Parental Health Literacy as a Contextual Factor in Proxy-Reported Child Mental Health: A Population-Based Study of...

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.