School leaders’ health literacy and mental health in 11 countries from Europe and Asia

Background

During population health crises, school principals are confronted with the management of additional challenging tasks like school closures. Previous studies indicated that school leaders are susceptible to mental health problems due to their job demands. The present study aimed to assess school leaders’ health literacy across 11 countries in Europa and Asia and to investigate the associations of health literacy with wellbeing and psychosomatic complaints.

Methods

The COVID-19 Health Literacy School Principal Survey was conducted in 11 countries during 2021 and 2022. Overall, N = 8644 school leaders or school management members completed the online survey. Health literacy was measured using the HLS-COVID-Q22, wellbeing using the WHO-5 Index and psychosomatic complaints using a subscale of the Burnout Assessment Tool. Health literacy levels were computed using Rasch analysis. Multiple linear regression analysis was conducted to investigate the association of school leaders’ self-reported health literacy with wellbeing and psychosomatic complaints.

Results

School leaders reported high health literacy. Using Rasch-Thurstonian thresholds, 0.1% were classified into Level 1, 3.3% into Level 2, 65.7% into Level 3 and 30.9% into Level 4 of self-reported health literacy. Health literacy positively predicted wellbeing (B = .205, p <.001) and psychosomatic complaints (B = .105, p <.001).

Conclusions

This is the first international study that gathered data on school leaders’ health literacy in Europe and Asia. Higher health literacy was associated with higher wellbeing and less psychosomatic complaints. Health literacy revealed to be an asset for school leaders’ mental health during times of crisis. Since school leaders are seen as gatekeepers of school health promotion, a systematic approach to strengthen their health literacy might also facilitate the health of the whole school.

Key messages

• This is the first cross-country study that gathered data on school leaders’ health literacy in Europe and Asia.

• Health literacy revealed to be a resource for school leaders’ mental health-related outcomes during times of crisis.