Abstract
OBJECTIVE: To examine the association between children's quality of life (QOL) and their experience of being heard by family and/or teachers during the COVID-19 pandemic. DESIGN: A cross-sectional study. SETTINGS: A randomly sampled postal survey of fifth or eighth grade children conducted in December 2020 in Japan. PARTICIPANTS: Responses from child/caregiver dyads (n=700) were adjusted for complex sampling to ensure the sample's national representativeness, incorporating all regions. INTERVENTIONS: Based on the survey results, children were categorised as 'being heard' if they reported being frequently asked about their thoughts regarding the pandemic and having their thoughts and feelings considered by family, teachers or both. MAIN OUTCOME MEASURES: Overall QOL and six QOL subscales measured through the Kid-KINDL Questionnaire (KINDL Questionnaire for Measuring Health-Related Quality of Life in Children and Adolescents). RESULTS: About half (52.9%) of children were heard by both family and teachers, with higher rates in fifth grade (59.9%) than in eighth grade (45.1%). The adjusted prevalence ratio for above median QOL was 4.40-fold (95% CI: 2.80 to 6.94) higher in children heard by both family and teachers than in unheard children. Associations remained significant but were lower in children heard only by family or teachers. QOL subscales showed similar associations, with family, self-esteem and friends being the strongest. Children asked for their thoughts or feelings without adult consideration did not exhibit higher QOL. CONCLUSIONS: 'Being heard' during the pandemic was positively associated with higher QOL. Recognising children's right to be heard and promoting environments where they are heard at home and school may improve their well-being.