Journal of Health Literacy

Journal of Health Literacy

Health Locus of Control, Health Literacy, and Depression in Pregnant Women: A Cross-sectional Study in Gonabad, Iran

Articles in Press

Document Type : Original Article

Authors
Mostafa Eghbalian 1
Seyyed Mohammad Hadi Hashemi 2
Mahdi Moshki 3
Roqhaieh Rahmani Bilandi 4
Ali Mohammad Mokhtari 5
1 Department of Epidemiology and Biostatistics, School of Health, Social Development and Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran.
2 Student Research Committee, Gonabad University of Medical Sciences, Gonabad, Iran.
3 Department of Health Education and Health Promotion, School of Health, Social Determinants of Health Research Center, Gonabad University of Medical Sciences, Gonabad, Iran.
4 Department of Midwifery, Reproductive Health and Population Research Center, Faculty of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran.
5 Department of Epidemiology and Biostatistics, School of Health, Reproductive Health and Population Research Center, Gonabad University of Medical Sciences, Gonabad, Iran.
10.22038/jhl.2026.95549.1970
Abstract
Background and Objectives: Depression in pregnant women and its negative consequences are serious issues. Health locus of control and health literacy are two essential components for the timely diagnosis of depression. This study aimed to investigate health locus of control, health literacy, and depression in pregnant women.

Materials and Methods: This cross-sectional study examined 216 pregnant women who referred to comprehensive health service centers. Data were collected using a stratified sampling method and questionnaires, including the Health Literacy Instrument for Adults (HELIA), the Multidimensional Health Locus of Control Scale (MHLC), and the Edinburgh Postnatal Depression Scale (EPDS). Statistical analyses were performed using R 4.5.0 software. All statistical tests were conducted at a 95% confidence level.

Result: The mean age of the participants was 29.04 ± 7.14 years. Significant positive correlations were found between the EPDS score and the number of pregnancies (p=0.001), number of children (p=0.003), and number of abortions (p=0.003). Higher EPDS scores were observed among illiterate mothers (p=0.020), mothers with unintended pregnancies (p=0.002) and mothers from low-income families (p<0.001). The EPDS score was significantly and negatively associated with most health literacy dimensions. The strongest correlations were observed for decision-making (r=-0.314, p<0.001) and the total HELIA Score (r=-0.311, p<0.001). Conversely, chance-related health locus of control (CHLC) was positively correlated with the EPDS score (r=0.247, p<0.001).

Conclusion: health literacy and a chance-related health locus of control significantly influence depressive symptoms among pregnant women. Higher health literacy was associated with a lower EPDS score, whereas CHLC showed a positive correlation. These results underscore the multifactorial nature of maternal depression and underscore the importance of educational interventions to improve health literacy and psychological control in pregnant women. Routine prenatal depression screening is recommended, especially for high-risk women.
Keywords
Health Literacy
Health Locus of Control
Depression
Pregnancy

Acknowledgments: The authors express their gratitude to all the women who participated in the study.


Availability of Data and Materials: The data that support the findings of this study are available from the corresponding author upon reasonable request.


Conflicts of interest: The authors have no financial or other relationships that could be perceived as a potential conflict of interest.


Consent for publication: Not applicable.


Ethical Approval and consent to participate: This study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. The study process was explained to all participants and informed consent forms were completed prior to participation in the study. This study was also approved by the Ethics Committee at Gonabad University of Medical Sciences under the code IR.GMU.REC.1401.155.


Funding: The authors declare that the funding sources for this study had no involvement in the study design; collection, analysis, or interpretation of data; writing of the report; or the Decision to submit the manuscript for publication.


Authors' Contribution: All authors have read and approved the final version of the manuscript.  Study concept and design: AM.M, M. M. Acquisition of data: AM.M, SM. H. Analysis and interpretation of data: M.E., R.RB, AM.M., M. M. Drafting of the manuscript: M.E., R.RB., AM.M., M. M., SM. H. Critical revision of the manuscript for important intellectual content: M.E., R.RB., AM.M. Statistical analysis: M.E, AM.M. Administrative, technical, and material support: AM.M, M. M. Study supervision: AM.M, M. M.

 

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/

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Journal of Health Literacy

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Available Online from 19 September 2026