Predictors of emotional wellbeing among German fourth-graders–a cross-sectional study (HL-Kids-NRW)

Abstract Background Children's emotional wellbeing is shaped by a complex interplay of sociodemographic factors, childhood adversity, and their home, social, and school environments. Evidence suggests health literacy (HL) may also play a role, yet few studies have jointly examined HL alongside children's living environments. This study addresses this gap by investigating how diverse factors affect emotional wellbeing. Methods A cross-sectional written survey was conducted in 40 schools in North Rhine-Westphalia, Germany. Emotional wellbeing was measured with the 4-item KINDL-R scale; HL with the HLS-Child-Q15. Home, neighborhood, and school environments were assessed with four items each. Sociodemographic variables and social desirability were also recorded. Linear regression was used to estimate effects on emotional wellbeing. Results The sample included 1,085 students (50.3% female), with a mean wellbeing score of 73.30 (SD = 17.21, transformed 1-100 scale). The regression model explained 14.5% of the variance in wellbeing. Predictors were the tendency to respond in a socially desirable way (β=.180; p<.001), HL (β=.150; p<.01), and neighborhood environment. Less frequent exposure to people smoking in the neighborhood (β=-.159; p<.001) and perceiving the neighborhood as a good place to play was linked to higher wellbeing (β=.138; p<.01). Wellbeing was lower for girls (β=.104; p<.05) and for children not born in Germany (β=-.103; p<.05). Attending a school participating in a health initiative was associated with higher wellbeing (β=.100; p<.05). Conclusions This study highlights the multifaceted interplay of factors shaping children's emotional wellbeing, but also underscores methodological challenges in assessing self-reported wellbeing due to the effect of social desirability bias. Still, factors such as school health initiatives and HL were shown to have a significant (independent) effect on wellbeing, underlining their potential regarding interventions to promote wellbeing. Key messages • This study highlights the complex interplay of factors influencing children’s wellbeing. • School health initiatives and interventions promoting HL might be pathways to promote wellbeing.