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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\u2019 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\u2019 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\u2019 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.<\/jats:p>","DOI":"10.1093\/heapro\/daag098","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T14:40:09Z","timestamp":1784299209000},"source":"Crossref","is-referenced-by-count":0,"title":["School principals\u2019 COVID-19 health literacy and its association with mental health: international findings from 11 countries in Europe and Asia"],"prefix":"10.1093","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6893-0525","authenticated-orcid":false,"given":"Marlene","family":"Meyer","sequence":"first","affiliation":[{"name":"WHO Collaborating Centre for Health Literacy, TUM Health Literacy Unit, Department of Health and Sport Sciences, TUM School of Medicine and Health, Technical University of Munich , Am Olympiacampus 11, 80809 Munich ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7367-5362","authenticated-orcid":false,"given":"Kevin","family":"Dadaczynski","sequence":"additional","affiliation":[{"name":"Department Sport and Health Sciences, University of Potsdam , Karl-Liebknecht-Str. 24-25, 14476 Potsdam ,","place":["Germany"]},{"name":"Center for Applied Health Science, Leuphana University Lueneburg , Wilschenbrucher Weg 84a, 21335 Lueneburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1782-7226","authenticated-orcid":false,"given":"Melanie","family":"Messer","sequence":"additional","affiliation":[{"name":"Institute of Nursing Science, University Hospital W\u00fcrzburg , Josef-Schneider-Str. 2, 97080 W\u00fcrzburg ,","place":["Germany"]},{"name":"Department of Nursing Science, University of W\u00fcrzburg , Josef-Schneider-Str. 2, 97080 W\u00fcrzburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5132-2462","authenticated-orcid":false,"given":"Rune M\u00fcller","family":"Kristensen","sequence":"additional","affiliation":[{"name":"Danish School of Education, Aarhus University , Tuborgvej 164, DK-2400 Copenhagen NV ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1391-9182","authenticated-orcid":false,"given":"Venka","family":"Simovska","sequence":"additional","affiliation":[{"name":"Danish School of Education, Aarhus University , Tuborgvej 164, DK-2400 Copenhagen NV ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6687-358X","authenticated-orcid":false,"given":"Areti","family":"Lagiou","sequence":"additional","affiliation":[{"name":"Laboratory of Hygiene and Epidemiology, Department of Public and Community Health, University of 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