Health literacy and related factors in postpartum women in Farsan, Iran

Document Type : Original Article


1 Master student, Reproductive Health Education, Faculty of Health, Isfahan University of Medical Sciences, Isfahan, Iran

2 Assistant professor, Reproductive Sciences and Sexual Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran


Background and Objectives: Health literacy provides us not only with motivation and knowledge, but also with the opportunity to seek, comprehend, assess, and apply information for making right decision in critical situations. Pregnancy and postpartum are considered to be unique and significant periods in a woman's life. Health literacy and its determinants can play an important role in protecting and improving the health of women. The aim of this study was to assess health literacy and its associated factors among postpartum women referring to Farsan comprehensive health centers.

Materials and Methods: This descriptive–analytical study was conducted on 300 postpartum women referring to Farsan comprehensive health centers in 2021. Quota-convenience Sampling was used to select the participants. Data were collected by demographic information and Iranian health literacy standard questionnaires. Descriptive statistics, Independent t-test and Pearson correlation test, kruskal-wallis and Mann-whitney tests were used to analyze the data.
Results: The total mean score of health literacy was 61.62±17.02. Among the dimensions of health literacy, the highest score belonged to understanding, followed by reading, accessibility, evaluation and decision making. 63 (21%) of the participants had inadequate health literacy, 96 (32%) had not quite adequate, 128 (42.7%) had adequate, and 13 (34.3%) had high health literacy. Health literacy was significantly correlated with age (r=0.342, p<0.001), education (Χ2= 17.734, p<.001), occupational status (t=-2.843, p=.005) and spouse' age (r=.264, p<.001). 

Conclusions: Health literacy score in more than half of women in our study was inadequate, especially in the young women with young husbands, low education level and housewives. The dimensions of evaluation and decision-making should be given more attention and effective interventions should be designed in this regard.


Acknowledgement: This article is the result of a master’s thesis at Isfahan University of Medical Sciences with the code of 399762. The researchers would like to express their thanks to the Vice Chancellor for Research of Isfahan University of Medical Sciences and the women who participated in the study.

Availability of data and materials: Data are available from the authors upon reasonable request 

Competing interests: The authors declare that they have no competing interests

Consent for publication: not applicable

Ethical considerations: This research was approved by the Ethics Committee of Isfahan University of Medical Sciences with the ethics code of IR.MUI.RESEARCH.REC.1399.668. All methods were performed in accordance with the relevant guidelines and regulations. Participation in this study was completely voluntary, and informed written consent was obtained from all participants. The questionnaires were anonymous, and the participants were assured that their information would remain confidential.

Funding: Research deputy of Isfahan University of medical sciences

Authors' contributions: MJ designed the work, analyzed and interpreted the data, was a major contributor in writing the manuscript; H.H designed and implemented the work, analyzed the data. Authors have read and approved the manuscript.

1- Brach C, Harris LM. Healthy people 2030 health literacy definition tells organizations: make information and services easy to find, understand, and use. J Gen Intern Med. 2021;36(4):1084-5.
PMid:33483812 PMCid:PMC8042077
2. Sorensen K, Van den Broucke S, Fullam J, Doyle G, Pelikan J, Slonska Z. i wsp. Health literacy and public health: A systematic review and integration of definitions and models.BMC Public Health. 2012;12(1):1-13.
PMid:22276600 PMCid:PMC3292515
3. Nutbeam D. Defining, measuring and improving health literacy. HEP.2015;42(4):450-6.
4- Fleary SA, Joseph P, Pappagianopoulos JE. Adolescent health literacy and health behaviors: A systematic review. J Adolesc. 2018; 62:116-27.
5- Gonzalez JS, Tanenbaum ML, Commissariat PV. Psychosocial factors in medication adherence and diabetes self-management: Implications for research and practice. Am Psychol. 2016;71(7):539.
PMid:27690483 PMCid:PMC5792162
6- Jandorf S, Krogh Nielsen M, Sørensen K, Sørensen TL. Low health literacy levels in patients with chronic retinal disease. BMC Ophthalmol. 2019;19(1):1-5.
PMid:31395040 PMCid:PMC6686552
7- Mehrtak M, Hemmati A, Bakhshzadeh A. Health Literacy and its Relationship with the medical, dietary Adherence and exercise in Patients with Type II Diabetes mellitus. J. Health Lit. 2018;3(2):137-44
8 - Dadipoor S, Ramezankhani A, Alavi A, Aghamolaei T, Safari-Moradabadi A. Pregnant women's health literacy in the south of Iran. J Family Reprod Health. 2017;11(4):211. (in Persian)
9- Eslami V, Sany SBT, Tehrani H, Ghavami V, Peyman N. Examining health literacy and self-efficacy levels and their association with preventive behaviors of urinary tract infection in Iranian pregnant women: across sectional study. BMC Women's Health. 2023;23(1):258.
PMid:37173682 PMCid:PMC10180610
10- Headley AJ, Harrigan J. Using the pregnancy perception of risk questionnaire to assess health care literacy gaps in maternal perception of prenatal risk. J Natl Med Assoc. 2009;101(10):1041-5.
11- Tugut N, Yesildag Celik B, Yılmaz A. Health literacy and its Association with Health Perception in pregnant women. J. Health Lit. 2021;6(2):9-20.
12 - Taheri S, Tavousi M, Momenimovahed Z, Direkvand-Moghadam A, Rezaei N, Sharifi N, Taghizadeh Z. Determining health literacy level and its related factors among pregnant women referred to medical and health centers of Tehran in 2019: a cross-sectional study. Shiraz E Med J. 2021;22(10):e109592.
13- Nawabi F, Krebs F, Vennedey V, Shukri A, Lorenz L, Stock S. Health literacy in pregnant women: a systematic review. Int J Environ Res Public Health. 2021;18(7):3847.
PMid:33917631 PMCid:PMC8038834
14- Rostamzadeh M, Ezadi Z, Hosseini M, Husseini AA. Maternal health literacy and pregnancy outcomes in Afghanistan. J Educ Health Promot. 2022;11:421
PMid:36824100 PMCid:PMC9942158
15- Poreddi V, Sundaram V, Reddy SN, Bidadi K, Thimmaiah R. Postpartum depression: Mental health literacy of Indian mothers. Arch Psychiatr Nurs. 2021;35(6):631-7.
16- Guler DS, Sahin S, Ozdemir K, Unsal A, Uslu Yuvacı H. Health literacy and knowledge of antenatal care among pregnant women. Health Soc Care Community. 2021;29(6):1815-23.
17- Montazeri A, Tavousi M, Rakhshani F, Azin A, Jahangiri K, Ebadi M. Development and psychometric measure of Health Literacy Iran Urban population (18 to 65 years). J. Health Sci. Institute. 2014;13(5):589-99.
18-Izadirad H, Niknami S, Zareban I, Hidarnia A, Masoudy G. Relationship between health literacy and prenatal care in young pregnant women. J. Health Lit Autumn 2017; 2(3): 141-147
19. Valero-Chillerón MJ, Mena-Tudela D, Cervera-Gasch Á, González-Chordá VM, Soriano-Vidal FJ, Quesada JA, Castro-Sánchez E, Vila-Candel R. Influence of health literacy on maintenance of exclusive breastfeeding at 6 months postpartum: a multicentre study. Int J Environ Res Public Health. 2022;19(9):5411.
PMid:35564807 PMCid:PMC9104596
20. Khazaei M, Tehrani H, Vahedian-Shahroodi M, Esmaily H, Taghipour A. women's health literacy and some related factors in Mashhad. J. Health Lit. 2021;5(4):9-16.
21. Yee LM, Silver R, Haas DM, Parry S, Mercer BM, Wing DA, et al. Association of health literacy among nulliparous individuals and maternal and neonatal outcomes. JAMA Netw Open. 2021;4(9): e2122576
PMid:34468757 PMCid:PMC8411280
22. Arioz Duzgun A, Gozuyesil E. The Relationship between Health Literacy and Health Practices in Pregnancy and their Affecting Factors: A Cross-Sectional Study. J. Midwifery Reprod. Health. 2022;10(3):3417-28.
23. Hakkak HM, Joveini H, Rajabzadeh R, Robatsarpooshi D, Tori NA, Haresabadi M, et al. Health literacy level and related factors among pregnant women referring to bojnord health centers in 2017. Int J Pharmaceut Res. 2019;11(1):152-8.
24. Mogharab F, Inaloo R, Javadpour S, Jamali S, Poornowrooz N. The correlation between health literacy and quality of life in pregnant women. Med Sci. 2018; 22:503-8.
25. Baharvand P, Anbari K, Abdolian M. Health Literacy and Its Predictors Among Pregnant Women: A Cross-sectional Study. J. Educ. Community Health. 2022 ;9(3):170-5.
26. Khorasani EC, Peyman N, Esmaily H. Measuring Maternal Health Literacy in Pregnant Women Referred to the Healthcare Centers of Mashhad, Iran, in 2015. J. Midwifery Reprod. Health. 2018;6(1).
27. Pirzadeh A, Nodooshan T, Nasirian M. Association between maternal health literacy level and prenatal care in Iran. J. Health Lit. 2019;4(1):60-7.
28. Senol D, Göl I, Ozkan S. The effect of health literacy levels of pregnant women on receiving prenatal care: a cross-sectional descriptive study. Int J Caring Sci. 2019;12(3):1717-24.
29. Masoudiyekta L, Nosratabadi M, Tayebpour M, Mehranfard S. Relationship between health literacy and pregnancy consequences in women referring to comprehensive health service centers. J. Health Lit. 2022;6(4):69-76.
30. Masoumy M, Jokar Z, Hamedi S, Zeratpisheh F, Ghaedi F. The relationship between maternal health literacy with Prenatal Cares in pregnant women referring to health centers. J. Health Lit. 2018;3(2):113-23.
31. Panahi R, Namdar P, Nayebi N, Anbari M, Yekefallah L, Dehghankar L. Sexual health literacy and the related factors among women in Qazvin, Iran. J. Educ. Community Health. 2021;8(4):265-70.
32. Abedini S, Nooradin S, Mohseni S, Daryafti H, Karimi F, Ezati-rad R. Health Literacy and Health-Promoting Behaviors in Southern Iran. J. Health Lit. 2021;6(2):53-60.
33. Safaie SZ, Rahebi SM, Haghjou S, Leili E. The relationship between maternal health literacy and pregnancy outcome in postnatal wards. J Biochem Tech. 2018; 2:120-7.
34- Pirdehghan A, Eslahchi M, Esna-Ashari F, Borzouei S. Health literacy and diabetes control in pregnant women. J Family Med Prim Care. 2020;9(2):1048.
PMid:32318465 PMCid:PMC7114019
35. Sajjadi H, Hoseinpoor N, Sharifian Sani M, Mahmoodi Z. Health literacy and unintended pregnancy among rural Iranian women. JRH. 2016;6(5):537-42.
36-Meldgaard M, Jensen AL, Johansen AD, Maimburg RD, Maindal HT. Health literacy and related behaviour among pregnant women with obesity: a qualitative interpretive description study. BMC Pregnancy Childbirth. 2022;22(1):712.
PMid:36123636 PMCid:PMC9483451
37-Zibellini J, Muscat DM, Kizirian N, Gordon A. Effect of health literacy interventions on pregnancy outcomes: A systematic review. Women Birth. 2021;34(2):180-6.