Maternal Health Literacy and Its Association with Spiritual Health in Women

Document Type : Original Article


1 Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Department of Health Education and Health Promotion, school of Health, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

4 Department of Public Health, School of Health, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran

5 Department of Public Health, School of Health, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran.

6 Department of Public Health, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran.


Background and Objective: Maternal health literacy is important  because women’s health and their children and family’s health depends on their women’s health literacy skills. Inadequate health literacy is a main factor to several health disparities and may   affect women’s spiritual health. However, the linkage between maternal health literacy and women's spiritual health has not yet been studied well and it remains an open question. . The aim of this study is to examine level of maternal health literacy of women Torbat Heydarieh and to explore its association with spiritual health.

Materials and Methods: A cross-sectional study was conducted, in 2018, through a multi-stage sampling design on 269 women in Torbat Heydarieh, Iran. Data was collected through valid and reliable questionnaires including the maternal health literacy, Paloutzian and Ellison Spiritual Health. Data were analyzed using correlation and regression coefficients test by the SPSS23.0.

Results: mean age of the studied women, maternal health literacy score, and spiritual health were 28.9±5.8 years, 42.9±5.8, and 88.7±13.3, respectively. There was no significant relationship between maternal health literacy and spiritual health (P=0.20), and level of education had a significant relationship with health literacy (P<0.0001).  
Conclusion: In this study, also there was no significant relationship between maternal health literacy and spiritual health among women, which can be an area of future research.


1. Nutbeam D KI. Advancing health literacy: a global challenge for the 21st century. Health promotion international. 2000;15(3):183-4.
2. Jafari A, Nejatian M, Momeniyan V, Barsalani FR, Tehrani H. Mental health literacy and quality of life in Iran: a cross-sectional study. BMC psychiatry. 2021;21(1):1-11..
PMid:34641793 PMCid:PMC8507341  
3. Karamali M, Yaghoubi M, Parandeh A. Scientific Mapping of Papers Related to Health Literacy Using Co-Word Analysis in Medline. Iranian Journal of Health Education and Health Promotion. 2021;9(3):280-95.  
4. Baker DW WM, Feinglass J, Thompson JA, Gazmararian JA, Huang J. Health literacy and mortality among elderly persons. Archives of Internal Medicine. 2007;167(14):1503-9.
5. Tol A PA, Rahimi Foroshani A, Tavassoli E. Assessing the effect of educational program based on small group on promoting knowledge and health literacy among women with type2 diabetes referring to selected hospitals affiliated to Tehran University of Medical Sciences. Razi Journal of Medical Sciences. 2013;19(104):10-9.  
6. Tehrani Banihashemi S AM, Haghdoost AA, Alavian S, Asgharifard H, Baradaran H, et al. Health Literacy and the Influencing Factors: A Study in Five Provinces of Iran. Strides in Development of Medical Education. 2007;4(1):1-9.  
7. Ghanbari S MF, Ghaffari M, Mahmoodi Majdabadi M. Evaluation of health literacy of pregnant women in urban health centers of Shahid Beheshti Medical University. Shahed Journal System 2012;19(97):1-12.  
8. Javadzade H SG, Reisi M, Tavassoli E, Rajati F. Health Literacy among Adults of Isfahan, Iran. Journal of health system research. 2013;9(5):540-9.  
9. Charoghchian Khorasani E, Tavaholy Sany SB, Orooji A, Ferns G, Peyman N. Health Literacy in Iranian Women: A Systematic Review and Meta-Analysis. Iran J Public Health. 2020;49(5):860-74.
PMid:32953674 PMCid:PMC7475634  
10. Rahimi N, Nouhi E, N. N. Spiritual Well-being and Attitude toward Spirituality and Spiritual Care in Nursing and Midwifery Students. Iran Journal of Nursing. 2013;26(85):55-65.  
11. Mozafarinia F, Amin-Shokravi F, A H. Relationship between Spiritual Health and Happiness among Students. Journal of health education and health promotion. 2014;2(2):97-107.  
12. Tabibi M, Ahmari Tehran H, Soltani Arabshahi SK, Heidari S, Abdi Z, Safaeipour R. The association between spiritual health and academic achievement in medical students of Qom University of Medical Sciences, 2011. Qom University of Medical Sciences Journal. 2013;7(2):72-8.  
13. Chiang Y-C, Lee H-C, Chu T-L, Wu C-L, Hsiao Y-C. The relationship between spiritual health, health-promoting behaviors, depression and resilience: A longitudinal study of new nurses. Nurse Education in Practice. 2021;56:103219.
14. Francis LJ, Lankshear DW, Eccles EL. Introducing the Junior Spiritual Health Scale (JSHS): assessing the impact of religious affect on spiritual health among 8-to 11-year-old students. International Journal of Children's Spirituality. 2021:1-15.  
15. Lintang G. The Relation between Physical, Mental and Spiritual Health. Academia Letters. 2021;27(2):2.  
16. Padehban V, Barasteh S, Rahimi A, Chobin M. The relationship between spiritual health with general health and health literacy in Iranian naval personnel in 2016. Journal of Marine Medicine. 2020;2(3):157-63.  
17. Zadeahmad Z, Abdolahi M, Tavakkoli Sani SB, Charoghchian Khorasani E. The study of tendency to childbearing and its relationship with spiritual health and health literacy in women referred to the healthcare centers of Torbat Heydarieh, Iran, in 2019. Razi Journal of Medical Sciences. 2020;27(8):32-41.  
18. Harsch S, Jawid A, Jawid ME, Saboga Nunes L, Sahrai D, Bittlingmayer UH. The relationship of health literacy, wellbeing and religious beliefs in neglected and unequal contexts-Results of a survey study in central Afghanistan. Health Promotion Journal of Australia. 2021;32:80-7.
19. Amiresmaili M NMM, Saberi anari S, Sadeghi A, Saber M, Taheri G, et al. Study of health literacy level of women referring to health centers-2010. Journal of North Khorasan University of Medical Sciences 2013. 2013;5(Student Research Committe Supplementary ):1079.  
20. Ghaffari M, Hatami H, Rakhshandrrou S, Shoghli A, Heidari A. Health Literacy among Women Referring to Healthcare Centers of Zanjan City, Iran: A Cross-sectional Study. Journal of Education and Community Health. 2018;5(1):42-8.  
21. JK. M. Influence of maternal health literacy on healthy pregnancy and pregnancy outcomes of womenattending publice hospitals in Ibaban, Oyo State,Nigeria. Afr Res Rev. 2011;5(3):28-39.  
22. Kharazi S PN, Esmaily H. An evaluation of the validity and reliability of the maternal health literacy and pregnancy outcome questionnaire. Journal of Health System Research. 2017;12(4):512-9.  
23. Rahmati Najarkolaei F, Haghighi M, Babaei Heydarabadi A, Ansarian A, M M. Investigation of spiritual healthin staff of one Medical Sciences University in Tehran. Reaserch on Religion & Health. 2015;1(1):13-20.  
24. Kilfoyle K VM, O'Conor R, Bailey S. Health Literacy and Women's Reproductive Health: A Systematic Review. Journal of Women's Health. 2016;25(12):1237-55.
PMid:27564780 PMCid:PMC5175428  
25. Ansari H AZ, Ansari-Moghaddam A, Mohammadi M, Peyvand M, Hajmohammadi M, et al. Health literacy in older adults and its related factors: a cross-sectional study in Southeast Iran. Health Scope. 2016;5:4.  
26. Bröder J OO, Bauer U, Bruland D, Schlupp S, Bollweg TM, et al. Health literacy in childhood and youth: a systematic review of definitions and models. BMC Public Health 2017;17(1):361.
PMid:28441934 PMCid:PMC5405535  
27. B. F. Health literacy and health disparities: The role they play in maternal and child health. Nursing for women's health. 2008;12(4):286-98.
28. JE C. Health literacy and women's health: challenges and opportunities. . Journal of midwifery & women's health. 2013;58(3):257-64.
29. Shieh C HJ. Understanding the impact of health literacy on women's health. . Journal of Obstetric, Gynecologic & Neonatal Nursing. 2009;38(5):601-12.
30. Endres LK SL, Haney E, Dooley SL. Health literacy and pregnancy preparedness in pregestational diabetes. Diabetes care. 2004;27(2):331-4.
31. Torres R MR. Relationships among health literacy, knowledge about hormone therapy, self-efficacy, and decision-making among postmenopausal health. Journal of health communication. 2009;14(1):43-55.
32. Pagán J BC, Asch D, Armstrong K, Bastida E, Guerra C. Health literacy and breast cancer screening among Mexican American women in South Texas. Journal of Cancer Education. 2012;27(1):132-7.
33. Kaufman H SB, Small L, Terry T, Mcgrew M. Effect of literacy on breast-feeding outcomes. . Southern medical journal. 2001;94(3):293-6.
34. Charoghchian Khorasani E, Peyman N, H. E. Relations between Breastfeeding Self-efficacy and Maternal Health Literacy among Pregnant Women. Evidence Based Care. Evidence Based Care. 2017;6(4):18-25.  
35. Khosravi A, Ahmadzadeh Kh, Arastoopoor Sh, R. T. Health Literacy Levels of Diabetic Patients Referred to Shiraz Health Centers and Its Effective Factors. Health Inf Manage. 2015;12(2):194-205.  
36. Safari Morad Abadi A, Agha Molaei T, Ramezankhani A, Dadipoor S. The Health Literacy of Pregnant Women in Bandar Abbas, Iran. Journal of School of Public Health and Institute of Public Health Research. 2017;15(2):121-32.  
37. Najimi A GP, Amini S. Health literacy and self-care in reproductive age: The role of reading and numeracy skills. Journal of Nursing Education. 2017;6(5):19-24.  
38. Peyman N, M A. The relationship between health literacy and self-efficacy physical activity in postpartum women. Journal of Health Literacy. 2016;1(1):5-12.  
39. E CK, N P, H E. Measuring Maternal Health Literacy in Pregnant Women Referred to the Healthcare Centers of Mashhad, Iran, in 2015. Journal of Midwifery and Reproductive Health. 2018;6(1):1157-62.