Journal of Health Literacy

Journal of Health Literacy

Health Literacy and Health Perception of Pregnant Women in the Southeast Region of Türkiye: A Cross-Sectional Study

Document Type : Original Article

Authors
Sema CIFCI 1
Aynur GüNES 2
Esra VERIM 3
1 Associate Professor, Mardin Artuklu University, Faculty of Health Science, Department of Nursing, Mardin.
2 Master's student, Mardin Artuklu University, Faculty of Health Science, Department of Nursing, Mardin.
3 Assistant Professor, Gaziantep University, Faculty of Health Sciences, Department of Midwifery, Gaziantep.
10.22038/jhl.2025.87429.1763
Abstract
Background and Objectives: This study was conducted to evaluate the relationship between health literacy level and health perception in third-trimester pregnant women and to determine the effect of health literacy on health perception.

Material and Methods: This descriptive and cross-sectional study was conducted in 2024 at Mardin Training and Research Hospital in Türkiye. Without selecting a sample, 201 third-trimester pregnant women who applied to obstetrics and gynecology units during the specified period were included in the study. The Personal Information Form, European Health Literacy Scale, and Health Perception Scale were used as data collection tools. Data were collected through face-to-face interviews and analyzed using nonparametric tests. İncluding the Mann–Whitney U test and Kruskal–Wallis test.

Results: 29.3% of the participants had inadequate, 46.2% had problematic, 23.3% had adequate, and only 0.9% had excellent health literacy. There was a significant correlation between health literacy and variables such as education level(p < 0.001), economic status(p = 0.002), housing type (p = 0.018), and reading frequency (p = 0.005). Health perception was generally found to be at a good level and showed significant associations with age at marriage (p = 0.014), economic status(p = 0.007), smoking (p = 0.036), and regular medication use(p = 0.011). However, no statistically significant correlation was found between health literacy and health perception(p = 0.412).

Conclusion: The study revealed that most pregnant women had inadequate or problematic health literacy levels, whereas their health perceptions were generally positive. Although both variables were influenced by various demographic and behavioural factors, no statistically significant relationship was found between health literacy and health perception. Reveals the importance of interventions to increase health literacy, especially in pregnant women.
Keywords
Health Literacy
Pregnancy
Health Perception

Acknowledgments: We express our profound appreciation to all the respondents involved in this study.


Availability of data and materials: The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.


Conflict of interest: The authors declare that they have no competing interests.


Consent for publication: Not applicable.


Ethics approval and consent to participate: Before the study, the approval of Artuklu University Non-Interventional Ethics Committee dated 13.02.2024 and numbered 2024/2-34 was obtained. Written informed consent was obtained from all participants, and the study was conducted in full compliance with the ethical principles of the Declaration of Helsinki. Participants were informed about the study's aim, advantages, risks, and procedures before the intervention. Participants were provided with a digital information sheet that contained written and verbal explanations of the study's contents. The researcher maintained the privacy of each participant's identity while safely storing the data for the necessary time.


Funding: This study was not financially supported by any person, institution, or organization.


Authors' contribution: SÇ was responsible for the study design. SE and EV are supervising the work. SÇ, AG, and EV data, statistical analysis, and provide data. SÇ wrote the first draft of the article. All authors have reviewed and agreed on the final version Manuscript.

 

Open Access Policy: This is an open-access article under the terms of the Creative Commons Attribution License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

  1. Sørensen K, Van den Broucke S, Fullam J, Doyle G, Pelikan J, Slonska Z, et al. Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health. https://doi.org/10.1186/1471-2458-12-80PMid:22276600 PMCid:PMC3292515
  2. Baccolini, V., Rosso, A., Di Paolo, C., Isonne, C., Salerno, C., Migliara, G., & Romano, F. (2021). What is the prevalence of low health literacy in European Union member states? A systematic review and meta-analysis. Journal of general internal medicine, 36(3), 753-761https://doi.org/10.1007/s11606-020-06407-8 PMid:33403622 PMCid:PMC7947142
  3. Moreira, L. (2018), "Health literacy for people-centred care: Where do OECD countries stand?",. OECD Health Working Papers, No. 107, OECD Publishing, Paris.
  4. T.C. Sağlık Bakanlığı Sağlığın Geliştirilmesi Genel Müdürlüğü, Türkiye Sağlık Okuryazarlığı Düzeyi ve İlişkili Faktörleri Araştırması, Yayın No:1298, Semih Ofset, Ankara(2024). https://sggm.saglik.gov.tr/TR-107354/ turkiye-saglik-okuryazarligi-duzeyi-ve-iliskili-faktorleri-arastirmasi-raporu.html
  5. Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011;155(2):97-107. https://doi.org/10.7326/0003-4819-155-2-201107190-00005PMid:21768583
  6. Essam N, Khafagy MA, Alemam DS. Health literacy of pregnant women attending antenatal care clinics in Mansoura district, Egypt. J Egypt Public Health Assoc. 2022;97:24. https://doi.org/10.1016/j.srhc.2022.100796 PMid:36413879
  7. Masoudiyekta L, Nosratabadi M, Tayebpour M, Mehranfard S. Relationship between health literacy and pregnancy outcomes in women referring to comprehensive health service centers. J Health Literacy. 2022;6(4):69-76.
  8. Crozier SR, Robinson SM, Borland SE, Godfrey KM, Cooper C, Inskip HM; SWS Study Group. Do women change their health behaviours in pregnancy? Findings from the Southampton Women's Survey. Paediatr Perinat Epidemiol. 2009;23(5):446-453. https://doi.org/10.1111/j.1365-3016.2009.01036.xPMid:19689495 PMCid:PMC3091015
  9. Guler DS, Sahin S, Ozdemir K, Unsal A, Uslu Yuvaci H. Health literacy and knowledge of antenatal care among pregnant women. Health Soc Care Community. 2021;29(6):1815-1823. https://doi.org/10.1111/hsc.13291PMid:33484046
  10. Olander EK, Smith DM, Darwin Z. Health behaviour and pregnancy: a time for change. J Reprod Infant Psychol. 2018;36(1):1-3. https://doi.org/10.1080/02646838.2018.1408965 PMid:29517295
  11. Souto TS, Ramires A, Leite Â, Santos V, Santo RE. Health perception: validation of a scale for the Portuguese population. https://doi.org/10.9788/TP2018.4-17Pt
  12. Janaki S, Prabakar S. Examining socioeconomic factors influencing maternal health in pregnancy. J Hum Behav Soc Environ. 2024;1-19. https://doi.org/10.1080/10911359.2024/2 310272
  13. Santi, D. R., Suminar, D., Devy, S. R., Mahmudah, M., Soedirham, O., & Prasetyorini, A. (2022). Pregnant Women's Perception of Pregnancy, Childbirth and Postpartum Care: Literature Review in Developing Countries. Open Access Macedonian Journal of Medical Sciences, 10(F), 600-606. https://doi.org/10.3889/oamjms.2022.9587
  14. Burilkina SA, Suprun NG, Guryanova IV. Socio-psychological determinants of pregnant women's health. In: Maximova SG, editor. Complex Social Systems in Dynamic Environments. Cham: Springer; 2023. p. 113. https://doi.org/10.1007/978-3-031-23856-7_113
  15. Ersanlı Kaya, C., & Atasever, Z. Pregnant Women's Self-Perception and Affecting Factors. Gumushane University Journal of Health Sciences. 2022; 11(3): 956-968. https://doi.org/10.37989/gumussagbil.908030
  16. Sahin DS, Sahin S, Ozdemir K, Unsal A, Uslu Yuvaci H. Health literacy and knowledge of antenatal care among pregnant women. Health Soc Care Community. 2021 Nov;29(6):1815-23. https://doi.org/10.1111/hsc.13291 PMid:33484046
  17. Tugut N, Yesildag Celik B, Yilmaz A. Health literacy and its association with health perception in pregnant women. J Health Literacy. 2021;6(2):9-20. doi:10.22038/jhl.2021.58949.1170
  18. Altuntas Y, Ucar AK. Validity and reliability of the Turkish version of the Maternal Health Literacy Inventory in Pregnancy scale: a methodological study. Womens Health Nurs. 2024 Dec;30(4):330-339. https://doi.org/10.4069/whn.2024.10.18PMid:39756477 PMCid:PMC11700718
  19. Dursun Tanrıöver vd., 2014; Kerkez, N., & Şahin, T. (2023). Sağlık Okuryazarlığı İle Sağlık Algısı İlişkisinin İncelenmesi Üzerine Bir Araştırma. Balıkesir Sağlık Bilimleri Dergisi, 12(2), 336-346. https://doi.org/10.53424/balikesirsbd.1177899
  20. Bilir, N. (2014). Sağlık okur-yazarlığı. Türkiye Halk Sağlığı Dergisi, 12(1), 61-68. https://doi.org/10.20518/thsd.46492
  21. Deniz, S. Ş., D., Özer, Ö., & Sonğur, C. (2018). Effect of health literacy on health perception: an application in ındividuals at age 65 and older. Social Work in Public Health, 33(2), 85-95.https://doi.org/10.1080/19371918.2017.1409680 PMid:29257934
  22. Filiz, E., & Bodur, S. (2022). Gebe Kadınlarda Sağlık Okuryazarlığı Ve Sağlık Algısı İlişkisinin Değerlendirilmesi. Selçuk Sağlık Dergisi, 3(1), 17-33.
  23. Akça, E., Gökyıldız Sürücü, Ş., & Akbaş, M. (2020). Gebelerde sağlık algısı, sağlık okuryazarlığı ve ilişkili faktörler. İnönü Üniversitesi Sağlık Hizmetleri Meslek Yüksek Okulu Dergisi, 8(3), 630-642. https://doi.org/10.33715/inonusaglik.735467
  24. Ugurlu M, Uctu AK. The Relationship of the Prenatal Distress with Health Literacy and Health Perception of Pregnant Women. Iran J Public Health. 2023 Sep;52(9):1917-1924. https://doi.org/10.18502/ijph.v52i9.13573 PMid:38033842 PMCid:PMC10682581
  25. Abacıgil, F., Harlak, H., & Okyay, P. (2016). Turkish adaptation of the European Health Literacy Scale. Okyay, P. and Abacıgil, F. (Eds.) Türkiye Health Literacy Scales reliability and validity study (pp. 21-41). Ankara: Republic of Türkiye Ministry of Health Publication No: 1025
  26. Diamond, J. J., Becker, J. A., Arenson, C. A., Chambers, C. V., & Rosenthal, M. P. (2007). Development of a scale to measure adults' perceptions of health: Preliminary findings. Journal of Community Psychology, 35(5), 557-561 https://doi.org/10.1002/jcop.20164
  27. Kadıoğlu, H. and Yıldız, A. Validity and reliability of the Turkish version of the Health Perception Scale. Turkiye Klinikleri Journal of Medical Sciences. 2012;32(1):47-53.https://doi.org/10.5336/medsci
  28. World Health Organization. (n.d.). Health literacy. World Health Organization. Retrieved July 6, 2025, from https://www.who.int/news-room/fact-sheets/detail/health-literacy
  29. Kara, P. Determinants of well-being in pregnancy: the impact of sociodemographic and obstetric variables and maternal health literacy, cross sectional study. BMC Pregnancy and Childbirth, 2025, 25.1: 524. https://doi.org/10.1186/s12884-025-07654-5 PMid:40316974 PMCid:PMC12046907
  30. Carbone, E., et al. Maternal health literacy and empowerment in the United States: a scoping review. Medical Research Archives, 2024, 12.12. https://doi.org/10.18103/mra.v12i12.6182
  31. Siriwan, Thitaporn, et al. A Cross-Sectional Study of Maternal Health Literacy Among Third-Trimester Pregnant Women: Key Socio-demographic Determinants. Pacific Rim International Journal of Nursing Research, 2025, 29.3: 558-572. https://doi.org/10.60099/prijnr.2025.272373
  32. Asadi L, Amiri F, Safinejad H. Effect of health literacy level on improving quality of care during pregnancy in women attending health centers. J Educ Health Promot. 2020;9:286. https://doi.org/10.4103/jehp.jehp_204_20 PMid:33282991 PMCid:PMC7709769
  33. Filiz E. The relationship between health literacy and pregnancy and health perception [doctoral dissertation]. Konya: Selcuk University Institute of Health Sciences; 2015.
  34. Gönenç İM. Health literacy in terms of women's health. Yıldırım F, Keser A, editors. Health literacy. Ankara: Ankara University Press House; 2015. p. 61-74.
  35. Kurt Durmuş M, Ören B. Health literacy level in pregnant women and the effect of personal characteristics on health literacy. Health Prof. Research Derg. 2022;4(2):88-94.
  36. Dadipoor S, Ramezankhani A, Alavi A, Aghamolaei T, Safari-Moradabadi A. Pregnant women's health literacy in the South of Iran. J Fam Reprod Health. 2017;11(4):211-218.
  37. Senol DK, Gol I, Ozkan SA. Effect of health literacy levels on prenatal care utilization among pregnant women: a cross-sectional descriptive study. Int J Caring Sci. 2019;12(3):1717-1726. https://www.internationaljournalofcaringsciences.org
  38. Charoghchian Khorasani E, Peyman N, Esmaily H. Measuring maternal health literacy in pregnant women referred to health centers of Mashhad, Iran. J Midwifery Reprod Health. 2018;6(1):1157-1162. doi: 10.22038/JMRH.2017.9613
  39. Yılar Erkek, Z., & Öztürk Altınayak, S. The Relationship Between E-Health Literacy and Healthy Life Behaviors in Pregnant Women. Journal of Midwifery and Health Sciences. 2024;7(2): 282-292.
  40. Aydın, D., & Aba, Y. A. The Relationship Between Mothers' Health Literacy Levels and Breastfeeding Self-Efficacy Perceptions. Dokuz Eylül University Faculty of Nursing Electronic Journal. 2019; 12(1): 31-39.
  41. Dunkel Schetter C, Tanner L. Anxiety, depression and stress in pregnancy: implications for mothers, children, research, and practice. Curr Opin Psychiatry. 2012;25(2):141-148. https://doi.org/10.1097/YCO.0b013e3283503680 PMid:22262028 PMCid:PMC4447112
  42. Oflaz S, Amanak K, Kulaksız D. The Relationship Between Smoking and Adjustment to Pregnancy and Body Perception. Journal of Addiction. 2024;25(2):143-152. https://doi.org/10.51982/bagimli.1324625
  43. Fiore MC, Jaen CR, Baker TB, Bailey WC, Benowitz NL, Curry SJ, et al. Treating tobacco use and dependence: 2008 update U.S. Public Health Service clinical practice guideline executive summary. Respir Care. 2008;53(9):1217-1222.
  44. Audritsh NL. Measuring the impact of health literacy on perinatal depression. Adv Fam Pract Nurs. 2022;4(1):159-172 https://doi.org/10.1016/j.yfpn.2021.12.010
  45. Şirin Gök, M., & Küçük, K. Kanbur, A. Investigation of the relationship between health literacy and health practices in pregnant women. Journal of Continuing Medical Education. 2023; 31 (6): 409-417. https://doi.org/10.17942/sted.1021910
  46. Baltacı, N., Kaya, N., & Kılıçkaya, İ. Investigation of E-Health Literacy and Healthy Life Behaviors of Pregnant Women. Journal of Continuing Medical Education. 2023; 32(4): 301-313. https://doi.org/10.17942/sted.1229364
  47. Çelik, A. S., & Derya, Y.A. Determination of the levels of self-care power and health practices of pregnant women and the factors affecting them. Gümüşhane University Journal of Health Sciences. 2019; 8(1): 111-119.
  48. Kılıç S, Yılmaz S. Relationship between psychosocial health status and fear of childbirth in primiparous pregnant women. Turk J Fam Med Prim Care. 2022;16(2):412-421. https://doi.org/10.21763/tjfmpc.1063671
  49. 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. https://doi.org/10.3390/ijerph18073847 PMid:33917631 PMCid:PMC8038834