Qualidade de vida, autopercepção de saúde, motivação para aprender e desempenho escolar de adolescentes: o estudo de um modelo de explicação

Abstract

Introduction: comprehensive health, quality of life and motivation to learn among adolescents are constructs of great importance for the areas of health and education, as they can guide pedagogical and care practices and support public policies. Objective: to describe and analyze the association between socioeconomic and demographic aspects, quality of life, self-perceived health, behavioral capabilities and difficulties related to mental health, family environment resources, motivation to learn and academic performance among adolescent students in the final years of elementary school of publicly and privately funded schools in the city of Belo Horizonte/MG. Methods: observational, analytical and cross-sectional study with a longitudinal component using participant characterization questionnaires, Pediatric Quality of Life Questionnaire Pediatric Quality of Life Inventory - PedsQL™ - patient-reported outcome (PRO), Self-perceived health, Capabilities Questionnaire and Difficulties Strengths and Difficulties Questionnaire – SDQ-Por, Learning Motivation Scale – EMAPRE applied to adolescents and their parents or guardians completed the Brazil Economic Classification Criteria - CCEB, Pediatric Questionnaire on Quality of life Pediatric Quality of Life Inventory - PedsQL ™ - observer-reported outcome (ObsRO) and the Family Environment Resources Inventory – RAF. School performance was obtained by averaging the result in the curricular subjects recommended by the BNCC and evaluation criteria adopted by the participating educational institutions. The systematic literature review was based on international guidelines (PRISMA) and submitted to the National Institute for Health Research - International Prospective Register of Systematic Reviews (PROSPERO) platform. The search equations were applied to the electronic databases National Library of Medicine (PubMed), Expertly curated abstract & citation database (Scopus) and Web of Science in February 2022 with update in June 2024 without period restrictions. Gray literature was searched in the BDTD and ProQuest databases. Document management was carried out using the Rayyan application and duplicate articles were excluded. Independently, the evaluators read the titles and abstracts of the selected articles, based on the eligibility criteria. Disagreements were resolved in a consensus meeting and, when necessary, a fourth evaluator was consulted. The methodological quality of eligible studies was critically assessed using standardized assessment instruments recommended by the JBI Institute. The results were presented in a qualitative way with a narrative synthesis of the participants' characterization and assessment of quality of life and motivation to learn, following the guidelines for preparing the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). For the analysis of statistical data from the field research, descriptive analyzes of the variables were carried out using absolute and relative frequency distribution of categorical variables and numerical synthesis of continuous variables, bivariate and multivariate association analyses. Descriptive analysis and Structural Equation Modeling were also carried out, where the variables Motivation to Learn, School Performance, Quality of Life and RAF were considered latent variables. The observable variables were obtained from primary variables or calculated through the items of each instrument. Categorical variables were expressed in terms of frequency and percentage and numerical variables were expressed in terms of mean, standard deviation, median, minimum and maximum. The data was analyzed using the R programming language. To evaluate the models, the Weighted Least Squares Mean and Variance adjusted (WLSMV) estimator was used. The Expected Cross-Validation Index (ECVI) indicator was used to comparatively evaluate the models estimated by WLSMV. The quality of the models was assessed using fit indicators. The relationships between the variables were analyzed according to the standardized regression coefficients (β), while the percentage of explained variance was evaluated using the R2 coefficient. Furthermore, possible changes to the model were evaluated using the MIMIC (Multiple Indicators, Multiple Causes) indicators. Results: of the 3975 imported articles, 2782 articles were considered for data analysis. 2682 were excluded because they had a different population and outcomes, leaving 96 articles, of which 34 were excluded after analysis by the evaluators. 62 articles were read in full with the exclusion of 34 from this group after consensus, leaving 28 studies for this systematic literature review. Quantitative and qualitative information on the motivation to learn of adolescents enrolled in elementary school belonging to tests to different socioeconomic contexts and their association with aspects related to students' health conditions and quality of life were found. The longitudinal component of the research showed that the majority of participants were female and belonged to the highest level of the economic classification criterion. In the comparison between the periods 2018 and 2021, there was a worsening in the assessment of self-perceived health in the descriptive analysis. Multivariate logistic regression showed that adolescents with a normal result in the assessment of abilities and difficulties were more likely to have a better quality of life in the perception of their parents in the two periods investigated (OR=5.35 and OR=5.51) and in the assessment of adolescents in 2021 (OR=11.05). Being a student in the initial years and better motivation to learn increased the chances of having a better self-reported quality of life by up to 9.7 and 5.02 times in 2018 and 2021, respectively. The logistic regression models in relation to the type of school (public or private) showed that for each increase of one point in the score in the Resources that promote proximal processes (RAF) domain, there is a 17.3% reduction in the chances of the adolescent being student at a publicly funded school (OR=0.827; CI=0.783-0.873). A one-point increase in the Peer Relationship Problems (SDQ) scale score increased the chances of the student attending a public school by 35.4% (OR=1.354; CI=1.096-1.673). Linear regressions indicated that Chronic health problem (p=0.027), Health rating (p=0.007), Emotional symptoms (p<0.001), Hyperactivity (p<0.001) and Relationship with peers (p=0.024) were associated with quality of life of adolescents in public schools. For students at privately funded schools, Physical quality of life according to parents' report (p=0.005), Self-perceived health (p=0.015), Emotional symptoms (p<0.001), Hyperactivity (p=0.002) and Relationship problems with peers (p<0.001) there was an association with quality of life in the adolescent's self-report. It was also possible to observe that the Quality of life self-reported by adolescents is influenced by SDQ-Difficulty (β= -0.667, p < 0.001) and Self-perceived health (β= 0.238, p = 0.003), while Motivation to learn is influenced of adolescents' self-reported Quality of Life (β= 0.811, p < 0.001). It was evident that the adolescents' self-reported Quality of Life was influenced by the SDQ-Difficulty (β= -0.676, p < 0.001) and Self-Perceived Health (β= 0.259, p = 0.001). Motivation to learn was influenced by the adolescents' self-reported Quality of Life (β= 0.384, p = 0.058) and the SDQ-Difficulty (β= -0.453, p = 0.016). For the correlation between CCEB and academic performance, the results were also significant (r= 0.255, p = 0.017). Conclusion: this investigation revealed an association between health, quality of life, behavior and motivation to learn, raising important reflections. With the collection of data from the literature review, it was possible to observe that motivation to learn proved to be a construct associated with health conditions and quality of life in adolescence, as well as issues related to the functioning of parental relationships and teaching methods. and learning, signaling its multidimensional and essential character for academic success. Thus, knowing the relationship between physical, emotional and contextual aspects and their influence on the quality of life and motivation to learn among elementary school adolescents favors decisions in favor of more effective strategies for promoting the health, development and comprehensive training of students through of actions in the school environment.