# Parental Health Literacy as a Contextual Factor in Proxy-Reported Child Mental Health: A Population-Based Study of Children Aged 6–10 Years

## TL;DR

Parents with higher health literacy are more likely to report better mental health in their children, even after accounting for socioeconomic factors.

## Contribution

This study identifies parental health literacy as an independent factor influencing proxy-reported child mental health outcomes.

## Key findings

- Higher parental health literacy is linked to lower emotional and behavioral difficulties in children.
- Parental health literacy is associated with higher psychosomatic complaint scores and perceived social support in children.
- The effects of parental health literacy on child mental health remain consistent even after adjusting for socioeconomic and language factors.

## Abstract

What are the main findings?
Parental health literacy is consistently associated with proxy-reported mental health outcomes across diagnostic domains in children aged 6–10 years.These associations were independent of socioeconomic factors and language context, suggesting added diagnostic relevance beyond background characteristics.

Parental health literacy is consistently associated with proxy-reported mental health outcomes across diagnostic domains in children aged 6–10 years.

These associations were independent of socioeconomic factors and language context, suggesting added diagnostic relevance beyond background characteristics.

What are the implications of the main findings?
Parental health literacy may shape symptom recognition and reporting, affecting the interpretation of proxy-based mental health screening and diagnostic assessment.Considering parental health literacy in early assessments may improve diagnostic accuracy and targeting of follow-up care in child mental health services.

Parental health literacy may shape symptom recognition and reporting, affecting the interpretation of proxy-based mental health screening and diagnostic assessment.

Considering parental health literacy in early assessments may improve diagnostic accuracy and targeting of follow-up care in child mental health services.

Background/Objectives: Parental health literacy is linked to child health outcomes, but the evidence relies mainly on parent proxy reports. This study examined the association between parental health literacy and proxy-reported mental health outcomes in children aged 6–10 years and assessed whether these associations reflect general reporting patterns. Methods: This study is a secondary analysis of data derived from a population-based cross-sectional survey conducted in South Tyrol, Italy, including proxy data from 3183 children aged 6–10 years. Parental health literacy was categorized as inadequate, problematic, adequate, or missing/insufficient. The outcomes included emotional and behavioral difficulties, psychosomatic complaints, and perceived social support. Linear regression models were estimated for each outcome, adjusted for children’s age, gender, parental age, education, family affluence, migration background, residential setting, and questionnaire language. Selective missingness and insufficient completion of parental health literacy data were examined using logistic regression analysis. Sensitivity analyses were used to adjust the mental health models for social support. Results: Higher parental health literacy was associated with lower emotional and behavioral difficulties (B = −1.40, 95% confidence interval [CI] −1.79 to −1.01), higher psychosomatic complaint scores (B = 0.61, 95% CI 0.40 to 0.081), and higher perceived social support (B = 0.14, 95% CI 0.02 to 0.26). The effect sizes were small. Missing or insufficient parental health literacy data showed social patterns by parental education and age, whereas no systematic predictors of early disengagement were observed among parents who partially completed the health literacy instrument. Sensitivity analyses attenuated but did not eliminate the associations between parental health literacy and child mental health outcomes. Conclusions: Parental health literacy is associated with proxy-reported psychosocial outcomes in children aged 6–10 years. The consistency of the effects across outcomes suggests that parental health literacy may influence how parents report child functioning, underscoring the importance of considering informant characteristics in proxy-based research.