The Effect of Health Literacy and Self-Efficacy Intervention on Nutrition of Pregnant Mothers and Infant Weight

Document Type : Original Article


1 Department of Health Education and Health Promotion, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran

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

3 Department of Biostatistics, Faculty of Health, Mashhad University of Medical Sciences, Mashhad, Iran.


Background and Objective: Maternal health literacy during pregnancy is essential in maintaining health of themselves and their children. The aim of this study was to determine the effects of a maternal education intervention based on the self-efficacy theory and health literacy on birth weight.

Materials and Methods: This clinical trial study was performed on 76 pregnant mothers, referred to Mashhad University of Medical Sciences health centers, Mashhad, Iran for routine prenatal checkups in 2016. The participants were assigned to two groups based on multistage cluster sampling method. Study questionnaires included demographic, maternal health literacy, pregnancy outcome and perceived dietary self-efficacy questionnaires Educational intervention including oral presentation, group discussion and multimedia tutorials. The questionnaires were completed at baseline, after intervention and at three months of follow up.

Results: The mean age of mothers was 24.92 ± 4.84 years (23.92 ± 4.59 and 25.92 ± 4.94 years in intervention and control groups respectively).  There was no significant difference between the intervention and control groups in terms of age, maternal health literacy and self-efficacy at baseline. Intervention resulted in significant improvement in health literacy (p<0.001) and nutrition self-efficacy (p<0.001) in the intervention group compared to control group. The mean birth weight of children was significantly higher in the intervention group (3324.14 ± 416.12 g) compared to the control group (3007.73 ± 468.63 g) (p=0.003).

Conclusions: The present findings indicate the effectiveness of the designed educational intervention based on self-efficacy theory in improving maternal health literacy and promoting normal birth weight in newborns.


1. Mohseni M, Khanjani N, Iranpour A, Tabe R, Borhaninejad VR. The relationship between health literacy and health status among elderly people in Kerman. Iranian Journal of Ageing. 2015;10(2):146-55.
2. Aghdasi Z, Tehrani H, Esmaiely H, Ghavami M, Vahedian-Shahroodi M. Application of social cognitive theory on maternal nutritional behavior for weight of children 6 to 12 months with Failure to thrive (FTT). Iranian Journal of Health Education and Health Promotion. 2021;9(2):145-58.
3. Vilanova CS, Hirakata VN, de Souza Buriol VC, Nunes M, Goldani MZ, da Silva CH. The relationship between the different low birth weight strata of newborns with infant mortality and the influence of the main health determinants in the extreme south of Brazil. Population health metrics. 2019;17(1):1-12.
PMid:31775758 PMCid:PMC6882357
4. Vargas-Terrones M, Nagpal TS, Barakat R. Impact of exercise during pregnancy on gestational weight gain and birth weight: an overview. Brazilian journal of physical therapy. 2019;23(2):164-9.
PMid:30527949 PMCid:PMC6428912
5. Muthayya S. Maternal nutrition & low birth weight-what is really important. Indian J Med Res. 2009;130(5):600-8.
6. Lee E-H, Lee YW, Moon SH. A structural equation model linking health literacy to self-efficacy, self-care activities, and health-related quality of life in patients with type 2 diabetes. Asian nursing research. 2016;10(1):82-7.
7. Torres RY, Marks R. 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.
8. Gaffari-Fam S, Lotfi Y, Daemi A, Babazadeh T, Sarbazi E, Dargahi-Abbasabad G, et al. Impact of health literacy and self-care behaviors on health-related quality of life in Iranians with type 2 diabetes: a cross-sectional study. Health and quality of life outcomes. 2020;18(1):1-9.
PMid:33148266 PMCid:PMC7640476
9. Renkert S, Nutbeam D. Opportunities to improve maternal health literacy through antenatal education: an exploratory study. Health Promotion International. 2001;16(4):381-8.
10. Creedy DK, Gamble J, Boorman R, Allen J. Midwives' self-reported knowledge and skills to assess and promote maternal health literacy: A national cross-sectional survey. Women and Birth. 2021;34(2):e188-e95.
11. Barnes LA, Barclay L, McCaffery K, Aslani P. Complementary medicine products: information sources, perceived benefits and maternal health literacy. Women and Birth. 2019;32(6):493-520.
12. Tehrani Banihashemi S-A, Haghdoost AA, Amirkhani MA, Alavian S-M, 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.
13. Endres LK, Sharp LK, Haney E, Dooley SL. Health literacy and pregnancy preparedness in pregestational diabetes. Diabetes care. 2004;27(2):331-4.
14. Ratzan SC, editor Integrating health literacy into primary and secondary prevention strategies. Institute of Medicine Workshop on Integrating Health Literacy into Primary and Secondary Prevention Strategies; 2009: Institute of Medicine September 15. Washington, DC.
15. Ashworth A. Effects of intrauterine growth retardation on mortality and morbidity in infants and young children. European journal of clinical nutrition. 1998;52:S34-41; discussion S.
16. Ohnishi M, Nakamura K, Takano T. Improvement in maternal health literacy among pregnant women who did not complete compulsory education: policy implications for community care services. Health policy. 2005;72(2):157-64.
17. Jones J, Housman J, McAleese W. Exercise, Nutrition, And Weight Management During Pregnancy. American Journal of Health Studies. 2010;25(3).
18. Szwajcer EM, Hiddink GJ, Koelen MA, van Woerkum CM. Nutrition awareness and pregnancy: implications for the life course perspective. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2007;135(1):58-64.
19. Shom ER. Perceived nutritional status, perceived dietary self-efficacy, and dietary behavior among bangladeshi pregnant women: Prince of Songkla University; 2010.
20. Pakniat H, Movahed F. Relationship between body mass index, weight gain during pregnancy and birth weight of infants. Alborz University Medical Journal. 2012;1(3):130-6.
21. Kohan S, Ghasemi S, Dodangeh M. Associations between maternal health literacy and prenatal care and pregnancy outcome. Iranian Journal of Nursing and Midwifery Research. 2008;12(4).
22. Nam S, Chesla C, Stotts NA, Kroon L, Janson SL. Barriers to diabetes management: patient and provider factors. Diabetes research and clinical practice. 2011;93(1):1-9.
23. Nejati A, Ahadi H, Meschi F, Seirafi Mr, kraskian mojembari A. Pain Sensation and Long-term Suffering due to Chronic Pain in Patients with Rheumatoid Arthritis: Mediating Role of Self-efficacy. Iranian Journal of Health Education and Health Promotion. 2020;8(1):10-22.
24. Khosravi A, Kh A, Sh A, Tahmasbi R. Health literacy levels of diabetic patients referred to Shiraz health centers and its effective factors. Health Inf Manage. 2015;12(2):205.
25. Erkal YA. The effects and related factors of health literacy status and self-efficacy of pregnant women. International Journal of Caring Sciences. 2019;12(3):1815-24.
26. Mohebi S, Sharifirad G, Rasekhi H, Matlabi M, Shahsiah M, Tabaraie Y. Effect of nutrition education program on the recommended weight gain in during pregnancy application of Health Belief Model: A randomaized cilinical trial. Qom University of Medical Sciences Journal. 2012;6(1):23-30.
27. Mojoyinola J. Influence of maternal health literacy on healthy pregnancy and pregnancy outcomes of women attending public hospitals in Ibadan, Oyo State, Nigeria. African Research Review. 2011;5(3).
28. Kharazi SS, Peyman N, Esmaily H. The Relationship between Maternal Health Literacy and Nutritional Dietary Self-Efficacy with Pregnancy Outcome. Journal of Midwifery and Reproductive Health. 2020;8(1):2058-68.
29. Tol A, Pourreza A, Tavasoli E, Foroshani R. Determination of knowledge and health literacy among women with type 2 diabetes in teaching hospitals of TUMS. Journal of Hospital. 2012;11(3).
30. Peyman N, Behzad F, Taghipour A, Esmaeily H. Promoting level of health literacy & self efficacy of chronic patients referred to health centers through educating health literacy for the staffs of health centers in Mashhad, 2013. Mashhad: Mashhad University of Medical Sciences School of Health. 2013.
31. Cavanaugh K, Wallston KA, Gebretsadik T, Shintani A, Huizinga MM, Davis D, et al. Addressing literacy and numeracy to improve diabetes care: two randomized controlled trials. Diabetes care. 2009;32(12):2149-55.
PMid:19741187 PMCid:PMC2782967
32. Kandula NR, Nsiah-Kumi PA, Makoul G, Sager J, Zei CP, Glass S, et al. The relationship between health literacy and knowledge improvement after a multimedia type 2 diabetes education program. Patient education and counseling. 2009;75(3):321-7.
33. Ashraf-Ganjoei T, Mirzaei F, Anari-Dokht F. Relationship between prenatal care and the outcome of pregnancy in low-risk pregnancies. Open J Obstet Gynecol. 2011;1(3):109-12.
34. Douglas F, Clark J, Craig L, Campbell J, McNeill G. "It'sa balance of just getting things right": mothers' views about pre-school childhood obesity and obesity prevention in Scotland. BMC public health. 2014;14(1):1-12.
PMid:25260375 PMCid:PMC4192741
35. Yee LM, Simon MA. The role of health literacy and numeracy in contraceptive decision-making for urban Chicago women. Journal of community health. 2014;39(2):394-9.
36. Afshari M, Khazaei S, Bahrami M, Merati H. Investigating adult health literacy in Tuyserkan city. Journal of Education And Community Health. 2022;1(2):48-55.
37. LeVine RA, LeVine SE, Rowe ML, Schnell-Anzola B. Maternal literacy and health behavior: a Nepalese case study. Social science & medicine. 2004;58(4):863-77.