Maternal Health Literacy and Empowerment in the United States: A Scoping Review
Main Article Content
Abstract
Background: Global health scholars argue that efforts to improve maternal health literacy and empowerment can produce greater, more sustainable benefits than simple information-giving or health education. Further, efforts might differentially impact disadvantaged mothers and thereby reduce inequities. There is a substantial body of literature on improving maternal-child health, but relatively little on maternal health literacy. While empowerment and health literacy are closely related, they have rarely been addressed together.
Aims: This scoping review aims to: 1) examine the extent, range and nature of research related to maternal health literacy and empowerment; and 2) assess the potential value of a global systematic review. Specifically, this scoping review summarizes and synthesizes U.S. researchers' reports about improving maternal health literacy and empowerment among women who are pregnant or raising infants/toddlers in poverty.
Methods: We searched MEDLINE and Google Scholar for primary sources addressing maternal health literacy in relation to health empowerment. Multiple keyword combinations captured sources throughout the medical and public health literature.
Results: Twelve studies met the inclusion criteria. Interventions were set in maternal-child health promotion programs (n=6) or prenatal care (n=1). Qualitative studies (n=5) elucidated mothers' perceived health risks, decision networks, and experiences with prenatal care, immunizations, and technology. Overall, findings indicate that with support, mothers can learn interactive (social) and critical (thinking) skills that enable them to better manage their health and the health of their families, even if they have low functional literacy skills.
Conclusion: U.S. research related to maternal health literacy and empowerment is limited and not empirically robust. Due to measurement and definitional variation, a global systematic review is unlikely to allow comparison of intervention designs and evaluation. However, analysis of global findings from community-based participatory research, health education initiatives, and qualitative studies may aid identification and understanding of barriers, facilitators, and meaningful indicators of maternal health literacy and empowerment within and across cultures.
Keywords:
Health Literacy, Empowerment, Maternal Health Literacy, Maternal Child Health, Scoping Review.
Article Details
How to Cite
CARBONE, Elena T. et al.
Maternal Health Literacy and Empowerment in the United States: A Scoping Review.
Medical Research Archives, [S.l.], v. 12, n. 12, dec. 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6182>. Date accessed: 06 jan. 2025.
doi: https://doi.org/10.18103/mra.v12i12.6182.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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28. Smith SA, Carroll LN. Data-driven maternal health literacy promotion and a postscript on its implications. Stud Health Technol Inform. 2017; 240:144-165.
29. Wollesen L, Peifer K. Life Skills Progression: An Outcome and Intervention Planning Instrument for Use with Families at Risk. Brookes Publishing Company; 2006.
30. Carroll LN, Smith SA, Thomson NR. Parents as Teachers Health Literacy Demonstration project: Integrating an empowerment model of health literacy promotion into home-based parent education. Health Promot Pract. 2015;16(2):282-290. doi:10.1177/1524839914538968.
31. Haynes GW, Neuman D, Hook C, et al. Comparing child and family outcomes between two home visitation programs. FCSRJ. 2015 Feb 13;43(3): 209–28. doi: 10.1111/ fcsr.12098.
32. Smith SA, Moore EJ. Health literacy and depression in the context of home visitation. Matern Child Health J. 2012;16(7):1500-1508. doi:10.1007/s10995-011-0920-8.
33. Mobley SC, Thomas SD, Sutherland DE, Hudgins J, Ange BL, Johnson MH. Maternal health literacy progression among rural perinatal women. Matern Child Health J. 2014;18(8):1881-1892. doi:10.1007/s10995-014-1432-0.
34. Willis E, Gundacker C, Harris M, Mameledzija M. Improving immunization and health literacy through a community-based approach. Stud Health Technol Inform. 2020;269:142-152.
doi:10.3233/SHTI200028.
35. Guy S, Sterling BS, Walker LO, Harrison TC. Mental health literacy and postpartum depression: A qualitative description of views of lower income women. Arch Psychiatr Nurs. 2014;28(4):256-262. doi:10.1016/j.apnu.2014.04.001.
36. Guendelman S, Broderick A, Mio H, Gemmill A, Lindeman D. Listening to communities: Mixed-method study of the engagement of disadvantaged mothers and pregnant women with digital health technologies. JMIR. 2017 Jul 5;19(7):e240. doi: 10.2196/jmir.7736.
37. Salinas-Miranda AA, King LM, Salihu HM, et al. Exploring the life course perspective in maternal and child health through community-based participatory focus groups: Social risks assessment. J Health Dispar Res Pract. 2017;10(1):143-166.
38. Sentell T, Agner J, Pitt R, Davis J, Guo M, McFarlane E. Considering health literacy, health decision making, and health communication in the social networks of vulnerable new mothers in Hawai‘i: A pilot feasibility study. Int J Environ Res Public Health. 2020 Mar 31;17(7):2356. doi: 10.3390/ijerph17072356.
39. Hernandez-Mekonnen R, Duggan EK, Oliveros-Rosen L, et al. Health literacy in unauthorized Mexican immigrant mothers and risk of developmental delay in their children. J Immigr Minor Health. 2016;18(5):1228-1231. doi:10.1007/s10903-015-0284-z.
40. Thomas SD, Mobley SC, Hudgins JL, Sutherland DE, Inglett SB, Ange BL. Conditions and dynamics that impact maternal health literacy among high risk prenatal-interconceptional women. Int J Environ Res Public Health. 2018;15(7):1383. doi:10.3390/ijerph15071383.
41. Gibson CH. A concept analysis of empowerment. J Adv Nurs. 1991;16(3):354-361. doi:10.1111/j.1365-2648.1991.tb01660.x.
42. Lee GV, Barnett BG. Using reflective questioning to promote collaborative dialogue. J
Staff Dev. 1994;15(1):16-21. https://eric.ed.gov/?id=EJ482565. Accessed October 16, 2024.
43. Venturelli N, Kalia I, Reed T, et al. Could group prenatal care work by improving maternal health literacy? Clin Obstet Gynecol Reprod Med. Jan 1 2017;3:1-4. doi:10.15761/COGRM.1000190.
44. Nutbeam D. Health outcomes and health promotion - defining success in health promotion. Health Promot Austr. 1996;6(2):58-60.
https://www.researchgate.net/publication/287376562_Health_outcomes_and_health_promotion_Defining_success_in_health_promotion. Accessed October 16, 2024.
45. Akey TM, Marquis JG, Ross ME. Validation of scores on the Psychological Empowerment Scale: A measure of empowerment for parents of children with a disability. Educ Psychol Meas. 2000;60 (3):419-438. doi:10.1177/00131640021970637.
46. Crondahl K, Karlsson LE. The nexus between health literacy and empowerment: A scoping review. SAGE Open. 2016 May 2;1-7. doi:10.1177/2158244016646410.
47. Paucar-Caceres A, Vílchez-Román C, Quispe-Prieto S. Health literacy concepts, themes, and research trends globally and in Latin America and the Caribbean: A bibliometric review. Int J Environ Res Public Health. 2023;20(22):7084. doi:10.3390/ijerph20227084.
doi:10.1080/1364557032000119616.
2. United Nations General Assembly. Political declaration of the high-level meeting on the prevention and control of non-communicable diseases: draft resolution September 16, 2011. Accessed October 11, 2024.
https://digitallibrary.un.org/record/710899?ln=en.
3. World Health Organization. Promoting health in the SDGs. Report on the 9th global conference for health promotion, Shanghai, China, November 21–24, 2016: All for health, health for all. Published May 10, 2017. Accessed October 13, 2024. https://www.who.int/publications/i/item/promoting-health-in-the-sdgs.
4. World Health Organization. Health promotion glossary of terms 2021. Accessed October 16, 2024. https://www.who.int/publications/i/item/9789240038349.
5. Renkert S, Nutbeam D. Opportunities to improve maternal health literacy through antenatal education: An exploratory study. Health Promot Int. 2001 Dec 1;16(4):381–8. doi: 10.1093/heapro/16.4.381.
6. Alsop R, Bertelsen M, Holland J. Empowerment in practice: from analysis to implementation. The International Bank for Reconstruction and Development/The World Bank; 2006. Accessed October 14, 2024.
https://openknowledge.worldbank.org/server/api/core/bitstreams/43f6c98e-646c-5caa-bf46-2cae86e82a7c/content.
7. Kickbush I, Maag D. Health literacy. In: Heggenhougen K, Quah S, eds. International Encyclopedia of Public Health. Vol 3. Academic Press; 2008:204-211.
https://www.ilonakickbusch.com/kickbusch-wAssets/docs/kickbusch-maag.pdf. Accessed October 17, 2024.
8. World Health Organization. Standing up for sexual and reproductive health and human rights;
2020. Accessed October 20, 2024.
https://www.who.int/news/item/19-11-2020-who-stands-up-the-right-to-health.
9. DeWalt DA, Hink A. Health literacy and child health outcomes: A systematic review of the literature. Pediatrics. 2009 Nov;124(Suppl 3):S265–74. doi: 10.1542/peds.2009-1162b.
10. Sørensen K, Van den Broucke S, Fullam J, et al. Health literacy and public health: A systematic review and integration of definitions and models. BMC Public Health. 2012 Jan 25;12(80).
https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-12-80. Accessed October 14, 2024.
11. Nutbeam D. The evolving concept of health literacy. Soc Sci Med. 2008 Dec;67(12):2072–8. https://www.sciencedirect.com/science/article/pii/S0277953608004577. Accessed October 14, 2024.
12. McKinn S, Linh DT, Foster K, McCaffery K. Distributed Health Literacy in the maternal health context in Vietnam. Health Lit Res Pract. 2019;3 (1):e31-e42. doi:10.3928/24748307-20190102-01.
13. Muscat DM, Gessler D, Ayre J, et al. Seeking a deeper understanding of 'distributed health literacy': A systematic review. Health Expect. 2022;25(3) :856-868. doi:10.1111/ hex.13450.
14. Wadhwa PD, Buss C, Entringer S, Swanson JM. Developmental origins of health and disease: Brief history of the approach and current focus on epigenetic mechanisms. Semin Reprod Med. 2009; 27(5):358-368. doi:10.1055/s-0029-1237424.
15. Halfon N, Hochstein M. Life course health development: An integrated framework for developing health, policy, and research. Milbank Q. 2002 Sep;80(3):433–79. doi: 10.1111/ 1468-0009.00019.
16. National Research Council and Institute of Medicine Committee on Integrating the Science of Early Childhood Development, Shonkoff JP, Phillips DA, eds. From Neurons to Neighborhoods: The Science of Early Childhood Development. Washington DC: National Academies Press; 2000.
17. Hanson M, Gluckman P, Nutbeam D, Hearn J. Priority actions for the non-communicable disease crisis. Lancet. 2011 Aug;378(9791):566–7. doi.org/10.1016/s0140-6736(11)61286-5.
18. Plianbangchang S. Keynote speech on women’s health and development. Fourth Central Asia Medical Women Association Conference; 2007 June 14-16; Bangkok, Thailand.
http://apps.who.int/iris/bitstream/10665/126437/1/RD-speeches_14JUNE07.pdf. Accessed October 13, 2024.
19. Schillinger D. Social determinants, health literacy, and disparities: Intersections and controversies. Health Lit Res Pract. 2021;5(3):e234-e243. doi:10.3928/24748307-20210712-01.
20. Smith SA, Carbone ET. Reintegrate empowerment and health literacy to advance public health and healthcare delivery. In: Logan RA, Siegel ER, eds. Health Literacy in Clinical Practice and Public Health. IOS Press; 2020:369-399.
21. Peters M, Godfrey C, McInerney P, Soares C, Khalil H, Parker D. The Joanna Briggs Institute Reviewers' Manual 2015: Methodology for JBI Scoping Reviews. The Joanna Briggs Institute. Adelaide, SA Australia; 2015. Accessed October 14, 2024. https://reben.com.br/revista/wp-content/uploads/2020/10/Scoping.pdf.
22. Harris J, Springett J, Croot L, et al. Can community-based peer support promote health literacy and reduce inequalities? A realist review. Public Health Res. 2015 Feb;3(3):1–192. doi:10.3310/phr03030.
23. United Nations Educational, Scientific, and Cultural Organization (UNESCO) Institute for Statistics Information Paper. Adult and Youth Literacy: National, Regional and Global Trends:1985-2015; 2013. Accessed October 14, 2024.
https://uis.unesco.org/sites/default/files/documents/adult-and-youth-literacy-national-regional-and-global-trends-1985-2015-en_0.pdf.
24. Freire P. Pedagogy of the Oppressed. Bloomsbury Academic; 1970.
25. Sykes S, Wills J, Rowlands G, Popple K. Understanding critical health literacy: A concept analysis. BMC Public Health. 2013 Feb 18;13;150-60. doi: 10.1186/1471-2458-13-150.
26. Colquhoun HL, Levac D, O’Brien KK, et al. Scoping reviews: Time for clarity in definition, methods, and reporting. J Clin Epidemiol. 2014 Dec;67(12):1291–4. doi: 10.1016/j.jclinepi.2014.03.013.
27. Roter DL, Erby LH, Rimal RN, et al. Empowering women's prenatal communication: Does literacy matter? J Health Commun. 2015;20 Suppl 2(0 2):60-68. doi:10.1080/ 10810730.2015.1080330.
28. Smith SA, Carroll LN. Data-driven maternal health literacy promotion and a postscript on its implications. Stud Health Technol Inform. 2017; 240:144-165.
29. Wollesen L, Peifer K. Life Skills Progression: An Outcome and Intervention Planning Instrument for Use with Families at Risk. Brookes Publishing Company; 2006.
30. Carroll LN, Smith SA, Thomson NR. Parents as Teachers Health Literacy Demonstration project: Integrating an empowerment model of health literacy promotion into home-based parent education. Health Promot Pract. 2015;16(2):282-290. doi:10.1177/1524839914538968.
31. Haynes GW, Neuman D, Hook C, et al. Comparing child and family outcomes between two home visitation programs. FCSRJ. 2015 Feb 13;43(3): 209–28. doi: 10.1111/ fcsr.12098.
32. Smith SA, Moore EJ. Health literacy and depression in the context of home visitation. Matern Child Health J. 2012;16(7):1500-1508. doi:10.1007/s10995-011-0920-8.
33. Mobley SC, Thomas SD, Sutherland DE, Hudgins J, Ange BL, Johnson MH. Maternal health literacy progression among rural perinatal women. Matern Child Health J. 2014;18(8):1881-1892. doi:10.1007/s10995-014-1432-0.
34. Willis E, Gundacker C, Harris M, Mameledzija M. Improving immunization and health literacy through a community-based approach. Stud Health Technol Inform. 2020;269:142-152.
doi:10.3233/SHTI200028.
35. Guy S, Sterling BS, Walker LO, Harrison TC. Mental health literacy and postpartum depression: A qualitative description of views of lower income women. Arch Psychiatr Nurs. 2014;28(4):256-262. doi:10.1016/j.apnu.2014.04.001.
36. Guendelman S, Broderick A, Mio H, Gemmill A, Lindeman D. Listening to communities: Mixed-method study of the engagement of disadvantaged mothers and pregnant women with digital health technologies. JMIR. 2017 Jul 5;19(7):e240. doi: 10.2196/jmir.7736.
37. Salinas-Miranda AA, King LM, Salihu HM, et al. Exploring the life course perspective in maternal and child health through community-based participatory focus groups: Social risks assessment. J Health Dispar Res Pract. 2017;10(1):143-166.
38. Sentell T, Agner J, Pitt R, Davis J, Guo M, McFarlane E. Considering health literacy, health decision making, and health communication in the social networks of vulnerable new mothers in Hawai‘i: A pilot feasibility study. Int J Environ Res Public Health. 2020 Mar 31;17(7):2356. doi: 10.3390/ijerph17072356.
39. Hernandez-Mekonnen R, Duggan EK, Oliveros-Rosen L, et al. Health literacy in unauthorized Mexican immigrant mothers and risk of developmental delay in their children. J Immigr Minor Health. 2016;18(5):1228-1231. doi:10.1007/s10903-015-0284-z.
40. Thomas SD, Mobley SC, Hudgins JL, Sutherland DE, Inglett SB, Ange BL. Conditions and dynamics that impact maternal health literacy among high risk prenatal-interconceptional women. Int J Environ Res Public Health. 2018;15(7):1383. doi:10.3390/ijerph15071383.
41. Gibson CH. A concept analysis of empowerment. J Adv Nurs. 1991;16(3):354-361. doi:10.1111/j.1365-2648.1991.tb01660.x.
42. Lee GV, Barnett BG. Using reflective questioning to promote collaborative dialogue. J
Staff Dev. 1994;15(1):16-21. https://eric.ed.gov/?id=EJ482565. Accessed October 16, 2024.
43. Venturelli N, Kalia I, Reed T, et al. Could group prenatal care work by improving maternal health literacy? Clin Obstet Gynecol Reprod Med. Jan 1 2017;3:1-4. doi:10.15761/COGRM.1000190.
44. Nutbeam D. Health outcomes and health promotion - defining success in health promotion. Health Promot Austr. 1996;6(2):58-60.
https://www.researchgate.net/publication/287376562_Health_outcomes_and_health_promotion_Defining_success_in_health_promotion. Accessed October 16, 2024.
45. Akey TM, Marquis JG, Ross ME. Validation of scores on the Psychological Empowerment Scale: A measure of empowerment for parents of children with a disability. Educ Psychol Meas. 2000;60 (3):419-438. doi:10.1177/00131640021970637.
46. Crondahl K, Karlsson LE. The nexus between health literacy and empowerment: A scoping review. SAGE Open. 2016 May 2;1-7. doi:10.1177/2158244016646410.
47. Paucar-Caceres A, Vílchez-Román C, Quispe-Prieto S. Health literacy concepts, themes, and research trends globally and in Latin America and the Caribbean: A bibliometric review. Int J Environ Res Public Health. 2023;20(22):7084. doi:10.3390/ijerph20227084.