by both young people and (YP #92, female, 17) parents included whether GPs have the appropriate training and experience to deal with bullying and the Young people’s opinions were divided on the appropri- time pressure of brief appointment slots. ateness of completing the questionnaire in the GP’s wait- ing room. Some participants felt that this was a good way of asking and that completing the questionnaire in Confidentiality and the presence of parents the waiting room would result in better engagement. A significant number of young people expressed a pref- erence for the questionnaire being anonymous, but in “I would feel comfortable answering a questionnaire the context of the comments it appears that there may in the waiting room as it gives me something to do have been some confusion between the terms ‘anonym- while I’m waiting … I think it would then be easier ous’ and ‘confidential’: to speak to the GP about when you went in” (YP #126, female, 16) “I know that this would be kept completely anonymous between myself and the doctor…” (YP #20, female, 14) But others, while positive about the idea of completing the questionnaire, raised concerns about privacy in the While participants acknowledged the link between waiting room and suggested alternatives, such as com- bullying and health and understood that the doctor pleting it at home or online. would be trying to help, some felt that being asked about Parental concerns were focussed on the possibility of bullying might be uncomfortable or awkward, but could the questionnaire causing distress to a child, while offer a means of relief: others questioned whether a child would complete the questionnaire honestly. It was observed that the ques- “I would personally feel weird and in an awkward tionnaire would only be of use if the doctor valued the position. However if one person does know about my questions and the responses provided. situation they may help me and I may not be a victim any more. (YP #9, female, 14) Discussion Both young people and parents recognised the link be- Discomfort was expected to be greater if their parents tween bullying and health, and would welcome greater were present and a few young people questioned whether GP involvement in recognising and supporting young Scott et al. BMC Family Practice (2016) 17:116 Page 7 of 9 people who are being bullied, providing this was done in affect their willingness to initiate discussion of a poten- a caring and compassionate way. Young people viewed tially sensitive topic [23]. the completion of a paper or online screening question- naire prior to the appointment as preferable to initially Strengths and limitations being asked about bullying face-to-face; parents also To our knowledge, this is the first report of young peo- found this approach acceptable. Parents and young ple’s and parents’ perspectives on the involvement of people disagreed about whether parents should be GPs in identifying and supporting young people who are present during the discussion about bullying. being bullied. These are important findings considering that up to The use of brief questions accompanied by unlimited 40 % of children never disclose bullying to their parents text boxes allowed participants to expand on their [14], but that talking to someone about bullying is the questionnaire answers and put them into context. This first step towards help. Thus confidential disclosure to combined approach resulted in a richer and more illu- GPs may provide an important avenue to break the si- minating data set than is usually possible using survey lence and initiate help. This may be in the form of coun- methods alone and reached a greater number of partici- selling or support from the GP to manage the physical pants than would typically be possible for traditional and psychological consequences of bullying, or referral qualitative work. The quantity of free text responses re- to specialist services such as the educational psychology ceived was unanticipated and what was originally ex- service or CAMHS [13]. pected to be a brief quantitative survey became a mixed Given the preference expressed by young people to methods study. complete a screening questionnaire rather than being Data analysis was carried out by a single researcher. asked directly about bullying, alternative routes to follow While her perspective may have influenced interpret- up with young people identified through screening ation of the data, the accompanying quantitative data should also be explored. Previous research has found from each participant clarifies their point of view (posi- school nurses to be a viable way of identifying and sup- tive, negative, uncertain) on each question, thereby redu- porting young people who are being bullied [16, 18]. For cing the risk of misinterpretation. this model to work in the UK, school nurses would need Recruiting participants through established bullying to be a more regular fixture in schools so that they are a charity social media channels was an effective means of trusted face rather than an infrequent visitor. The partic- involving individuals with a diverse range of experience. ipants in this study placed significant value on the doc- Distributing paper questionnaires through schools or tor’s independence from the school. Hence, the GP youth groups would likely have drawn a minority of par- practice nurse might also provide an appropriate source ticipants with first-hand experience of chronic bullying. of support. The use of an online survey also allowed greater preser- Both parents and young people expressed concerns vation of participant anonymity. The use of different on- about how the GP would facilitate disclosure of bully- line research methods in health services research has ing. The qualitative findings suggest that GPs may been discussed in detail elsewhere [24, 25]. need to be more attuned to the importance of (a) The main limitation of the sample is that the extent considering a young person’s experience of bullying as to which it is representative of the wider population of a risk factor for poor physical and mental health, (b) bullied young people and their parents is unknown. As building a trusting relationship with their young pa- recruitment was undertaken through bullying charity tients, (c) ensuring that enquiries about bullying are websites, the sample may have been biased towards in- made in a caring and compassionate way; and (d) that dividuals who are already actively seeking support to young people are given their full attention when talk- cope with bullying and may therefore be more receptive ing about bullying experiences. While many GPs may towards alternative sources of support, such as GPs. feel that they already seek to do these things, it still Furthermore the sample was predominantly female remains that these are the areas where young people and, although girls are more likely to be bullied than and parents see room for improvement. boys [1], the difference is not as pronounced as the im- The discrepancy between young people’s and parents’ balanceinour sample.Inaddition tothis, girls and views related to parental presence when questions about boys typically experience different types of bullying [1] bullying were being asked needs to be addressed. Most and we did not collect any information on the type of parents expected their child’s responses to be shared bullying experienced by the participants. Although we with them, but many young people expressed a prefer- observed no differences in the responses recorded by ence for parents/carers not to be present during discus- age or gender on this occasion, this does not mean that sions about bullying. Similar research conducted with the results are necessarily generalizable to all bullying GPs has shown that the presence of a parent may also victims. Further work is needed to explore the opinions Scott et al. BMC Family Practice (2016) 17:116 Page 8 of 9 of young males who have been bullied and efforts Received: 15 April 2016 Accepted: 16 August 2016 should be made to obtain data on the types of bullying experienced by participants. References 1. Health & Social Care Information Centre. Health and Wellbeing of 15 year Conclusion olds in England: Findings from the What About YOUth? Survey 2014. 2015. This study reinforces calls for greater GP involvement in http://digital.nhs.uk/catalogue/PUB19244. 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All authors read and approved the final manuscript. symptoms with bullying in primary school children. BMJ. 1996;313:17–9. 17. Fekkes M, Pijpers FIM, Veloove-Vanhorick SP. Bullying behaviour and Competing interests associations with psychosomatic complaints and depression in victims. The authors declare that they have no competing interests. J Pediatr. 2004;144:17–22. 18. Borup I, Holstein BE. Schoolchildren who are victims of bullying benefit Consent for publication from health dialogues with the school health nurse. Health Educ J. No individual patients’ data is included in an identifiable format. All 2007;66:58–67. participants were aware that free text responses given may be used in an 19. Scrabstein JC, Leventhal BL. Prevention of bullying-related morbidity and anonymised form. mortality: a call for public health policies. Bull World Health Organ. 2010;88: 403. doi:10.2471/BLT.10.077123. Ethics approval and consent to participate 20. National Institute of Health and Care Excellence. Depression in children and The study received ethical approval from the University of Warwick’s young people: Identification and management in primary, community and BioSciences Research Ethics Committee (REC ref no.: REGO-2013-577). The secondary care – NICE Clinical Guideline 28 (CG28). 2005. https://www.nice. survey was anonymous and participants were recruited online without any org.uk/guidance/cg28. Accessed 13 Nov 2014. direct researcher contact. Thus, completion of the online survey, after 21. National Institute of Health and Care Excellence. Managing overweight and reading the introductory information about how their responses would be obesity among children and young people: lifestyle and weight used, was considered implied informed consent. management services – NICE Public Health Guidance 47 (PH47). 2013. https://www.nice.org.uk/guidance/ph47. Accessed 13 Nov 2014. Author details 22. Anti-Bullying Alliance. Bullying – A short guide for GPs. 2015. http://www. Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK. anti-bullyingalliance.org.uk/media/34573/Advice-for-GPs-final-November- Department of Psychology, University of Warwick, Coventry CV4 7AL, UK. 2015.pdf. Accessed 03 Dec 2015. Scott et al. BMC Family Practice (2016) 17:116 Page 9 of 9 23. Fox F, Stallard P, Cooney G. GPs role identifying young people who self- harm: a mixed methods study. Fam Pract. 2015;32(4):415–9. 24. Walker D. The internet as a medium for health service research. Part 1. Nurse Res. 2013;20(4):18–21. 25. Walker D. The internet as a medium for health service research. Part 2. Nurse Res. 2013;20(5):33–7. 26. Klein DA, Myhre KK, Ahrendt DM. Bullying among adolescents: a challenge in primary care. Am Fam Physician. 2013;88(2):87–92. 27. Lamb D, Pepler D, Craig W. Clinical review: approach to bullying and victimisation. Can Fam Physician. 2009;55:356–60. 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Young people who are being bullied – do they want general practice support?

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Publisher
Springer Journals
Copyright
Copyright © 2016 by The Author(s).
Subject
Medicine & Public Health; General Practice / Family Medicine; Primary Care Medicine
eISSN
1471-2296
DOI
10.1186/s12875-016-0517-9
pmid
27550153
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See Article on Publisher Site

Abstract

Background: Childhood bullying is a major risk factor for health, education and social relationships, with effects persisting into adulthood. It affects half of all children at some point, with 10–14 % experiencing bullying that lasts for years. With the advent of cyberbullying, it can happen at all times and places. There have been calls for GPs to take a more active role in identifying and supporting young people who are being bullied. This paper explores young people’s and parents’ opinions about whether general practice should be involved in identifying and supporting young people who are being bullied. Methods: Two hundred six young people (85.9 % female, mean ± sd age 16.2 ± 3.2 years) and 44 parents were recruited through established bullying charity websites and their social media channels to complete an online questionnaire comprising multiple-choice questions and unlimited narrative responses. Questionnaire responses were analysed by age and gender using descriptive statistics. A descriptive analysis of the narrative responses was undertaken and key themes identified. Results: Young people (90.8 %) and parents (88.7 %) thought it was important for GPs to be better able to recognise and help young people who are being bullied. Most recognised the link between bullying and health. The doctor’s independence was seen as advantageous. Young people preferred completing a screening questionnaire to disclose experience of being bullied than being asked directly. They expressed concerns about how questions would be asked and whether information would be shared with parents/guardians. Parents were supportive of the use of a screening questionnaire, and most expected their child’s disclosure to besharedwiththem. Conclusion: Young people and parents recruited through anti-bullying websites and social media would welcome greater GP involvement in identifying and supporting young people who are being bullied and their families, provided it is offered in a caring, compassionate and confidential manner. Keywords: General practice, Bullying, Children, Parents, Questionnaire, Internet Abbreviations: CAMHS, Child and Adolescent Mental Health Services; GP, General Practitioner; NICE, National Institute of Health and Care Excellence; RCGP, Royal College of General Practitioners; UK, United Kingdom; WHO, World Health Organisation; YP, Young Person Background both minority ethnic and white youths reporting compar- Bullying is a systematic abuse of power characterised by able levels of victimisation [4]. Although often perceived repeated psychological or physical aggression with the as a school-based problem, bullying is increasingly intention to cause distress to another person. Over half community-based. Social networking sites and smart- of young people (55 %) report having recently been phones have brought with them a new phenomenon – bullied [1], with 10–14 % experiencing chronic bullying cyber-bullying, which can happen at all times and in all lasting for more than six months [2]. Bullying occurs at places [5]. Recent figures show that 15 % of 15 year similar rates across all socio-economic strata [1, 3] with olds in the UK have experienced cyber-bullying. Girls are more likely to experience psychological, emotional and cyber-bullying, whereas boys are more likely to be * Correspondence: e.j.scott@warwick.ac.uk Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK physically bullied [1]. Full list of author information is available at the end of the article © 2016 The Author(s). Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Scott et al. BMC Family Practice (2016) 17:116 Page 2 of 9 Childhood bullying is a major risk factor for health, that include primary care and mental health services [19]. educational attainment and social relationships. Bullied This has been echoed by NICE who include the evaluation children are twice as likely as non-victims to suffer from of bullying as a risk factor and the development of anti- psychosomatic problems, such as headaches, abdominal bullying strategies in several of its guidance documents, pain, sleeping problems, poor appetite and enuresis [6]. including depression [20] and weight management in They are at increased risk of psychiatric disorders young people [21] which specifically mention general including depression, eating disorders, self-harm and practice. The Anti-Bullying Alliance, in collaboration with suicidal behaviour [7, 8]. They also have high rates of the Royal College of General Practitioners, marked Anti- poor academic performance resulting from absenteeism Bullying Week 2015 with the publication of guidance and worries at school [9, 10]. Over 16,000 young people notes for GPs [22]. in the UK aged 11–15 years are estimated to be absent Despite the calls for greater health service involve- from state school with bullying as the main reason, and ment, the extent to which young people and their fam- a further 78,000 are absent where bullying is one of the ilies see bullying as a health issue relevant to general reasons given [11]. The adverse consequences of child- practice is unknown. This paper reports on work explor- hood bullying continue into adulthood leading to sub- ing the views of young people and parents about GPs stantial health and wider societal costs. This includes taking a more active role in identifying and supporting difficulties with employment and social relationships, young people who are being bullied. and mental health consequences such as general anx- iety disorder, panic disorder, agoraphobia, depression, Methods and suicidal acts [12]. Recruitment General Practitioners (GPs) in the UK can offer sup- Four national UK-based bullying charities (Anti-Bullying portive counselling either within the practice or from a Alliance, BeatBullying, Bullies Out, Kidscape), which third sector agency specialising supporting young offer support to young people aged 11-25years, posted people or bullying. They also have access to a range of brief information on their websites, Facebook pages and other resources as recommended by the Royal College twitter feeds, inviting young people who had experienced of General Practitioners (RCGP) [13]. If bullying is af- bullying to complete a brief survey. A hyperlink was pro- fecting the young person’s education, the GP can refer vided to a page on the University’s website where more them to the educational psychology service or to Chil- detailed information about the study was given, together dren and Adolescent Mental Health Service (CAMHS) with a link to a confidential survey page. if there is evidence of severe mental health issues. In There was no direct contact between researcher and addition to this, GPs are optimally placed to identify participant. Parental consent was not obtained for the and treat the physical and psychological consequences young people participating. Clicking the link given in the of bullying outlined above. Talking to someone about invitation from the charity and then completing the on- bullying is the first step to getting help, but up to 40 % line survey after reading the age appropriate information of children never disclose bullying to their parents [14]. supplied about how their responses would be used, was Hence, the opportunity to discuss bullying with a considered to be implied informed consent. The reason healthcare professional may provide an important av- for not seeking parental consent was to ensure that po- enue to break the silence and initiate help. tential participants who have not disclosed the fact that Given the impact on health, children who are being they are being bullied to a parent were not unfairly ex- bullied are likely to have greater need for health care cluded from the survey. There are many reasons that than their non-bullied peers. Although research to con- young people may not tell their parents that they are be- firm the extent to which this leads to more frequent ing bullied and it is particularly important that their attendance at general practice is lacking [15], previous opinions on other sources of support are heard. Our in- work with school nurses has confirmed that there is a stitutional ethics review board approved this approach positive correlation between self-reported health symp- and the rationale behind it. toms (e.g. poor sleep, frequent headache) and frequency A parallel request was made for parents of children of bullying experienced [16, 17]. In the UK, school who had been bullied to complete a similar survey. No nurses do not typically consult with every student in active effort was made to recruit parent-child dyads. Par- the school every year. In countries, however, such as ental participation was not contingent on their child also Denmark, where an annual consultation is routine, stu- completing the questionnaire and no information was dents who are being bullied are more likely to report collected to match parent and child participants. Com- positive effects of their dialogue with the school nurse pletion of the survey, after reading the introductory in- and to initiate additional visits to the nurse [18]. The formation about how their responses would be used, was WHO has called for society-wide inter-agency approaches considered implied informed consent. Scott et al. BMC Family Practice (2016) 17:116 Page 3 of 9 The study received ethical approval from the Univer- be significant. All data analysis was conducted using sity’s BioSciences Research Ethics Committee. IBM SPSS Statistics 22. Free text responses were downloaded verbatim from the online survey output and initially collated by which Data collection survey question elicited the comment. The lead author For young people, the survey comprised three multiple familiarised herself with the responses before undertak- choice questions with free text space under each ques- ing a descriptive analysis of the data. As this was ex- tion. The questions were intended to stimulate interest, ploratory work, an inductive approach was taken. The with topics covering the perceived importance of GP data was subjected to a process of complete coding and involvement in identifying and supporting children who candidate themes identified. These themes were then re- are being bullied, and whether they would be comfort- fined, redundant themes removed and further themes able with (a) their GP asking about bullying and (b) added as identified during subsequent readings of the completing a screening questionnaire which included data. The relationship between the themes and partici- questions on bullying, in the waiting room prior to see- pants’ responses to the multiple choice questions was ing the GP. The questions and answer options are pre- considered during analysis. As some themes were com- sented in full in Table 1. mon to more than one question, the data was collapsed The parental survey had eight questions, three of and the findings presented by theme. which related to the bullying experienced by their child. The remaining questions covered the perceived import- Results ance of greater GP involvement, feelings about their Participant characteristics child being asked to complete a screening tool for bully- Two hundred and six young people (85.9 % female, ing, whether they thought their child would be honest mean ± sd age 16.2 ± 3.2 years) and 44 parents (88.6 % about bullying if the GP asked and their experience of female, aged 25–58 years) participated. The majority discussing bullying with their own GP. The questions (55.4 %) of young people were aged 13–16 years (see and answer options are presented in full in Table 2. Fig. 1), and there was no difference in gender distribu- Age and gender were collected for participants in both tion by age (p= .142). surveys. Most parent participants (86.4 %) were certain that their The questions in both surveys were initially developed child had been bullied, the others were less sure. Parents in consultation with representatives from the Anti-Bully- reported a wide range of types of bullying experienced by ing Alliance and Kidscape. The response options were their child (see Table 2) with school bullying (86.4 %) be- refined with input from local parents and young people ing the most common. In the majority of cases (90.9 %) with experience of bullying. There was no formal pilot the child was aged 16 years or younger at the time. test phase. Data analysis Quantitative data For the multiple choice questions in both surveys, re- All multiple choice questions received a 100 % response sponse frequencies were tallied. Chi-square tests were (see Tables 1 and 2). For young people, there were no dif- conducted to explore any differences in response by age ferences in responses to any question by age (all p >.495) or gender, with a p-value of less than 0.05 considered to or sex (all p >.119). Table 1 Young people’s responses to the multiple choice questions Q1: How important do you think it is for GPs to be better able to recognise and help young people who are affected by bullying? Very important Quite important Not Sure Not very important Not important at all n = 109, 52.9 % n = 78, 37.9 % n = 11, 5.3 % n = 7, 3.4 % n = 1, 0.5 % Q2: As a young person, how would you feel if a GP asked you about experiences of being bullied if you were attending the GP for an everyday problem such as a headache or tummy ache? Would you feel comfortable with this? Yes, completely Yes, a bit Not sure Not very much Not at all n = 36, 17.5 % n = 72, 35.0 % n = 50, 24.2 % n = 36, 17.5 % n = 12, 5.8 % Q3: We are thinking of asking young people to complete a questionnaire while in the waiting room when they visit the doctor to ask about their current health. This would include some questions about their experience of being bullied. Would you feel comfortable answering such a questionnaire in the waiting room? Yes, completely Yes, a bit Not sure Not very much Not at all n = 100, 48.5 % n = 68, 33.0 % n = 15, 7.3 % n = 17, 8.3 % n = 6, 2.9 % Scott et al. BMC Family Practice (2016) 17:116 Page 4 of 9 Table 2 Parents’ survey responses Q1: Has your child ever been bullied? Yes No Unsure n = 38, 86.4 % n = 4, 9.1 % n = 2, 4.5 % Q2: If you answered yes to Q1, what type of bullying was it? You may choose more than one option School Outside school Cyber Emotional Physical Psychological Other n = 38, 86.4 % n = 18, 40.9 % n = 11, 25.0 % n = 20, 45.5 % n = 14, 31.8 % n = 13, 29.5 % n = 2, 4.5 % Q3: Was your child aged 16 years or younger? Yes – primary school Yes - secondary school Yes – both schools Yes – age not given No n = 10, 22.7 % n = 10, 22.7 % n = 4, 9.1 % n = 20, 45.5 % n = 2, 9.1 % Q4: Do you think it is important that GPs should be better able to recognise and help young people being affected by bullying? Very important Quite important Not Sure Not very important Not important at all n = 31, 70.5 % n = 8, 18.2 % n = 5, 11.3 % n =0 n =0 Q5: How would you feel if your child was asked to complete a questionnaire while in the doctor’s waiting room which covered questions about their current health including their experience of being bullied? Positive – would expect child Positive – would not expect Not Sure Negative – I don’t think this to share answers child to share answers is appropriate n = 24, 54.5 % n = 12, 27.3 % n = 3, 6.8 % n = 5, 11.4 % Q6: If your child was being bullied do you think they would report this during a visit with a doctor if asked? Yes, definitely Yes, maybe Not sure No, probably not No, definitely not n = 6, 13.6 % n = 18, 40.9 % n = 9, 20.5 % n = 9, 20.5 % n = 2, 4.5 % Q7: What kind of problem do you see bullying as? You may choose more than one option School Health Neither Other n = 33, 75.0 % n = 23, 52.3 % n = 1, 2.3 % n = 17, 38.6 % Q8: Have you ever discussed with a GP any incidents of bullying of your child and its consequences? Yes – GP helpful Yes – GP not helpful No Not yet, but am considering n = 7, 15.9 % n = 9, 20.5 % n = 26, 59.1 % n = 2, 4.5 % Note: parents were able to select more than one type of bullying so percentages will not add up to 100 % Involvement of GPs bullying (n = 2), family problem (n = 2), a self-esteem Most young people thought it important (very im- problem (n = 1), “a fact of life” (n = 1). portant52.9%;quite important37.9%)for GPstobe Over a third of parents (36.4 %) had discussed the better able to recognise and help young people who bullying of their child and its consequences with their are affected by bullying. Likewise, most parents also GP, but less than half had found it helpful. believed this to be important (very important 70.5 %; quite important 18.2 %). Just over half of the young people described feeling Screening for bullying comfortable (completely comfortable 17.5 %; quite com- When asked about completing a health questionnaire, fortable 35.0 %) with their GP asking about bullying if which included questions about bullying, before seeing a they attended the surgery for a problem such as a head- GP, the vast majority of young people would feel com- ache. A quarter, however, would not be comfortable be- fortable doing this (completely comfortable 48.5 %; quite ing asked (not very comfortable 17.5 %; not at all comfortable 33.0 %). A few were unsure (7.3 %) and comfortable 5.8 %) and the remaining 24.2 % were un- some were not comfortable with this idea (not very com- certain. This pattern of responses was similar across all fortable 8.3 %; not at all comfortable 2.9 %). age ranges (p= .495). The vast majority (81.8 %) of parents were positive Most parents recognised bullying as a school and/or about the idea of their child being asked to complete a health problem, with a significant proportion (38.6 %) screening questionnaire that included questions on identifying additional or alternative routes of the prob- bullying. Most would expect their child to show them lem, i.e. social/community problem (n = 8), cyber- their answers. Scott et al. BMC Family Practice (2016) 17:116 Page 5 of 9 Fig. 1 Age distribution of young people completing the questionnaire Qualitative data “A medical problem may well be the first sign of In total, young people provided 232 free text comments bullying … it would be helpful if GPs were more aware with a further 56 from parents. Most were quite brief (10– of how prevalent bullying is and included it in any 20 words) but others were notably longer (up to 700 assessment of the child.” (Parent #43, female, aged 52) words). Analysis identified four themes: Awareness of the link between bullying and health; The appropriateness of The appropriateness of GP involvement GP involvement; Confidentiality and the presence of par- Whilst both young people and parent participants were ents; and, Practical issues surrounding screening. overwhelmingly in favour of GPs being better able to identify and support young people who are being bullied, Awareness of the link between bullying and health they also expressed a number of reservations. A very Most young people and parents demonstrated under- small minority felt that tackling bullying was outside the standing that bullying can be a cause or contributory doctor’s remit and should remain the responsibility of factor in both physical and mental ill-health throughout teachers and parents. the comments they provided. In many cases they spoke Both young people and parents thought GPs being re- from experience and included personal examples. A mi- moved from the school setting was an advantage. The nority, however, appeared unaware of bullying as a po- doctors’ independence from both the family and school tential risk factor for common health concerns: was considered beneficial and likely to allow a more ob- jective assessment of the child and situation. In addition “I don’t really see the link between GP and bullying. to this, young people felt it would be easier to talk to a If I go in with a tummy ache or headache I would just more independent adult: want to get in there get medication and then come out.” (Young Person #85, female, aged 14) “…it may be easier to talk to someone that they know probably doesn’t know the people they are talking Experience of approaching the GP for support with about and that they won’t tell them.” bullying-related health problems was variable. GPs were (Young Person #20, female, aged 14) perceived to lack understanding of bullying and its links to physical and mental health. Parents were par- Over half of the parents surveyed thought that if their ticularly critical: child was being bullied that they would probably tell the Scott et al. BMC Family Practice (2016) 17:116 Page 6 of 9 doctor, if asked, and those leaving comments identified children would disclose bullying in their parent’spresence. the doctor’s approach to questioning as being key to fa- Many young people expressed a preference for parents/ cilitating disclosure. Parents and young people agreed carers not to be present during discussions about bullying. that they would be more likely to report bullying if they Most parents, however, expected their child’s disclos- understood why the doctor was asking (i.e. the link be- ure to be shared with them and some expressed a desire tween bullying and health). Other key factors were GP to be the first person to help their child. Others gave a sensitivity and offering reassurance: more balanced view about providing support to the child: “As long as they were friendly and genuine I would quite happily talk about problems if someone was “Would hope that my child would share info with me, there to listen. I wouldn’t talk if it was spoken about in but it is important that they know it would be a generic way like a check mark against their daily confidential if they wish.” (Parent #43, female, 52) tasks.” (YP #176, female, 22) Practical issues surrounding screening Young people felt the most significant barrier to dis- Participants identified a number of practical issues re- closure was the feeling that they didn’t have an estab- garding the use of a screening questionnaire to identify lished relationship with their GP. They expressed young people who are being bullied including delivery concern about their lack of connection with their doctor format and venue. There was a strong preference among and the difficulties this may present in feeling safe talk- young people for initially answering questions about ing to them: bullying in a paper or online questionnaire rather than verbally face-to-face: “You might not even want to tell an adult you trust, let alone one that you don’t really know” “I think this would be a more suitable and effective (YP #138, female, 13) way of approaching this topic … it’s easier to write things down than speak to someone” Other concerns expressed by both young people and (YP #92, female, 17) parents included whether GPs have the appropriate training and experience to deal with bullying and the Young people’s opinions were divided on the appropri- time pressure of brief appointment slots. ateness of completing the questionnaire in the GP’s wait- ing room. Some participants felt that this was a good way of asking and that completing the questionnaire in Confidentiality and the presence of parents the waiting room would result in better engagement. A significant number of young people expressed a pref- erence for the questionnaire being anonymous, but in “I would feel comfortable answering a questionnaire the context of the comments it appears that there may in the waiting room as it gives me something to do have been some confusion between the terms ‘anonym- while I’m waiting … I think it would then be easier ous’ and ‘confidential’: to speak to the GP about when you went in” (YP #126, female, 16) “I know that this would be kept completely anonymous between myself and the doctor…” (YP #20, female, 14) But others, while positive about the idea of completing the questionnaire, raised concerns about privacy in the While participants acknowledged the link between waiting room and suggested alternatives, such as com- bullying and health and understood that the doctor pleting it at home or online. would be trying to help, some felt that being asked about Parental concerns were focussed on the possibility of bullying might be uncomfortable or awkward, but could the questionnaire causing distress to a child, while offer a means of relief: others questioned whether a child would complete the questionnaire honestly. It was observed that the ques- “I would personally feel weird and in an awkward tionnaire would only be of use if the doctor valued the position. However if one person does know about my questions and the responses provided. situation they may help me and I may not be a victim any more. (YP #9, female, 14) Discussion Both young people and parents recognised the link be- Discomfort was expected to be greater if their parents tween bullying and health, and would welcome greater were present and a few young people questioned whether GP involvement in recognising and supporting young Scott et al. BMC Family Practice (2016) 17:116 Page 7 of 9 people who are being bullied, providing this was done in affect their willingness to initiate discussion of a poten- a caring and compassionate way. Young people viewed tially sensitive topic [23]. the completion of a paper or online screening question- naire prior to the appointment as preferable to initially Strengths and limitations being asked about bullying face-to-face; parents also To our knowledge, this is the first report of young peo- found this approach acceptable. Parents and young ple’s and parents’ perspectives on the involvement of people disagreed about whether parents should be GPs in identifying and supporting young people who are present during the discussion about bullying. being bullied. These are important findings considering that up to The use of brief questions accompanied by unlimited 40 % of children never disclose bullying to their parents text boxes allowed participants to expand on their [14], but that talking to someone about bullying is the questionnaire answers and put them into context. This first step towards help. Thus confidential disclosure to combined approach resulted in a richer and more illu- GPs may provide an important avenue to break the si- minating data set than is usually possible using survey lence and initiate help. This may be in the form of coun- methods alone and reached a greater number of partici- selling or support from the GP to manage the physical pants than would typically be possible for traditional and psychological consequences of bullying, or referral qualitative work. The quantity of free text responses re- to specialist services such as the educational psychology ceived was unanticipated and what was originally ex- service or CAMHS [13]. pected to be a brief quantitative survey became a mixed Given the preference expressed by young people to methods study. complete a screening questionnaire rather than being Data analysis was carried out by a single researcher. asked directly about bullying, alternative routes to follow While her perspective may have influenced interpret- up with young people identified through screening ation of the data, the accompanying quantitative data should also be explored. Previous research has found from each participant clarifies their point of view (posi- school nurses to be a viable way of identifying and sup- tive, negative, uncertain) on each question, thereby redu- porting young people who are being bullied [16, 18]. For cing the risk of misinterpretation. this model to work in the UK, school nurses would need Recruiting participants through established bullying to be a more regular fixture in schools so that they are a charity social media channels was an effective means of trusted face rather than an infrequent visitor. The partic- involving individuals with a diverse range of experience. ipants in this study placed significant value on the doc- Distributing paper questionnaires through schools or tor’s independence from the school. Hence, the GP youth groups would likely have drawn a minority of par- practice nurse might also provide an appropriate source ticipants with first-hand experience of chronic bullying. of support. The use of an online survey also allowed greater preser- Both parents and young people expressed concerns vation of participant anonymity. The use of different on- about how the GP would facilitate disclosure of bully- line research methods in health services research has ing. The qualitative findings suggest that GPs may been discussed in detail elsewhere [24, 25]. need to be more attuned to the importance of (a) The main limitation of the sample is that the extent considering a young person’s experience of bullying as to which it is representative of the wider population of a risk factor for poor physical and mental health, (b) bullied young people and their parents is unknown. As building a trusting relationship with their young pa- recruitment was undertaken through bullying charity tients, (c) ensuring that enquiries about bullying are websites, the sample may have been biased towards in- made in a caring and compassionate way; and (d) that dividuals who are already actively seeking support to young people are given their full attention when talk- cope with bullying and may therefore be more receptive ing about bullying experiences. While many GPs may towards alternative sources of support, such as GPs. feel that they already seek to do these things, it still Furthermore the sample was predominantly female remains that these are the areas where young people and, although girls are more likely to be bullied than and parents see room for improvement. boys [1], the difference is not as pronounced as the im- The discrepancy between young people’s and parents’ balanceinour sample.Inaddition tothis, girls and views related to parental presence when questions about boys typically experience different types of bullying [1] bullying were being asked needs to be addressed. Most and we did not collect any information on the type of parents expected their child’s responses to be shared bullying experienced by the participants. Although we with them, but many young people expressed a prefer- observed no differences in the responses recorded by ence for parents/carers not to be present during discus- age or gender on this occasion, this does not mean that sions about bullying. Similar research conducted with the results are necessarily generalizable to all bullying GPs has shown that the presence of a parent may also victims. Further work is needed to explore the opinions Scott et al. BMC Family Practice (2016) 17:116 Page 8 of 9 of young males who have been bullied and efforts Received: 15 April 2016 Accepted: 16 August 2016 should be made to obtain data on the types of bullying experienced by participants. References 1. Health & Social Care Information Centre. Health and Wellbeing of 15 year Conclusion olds in England: Findings from the What About YOUth? Survey 2014. 2015. This study reinforces calls for greater GP involvement in http://digital.nhs.uk/catalogue/PUB19244. 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BMC Family PracticeSpringer Journals

Published: Aug 22, 2016

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