Bullying among schoolchildren is a significant public health problem worldwide with long-term detrimental consequences on children's physical and mental health. The prevalence of being bullied is 36% and 15%, respectively in the USA and European countries (Chester et al, 2015; Eyuboglu et al, 2021; Modecki et al, 2014) and ranges from 7% to 20% in Scandinavia (Krusell et al, 2019). The Norwegian government maintains that in accordance with regulation for health promotion and prevention in the school health services, the school nurse will collaborate with the school to create a good psychosocial environment for the children (Norwegian Directorate of Health, 2017). The United Nations Convention on the Rights of the Child reflects the international consensus on standards for ensuring the overall wellbeing of all children and young people up to the age of 18 years (World Health Organization, 2013).
A solution-focused approach (SFA), designed to find solutions rather than focus on a specific problem, is an effective treatment strategy for a wide variety of behavioural and psychological outcomes (DeJong and Berg, 2002; Gingerich and Peterson, 2013; Öztürk Çopur and Kubilay, 2021). This approach provides an opportunity for the children to feel that they are important contributors to their own lives and social circle. The SFA emphasises people's personal strengths and successes as valuable learning experiences (Young and Holdorf, 2003). SFA acknowledges that people can change, and presumes that shifting from being a victim to taking a stand creates optimism, self-belief, and trust that a situation can be altered (Young, 2009). The SFA uses the role of friendship to promote the social and emotional competence of students (Heitmann et al, 2022; Kvarme et al, 2015).
In Norway, the government decided that different organisations working with children and youth must collaborate to prevent bullying. They established the Partnership Against Bullying coalition, which consists of 14 national organisations, including the Norwegian Public Health Nurses Organization. This coalition shares a vision of inclusive learning environments that are free from bullying for all children. This research has contributed to understanding bullying in school as repeated negative behaviour from one or more people together, aimed at someone who cannot defend themselves. Recently, this understanding has been challenged by Nordic researchers (Lund and Helgeland, 2020; Søndergaard, 2012) who consider bullying as an expression of social marginalisation where exclusionary mechanisms in children and young people's communities create a fertile ground for bullying. This new thinking reflects a shift in focus from individual characteristics to the social processes that may lead to bullying. Inspired by this research, we sought to understand bullying using a systemic approach.
Bronfenbrenner's (1977) systemic approach was used as a framework for school bullying. Structures where children have direct contact are referred to as a microsystem, including peers, family, community, and schools. The interaction between the microsystems occurs in the mesosystem; for example, the interaction between the family and school, such as parental involvement in their child's school (Bronfenbrenner, 1977).
To our knowledge, a systemic approach has not yet been used to understand the experience of bullied children and their supporters in SFA groups.
Aim
The aim of this study was to explore the experience of the children, mothers, and school nurse with regard to support groups.
Methods
Design
This study has a case study design with a focus group and individual interviews. The data were collected and analysed in accordance with the guidelines for qualitative research, which imply a phenomenological hermeneutic mode of understanding. Qualitative methods of interviewing the participants regarding their experiences with support groups were used. Graneheim and Lundman's (2004) methodology for data analysis was applied. This study was approved by the Regional Ethical Committee.
Sample
The study sample consisted of 10 participants. The participants included seven schoolchildren: one boy who was bullied and six boys in the support group. Two mothers, one representing the bullied boy and one representing a child from the support group, and the school nurse were also interviewed. The boys were aged 9–10 years, and they lived with their parents and siblings. The participants volunteered after receiving the relevant information about the study.
Data collection
The data were collected at the children's school during March 2021. Individual interviews were conducted with the bullied child, mothers, and school nurse. A focus group interview was also conducted for the support group. The interviews were conducted by audio-recorder on school days and lasted for about one hour each. The first author, who is experienced in leading discussion groups with children of these ages, acted as the moderator for the focus group and individual interviews. The last author observed the group interview process and recorded the participants’ comments.
Interview guides
The interview guides contained open-ended questions covering aspects of being bullied and elements of the SFA that emphasised how the bullied children experienced having a support group or participating in such a group. The individual interviews with the mothers and school nurse included open questions regarding their experience with the bullied boy and support group. An example of the question to the bullied boy was: How is your experience of having a support group? What are the benefits or the disadvantages? As recommended by Kreuger and Casey (2000), the interviews were started using neutral and unthreatening questions and were ended by providing the participants an opportunity to add comments before the session was closed.
Ethical approval and considerations
This study was approved by the Norwegian Social Science Data Services and the Regional Ethical Committee (REC 106944). Ethical issues are important in all research works, especially in research involving vulnerable children. Written informed consent to participate was obtained from all participants and their parents before the interviews were conducted. The moderator followed professional practice and ensured that no information in the findings of the study would identify any individual study participant. The information provided to the parents and children described the aims of the study, the data collection procedures, and the fact that participation was voluntary. The participants were also assured that they could withdraw from the study at any time without any consequences. The participants were asked not to talk about the content of the discussions in the focus group with anyone. They were also asked to create an atmosphere of trust by showing respect and listening carefully to the other participants.
Solution-focused approach
This study used the SFA to help a child who was bullied (Heitmann et al, 2022; Kvarme et al, 2016; Young, 2009). SFA is a social constructionist approach established to facilitate change by highlighting students’ goals, strengths, and resources, and to identify exceptions to the problem. The intervention provides an opportunity for bullies to change their role in a positive and safe way with close follow-up from a teacher or school nurse. The nurse or teacher has weekly consultations with the child who needs help, to look for progress and make sure the situation improves. The bullied boy chose which children he would like to have in a support group. When the selected children were asked to join in the support group, they were informed about the situation of the bullied child, asked if they had experienced a similar situation, and if they wanted to help. The nurse or teacher held weekly consultations with the support group and individual talks with the bullied boy. Members of the support group were encouraged to suggest helpful ways to help the bullied child.
Data analysis
The interviews were analysed using qualitative content analysis (Graneheim and Lundman, 2004). They were read several times to gain an understanding of the material as a whole and line by line to identify meaning units. The meaning units were condensed and coded, using descriptions close to the text. Then, guided by the research question, the codes were examined for similarities and differences across the interviews and sorted and abstracted into categories in line with the manifest content. To develop themes, the categories were abstracted and interpreted to enable us to be receptive to the latent content that was conveyed (Table 1). Researcher triangulation was used to facilitate credibility. Each step of the analysis was conducted independently by the first and last authors. Then, they discussed each step and reached an agreement by consensus. Furthermore, the second author asked critical questions to enhance alternative interpretations and progress beyond the preconceptions.
Table 1 Examples from the analysis of the interviews
| What was said | What is it about | Sub-theme | Theme |
|---|---|---|---|
| I have become better at ignoring him …Like I'm going to focus on what I think is good, and it has helped me a lot. So, if I kind of have a slightly bad day, then I can try to think of something good. | He thinks about what is good | Changes his way of thinking | Feeling stronger, safer, and happier |
| They have sort of asked me if I would like to visit their home, and if I have been bullied, they have tried to back me up in a way. | He has been invited home to his peers | He has been included | They have done what a real friend does |
| It affects everyday life. It hurts me when he comes home and is sad and crying and in pain. And then you feel quite frustrated because you feel you can do so little. | The mother gets hurt when her boy is upset | She is frustrated about their situation | Bullying affects the whole family |
| The nurse calls us. I think that it was a wise choice, even if it feels a little scary, because in a way it makes him very vulnerable. | The mother of the bullied boy talks of being contacted by the school nurse | Talking about her boy and also the environment of the class | Working together as a team |
| It is a fantastic tool that has been long awaited. It is important to be true to a solution-focused approach and plan the measure well with the school and parents. It is important to motivate the child to see what he or she can work on to get better at school. | It is important to use this in conversation with the participants and motivate the children | Anchor the initiative in the school and have a good collaboration between home and school | Support group a useful tool |
Results
The following main themes were found in this study:
- Feeling stronger, safer, and happier
- They have done what a real friend does
- Bullying affects the whole family
- Working together as a team
- Support group as a useful tool.
Feeling stronger, safer and happier
The bullied boy reported that he had been bullied and felt like an outsider at school for years. A particular boy in the class often bullied him, said rude things to him, and made him feel unsafe:
‘I have anxiety, and he bullies me because I have managed to say it … so he bullies me because I have anxiety.’
He stated that he was proud of himself:
‘I have become better at ignoring him. Because if he says: “No one wants to be friends with you, they just do it to fool you and talk behind your back", then I say that you have told me so many lies that were not true. I try to contradict him many times. I experience fewer comments now because others back me.’
Moreover, he learned to focus on good things encouraged by the school nurse:
‘Like I'm going to focus on what I think is good, and it has helped me a lot. So, if I kind of have a slightly bad day, then I can try to think of something good.‘
The mother reported that he is happier now after receiving help from the support group. She described how her son had changed lately:
‘He experiences getting support when it is difficult. And his teacher also comments that he has become better … because he can kind of get a little stuck in situations. I feel that he has a better everyday life and is a happier boy now.’
They have done what a real friend does
The support group helped him when he was injured. ‘And then many have asked if I wanted them to be with me at home and how I feel.’ He said that the support group does what a real friend does:
‘They have sort of asked me if I would like to visit their home, and if I have been bullied, they have tried to back me up in a way. Yes, they have done what a real friend does. So, I'm glad that we have a lot of fun when we are at home with each other.’
The support group members reported that they felt nice to be a part of the support group, as did the boy who was bullied. They thought that it was nice to help and played a lot with the bullied boy and invited him home. They comforted him if he was sad and were kind to him and included him in games. One support group boy said:
‘I helped him when he was upset. Asked if it is going well and waited until the others had entered.’
They tried not to argue much. They did not tease or say stupid things to the bullied boy. They helped him, played with him, asked him how he was doing, and paid attention to him. A support group boy said:
‘When others are bad, I have supported him. I have told them that they should stop being naughty.’
The support group members also mentioned that the classroom environment was better now; it was rated 9 on a scale from 0 to 10, where 10 indicated the best classroom environment. They said:
‘In a good classroom environment, you argue less, are kind, and include everyone in play.’
The participants in the support group believed that not interrupting each other and raising their hands before speaking could help in making the classroom environment even better. They could imagine participating in support groups again and liked collaborating with the school nurse.
The mother of the bullied boy said:
‘The support group shows care. They are so sweet. He is a little scared of the dark and doesn!t like going home alone when it is dark. One boy followed him because he knows he is afraid to go in the dark. They kind of look after each other like that.’
Bullying affects the whole family
Finding from this study shows that being bullied does not only affect the child, but his entire family.
The mother of the bullied boy described how it affects her to have a son who is bullied at school:
‘It affects everyday life. It hurts me when he comes home and is sad and crying and in pain. And then you feel quite frustrated because you feel you can do so little. Except I get to comfort him, I get to talk to him.’
His mother did also have contact with the mother of the boy who bullied her son:
‘I have a good dialogue with the other parents in the class and … it is specifically one boy with whom my son struggles. His mum is really nice, and we talk to each other, but there is a reason why he is the boy he is and does as he does. And we’re talking about it.’
Even his sister got involved when he is bullied. The mother also commented on her son's reactions when he came home from school:
‘It affects us that he comes home and is sad. He is frustrated. He just says mom now I just have to go to my room and scream a little. And then there's a little sister here, and she's also trying to take care of her big brother. And also, the bullying has become much harder and more physical.’
She explained how this situation affected the whole family, but her son was still allowed to show his feelings:
‘He is allowed to be angry and sad, and to get those feelings out. And then we talk about it and he says that sometimes it's hard to say things, but I know I feel better afterwards.’
The mother also reported that he had sleep problems:
‘He wakes up at night because he has nightmares again, and it affects our night's sleep. He wakes up in the morning and does not want to go to school. He is sad and I just allow him to stay home and watch movies together.’
The bullied boy and his family were working toward seeing improvements. The mother described talking with the school nurse on how to look for progress and what is better.
Working together as a team
It is important to collaborate with the school to prevent bullying. The school nurse is also an important collaborator in bullying situations. The mother of the bullied child also commented on how the school nurse helped them:
‘The nurse also calls us. I think that it was a wise choice to get help from the support group, even if it feels a little scary, because in a way it makes him very vulnerable.’
The mother of a child in the support group reported that information about what participation in the support group entails is important for the parents. She stated: ‘Nice for us parents that our child can help others.’ She also stated that the support group can be an important intervention, and it had calmed the overall class environment. Furthermore, she mentioned:
‘I think it has affected in a positive sense. So do other parents in the class.’
‘No, my son is happy anyway, so I have never been worried or worried that it will affect him negatively. Rather, I'm very happy that he could help improve the class environment. As a mother, it is nice to see that my son gets a feeling of mastery and know that he contributes to something that is important to others.’
Support group as a useful tool
The school nurse described her own experiences with the support groups and emphasised the value of having an intervention that can help children who are exposed to bullying or who do not have friends. She said:
‘It is a fantastic tool that has been long awaited. It is important to be true to a solution-focused approach and plan the measure well with the school and parents. It is important to motivate the child to see what he or she can work on to get better at school. Anchor the initiative in the school and have a good collaboration between home and school.’
‘My experience and the school also has a few tools really. It's not so easy to develop friendship with a child.’
She mentioned that she had been provided a tool that helps her become more confident in her role as a school nurse:
‘Yes, I have been given a tool that I can use. So, to have something very concrete that we can work with, and then it is easier to work in a solution-oriented way.’
The school nurse stated that being true to an SFA, planning the measure well, and collaborating with teachers and parents were important.
She mentioned that it was important to work with a support group that would help children, but the vulnerable child also needed to work and perform some specific tasks. Moreover, it was crucial to work and motivate the vulnerable child to plan well and involve both the parents and the child. Furthermore, the initiative needed to be firmly set up in the school and planned well with the parents, school, and child. It was also important to work with the whole family of the vulnerable child:
‘Yes, in a way, anchor it in both the child and their parents, so that we sort of work together. Here, I have worked quite closely with the mother, for example, with them at home also focusing on what is good.’
She said that when you organise a support group, it may affect not only the individual child but also the class and whole school:
‘Yes, I have seen that it – and several teachers have also seen – that they see improvement in the whole class environment. Students worked with that team feeling of the support group. We included in the support group, the two boys in the class who were the worst, who said lots of rude comments. They got a more positive role.’
She also stated that because the teachers were with the students every day, it was important to work with them.
‘Teachers are also an important piece in it, and in helping the vulnerable child. Yes, so, it is important with collaboration that it is not just such a stunt from a teacher or nurse, but that there are many who participate in this.’
Furthermore, good cooperation with the teacher was necessary:
‘I think that the key here is to also involve the teacher. Then, there is perhaps a greater probability that it can also work in the class.’
Discussion
The main theme identified in this study was that the bullied boy felt stronger, safer, and happier as a result of the support group. The support group members liked to help him and felt that the classroom environment had improved. It was noted that bullying affected the whole family of the bullied boy. Moreover, working together as a team is important to prevent and stop bullying. The school nurse was pleased to have the support group as a useful tool.
Positive impact on the victim
Our study supports the findings of previous studies that children who experience bullying feel lonelier and have greater difficulties in maintaining friendships (Schafer et al, 2004; Holt and Espelage, 2007). In line with previous research (Young, 2003; Kvarme et al, 2015; Öztürk and Kubilay, 2021), we found that the support group greatly helped the bullied boy. The support group members invited him home, comforted him, and included him in games. Previous research has found that peer support and friendship can protect children against bullying (Kendrick et al, 2012). Moreover, having supportive friends may affect a person's feelings positively, such as making one feel stronger and safer.
The opportunity for a change of role for the bullied boy
The bullied boy in this study talked about how he thought differently about himself, after being helped by the support group. Some children are more vulnerable to become victims of bullying because of several reasons and some are affected by cyberbullying (Kvarme et al, 2014). The combination of individual characteristics and social factors may account for children remaining in the role of the victim. The development of proactive and adaptive coping strategies that enable children to cope more successfully with victimisation is key. Those who continue to be victimised often have less effective coping skills. Coping behaviour can be influenced by both internal resources such as self-esteem, personality, and emotional health, and external resources, such as social support (Wolke et al, 2009). Internal resources, such as increased self-esteem, are important to overcome victimisation (Sapouna and Wolke, 2013). The victim in this study spoke of increased self-esteem after receiving help from his support group. He said that after receiving support, he managed to state his opinions, and being able to focus on his resources was helpful. Moreover, good relationships with friends and family appear to play a role in experiencing resilience to bullying (Sapouna and Wolke, 2013). Furthermore, victims of bullying perceived that they had a low level of control, which may be due to an imbalance of power between themselves and the bullies. Previous research has found that peer support (Wolke et al, 2009) and friendship can protect children from bullying (Kendrick et al, 2012). Encouraging schoolchildren to practise safe strategies to support and defend their victimised peers can help in limiting bullying behaviour (Poyhonen et al, 2012).
Bullying impacts the whole family
The mother of the bullied boy talked about the consequences of her son being bullied for the whole family. The family members felt sad when the boy was sad and tried to support him as much as they could as a family. Previous research showed that supportive familial relations can also buffer the impact of being involved in bullying (Barboza et al, 2009). When victims of bullying have warm relationships with their families, they have more positive outcomes, both emotionally and behaviourally (Bowes et al, 2010; Holt and Espelage, 2007).
It has been speculated that defending victims is stressful and can contribute to poor mental health. Recent studies have not supported those findings, however (Malamut et al, 2021; Sjøgren et al, 2020). A longitudinal analysis among 4 086 children and young people showed that, for those with social resources, defending victims can have a protective effect on mental wellbeing. These findings are important for the further development of support groups as a tool to combat bullying, and they emphasise the importance of knowing who should participate in the groups, of the duration of the follow-up and of the knowledge and capacity to follow up the participants in a professional manner.
Overcoming a bystander role and becoming a person who stands up for others can influence a child's self-esteem to a great extent (Salmivalli, 2010). According to Menesini and Salmivalli (2017), involving parents seems to strengthen the programme. Nurses have a key role in safeguarding children's mental health and they are in an ideal position to initiate interventions to prevent bullying.
The family of the bullied boy supported him in collaboration with the support group, school, and school nurse. One person cannot prevent or stop bullying alone; it is dependent on collaboration with others. According to the system theory (Bronfenbrenner, 1977), the microsystem includes peers, family, community, and schools, and the mesosystem comprises the interactions between the family and school, such as parental involvement in their child's school.
Bronfenbrenner's model helps understand the context of the child's situation, how the interaction between the different system levels affects the child, and the outcome of the intervention. It confirms the importance of including parents in the intervention. The system theory represents a shift in focus from individual characteristics to the social processes that may lead to bullying (Lund and Helgeland, 2020; Søndergaard, 2012). Bullying is not simply an individual response to a particular environment, it is a peer-group behaviour. Moreover, improving children's ability to access family support systems and improving school environment are potentially useful interventions to limit bullying behaviour (Barboza et al, 2009). Findings from this study demonstrate the importance of collaboration to prevent bullying in schools. It is crucial to collaborate with different professionals and organisations, such as politicians and the Partnership Against Bullying coalition, to prevent bullying.
Ethical considerations
Bullied children are vulnerable. Thus, it is necessary to be aware of the degree of benefit against risk of mental and emotional disturbances when performing research involving such children. In the present study, we attempted to minimise the risks involved by creating a safe atmosphere in the interviews. The interactions between the participants and interviewer were unrestrained and relaxed. This was important because good interactions significantly affect the trustworthiness of the data collected and their interpretation.
Limitations of this study
This study was small and was carried out in one school in Eastern Norway. Because the study sample was small, the findings cannot be generalised. However, the findings are probably transferable to other settings with schoolchildren of the same age. The analysis and interpretation of the findings were guided by a good understanding of bullying for the school nurses and researchers involved and by the selected theoretical framework.
Recommendations for future research
Further research could combine interdisciplinary school-based programmes, including support groups, and evaluate the effect of such programmes on the victims of bullying over time.
Conclusions
The main finding of this study was that the participants liked to help the bullied boy who in turn reported that he felt better after the help. Bullying affected the whole family of the bullied boy. Furthermore, working together as a team is important to prevent bullying, and the school nurse was pleased to have the support group as a useful tool.
The findings suggest that taking a systemic approach to bullying is helpful. In addition, close follow-up from school nurses, parents and teachers are important to prevent bullying.