Journal of Health Literacy

Journal of Health Literacy

Associations between Maternal Health Literacy, Health-Seeking Behavior, and Maternal and Child Health Service Utilization: A Cross-Sectional Study

Articles in Press

Document Type : Original Article

Authors
Reny Nugraheni 1
David Raditya Suhartono 1
Ekawati Sutikno 1
Wahyu Sri Astutik 2
Santy Irene Putri 3
1 Faculty of Technology and Health Management, Institut Ilmu Kesehatan Bhakti Wiyata, Kediri, 64114, Indonesia.
2 Department of Nursing, Faculty of Health, Institut Ilmu Kesehatan Bhakti Wiyata, Kediri, 64114, Indonesia.
3 Health Information Management Study Program, Politeknik Kesehatan Wira Husada Nusantara Malang, 65144, Indonesia.
10.22038/jhl.2026.97409.2019
Abstract
Background and Objective: In Indonesia, many women who are planning to conceive or have already given birth lack sufficient knowledge of health-related issues and seldom take the initiative to seek medical help. These two problems have prevented local pregnant and postnatal women from accessing the necessary medical services. This study aims to clarify the specific associations between the five domains of maternal health cognition, their behaviors of actively seeking health services, and the actual utilization of maternal and child health services.

Materials and Methods: A cross-sectional study was conducted for this research, which collected relevant information from a group of people at the same time point for analysis. A total of 589 mothers were included, whose children were all aged between 0 and 59 months, with the youngest being newly born and the oldest less than five years old. The study used questionnaires to assess these mothers' level of health cognition, covering the cognitive domains of prenatal care, vaccination, breastfeeding, child growth monitoring, and Posyandu-related content. It also measured whether they would take the initiative to seek health help, as well as their actual utilization of health services. All collected data were analyzed using the generalized structural equation model (binomial logit model) in the STATA 17 software.

Results: Multivariable analysis revealed that ANC literacy (B=0.72; p=0.008; OR=2.05; 95% CI=1.21-3.48), immunization literacy (B=0.42; p=0.037; OR=1.53; 95% CI=1.03-2.27), breastfeeding literacy (B=0.58; p=0.007; OR=1.79; 95% CI=1.17–2.74), child growth monitoring literacy (B=0.51; p=0.036; OR=1.66; 95% CI=1.03-2.67), Posyandu literacy (B=0.76; p=0.008; OR=2.14; 95% CI=1.23-3.75), and health seeking behavior (B=0.49; p=0.017; OR=1.62; 95% CI=1.09-2.42) were significantly associated with maternal and child health service utilization. GSEM showed a statistically significant association between child growth monitoring literacy and health-seeking behavior.

Conclusion: Among mothers of children aged 0-59 months, a number of maternal health literacy and health-seeking behaviour categories were substantially correlated with the use of maternal and child health services.
Keywords
Antenatal Care Literacy
Health Seeking Behavior
Maternal Health Literacy
Posyandu Literacy

Acknowledgements: We appreciate the whole contribution of all mothers participated in this study. We also express our gratitude to the field enumerators, community health workers, and local health authorities who facilitated the data collection process.


Availability of Data and Materials: Available upon request to the corresponding author.


Conflicts of Interest: The authors declare no competing interests of this study.


Consent for Publication: Not applicable.


Ethics Approval and Consent to Participate: This study was approved by the Research Ethics Committee of Bhakti Wiyata Institute of Health Sciences, Kediri (Approval Number: 29/FTMK/EP/I/2026). The study was conducted in accordance with the ethical principles of the Declaration of Helsinki, including respect for participants, protection of their rights and welfare, respect for privacy and confidentiality, and the requirement for voluntary informed consent. 


Funding: This research received no financial support. 


Authors' Contributions: RN: Conceptualization, data collection, analysis and interpretation, writing draft. DRS: Conceptualization, methodology, supervision, validation, review and editing. ES: Investigation, data curation, validation, interpretation of findings, and editing. WSA: Formal analysis, visualization, data interpretation, validation, and manuscript revision. SIP: Supervision, conceptual guidance, critical manuscript review, validation.

 

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 20 October 2026