Qualitatively evaluating school health and mental health literacy programmes: Using a reflexive approach

Abstract

Background:

Schools are important settings for the promotion of health and well-being. Many health-related education programmes in schools in England, including those delivered in-house by school staff or by external providers, have been evaluated to demonstrate their impact and effectiveness. However, narrative and reflexive accounts of researchers’ experiences coordinating and conducting evaluations of such programmes are limited.

Methods:

Drawing on reflexive research journals, we offer our reflections of qualitative data collection in primary and secondary schools in north-west England for the purpose of evaluating school-based health and mental health literacy programmes.

Findings:

This article explores two themes: (1) researcher identity and building relationships, and (2) the practicalities of qualitative data collection in schools in respect of time and space. Our account provides insight into the practical considerations researchers must remain mindful of when planning and generating qualitative data collection on general health and mental health and well-being issues in schools.

Conclusion:

Findings show that research in schools often requires considerable unseen time and effort on the researcher’s behalf. They suggest the need for more reflective and discursive writing on research processes to complement observations, findings and conclusions. Greater understanding of the realities of data collection in schools will likely improve the approaches adopted by researchers, especially those early in their careers.

Introduction

A growing international policy response to rising concerns about children and young people’s mental health has identified schools as important settings for the promotion of positive mental health, as well as health more generally, alongside the prevention of poor mental health (Hayes et al., 2023; Ma et al., 2022).

In England, mental health promotion in schools has historically taken place through universally provided interventions and programmes delivered by school staff using a whole school approach (Department of Health and Social Care [DHSC] and Department for Education [DfE], 2018); through relationships and sex education curricula (DfE, 2018); in tandem with National Health Service initiatives such as Mental Health Support Teams and Education Mental Health Practitioners (DHSC and DfE, 2018); and in partnership with external organisations such as Football Club Community Trusts (FCCTs) (Hale et al., 2025). Much of the existing published literature in this field has focused on quantitatively evidencing the impact and effectiveness of such interventions and programmes using validated pre–post outcome measures (Mackenzie and Williams, 2018), complemented by more limited qualitative evidence (Foulkes and Stapley, 2022).

The existing body of research recognises that schools are complex and busy institutions in which the competing priorities of teachers and wider school staff can make it difficult to conduct health-related research (Neill et al., 2022; O’Reilly et al., 2018). However, a few reflexive accounts from researchers report on their experiences of conducting other kinds of research in schools (e.g. Fitzgerald, 2020; Powell, 2021). In this paper, we begin to address this gap by describing our experiences conducting qualitative research in schools in north-west England to evaluate three health-related education programmes delivered by one FCCT. We contribute to the existing literature by providing insights into the enabling and constraining factors we experienced through the discussion of two topics, namely, (1) researcher identity and the importance of building relationships, and (2) the practicalities of qualitative data collection in schools in terms of time and space.

Research context and methodological and ethical considerations

In this paper, we describe our experiences conducting independent evaluations of universal health and mental health literacy and education programmes delivered in schools in north-west England between 2021 and 2024 by the programme coordinators of one FCCT. In England, FCCTs are the charitable or not-for-profit wings of a professional football club. They use the power of football to create social impact within the local community by addressing issues such as health, education, inclusion, employability and youth engagement. While they carry the branding of a football club and benefit from its popularity, these trusts (or club community organisations as they are sometimes called) have separate governance, funding and staff structures (Hale et al., 2025). All the studies were approved by Edge Hill University’s Science Research Ethics Committee (reference numbers ETH2223-0025, ETH2122-0013 and ETH2324-0148). All the parents or legal guardian of the pupils who took part in the studies referred to in this article provided written consent for their child to take part in an audio-recorded focus group. The pupils also provided their own assent to take part in such a focus group.

The first author of this paper (R.W.) led the evaluation of a co-produced mental health literacy programme for pupils aged 6–16 delivered in 22 primary schools and 12 secondary schools since 2020. Topics including mental health, mental illness, feelings and emotions, and relationships were delivered over a 20-week period between January and June of each school year through classroom and sports and arts-based workshops (see Smith et al., 2024; Wilcock et al., 2025). As part of her doctoral research, S.W. evaluated a 20-week classroom-based personal development programme delivered in three secondary schools to support young peoples’ personal, social and employability skills (see Ward, 2024). In later work, she led the evaluation of an 8-week health literacy programme for pupils aged 4–11 in five primary schools, which aimed to enhance knowledge on sleep hygiene, physical activity and nutrition. Activities were sports and classroom-based, and included live cooking workshops facilitated by a private sector agency. Primary schools participated as whole classes, typically during relationships and sex education curriculum time, and secondary pupils were individually selected by their schools. Programme teams at the FCCT recruited the schools involved in this work either by invitation (aligned to targeted funding priorities) or through expressions of interest from schools for reasons including the fact that it was externally facilitated and/or presence of a local FCCT in their school (Wilcock et al., 2025).

Reflecting our intention to understand how pupils experienced the programmes within the settings and networks of which they were a part, our evaluation work was informed by constructivism underpinned by a relativist ontology (i.e. stressing the existence of multiple social realities) and a constructionist epistemology (i.e. recognising multiple constructions of knowledge) (Sparkes and Smith, 2014). A qualitative methodological approach using focus groups and participatory methods was used to explore pupils’ experiences of, and learning from, school-based programmes in a confidential, meaningful and empowering way (Foulkes and Stapley, 2022; Nawaz et al. 2023; Sparkes and Smith, 2014). This was important since our goal was to create research environments where multiple views and experiences were able to be heard, trusted and respected.

Following ethical approval by Edge Hill University’s Science Research Committee and the university’s Social Science Research Ethics Committee, we provided each school with an online link and a hard paper copy of the participant information sheet and informed consent form which gatekeepers at each school then distributed to parents and legal guardians. We offered after school information sessions for parents in addition to our contact details on the information sheet. The school–parent communication, the involvement of the FCCT and attachment of the research projects to a specific programme enabled a favourable response rate of parental consent (Cree et al., 2002; Ward and Wilcock, 2026). Upon receipt of parent or legal guardian consent, we invited pupils to take part in the research. We sat with them and verbally explained what the research project was about, offering them time to read through, or have read to them, the written participant information sheet with opportunities to ask questions and provide their written and verbal informed assent (Ward and Wilcock, 2026).

Two of the research projects engaged the children and young people in multiple rounds of focus groups to enable time to think about and share their thoughts about different elements of the programme in which they engaged, and verbal assent was gained for their participation each time. Students were told they could withdraw from the research at any time during the school year and up to 4 weeks after the last research activity had taken place – without this impacting on their involvement in the programme. In total, R.W. conducted 52 focus groups using visual methods in the form of worksheets and written or picture prompts with 111 pupils across 13 primary schools and 3 secondary schools, and S.W. conducted 58 separate focus groups with 101 pupils across 3 primary schools and 3 secondary schools. All focus groups were conducted on the school site during the school day and involved three to five pupils, who contributed in single- and mixed-sex groups which lasted for up to 45 minutes.

As Karcher et al. (2024) have noted, (self-)reflexivity/reflection practices are common in sensitive research, with researchers critically considering the contexts in which they conduct their research and the effects of doing research and producing knowledge. Using handwritten journals (R.W.), or digitally via the SimpleMinds platform (S.W.), we noted down our thoughts, feelings and reflections to throughout. We did not specifically structure this process, but our reflexive entries included ethical considerations about the space we were provided by the schools, where we sat physically in the group, what we wore, how much we spoke, the engagement of the children and young people, the activities used, the questions asked and how we sought to connect with the children and young people. Alongside this, we supported one another throughout the evaluation work, sharing challenges and positive experiences.

Researchers’ ‘identity’ and building relationships

Building relationships with participants is crucial to the research process and participation (Bradbury-Jones et al., 2018; Enright and O’Sullivan, 2012; Graham et al., 2016; Fitzgerald, 2020; Ramos et al., 2020; Walsh et al., 2024). How this is achieved carries implications for the role(s) researchers adopt and the complications that can arise in school settings (Fitzgerald, 2020; Soffer and Ben-Arieh, 2014). As researchers in schools, the identity of ‘researcher’ is typically placed upon us both by ourselves and our employment. Yet, when we are out ‘in the world’ conducting research in the spaces and communities that belong to others (in this case, the participants in this study), it is they who also have the power to decide on our role and our identities. Recognising this created an unanticipated complexity for us, and like Fitzgerald et al. (2020), we experienced an identity dilemma, causing us to question ‘who are we in this context for them?’. We continued to query this with ourselves and each other throughout the evaluations we undertook and share our experiences of navigating and negotiating our research identity in schools while seeking to build and maintain relationships with children and young people.

Prior to programme delivery, we were not known to the schools or pupils, so we spent an initial period of time in programme sessions seeking to become integrated, intending to address with others who we were, where we have come from and what we do (i.e. create an assurance of our researcher identity). However, our affiliation with the FCCT often caused initial confusion since many children and young people identified us as programme staff (i.e. those charged with delivering the programme) or members of the professional women’s team (Ward and Wilcock, 2026). The hierarchical structures of the schools also caused us to be perceived in some capacity as persons of authority and influence, or members of school staff, as we were often referred to as ‘Miss’ despite allowing pupils and others to call us by our first names. Through our time with the programme delivery team, and with growing recognition, we managed to move away from this formality, which helped pupils more feel comfortable with us and our presence in their space (i.e. school and classroom), and get to know us. Generally, and more the case in the primary schools, pupils were excited to see us and would shout ‘it’s Rachel, [or] Sarah! Hi!’, highlighting our acceptance in their school.

As researchers our goal was to understand learning from the programme with which we were involved. While we tried to downplay the more ‘teachery’ aspects of identity placed upon us, this became difficult at times (Fitzgerald et al., 2020). This was possibly the children and young people’s first experience with a researcher, and we were keen to support their understanding of us as such. We adopted a friendly and helpful role to create an inclusive environment in which pupils would feel comfortable to contribute in meaningful ways (Ramos et al., 2020), but there were times where it was necessary to also become a ‘professional adult’ when behaviour management (e.g. not listening to each other, conflicts over sharing pens and pencils) was needed, and when we were the only adult present.

In an attempt to establish a better understanding of our identities and roles and to establish a distinction between research and the more ‘normal’ aspects of schooling, we created spaces that differed from those that were more typical of the school. For example, we (re)arranged the placement of tables and chairs (where possible), asked children and young people where they would like us to sit, allowed them to drink water and eat, and stand up or sit down as they preferred. Primary school children were generally more open to asking questions about us, for example, what we did at our institution, whether we had any siblings, our sports interests, the music we listened to, where we lived and whether we had seen the latest viral meme or TikTok dance. It was these conversations that helped us become ‘insiders’ (Phillippo and Nolan, 2024; Yip, 2024), as we opened up and shared information about ourselves. This was helpful in building trusting relationships ahead of the research process, as reflected in the following research diary quote.

I feel like the group trust me even more now and are more open to sharing experiences personal to them . . . trust is earned, not guaranteed. (R.W.’s research diary)

The outcomes of relationship building were different in secondary schools. Here, the relationships were more challenging to develop, the researcher–researched power relations were more noticeable, and we felt we had to become more authoritarian than we had originally intended in order to maintain discipline. Power relations are always present in evaluation research, creating and enacting a ‘between-ness’ and co-dependence between ourselves and the pupils (Holland et al., 2010: 363). As funders expected us to generate outcome-based evidence, we felt this often shifted the power balance towards ourselves (Jackson-Hollis, 2019). While we encouraged all pupils to share, or not, in the secondary schools we felt that some participants had a greater awareness of the identities as researchers and a fuller appreciation of our role and what that might mean for them. Some of these tensions are reflected in the following research diary entry.

Sometimes it feels like a lot and nothing at the same time, attending and supporting the programme sessions to build relationships but it doesn’t feel like a direct, explicit contribution to my research (yet). I am trying to communicate empathy and support, demonstrating that I am genuinely interested, I hope it comes across like that. (S.W.’s research diary)

Although there were constant challenges to negotiate, spending a considerable amount of research time in schools enabled us to build relationships and a comfortable and positive setting in which the pupils were happy to contribute. This was captured in the following research diary extract:

Yes, it was worth it! The participants remember me being there, participating, putting effort in with them, repeatedly. They feel comfortable in my presence, and me in theirs. Remember – trust the process. (S.W.’s research diary)

Practicalities of qualitative data collection in schools: time and space

As Fitzgerald (2020) noted, our experiences of having sufficient time for data collection in schools were mixed. We found that our attachment to the FCCT and being an embedded researcher with the programmes enabled us to work with schools and pupils in respectful, trusting and reciprocal ways. This enabled our research work to be appreciated by the school staff as a sub-element within the programme they were delivering. As a result, gatekeepers and other staff members accommodated the research activity as much as possible and arranged the necessary time for data collection to take place. In each case, we agreed with schools that data collection would take place during the school day, and we would be allocated the equivalent of one school lesson (of 1 hour). In order to do this. R.W. conducted focus groups within a programme session and did not require additional time beyond programme commitments (Glass et al., 2024). S.W., in contrast, conducted data collection after the programmes had ended and liaised with the gatekeepers to identify mutually convenient times for pupils to participate during the school day.

Both of our experiences required us to navigate the time available, adapting to the circumstances of each day and factors that impacted time. While it was often more straightforward to find time in the primary schools, in both primary and secondary schools, the allocated hour was often disrupted by the transition from break times to lessons. This situation was further complicated in secondary schools if participants forgot to attend their pre-agreed focus group and had to be located. Situations like this often meant there had to be a degree of clock-watching.

I really had to balance between letting them [the children] go off task/tangent and bringing them back on task due to time. Is there a better way to fit [programme] evaluations into schools? So far, it does work well during [programme] sessions so the children don’t miss any curricular time. (R.W.’s research diary)

As Fitzgerald et al. (2020) noted, throughout the evaluations we conducted, we were worried about the research ‘working’ and the need to get ‘good data’ about the programmes within the time available. Similar to Warrington et al. (2024), as a necessary adaptation to the time that was available to us by schools, we planned for a 30- to 40-minute time slots and used visual worksheets to give the participants time to think, process, write, draw and visually express their thoughts in ways that were meaningful to them (Harley and Langdon, 2018). Where we sought to explore different aspects of a programme(s), we invited pupils to participate in multiple focus groups. This ‘messier’ approach (Fitzgerald et al., 2020; Warrington et al., 2024) reduced the transactional nature of research and enabled the pupils to share (or not) their experience of the programmes. Regardless of our efforts, however, there were occasions when last-minute changes (e.g. curriculum changes, spaces becoming unavailable, sports days, school trips and pupil absences) and cancellations after arrival at the school, which required us to be flexible and rearrange things for a later time (Ramos et al., 2020; Ward and Wilcock, 2026).

Having a suitable space in which to conduct the focus groups proved to be an ongoing challenge since audio-recorded discussions with visual activities best take place within a quiet, empowering and confidential environment (Harley and Langdon, 2018; Jackson-Hollis, 2019; Sparkes and Smith, 2014). We acknowledged early on that a regular space for data collection was unrealistic and navigated the situation by emailing ahead and liaising with school staff in person to book a space and remind them about agreed arrangements. In the end, focus group activities took place in spaces such as the school library, classrooms, learning mentors’ rooms, the school hall and outside. Some spaces were more appropriate for the research than others as the following examples illustrate.

We used a quiet room in the school, I think the learning mentors’ room . . . this worked well! The children know the room is for that and respected the room and what we were doing. (R.W.’s research diary)

The library was a great location, nice easy room for the participants to get to and unironically was very quiet, great for the audio recording. The librarian was thoughtful with giving us plenty of space, and there were big soft chairs – helping to reduce that classroom feel while also being comfortable! (S.W.’s research diary)

Since we were evaluating externally facilitated programmes, pupils were relatively open to talking about the programmes in places where school staff may have been close by. In contrast, they were more wary about sharing personal mental health issues or health experiences if staff were nearby and we reinforced that they only needed to share things they felt comfortable to.

Discussion

This paper has set out to document our experience conducting qualitative research in schools to evaluate three health education programmes delivered by one FCCT in north-west England. While our experiences are specific to one area of England, they are consistent with those reported by others (e.g. Fitzgerald, 2020; Taylor and Owen, 2020; Warrington et al., 2024).

In order to be successful, research partnerships with schools should be equitable, flexible and open to negotiation to enhance a positive experience for all involved (Fitzgerald, 2020; Mansfield, 2016; Ramos et al., 2020). The partnerships we developed with the schools were easier to negotiate because we were enquiring into programmes that were delivered by an FCCT as part of a pre-existing partnership and programmes. Despite this, however, we navigated challenges due to the nature of the school day and limited resources, including time and space. If researchers are to maximise the potential of conducting research with and in schools, it is important to establish equitable, flexible, collaborative and mutually beneficial partnerships that respect the priorities of both the schools and the research (Mansfield, 2016; Wilcock et al., 2025).

A significant finding from our experience was the fact that the identity and role of a researcher remained open to interpretation by the children and young people who needed to make sense of ourselves and our presence within the school context. For ourselves, there was a tension between being an academic and being a friendly individual the children and young people would be comfortable, safe and empowered to be with. It is hard to know the extent to which our broader positionality in terms of factors such as gender, age and accent impacted data collection. A more systematic and structured approach to reflexivity and self-reflection might have enabled a deeper understanding of (1) insider–outsider positionality and change, and (2) how this might have impacted our interpretation of the data collection process (Karcher et al., 2024).

Another important finding relates to the time and space afforded to conduct research. In some instances, available space was at a premium and was prioritised for in-house school interventions and support. The duality of the support provided by the school (e.g. extracurricular reading groups) and outsourced providers (both programme delivery and research activities) led to competition for space and time, which in turn created competition for pupils’ time. Researchers should remain aware of such challenges and be prepared to use alternative spaces in schools and re-schedule data collection when unanticipated events result in cancellations.

Limitations and strengths

We acknowledge that the account we offer here is limited by the small number of secondary schools studied and limited reflections on our position as cultural insiders or outsiders in the context of north-west England. However, this is one of the first papers to report on researchers’ experiences of the enabling and constraining factors in evaluating school-based health education programmes delivered by a FCCT. More accounts are needed of UK and international researchers’ experience of researching and evaluating school-based health programmes – including those delivered by sports community trusts and other organisations – to more thoroughly appreciate the different factors that should be considered when conducting qualitative school-based research on issues related to health.

Conclusion

This paper set out to provide a better understanding of the experiences of researchers conducting evaluative qualitative research in schools. We have highlighted how research in schools requires significant time on the researcher’s behalf to build and maintain relationships and manage space and time to conduct data collection. Health-related education researchers should continue to reflect on and document their practical experiences of school-based research. Narrative accounts of these and commentary-style articles will help others understand how researchers are perceived and their impact on schools’, teachers’ and students’ engagement in research.