The World Health Organization (WHO) defines Quality of Life (QoL) as “individuals' perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards, and concerns” [1]. The study of QoL in adolescence evaluates the perception of emotional, physical, and material well-being, adolescents’ integration into the community and their personal development, taking into account the differences in the students' cultural context [2]. QoL begins to occupy an important place in the study of health and well-being, with interest in health-related QoL (HRQoL) increasing in recent years.
HRQoL is a multidimensional construct that includes social, physical, and psychological components of human well-being [3–4]. Although there is no single definition, HRQoL consists of the subjective evaluation a person makes of their life, considering the dimensions that allow them to improve their health status and well-being [5–6]. The individual perception of HRQoL is not alien to the cultural context. Mental, social, and emotional dilemmas are expressed in different ways depending on the normative standards of the person's society [7]. Despite the growing interest in HRQoL, studies during childhood and adolescence are scarce [5]. Considering the great physical, social, and psychological changes during adolescence, it makes sense to study adolescents during this stage. How adolescents adapt to their evolutionary changes will directly affect their well-being [8]. The first years of life are fundamental stages to promote the improvement of QoL through longitudinal actions that guarantee good health in the future society [9]. Adolescents should construct their identity, and this search can lead to the cultivation of inappropriate habits affecting their health status [10]. According to the model of positive adolescent development, a perspective focused on well-being, healthy adolescence is not only based on the avoidance of risky behaviors, but also requires evolutionary achievements [11] to ensure well-being at the emotional, physical, social, and, psychological levels [2].
In South America, and specifically in Chile, there are few published studies on QoL in adolescence and childhood that can be useful for making health diagnoses [12–13]. Although many studies have been carried out with a sick population [14], fewer have been dedicated to analyzing this topic with psychosocial variables. Specifically, in Chile, there is a high presence of a population at high social risk, with the School Vulnerability Index (SVI) of 86.88% in 2019 [15]. It is well known that in contexts where there is neglect and abuse of fundamental rights, a decrease in the mental and physical dimensions of HRQoL in the adolescent population is more likely [16]. In contexts of socio-family vulnerability, the school turns into a common space for protection and mediation where the HRQoL of adolescents at high social risk can be safely monitored [3]. These schools can generate important environments for health promotion, through initiatives that encompass students, families, and the school community and directly impact the students’ present and future health [17].
There are some individual differences in adolescent HRQoL, including those related to gender and age. As of adolescence, girls perceive their HRQoL as worse than that of boys [18]. This difference could be related to the fact that the physical changes in female adolescence appear earlier, and also that girls have a greater capacity to reflect and verbalize the perceived problems [19]. On the other hand, different studies have shown that HRQoL decreases as adolescence progresses; younger adolescents have a more positive perception of their HRQoL. This finding is accentuated in the dimensions of the school environment, psychological well-being, and physical well-being [3, 20]. As adolescents grow older, they become more sensitive to perceptions of unhappiness and impotence, which affects their psychological well-being, considered as a set of positive emotions ranging from satisfaction with life to negative feelings such as sadness and loneliness [3]. Family economic circumstances are also related to HRQoL, as high monthly incomes correlate positively with better adolescent HRQoL [21], and a worse family economic situation poses a risk of low HRQoL [22]. In addition, it has been shown that families with sufficient economic stability to own a home have a positive influence on their children’s HRQoL [23]. The authors explain this relationship by the fact that, when adolescents feel satisfied to live with their family, their HRQoL increases. Other studies, however, find no such relationship. Nunes et al. [7] show how poorer and less educated people have an HRQoL similar to richer and more educated people. A possible explanation, based on the theory of social comparisons and expectations of Krupinski [24], is that the subjective perception of HRQoL, where there is a distance between the real and the desired situation, is independent of the socioeconomic context. Studies conducted in Chile also show relationships between family, socioeconomic status, and adolescent HRQoL [14]. Maheri et al. [23] have shown how families' higher occupational status positively influences the adolescent students' resilience and HRQoL, and illiteracy and unemployment in the parents are directly related to their children's low HRQoL.
The present work aims to describe the socio-family context and analyze the HRQoL of Chilean children and adolescents enrolled in areas of high social risk, as well as to study its relationship with sociodemographic and family factors. We also intend to establish the baseline for further psychoeducational intervention in these educational centers. According to the previous review, these children from vulnerable backgrounds are expected to have a worse QoL than other children in contexts without this risk. We also expect to find some differences related to sociodemographic and family variables: girls, older ages, and adolescents from more vulnerable families will have worse HRQoL.