Association of Health Literacy Among Nulliparous Individuals and Maternal and Neonatal Outcomes

Determinants of well-being in pregnancy: the impact of sociodemographic and obstetric variables and maternal health literacy, cross sectional study

BACKGROUND

Maternal well-being is paramount in elevating maternal, fetal, and societal health. This study aimed to examine the impact of pregnant women's sociodemographic and obstetric variables, as well as maternal health literacy, on well-being during pregnancy.

METHODS

A cross-sectional study was conducted between April and October 2024 at a public hospital in a southeastern province of Türkiye. The study was completed with the participation of 456 pregnant women who met the inclusion criteria. Data were collected utilizing the "WHO-5 Well-Being Index", the "Maternal Information Form," and the "Maternal Health Literacy Inventory in Pregnancy (MHELIP)". The statistical significance level was defined as p<0.05 for all analyses.

RESULTS

The study identified maternal health literacy as the most significant predictor of well-being during pregnancy (β=0.320). Additionally, perceiving income as insufficient (B=-1.872), residing in urban centers (B=-1.708), and the presence of pregnancy-related risks (B=-2.145) were found to contribute substantially to diminished well-being during pregnancy (p<0.05).

CONCLUSION

This study found that maternal health literacy along with various maternal socio-demographic and obstetric variables are important determinants of well-being in pregnancy. These findings may provide essential insights to better comprehend the necessities for improving well-being during pregnancy, guiding policymakers and healthcare providers in developing targeted solutions. This understanding could also inform the adaptation of existing health and community services to create a health literacy-sensitive environment more likely to address the diverse health needs of pregnant women and mothers.

Exploring nurse and patient perspectives on WeChat-based prenatal education in Chinese public hospitals: a qualitative inquiry

BACKGROUND

With the increasing digitization of healthcare, WeChat has emerged as a popular platform for delivering prenatal education in China. While studies have shown its potential benefits, few investigations systematically explore how nurses implement WeChat-based prenatal education and how pregnant women engage with these interventions within public hospital settings. Understanding both provider and patient perspectives is critical for developing equitable, effective digital maternal care.

METHODS

A qualitative exploratory design was employed in four public hospitals in Shanxi Province, China. Seventeen obstetric nurses and eight pregnant women participated in semi-structured interviews between March and August 2024. Data were analyzed using thematic analysis to identify commonalities and divergences between nurse-driven and patient-driven experiences.

RESULTS

Nurses perceived WeChat as extending their professional reach beyond physical clinic hours and enhancing patient education, aligning with the Technology Acceptance Model constructs of perceived usefulness and ease of use. However, organizational constraints, digital training gaps, and blurred work-life boundaries posed challenges. Pregnant women similarly recognized WeChat's convenience for quick clarifications and access to nurse-vetted information, yet wide variations in digital health literacy led to uneven engagement. Cultural factors, such as extended family involvement and preferences for in-person consultations, further influenced both nurse and patient usage patterns. Despite these challenges, participants converged on WeChat's value as a complementary platform that could reduce clinic visits, offer immediate reassurance, and bolster continuity of care.

CONCLUSION

WeChat-based prenatal education holds significant promise for improving maternal health outcomes by facilitating frequent, real-time communication between nurses and expectant mothers. Nonetheless, the findings underscore the need for hospital-level policies, structured training programs, and culturally sensitive strategies to address privacy concerns, manage workloads, and reduce digital disparities. An integrated approach that combines nurse acceptance and patient digital literacy is essential to fully harness WeChat's potential in public hospital contexts.

IMPLICATIONS

The study highlights practical steps for enhancing digital prenatal interventions, including standardized protocols for WeChat-based interactions, comprehensive nurse training in eHealth communication, and tailored support for pregnant women with limited digital skills. Such interventions can inform wider policymaking on telehealth and guide technology developers in creating user-friendly, secure digital platforms that optimize maternal care and reduce health inequities.

CLINICAL TRIAL NUMBER

Not applicable.

Improving Understanding of Macrosomia with a Graphics-Based Educational Tool: A Randomized Controlled Trial (MATE)

We aimed to determine if a graphics-based education tool (GBET) leads to improved macrosomia knowledge on risk factors/complications (RF/C) and management options (MO) for macrosomia among pregnant individuals compared to routine care.We conducted a randomized control trial (NCTO6281301). Inclusion criteria were individuals at 18 to 55 years, with singleton pregnancy delivering at ≥ 36 weeks. After consent, participants were randomized to either routine care or GBET. To assess knowledge of macrosomia, a questionnaire consisting of 17 questions relating to the RF/C (11 questions) and MO (six questions) of suspected macrosomic fetuses was administered to participants one time either directly after consent (if routine care) or directly following review of GBET. The primary outcome was the overall score on the questionnaire. Secondary outcomes were summary scores on the RF/C and MO. Descriptive statistics were used for baseline characteristics and outcomes. Chi-squared test or Fisher's exact test was used to compare categorical variables and the student's t-test for continuous variables.From January to July 2023, 232 eligible individuals were approached and 196 (84%) agreed to participate; of them, 98 received the GBET, while 98 received routine care. Baseline demographics were similar. The majority (42%) of respondents were non-Hispanic Black, 60% were employed, 56% had some level of college education, and 30% lived below the poverty line. There were 41% nulliparous, 67% with a BMI ≥ 30 kg/m2, and 16% with diabetes. The primary outcome was significantly higher in those who received the GBET (70 vs. 64%; p < 0.001). The RF/C scores were also higher in the GBET group (72 vs. 63%; p = 0.001); however, the MO scores were similar between groups (65 vs. 68%; p = 0.084).In our population, a GBET improved participant knowledge on the RF/C for macrosomia, but not their MO. · In our population, overall macrosomia knowledge was poor.. · An education tool on macrosomia improved knowledge.. · Studies ought to determine if increased knowledge improves outcomes..

The Impact of Education and Health Literacy on Neonatal and Family Well-Being

Education access and quality are the second of five domains of determinants of health influencing the well-being of families and communities. In this column, the impacts of educational attainment and health literacy on health and well-being will be described. There is an increased need for adequate health literacy during pregnancy and parenting, including when infants require NICU care and following their discharge into the early years and beyond. Creating environments where universal precautions for health literacy and plain language communication are used will improve health outcomes for infants and parenting confidence. NICU nurses hold an essential role in creating these environments and tailoring education to parent needs.

Social determinants of health and language outcomes in preterm infants with public and private insurance

OBJECTIVE

To evaluate associations of maternal social determinants of health (SDOH) with language outcomes of preterm infants with public and private insurance.

STUDY DESIGN

Single center study of 375 neonates born ≤ 28 weeks. Perinatal characteristics were collected, and the Bayley III was administered at 18-24 months. Primary outcome was language scores of <85. Bivariate and multivariable analyses were used to compare groups.

RESULTS

Mothers with public insurance had higher rates of psychosocial risk factors. In regression analysis, People of Color (aOR 2.4, 1.47-4.04), non-English speaking household (aOR 4.05, 1.47-11.15) and public insurance (aOR 2.03, 1.18-3.49) significantly increased the odds of having a language composite score of <85, whereas breast milk (aOR 0.47, 0.28-0.79) was protective.

CONCLUSIONS

Preterm infants with public insurance are at increased risk of exposure to multiple SDOH which are independently associated with language delay at 18-24 months.

Risk factors for neonatal admission from the beginning of pregnancy in Northeast Spain

AIM

Maternal health and gestational control are crucial to improving the newborn's prognosis. This study analyses demographic and obstetric factors at the beginning of pregnancy related to neonatal health, assessing their impact on the risk of hospital admission and prematurity.

METHODS

Observational retrospective study conducted in Northeast Spain with data of 9560 newborns between February 2017 and February 2022. The following have been evaluated as risk factors for hospital admission: nulliparity, multiple gestation, fertilisation techniques, foreign maternal origin, maternal age, smoking and residential location, dividing the sample according to gestational age. Hypothesis testing and logistic regression were performed.

RESULTS

Nulliparity, fertilisation techniques and multiple gestation represent a risk factor for neonatal admission (OR 22.48, 4.04 and 3.34, respectively), especially in premature newborns <32 weeks of GA (OR: 30.71, 10.71 and 22.76, respectively). Foreign maternal origin also adds risk of admission, both in term newborns (OR 1.26; CI: 1.10-1.43) and in premature babies <32 weeks of GA (OR 1.61; CI: 1.09-2.38). Tobacco does not present a significant risk of neonatal admission. The multivariate analysis model confirms the influence of the following factors in all the studied groups: nulliparity, multiple gestation and foreign maternal origin.

CONCLUSIONS

Nulliparity and multiple pregnancies are both main risk factors for neonatal admission and premature delivery. The use of fertilisation techniques and the foreign origin of the mother significantly associate increased risk of admission and neonatal prematurity. These findings underscore the need for a comprehensive approach to prenatal care to improve neonatal prognosis and promote long-term health in risk populations.

Validity and reliability of the Turkish version of the Maternal Health Literacy Inventory in Pregnancy scale: a methodological study

PURPOSE

This study aimed to translate the Maternal Health Literacy Inventory in Pregnancy (MHELIP) scale into Turkish and evaluate its validity and reliability for use in the Turkish population.

METHODS

The participants in this methodological study included 250 pregnant women who presented to the antenatal clinic of the Florence Nightingale Hospital in Istanbul, Turkiye. Content validity was assessed using expert approval. Confirmatory factor analysis, exploratory factor analysis, and structural equation modeling were used to assess the validity. Criterion validity was evaluated using the shortform health literacy survey tool, the Short-Form Health Literacy Questionnaire (HLS-SF12). To assess reliability, Cronbach's alpha, item analysis, and the test-retest method were used.

RESULTS

The mean age of the participants was 32.02±4.15 years. The content validity index of the scale was .99. The scale had a four-factor structure that fit well with 48 items. "Maternal health knowledge," "maternal health information search," "maternal health information assessment," and "maternal health decision making and behavior" subscales had Cronbach's alpha values of .91, .76, .85, and .90, respectively. The MHELIP and HLS-SF12 scores were significantly correlated (r=.422, p<.001).

CONCLUSION

The MHELIP was found to be a valid and reliable measurement tool in pregnant Turkish women.

Health literacy interventions for pregnant women with limited language proficiency in the country they live in: a systematic review

BACKGROUND

Low health literacy can present significant risks throughout pregnancy, impacting both maternal and fetal health outcomes. Those who do not speak the main language of their country of residence are more likely to have lower health literacy. Considering the heightened challenges faced by this demographic in accessing, understanding, and engaging with health information and services, designing and implementing tailored interventions is crucial to mitigate health disparities. This review aims to identify and examine health literacy interventions developed for pregnant women whose first language differs from the language predominantly spoken in their residing country.

METHODS

Electronic databases of Embase and Medline were searched using relevant search terms from their inception to July 2023. Data were extracted and analysed using narrative synthesis.

RESULTS

Of the 1964 identified records, three were included. The studies were conducted in Australia and Denmark, and ranged in design, including: a cluster randomised controlled trial, mixed methods design; and qualitative design. Health literacy intervention modalities included midwifery education combined with a smartphone application and leaflet, culturally adapted group classes, and informative videos. The interventions were translated into various languages to cater to the target populations. Two studies used the Health Literacy Questionnaire to assess the intervention effectiveness, yielding contrasting results: one showed no improvement, while the other reported increased post-intervention health literacy scores. The third had not yet evaluated intervention effectiveness.

CONCLUSIONS

This review identifies a significant scarcity in health literacy interventions for pregnant women whose first language differs to the predominant language of the country they live in, despite their greater need for support. While few studies were found, their diversity suggests multiple strategies for enhancing health literacy. Bridging this health literacy gap for linguistically diverse pregnant populations could reduce disparities in maternal and fetal outcomes, underscoring the need for targeted, evaluated interventions that actively engage affected women and their support networks.

TRIAL REGISTRATION

Registered with PROSPERO: CRD42023475511. Date of registration: 10.11.23.

Effects of eHealth literacy on maternal and neonatal outcomes

eHealth literacy plays a crucial role during pregnancy, as maternal health behavior can influence health outcomes for both mother and child. This study assessed the impact of eHealth literacy on maternal-fetal health outcomes through a cross-sectional analysis of 1,265 pregnant women admitted to a tertiary maternity hospital in Turkey between April and July 2022. Data on sociodemographic information, obstetric variables, birth outcomes, Internet usage, and eHealth Literacy Scale (eHEALS) were collected. Kolmogorov-Smirnov, Mann - Whitney U, Kruskal-Wallis, and Spearman correlation were used for data analysis. The median age of women was 28 years, and the mean gestational age was 38.6 weeks. Median eHealth literacy score was 21 (range:8-40). Pregnant women who had planned pregnancies, received spousal support, attended 9-12 antenatal care visits, received vaccinations, adhered to iron and folic acid supplementation, engaged in regular physical activity, and maintained regular sleep patterns exhibited higher eHealth scores (all p < .001). eHEALS scores were higher in women who experienced normal vaginal deliveries (p < .001), while lower eHEALS scores were noted in those with comorbidities (p = .001). The study suggested that higher eHealth literacy among pregnant women was associated with improved health-promoting behaviors, more favorable health perceptions, increased utilization of health services, and better maternal and fetal outcomes.

Knowledge of pregnancy care behaviors, complications, and urgent maternal warning signs up to one year postpartum among Georgia residents

OBJECTIVES

Maternal mortality in the U.S. continues to increase, and the State of Georgia has one of the highest maternal mortality rates among the 50 states at 33.9 deaths per 100,000 live births, disproportionately affecting Black and rural populations. This study sought to ascertain knowledge of adults living in Georgia about proper pregnancy care behaviors and their ability to identify warning signs and symptoms (WSS) of life-threatening complications during pregnancy and up to 1-year postpartum.

METHODS

In 2022, using a cross-sectional study design, a questionnaire including items from validated instruments was distributed to adults residing in Georgia through social media and email. Questions were grouped into categories: total pregnancy knowledge, general pregnancy care behaviors, and pregnancy and postpartum WSS. Based on correct answer choices, scores were created for each of the four categories and compared by gender, age, education, race, and ethnicity using multiple linear regressions.

RESULTS

Participants (n = 588) ranged from 18 to 76 years old and were primarily female (80%). The vast majority (83.3%) failed to identify important pregnancy care behaviors. More than half of all participants were unable to recognize pregnancy and postpartum WSS of complications, 52% and 56% respectively. Male, Black, and Hispanic self-identified adults exhibited lower recognition of pregnancy care behaviors and WSS of pregnancy and postpartum complications, relative to other genders, races, and ethnic groups, respectively (p < 0.001).

CONCLUSIONS

This research identified important gaps in maternal health knowledge among adults living in the State of Georgia, highlighting specific opportunities for intervention and offering evidence-based information that can help improve health literacy for better maternal outcomes.

The association between health literacy and screening for disease-specific complications among community-dwelling adults with diabetes

Introduction

Diabetic retinopathy and nephropathy are examples of complications of uncontrolled diabetes. We hypothesized that health literacy has a defining role in understanding the importance of attending routine screening for diabetes complications. Therefore, our study investigated the relationship between verbal health literacy (VHL) and written health literacy (WHL) and screening for disease-specific complications in individuals with diabetes.

Methods

Cross-sectional data on 28,210 participants with diabetes was derived from the 2021 Korean Community Health Survey. Adjusted multiple logistic regression analysis was employed to investigate the association between VHL and WHL and diabetes complication screening. Further analysis was also carried out to further comprehend the relationship between those two forms of health literacy and other factors with diabetic retinopathy and nephropathy screening.

Results

Compared to those with high VHL, participants with low VHL had lower odds of diabetes complication screening; OR 0.89 (95% CI 0.84-0.95). The same was true for WHL, those who were uninterested reported the lowest odds ratio; OR 0.73 (95% CI 0.69-0.78), followed by low WHL; OR 0.88 (95% CI 0.82-0.94), of undergoing diabetes complication screening, when compared to individuals with high WHL. Our subgroup analysis presented similar results for diabetic nephropathy and retinopathy with both VHL and WHL.

Conclusion

Among individuals with diabetes, limited VHL and WHL was significantly associated with lower odds of diabetes complication screening. Interventions aimed at improving health literacy and associated health outcomes in the community setting are warranted.

Health Literacy Levels of Women Attending a Perinatology Outpatient Clinic for High-Risk Pregnancy Follow-Up

BACKGROUND

Health literacy, defined as the ability to obtain, understand, evaluate, and apply health information with knowledge, motivation, and skills, is crucial for maintaining and improving quality of life. Despite the availability of health information, limited health literacy is linked to health disparities, inadequate self-management of chronic diseases, and poorer health outcomes.

OBJECTIVE

The purpose of this study is to assess the health literacy of pregnant women who visit the Perinatology Outpatient Clinic for follow-up care. It seeks to identify gaps in knowledge and understanding that may impede effective healthcare delivery and inform targeted health education and public awareness programs to enhance health literacy.

METHODS

This prospective survey study included 210 pregnant women aged 18 to 40 years attending the Perinatology Outpatient Clinic at Giresun Obstetrics and Gynecology Training and Research Hospital, Turkey. Participants completed a questionnaire on health literacy, sociodemographics, and basic health status via Google Forms (Google Inc., Mountain View, CA, USA). Statistical analysis was performed using SPSS Statistics version 26.0 (IBM Corp., Armonk, NY, USA), employing tests such as Kolmogorov-Smirnov, Mann-Whitney U, Kruskal-Wallis, Student's t-test, ANOVA, Spearman, and Pearson correlation, and multivariate linear regression analysis.

RESULTS

The mean age of participants was 29.97±5.44 years, with a mean health literacy score of 29.89±7.05. Education level and living place significantly influenced health literacy scores, with higher scores among those with higher education and urban living (p = 0.014 and p = 0.038, respectively). Economic status also significantly impacted health literacy, with lower scores among those with poor economic status (p<0.001). Health literacy scores were higher among those receiving health information from healthcare professionals (p = 0.006) and lower among those finding medical information from doctors insufficient (p = 0.008).

CONCLUSION

Health literacy is significantly influenced by education level, living place, and economic status. The study emphasizes the necessity of focused health education initiatives, especially for individuals with lower educational attainment and those residing in rural regions. Improving health literacy via efficient communication from medical professionals can benefit expectant mothers and their unborn children by lowering medical expenses and improving health outcomes.

The relationship between vaccine hesitancy and health literacy in pregnant women: a cross-sectional study

BACKGROUND

Pregnancy; It is an important process that directly affects the mother and the fetus, where women benefit more from health services and the need for health-related decision-making and information increases. It is very important to determine and improve the health literacy level of these women. The study determined the relationship between vaccine hesitancy and health literacy in pregnant women.

METHODS

It is a cross-sectional type of research. The research was carried out in a state hospital. The online form was sent to 230 pregnant women. Ethics committee, institution and scale permissions were obtained for the study. The data of the study were collected online by using the questionnaire prepared by scanning the literature, the Anti-Vaccination Scale and the Health Literacy Scale. Statistical analyzes of the data were performed using the SPSS version 25 program.

RESULTS

The Vaccine Hesitancy Scale score of the pregnant women was 55.53 ± 10.15, whereas their Health Literacy Scale score was 98.57 ± 21.48. Health literacy was associated with the sociodemographic and obstetric characteristics of the pregnant women. Educational status, economic status, place of residence, and family structure were associated with vaccine hesitancy.

CONCLUSIONS

It was determined that there was a negative correlation between the anti-vaccination scale scores of the pregnant women and the health literacy scale scores. As a result, it was determined that the anti-vaccination level of the pregnant women was moderate and the health literacy level was sufficient. It can be recommended to provide appropriate trainings and counseling to target groups, which will increase the health literacy level of pregnant women.

Racial and Ethnic Disparities among Pregnancies with Chronic Hypertension and Adverse Outcomes

OBJECTIVE

We aimed to ascertain whether the risk of adverse pregnancy outcomes in the United States among individuals with chronic hypertension differed by maternal race and ethnicity and to assess the temporal trend.

STUDY DESIGN

Population-based retrospective study using the U.S. Vital Statistics datasets evaluated pregnancies with chronic hypertension, singleton live births that delivered at 24 to 41 weeks. The coprimary outcomes were a composite maternal adverse outcome (preeclampsia, primary cesarean delivery, intensive care unit admission, blood transfusion, uterine rupture, or unplanned hysterectomy) and a composite neonatal adverse outcome (preterm birth, small for gestational age, Apgar's score <5 at 5 minutes, assisted ventilation> 6 hours, seizure, or death). Multivariable Poisson regression models were used to estimate adjusted relative risks (aRRs) and 95% confidence intervals (CIs).

RESULTS

Between 2014 and 2019, the rate of chronic hypertension in pregnancy increased from 1.6 to 2.2%. After multivariable adjustment, an increased risk for the composite maternal adverse outcome was found in Black (aRR = 1.10, 95% CI = 1.09-1.11), Hispanic (aRR = 1.04, 95% CI = 1.02-1.05), and Asian/Pacific Islander (aRR = 1.07, 95% CI = 1.05-1.10), compared with White individuals. Compared with White individuals, the risk of the composite neonatal adverse outcome was higher in Black (aRR = 1.39, 95% CI = 1.37-1.41), Hispanic (aRR = 1.15, 95% CI = 1.13-1.16), Asian/Pacific Islander (aRR = 1.34, 95% CI = 1.31-1.37), and American Indian (aRR = 1.12, 95% CI = 1.07-1.17). The racial and ethnic disparity remained unchanged during the study period.

CONCLUSION

We found a racial and ethnic disparity with maternal and neonatal adverse outcomes in pregnancies with chronic hypertension that remained unchanged throughout the study period.

KEY POINTS

· Between 2014 and 2019, the rate of chronic hypertension in pregnancy increased.. · Among people with chronic hypertension, there are racial and ethnic disparities in adverse outcomes.. · Black, Hispanic, and Asian/Pacific Islander have a higher risk of the adverse neonatal outcomes..

Bridging the literacy gap for surgical consents: an AI-human expert collaborative approach

Despite the importance of informed consent in healthcare, the readability and specificity of consent forms often impede patients' comprehension. This study investigates the use of GPT-4 to simplify surgical consent forms and introduces an AI-human expert collaborative approach to validate content appropriateness. Consent forms from multiple institutions were assessed for readability and simplified using GPT-4, with pre- and post-simplification readability metrics compared using nonparametric tests. Independent reviews by medical authors and a malpractice defense attorney were conducted. Finally, GPT-4's potential for generating de novo procedure-specific consent forms was assessed, with forms evaluated using a validated 8-item rubric and expert subspecialty surgeon review. Analysis of 15 academic medical centers' consent forms revealed significant reductions in average reading time, word rarity, and passive sentence frequency (all P < 0.05) following GPT-4-faciliated simplification. Readability improved from an average college freshman to an 8th-grade level (P = 0.004), matching the average American's reading level. Medical and legal sufficiency consistency was confirmed. GPT-4 generated procedure-specific consent forms for five varied surgical procedures at an average 6th-grade reading level. These forms received perfect scores on a standardized consent form rubric and withstood scrutiny upon expert subspeciality surgeon review. This study demonstrates the first AI-human expert collaboration to enhance surgical consent forms, significantly improving readability without sacrificing clinical detail. Our framework could be extended to other patient communication materials, emphasizing clear communication and mitigating disparities related to health literacy barriers.

Development of the Conversational Health Literacy Assessment Tool for maternity care (CHAT-maternity-care): participatory action research

BACKGROUND

Limited health literacy in (expectant) parents is associated with adverse health outcomes. Maternity care providers often experience difficulties assessing (expectant) parents' level of health literacy. The aim was to develop, evaluate, and iteratively adapt a conversational tool that supports maternity care providers in estimating (expectant) parents' health literacy.

METHODS

In this participatory action research study, we developed a conversational tool for estimating the health literacy of (expectant) parents based on the Conversational Health Literacy Assessment Tool for general care, which in turn was based on the Health Literacy Questionnaire. We used a thorough iterative process including different maternity care providers, (expectant) parents, and a panel of experts. This expert panel comprised representatives from knowledge institutions, professional associations, and care providers with whom midwives and maternity care assistants work closely. Testing, evaluation and adjustment took place in consecutive rounds and was conducted in the Netherlands between 2019 and 2022.

RESULTS

The conversational tool 'CHAT-maternity-care' covers four key domains: (1) supportive relationship with care providers; (2) supportive relationship within parents' personal network; (3) health information access and comprehension; (4) current health behaviour and health promotion. Each domain contains multiple example questions and example observations. Participants contributed to make the example questions and example observations accessible and usable for daily practice. The CHAT-maternity-care supports maternity care providers in estimating (expectant) parents' health literacy during routine conversations with them, increased maternity care providers' awareness of health literacy and helped them to identify where attention is necessary regarding (expectant) parents' health literacy.

CONCLUSIONS

The CHAT-maternity-care is a promising conversational tool to estimate (expectant) parents' health literacy. It covers the relevant constructs of health literacy from both the Conversational Health Literacy Assessment Tool and Health Literacy Questionnaire, applied to maternity care. A preliminary evaluation of the use revealed positive feedback. Further testing and evaluation of the CHAT-maternity-care is required with a larger and more diverse population, including more (expectant) parents, to determine the effectiveness, perceived barriers, and perceived facilitators for implementation.

Health literacy among pregnant women in the United Arab Emirates: The Mutaba'ah study

BACKGROUND

Health literacy is the degree to which individuals can obtain, process, understand, and communicate health-related information. Health literacy among pregnant women, in particular, may have a significant impact on maternal and child health. In the United Arab Emirates, no previous studies have been carried out to investigate the health literacy levels of pregnant women.

OBJECTIVE

This study aimed to investigate antenatal health literacy levels and identify associated factors among pregnant Emirati women in the United Arab Emirates.

DESIGN

This analysis was based on the baseline cross-sectional data for pregnant women participating in the prospective cohort Mutaba'ah Study, recruited between May 2017 and August 2022.

METHODS

Participants completed a self-administered questionnaire during their antenatal visits that collected sociodemographic and pregnancy-related information. Adequacy of health literacy was assessed using the BRIEF health literacy screening tool with adequate health literacy defined as a score ⩾ 17. Regression modeling investigated the association between the pregnant women characteristics with having adequate health literacy level (ability to read and comprehend most patient education materials).

RESULTS

A total of 2694 responses to the BRIEF health literacy screening tool were analyzed. Approximately, three-quarters (71.6%) of respondents showed adequate health literacy, followed by marginal (22.8%), and limited (5.6%) health literacy levels, respectively. Higher education levels (adjusted odds ratio (aOR) = 1.74, 95% confidence interval = 1.46-2.08), employment (adjusted odds ratio = 1.35, 95% confidence interval = 1.10-1.65), and adequate social support (adjusted odds ratio = 1.69, 95% confidence interval = 1.26-2.28) were associated with adequate health literacy levels. Participants who expressed worry about birth were less likely to have adequate literacy levels (adjusted odds ratio = 0.70, 95% confidence interval = 0.58-0.85).

CONCLUSION

Nearly three-quarters of pregnant women have adequate health literacy. Nevertheless, measures including policies to sustain and enhance health literacy levels among all expectant mothers are required, with a specific focus on those having limited health literacy.

Climate change and its influence in nephron mass

PURPOSE OF REVIEW

The consequences of climate change, including heat and extreme weather events impact kidney function in adults and children. The impacts of climate change on kidney development during gestation and thereby on kidney function later in life have been poorly described. Clinical evidence is summarized to highlight possible associations between climate change and nephron mass.

RECENT FINDINGS

Pregnant women are vulnerable to the effects of climate change, being less able to thermoregulate, more sensitive to the effects of dehydration, and more susceptible to infections. Exposure to heat, wildfire smoke, drought, floods and climate-related infections are associated with low birth weight, preterm birth and preeclampsia. These factors are associated with reduced nephron numbers, kidney dysfunction and higher blood pressures in offspring in later life. Exposure to air pollution is associated with higher blood pressures in children and has variable effects on estimated glomerular filtration rate.

SUMMARY

Climate change has important impacts on pregnant women and their unborn children. Being born too small or too soon is associated with life-time risk of kidney disease. Climate change may therefore have a dual effect of impacting fetal kidney development and contributing to cumulative postnatal kidney injury. The impact on population kidney health of future generations may be significant.

Advantages and disadvantages of using theory-based versus data-driven models with social and behavioral determinants of health data

OBJECTIVE

Theory-based research of social and behavioral determinants of health (SBDH) found SBDH-related patterns in interventions and outcomes for pregnant/birthing people. The objectives of this study were to replicate the theory-based SBDH study with a new sample, and to compare these findings to a data-driven SBDH study.

MATERIALS AND METHODS

Using deidentified public health nurse-generated Omaha System data, 2 SBDH indices were computed separately to create groups based on SBDH (0-5+ signs/symptoms). The data-driven SBDH index used multiple linear regression with backward elimination to identify SBDH factors. Changes in Knowledge, Behavior, and Status (KBS) outcomes, numbers of interventions, and adjusted R-squared statistics were computed for both models.

RESULTS

There were 4109 clients ages 13-40 years. Outcome patterns aligned with the original research: KBS increased from admission to discharge with Knowledge improving the most; discharge KBS decreased as SBDH increased; and interventions increased as SBDH increased. Slopes of the data-driven model were steeper, showing clearer KBS trends for data-driven SBDH groups. The theory-based model adjusted R-squared was 0.54 (SE = 0.38) versus 0.61 (SE = 0.35) for the data-driven model with an entirely different set of SBDH factors.

CONCLUSIONS

The theory-based approach provided a framework to identity patterns and relationships and may be applied consistently across studies and populations. In contrast, the data-driven approach can provide insights based on novel patterns for a given dataset and reveal insights and relationships not predicted by existing theories. Data-driven methods may be an advantage if there is sufficiently comprehensive SBDH data upon which to create the data-driven models.

Associations between maternal health literacy, neonatal health and breastfeeding outcomes in the early postpartum period

INTRODUCTION

Maternal health literacy is a social skill that is relevant to successful postnatal newborn adaptation, neonatal feeding, and neonatal health outcomes, given the importance of maternal health literacy in newborn healthcare. The study aims to identify and assess the associations between maternal health literacy, neonatal health, and breastfeeding outcomes during the early postpartum period.

METHODS

Five hundred women who gave birth to full-term newborns at Vilnius University Hospital were invited to the study from 1 May to 30 September 2022. The 47 questions of the European Health Literacy Questionnaire (HLS-EU-Q47) were used to assess maternal health literacy on days 2 and 3 after birth. Each subject's health literacy indices were divided into four categories: inadequate, problematic, sufficient, and excellent. The neonatal health indicators were birth weight and height, along with the APGAR score and the outcomes of feeding either exclusively with breast milk or with adapted formula in addition to breastfeeding.

RESULTS

Most women who participated in the survey had insufficient or problematic health literacy (69%). The study showed that women's higher health literacy is associated with a lower risk of obesity, a healthier diet, regular physical activity, and a higher birth weight and height of their newborns (p<0.05). Mothers with inadequate/problematic health literacy were more likely to feed their newborns with adapted formula in addition to breastfeeding.

CONCLUSIONS

Women's health literacy is a factor that affects women's healthy lifestyle choices before and during pregnancy and is significant for newborns' health indicators.

The Turkish validity and reliability of the maternal health literacy inventory in pregnancy

BACKGROUND

There is no Turkish scale measuring maternal health literacy during pregnancy. This study adapted the Maternal Health Literacy Inventory in Pregnancy (MHELIP) to Turkish.

METHODS

A methodological study's sample consisted of 500 pregnant women admitted to the antenatal clinics of a Maternity Hospital in Ankara, Türkiye. Data were collected using a personal information form, the MHELIP and the Turkish Health Literacy Index (HLI). Language, content, and construct validity were determined. Cronbach's alpha coefficient and item analysis were used to assess reliability. Equivalent-form reliability was evaluated using the HLI.

RESULTS

The scale has a four-factor structure that fits well with 48 items (factor loadings: 0.57-0.92; fit index: 4.15 x2/df, 0.08 RMSEA, 0.07 SRMR). The total scale has a Cronbach's alpha of 0.96. The subscales "maternal health knowledge," "search for maternal health information," "assessment of maternal health information," and "maternal health decision making and behavior" have Cronbach's alpha of 0.96, 0.91, 0.86, and 0.94, respectively. There is a correlation between MHELIP and HLI scores (r = 0.570, p<0.001).

CONCLUSION

The MHELIP is a valid and reliable tool for measuring and screening the maternal health literacy of Turkish pregnant women.

Social Media and Black Maternal Health: The Role of Health Literacy and eHealth Literacy

BACKGROUND

Black women experience greater maternal mortality and morbidity than White women. Although there are many causes of this disparity, providing more and better maternal health information to this population may be beneficial. Social media offers a way to easily and quickly disseminate information to empower and educate Black women about health during pregnancy.

OBJECTIVE

This study sought to identify social media use patterns to determine what sources Black women used to obtain information about pregnancy and to explore whether health literacy/eHealth literacy influence those patterns.

METHODS

This cross-sectional, nationally representative survey panel included 404 Black women. Health literacy was measured by the Single Item Literacy Screener, and eHEALS was used to measure eHealth literacy. We examined participants' social media activity, social media use, social media use for support, and sharing of pregnancy-related health information. Relationships between health literacy, eHealth literacy, and social media use were assessed.

KEY RESULTS

Overall, 67.5% of participants had high health literacy, and the average eHealth literacy score was high (34.5). Most women (71.6%) reported using more than three social media accounts as a source for pregnancy information. Women with low health literacy searched social media for general and specific pregnancy health information, reported more social media use during pregnancy in general (p < .001), and more use of social media for giving and getting support (p = .003). Women with higher eHealth literacy were more likely to report more social media use (r = 0.107, p = .039) and often used social media to give and get support (r = 0.197, p = .0001). Women with high health literacy more often reported sharing the pregnancy information they found on social media with their nurse (χ² = 7.068, p = .029), doula (χ² = 6.878, p = .032), and childbirth educator (χ² = 10.289, p = .006). Women who reported higher eHealth literacy also reported more often sharing the pregnancy information they found on social media with their doctor (r = 0.115, p = .030), nurse (r = 0.139, p = .001), coworkers (r = 0.160, p = .004), and family or friends (r = 0.201, p = .0001).

CONCLUSION

Substantial numbers of Black women use social media to find pregnancy health information. Future studies should elicit more detailed information on why and how Black women use social media to obtain pregnancy information and support as well as what role health literacy and eHealth literacy may have on birth outcomes. [HLRP: Health Literacy Research and Practice. 2023;7(3):e119-e129.].

Communicating the Gynecologic Brachytherapy Experience (CoGBE): Clinician perceived benefits of a graphic narrative discussion guide

PURPOSE

Many current radiotherapy patient education materials are not patient-centered. An interprofessional team developed Communicating the Gynecologic Brachytherapy Experience (CoGBE), a graphic narrative discussion guide for cylinder, intracavitary, and interstitial high-dose-rate (HDR) gynecologic brachytherapy. This study assesses perceived clinical benefits, usability, and anxiety-reduction of CoGBE.

METHODS AND MATERIALS

An electronic survey was sent to members of the American Brachytherapy Society. Participants were assigned to assess one of the three modality-specific CoGBE versions using a modified Systems Usability Scale (SUS), modified state-trait anxiety index (mSTAI), and Likert-type questions. Free response data was analyzed using modified grounded theory.

RESULTS

Median modified SUS score was 76.3 (interquartile range [IQR], 71.3-82.5) and there were no significant differences between guide types. Median mSTAI was 40 (IQR, 40-43.3) for all guides collectively. The cylinder guide had a significantly higher median mSTAI than the intracavitary and interstitial guides (41.6 vs. 40.0 and 40.0; p = 0.04) suggesting the cylinder guide may have less impact on reducing anxiety. Most respondents reported that CoGBE was helpful (72%), would improve patient understanding (77%) and consultation memorability (82%), and was at least moderately likely to be incorporated into their practice (80%). Qualitative analysis themes included personalization and relatability (positive); generalizability (negative); illustrations (both).

CONCLUSIONS

Clinicians rate CoGBE as usable with potential to reduce patient anxiety, especially with more invasive treatment modalities including intracavitary or interstitial high-dose-rate. CoGBE has the potential to improve patient-clinician communication for a wider range of patients due to its accessible, adaptable, and patient-centered design.

The development and progress of health literacy in China

Limited health literacy is a serious public health problem. It is strongly associated with increased hospital admissions and readmission, poorer self-management, and health outcomes. It can lead to poor management of chronic disease, lower health care quality, increased mortality, and higher healthcare expenditures. Understanding China's current situation and the progress of health literacy levels are critical to achieving practical solutions for improving population health. This paper intended to provide a concise overview of the key milestones and specific practices in health literacy in China. We summarized the characteristics and changing profile of health literacy from 2008 to 2020 in China. We developed an intervention framework based on social ecosystem theory for improving health literacy in China. Meanwhile, some multi-level actionable recommendations were proposed. The study revealed that China has made progress in improving health literacy in the last decades. Health literacy levels increased from 6.48% of the population in 2008 to 23.15% in 2020. Geographic disparities were substantial. The East performed better health literacy than the Central and West, and cities had higher adequate health literacy than rural areas. Social development index, age, and education level were highly associated with health literacy. A global joint effort to improve health literacy will be required. And we advocate a whole-of-society approach that involves the participation of the entire ecosystem around the targeted population.

Racial and Ethnic Disparities in Primary Cesarean Birth and Adverse Outcomes Among Low-Risk Nulliparous People

OBJECTIVE

To compare trend of primary cesarean delivery rate and composite neonatal and maternal adverse outcomes in low-risk pregnancies among racial and ethnic groups: non-Hispanic White, non-Hispanic Black, and Hispanic.

METHODS

This population-based cohort study used U.S. vital statistics data (2015-2019) to evaluate low-risk, nulliparous patients with nonanomalous singletons who labored and delivered at 37-41 weeks of gestation. The primary outcome was the primary cesarean delivery rate. Secondary outcomes included composite neonatal adverse outcome (Apgar score less than 5 at 5 minutes, assisted ventilation for more than 6 hours, seizure, or death), and composite maternal adverse outcome (intensive care unit admission, blood transfusion, uterine rupture, or unplanned hysterectomy), as well as infant death. Multivariable Poisson regression models were used to estimate adjusted relative risks (aRR) and 95% CIs.

RESULTS

Among 4.3 million births, 60.6% identified as non-Hispanic White, 14.6% identified as non-Hispanic Black, and 24.8% identified as Hispanic. The rate of primary cesarean delivery was 18.5% (n=804,155). An increased risk for cesarean delivery was found in non-Hispanic Black (21.7%, aRR 1.24, 95% CI 1.23-1.25) and Hispanic (17.3%, aRR 1.09, 95% CI 1.09-1.10) individuals, compared with non-Hispanic White individuals (18.1%) after multivariable adjustment. There was an upward trend in the rate of primary cesarean delivery in all racial and ethnic groups ( P for linear trend<0.001 for all groups). However, the racial and ethnic disparity in the rate of primary cesarean delivery remained stable during the study period. The composite neonatal adverse outcome was lower in Hispanic individuals in all newborns (10.7 vs 8.3 per 1,000 live births, aRR 0.74, 95% CI 0.72-0.75), and in newborns delivered by primary cesarean delivery (18.5 vs 15.0 per 1,000 live births, aRR 0.73, 95% CI 0.70-0.76), compared with non-Hispanic White individuals.

CONCLUSION

Using a nationally representative sample in the United States, we found racial and ethnic disparities in the primary cesarean delivery rate in low-risk nulliparous patients, which persisted throughout the study period.

Preconception Mental Health, Socioeconomic Status, and Pregnancy Outcomes in Primiparous Women

Background:

One in four women of childbearing age has some degree of mental disorders and are, therefore, prone to both pregnancy complications and adverse health outcomes in their offspring. We aimed to evaluate the impact of preconception severe mental disorders on pregnancy outcomes in primiparous women.

Methods

The study cohort was composed of 6,189 Finnish primiparous women without previously diagnosed diabetes, who delivered between 2009 and 2015, living in the city of Vantaa, Finland. Women were classified to have a preconception severe mental disorder if they had one or more outpatient visits to a psychiatrist or hospitalization with a psychiatric diagnosis 1 year before conception. Data on pregnancies, diagnoses, and pregnancy outcomes were obtained from national registers at an individual level.

Results

Primiparous women with preconception severe psychiatric diagnosis were younger, more often living alone, smokers, and had lower educational attainment and lower taxable income than women without psychiatric diagnosis (for all p < 0.001). Of all women, 3.4% had at least one psychiatric diagnosis. The most common psychiatric diagnoses were depression and anxiety disorders. The most common comorbidity was the combination of depression and anxiety disorders. There were no differences in the need for respiratory treatments, admissions to the neonatal intensive care unit, or antibiotic treatments between the offspring's groups.

Conclusion

Although primiparous women had severe mental disorders, the well-being of newborns was good. The most common severe mental health disorders were depression and anxiety disorders, and psychiatric comorbidity was common. Women with severe mental disorders more often belonged to lower socioeconomic groups.

Spaces of Segregation and Health: Complex Associations for Black Immigrant and US-Born Mothers in New York City

Black immigrants are a growing proportion of the Black population in the USA, and despite the fact that they now comprise nearly a quarter of Black urban residents, few studies address the relationships between racial segregation and maternal and birth outcomes among Black immigrants. In this study of birth outcomes among US-born and immigrant Black mothers in New York City between 2010 and 2014, we applied multilevel models, assessing the association between segregation (measured through a novel kernel-based measure of local segregation) and adverse birth outcomes (preterm birth (PTB) and low birth weight (LBW; < 2500 g)) among African-born, Caribbean-born, and US-born Black mothers. We found that African-born and Caribbean/Latin American-born Black mothers had a significantly lower incidence of PTB compared with US-born Black mothers (7.0 and 10.1, respectively, compared with 11.2 for US-born mothers). We also found disparities in the incidence of infant LBW by nativity, with the highest incidence among infants born to US-born mothers (10.9), compared with African-born (6.9) and Caribbean-born mothers (9.0). After adjusting for maternal (maternal age; higher rates of reported drug use and smoking) and contextual characteristics (neighborhood SES; green space access), we found that maternal residence in an area with high Black segregation increases the likelihood of PTB and LBW among US-born and Caribbean-born Black mothers. In contrast, the association between segregation and birth outcomes was insignificant for African-born mothers. Associations between tract-level socioeconomic disadvantage and birth outcomes also varied across groups, with only US-born Black mothers showing the expected positive association with risk of PTB and LBW.