Discussion
This study revealed that being both asked about thoughts and feelings regarding the pandemic and having them considered (‘being heard’) was associated with a higher than median QOL for fifth and eighth grade children in Japan. Approximately half of the children experienced being heard by both their family and teachers, while one in four reported being heard by neither. Older children were less likely to meet the criteria for being heard, possibly due to their growing independence and reduced direct engagement with adults.33 However, for older children who were both asked and considered, the association with higher QOL was stronger than for younger children.
Although the pandemic’s impact on children’s well-being and the importance of children’s right to be heard have been recognised, research examining the relationship between listening to children’s voices on crucial matters, such as COVID-19, and their well-being has been limited. This study quantitatively established the connection between being heard and children’s QOL, emphasising the importance of being listened to by both family and teachers. Our findings align with existing research that highlights the significance of open communication at home and school for positive mental and emotional outcomes in children during the pandemic.14 16 Our study’s findings also have implications that extend beyond the immediate context of the pandemic. Prepandemic research demonstrated that children have a significantly higher QOL when adults facilitate their expression of views and took their views seriously.3 Overall, positive relationships between children and their family and teachers promotes children’s well-being and resilience.4 6 34 This study directly asked children about their experiences of being heard and their QOL during childhood, compared with other studies that focus on adult reports regarding their childhood and current health status. As such, this study builds knowledge regarding the shorter term and immediate associations between positive relational experiences and health during childhood.
The vital association between being heard and self-esteem is not only attributed to neurologically protective impacts of children’s sense of safety and being cared about but also to how this fosters a child’s sense of agency and autonomy whereby children develop a positive self-image and a sense of control over their lives.35 In self-determination theory, autonomy is a fundamental psychological need for children’s well-being.36 Adults can support children’s autonomy by acknowledging their perspectives, providing choices and explaining decisions,37 and this is closely related to ‘being considered’, namely, giving due weight in accordance with the age, maturity and the capacity of each child.
Past studies document a dose–response association of PCEs, which was also found in this study such that being heard by multiple adults is most strongly associated with a higher QOL.4 This observation also aligns with ecological frameworks regarding child development that postulate the importance of various systems of interaction that affect children’s healthy development.38 39 It is noteworthy that even when children were heard solely by teachers, there was a tendency of improvement in family-related QOL, and vice versa. This suggests a ubiquitous impact of ‘being heard’ on QOL, irrespective of the listener and confirms prior research on PCEs regarding the importance of feeling a sense of belonging and inclusion in school and the community.6
Our study supports Article 12 of the UNCRC, which ensures children’s rights to freely express their views, feelings and wishes and to have these considered.1 However, the bifurcation of ‘being asked’ and ‘being considered’—each integral to the realisation of children’s rights to be heard—had not been empirically explored in relation to children’s QOL. The study findings underscore the importance of proactively soliciting and encouraging children’s input rather than passively receiving their thoughts and feelings.40
Limitations of the current study
This study has four primary limitations. First, this is a cross-sectional study, and we cannot conclude causality. Second, the Kid-KINDL QOL measure does not incorporate clinical assessments of children’s health, limiting a fully comprehensive view of children’s well-being. Third, although our questionnaires were answered directly by children and its validity is expected to be higher than when answered by a caregiver, further measurement validation on asking children about being heard is important.2 3 Fourth, the study’s generalisability may be limited since the study sample had higher QOL scores than the national average reported before the pandemic.22 However, this would not impact the validity of observed associations between QOL and being heard.
Study implications and next steps
Promoting meaningful participation in decision-making processes and enhancing adults’ listening abilities are critical elements of respecting children’s right to be heard in homes, schools and policymaking bodies. Further research is needed to refine and validate instruments to gauge children’s sense of being heard in population-based surveys. Moreover, qualitative studies are essential to understand children’s experiences and the mechanisms through which being heard influences QOL.