Health literacy levels among women in the prenatal period: A systematic review

Abstract

Background: A pregnant woman's health literacy refers to her knowledge, motivation, and skills to access, understand, appraise, and apply health information to make decisions in everyday life concerning her health. Inadequate health literacy increases the risk of adverse pregnancy and birth outcomes. This systematic review aimed to explore existing evidence of women's health literacy levels in the prenatal period.

Methods: We searched four databases: MEDLINE, Embase, CINAHL, and PsycInfo. Study eligibility criteria were: 1) a study population of women in the prenatal period, 2) an English language text, and 3) a clear statement of health literacy assessment. We used the Joanna Briggs Institute (JBI) appraisal checklist for quality assessment of the included studies. We synthesized results using thematic synthesis in three stages 1) coding text, 2) developing descriptive themes, and 3) generating analytical themes.

Results: Of the 2,238 studies screened, we included forty-four in the systematic review. Most studies were conducted in the United States of America, some in Iran and Europe, and a few in Australia and Africa. We identified twenty different health-literacy measurement tools used in included studies. Four themes were synthesized: 1) socio-economy and determinants, 2) functional health literacy, 3) interactive health literacy, and 4) critical health literacy.

Conclusions: Low health literacy is associated with socio-economy, including education, employment and ethnicity and age in the prenatal period. Most identified studies (n = 24) addressed functional health literacy including information, understanding, knowledge, oral health knowledge, perception, behavior, and lifestyle. Some studies addressed interactive health literacy (n = 13) including active technology engagement, social network, interaction with health professionals, and group prenatal care. Few studies addressed critical health literacy (n = 4). Evidence of critical health literacy in the prenatal period is sparse, and high-quality research warranted.

Keywords: Antenatal care; Health literacy; Health promotion; Maternal care; Maternal health literacy; Public health.