Background Self-reported health (SRH), also referred to as self-assessed or global health, is a widely used health indicator in questionnaires. Its usefulness is based on its association with mortality and morbidity measures. To fully utilise the potential of the SRH measure, we need to know what factors respondents consider while rating their health. This systematic review identified and synthesised the findings of qualitative studies that investigated young people’s conceptualisation of health overall, and when they are asked to rate their health.

Methods Systematic searches were conducted on the MEDLINE (Ovid), PsycINFO (APA PsycNet), ProQuest Sociology Collection (Applied Social Sciences Index & Abstracts (ASSIA) / Sociological Abstracts / Sociology Database, and Web of Science Core Collection. We also utilised backwards and forward citation searching through Google Scholar. We used a modified version of the Quality Framework to appraise included studies. The conceptual framework for the data synthesis was informed by the 1) definitions of health that include physical, mental, social, and cultural dimensions of health; and 2) social determinants of health approach. We used the thematic synthesis strategy as proposed by Thomas and Harden.

Results 21 studies were included in this review. Most of them were completed in European or North American countries. Two analytical themes with sub-themes were developed: 1) ‘Dimensions of health’, and 2) ‘Health in context’. Factors from the physical dimension such as healthy eating, physical activity or symptoms were common in young people’s conceptualisation of health. We identified evidence on the two forms of SRH health questions. When the questionnaire question includes the word ‘health’, young people mostly consider physical factors. When the word ‘feel’ is used, respondents move towards holistic conceptualisation by including elements from social and mental dimensions such as relationships with family and friends, or negative and positive emotions. We also identified studies where young people described health as related to the physical context or informational and cultural environment; and discussed the impact of violence on their health.

Conclusion Our review indicates that when young people are explicitly asked about their health, they focus on physical health and health behaviours. However, overall, young people hold a holistic conceptualisation of health that is influenced by the context of their lives. Supportive learning environments and exciting and accessible activities or services are needed to support the healthy development of all young people.