School principals' COVID-19 health literacy and its association with mental health: international findings from 11 countries in Europe and Asia.

School principals are prone to mental health problems due to work demands. During the COVID-19 pandemic, school principals were additionally tasked with managing challenging responsibilities, i.e. implementing hygiene regulations, communicating frequent policy updates, and transitioning to online teaching. This international study aimed to assess school principals' COVID-19 health literacy (HL) levels as a resource during the pandemic and to examine associations with well-being and psychosomatic complaints. The COVID-19 Health Literacy School Principal Survey was jointly conducted in 11 countries during 2021 and 2022. N = 8644 school or vice principals completed the online survey. Well-being was assessed using the WHO-5 Well-Being Index, psychosomatic complaints with a subscale of the Burnout Assessment Tool and self-reported COVID-19 HL through the HLS-COVID-Q22. HL levels were computed using Rasch analysis. Multiple linear regression analysis was conducted to investigate the association of school principals' COVID-19 HL with well-being and psychosomatic complaints while controlling for sociodemographic and school-level factors. Overall, 0.1% of school principals had insufficient COVID-19 HL, 3.3% problematic, 65.7% sufficient, and 30.9% excellent. COVID-19 HL significantly predicted well-being and psychosomatic complaints even after controlling for sex, age, position, school type, teaching load, and working hours. Despite the small explained variance, the findings emphasize a need to invest in school principals' HL as a resource during times of crisis and beyond. Health promotion interventions should be developed to enhance HL and hence health, especially of female and younger school principals, who reported lower well-being and more frequent psychosomatic complaints.