Development of Maternal Health Literacy Measurements: A Scoping Review


  • Anggie Pradana Putri National Taipei University of Nursing and Health Sciences, Taiwan & Mamba'ul 'Ulum Health College of Surakarta
  • Ady Irawan AM. Duta Bangsa University, Indonesia
  • Yu Ying Lu National Taipei University of Nursing and Health Sciences



scoping review, maternal health literacy, pregnant women


Background: Maternal health literacy (MHL) is essential in identifying pregnant women with limited MHL, especially in the post-COVID-19 period. The data can assist in the design of tailored interventions for improving MHL. Nevertheless, MHL measurements are not routinely applied because more general health literacy scales are used to assess MHL in pregnancy. Objective: This study aimed to provide an overview of MHL measurement development. Method: A scoping review was utilized in this study. The search was conducted through four electronic databases (CINAHL, PubMed, Web of Science, and Science Direct) published in English and Indonesian between 2001 to 2021, with the searching process of PCC (Population: pregnant women, Concept: maternal health literacy instrument development, Context: clinical or community setting). The selection process of the articles is referred to as Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Result: The selected articles' critical appraisal was done using The Joanna Briggs Institute Checklist. The measurements of MHL are Maternal Health Literacy and Pregnancy Outcome Questionnaire (MHLAPQ), Maternal Health Literacy (MaHeLi), and Maternal Health Literacy Inventory in Pregnancy (MHELIP). These instruments are adequate, valid, and reliable. The MHELIP is the fittest instrument to capture the MHL concept because it consists of specific items to measure MHL in pregnancy. Future studies must investigate this topic as thoroughly as the current material available in some databases. In addition, healthcare practitioners can apply the MHL in pregnancy measurement to analyze and report client cases, contributing to the expansion of MHL's body knowledge.


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Sørensen K, Van den Broucke S, Pelikan JM, Fullam J, Doyle G, Slonska Z, et al. Measuring health literacy in populations: illuminating the design and development process of the European Health Literacy Survey Questionnaire (HLS-EU-Q). BMC Public Health. 2013;13(1):948--52.

Renkert S, Nutbeam. Opportunities to improve maternal health literacy through antenatal education: an exploratory study. Health Promotion International. 2001;16(4):381–8.

Kharazi SS, Peyman N, Esmaily H. The Relationship between Maternal Health Literacy and Dietary Self-Efficacy with Pregnancy Outcomes. JMRH. 2020;8(1):2058–68.

Mojoyinola J. Influence of Maternal Health Literacy on Healthy Pregnancy and Pregnancy Outcomes of Women Attending Public Hospitals in Ibadan, Oyo State, Nigeria. Afr Res Rev [Internet]. 2011 Jun 22 [cited 2021;5(3): 231-240.

Adanri O. Maternal Health Literacy, Antenatal Care, and Pregnancy Outcomes in Lagos, Nigeria. 2017;149-155.

Taheri S, Tavousi M, Momenimovahed Z, Direkvand-Moghadam A, Tiznobaik A, Suhrabi Z, et al. Development and psychometric properties of maternal health literacy inventory in pregnancy. Tu WJ, editor. PLoS ONE. 2020;15(6):e0234305.

Polit DF, Yang FM. Measurement and the measurement of change. Philadelphia: Wolters Kluwer; 2016.

Hernandez LM, Institute of Medicine (U.S.), Roundtable on Health Literacy, Institute of Medicine (U.S.), Board on Population Health and Public Health Practice, Workshop on Measures of Health Literacy, editors. Measures of health literacy: workshop summary. Washington, D.C.: Institute of Medicine of the National Academies?: The National Academies Press; 2009.

Guttersrud Ø, Naigaga MDAS, Pettersen KS. Measuring Maternal Health Literacy in Adolescents Attending Antenatal Care in Uganda: Exploring the Dimensionality of the Health Literacy Concept Studying a Composite Scale. j nurs meas. 2015;23(2):50–66.

Nutbeam D. Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health Promotion International. 2000;15(3):259–67.

Barnes LAJ, Barclay L, McCaffery K, Aslani P. Complementary medicine products used in pregnancy and lactation and an examination of the information sources accessed pertaining to maternal health literacy: a systematic review of qualitative studies. BMC Complement Altern Med. 2018;18(1):229.

Johri M, Subramanian S, Koné GK, Dudeja S, Chandra D, Minoyan N, et al. Maternal Health Literacy Is Associated with Early Childhood Nutritional Status in India. The Journal of Nutrition. 2016;146(7):1402–10.

Naigaga MD, Guttersrud Ø, Pettersen KS. Measuring maternal health literacy in adolescents attending antenatal care in a developing country - the impact of selected demographic characteristics. J Clin Nurs. 2015;24(17–18):2402–9.

Lindberg L, Nhambonga I, Nhampossa T, Munguambe K, Priebe G. A qualitative study of mothers health literacy related to malnutrition in under-5-year-old-children in southern Mozambique. Cambridge University Press. 2021;25(7):1947–55.

Charoghchian Khorasani E, Peyman nooshin, Esmaily H. Measuring Maternal Health Literacy in Pregnant Women Referred to the Healthcare Centers of Mashhad, Iran, in 2015. JMRH. 2017;6(1):1157-1162.

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):1881–92.

Waraphok S, Ratinthorn A, Limruangrong P. Factors Influencing Maternal Health Literacy in Pregnant Women. 87 Journal of Thailand Nursing and Midwifery Council. 2020;35(1):87–98.

Phommachanh S, Essink DR, Wright PE, Broerse JEW, Mayxay M. Maternal health literacy on mother and child health care: A community cluster survey in two southern provinces in Laos. Fischer F, editor. PLoS ONE. 2021;16(3):e. doi: 0244181. 10.1371/journal.pone.0244181

Khorasani E, Peyman nooshin, Esmaily H. Measuring Maternal Health Literacy in Pregnant Women Referred to the Healthcare Centers of Mashhad, Iran, in 2015. JMRH [Internet]. 2018 [cited 2021 August 15th];(Online First). Available from:

Lee JY, Murry N, Ko J, Kim MT. Exploring the Relationship between Maternal Health Literacy, Parenting Self-Efficacy, and Early Parenting Practices among Low-Income Mothers with Infants. Journal of Health Care for the Poor and Underserved. 2018;29(4):1455–71.

Safaie SZ, Rahebi SM, Haghjou SNM, Leili K. The Relationship between Maternal Health Literacy and Pregnancy Outcome in Postnatal Wards. 2018;8.

Tripathi P, Singh DN. A Need for Maternal Health Literacy to Promote Maternal and Neonatal Health: A Review. International Journal of Health Sciences. 2019;9(8):6.

Graus TM, Brandstetter S, Seelbach-Göbel B, Melter M, Kabesch M, Apfelbacher C, et al. Breastfeeding behavior is not associated with health literacy: evidence from the German KUNO-Kids birth cohort study. Arch Gynecol Obstet [Internet]. 2021 April 27th [cited 2021 August 28th]; Available from:

Moynihan A. The Association of Maternal Health Literacy Levels and Preterm Birth. 2015;153.

Nodoshan T, Pirzadeh A, Nasirian M. The Relationship between Maternal Health Literacy and Pregnancy Status in New Mothers Who Referred to Health Centers of Yazd. TBJ [Internet]. 2020 April 4th [cited 2021 July 26th]; Available from:

Thomas S, Mobley S, Hudgins J, Sutherland D, Inglett S, Ange B. Conditions and Dynamics That Impact Maternal Health Literacy among High-Risk Prenatal-Interconceptional Women. IJERPH. 2018;15(7):1383.

Kohan S, Ghasemi S, Dodangeh M. Associations between maternal health literacy and prenatal care and pregnancy outcome. 2007;12(4):8-15.

Kementerian Kesehatan RI. Laporan Kinerja Kementerian Kesehatan Tahun 2020. Kementerian Kesehatan RI; 2021. Kementerian Kesehatan RI. Laporan Kinerja Kementerian Kesehatan Tahun 2020. Kementerian Kesehatan RI; 2021.

World Health Organization. Sustainable Development Goals.html [Internet]. Health topics: Sustainable Development Goals. 2021 [cited 2021 July 5th]. Available from:

Kementerian Kesehatan RI. Pedoman pelayanan antenatal, persalinan, nifas, dan bayi baru lahir di era adaptasi kebiasaan baru, revisi 2. Kementerian Kesehatan RI; 2020.

Bonciani M, De Rosis S, Vainieri M. Mobile Health Intervention in the Maternal Care Pathway: Protocol for the Impact Evaluation of hAPPyMamma. JMIR Res Protoc. 2021;10(1):e19073.

Creedy DK, Gamble J, Boorman R, Allen J. Midwives’ self-reported knowledge and skills to assess and promote maternal health literacy: A national cross-sectional survey. Women and Birth. 2021;34(2):e188–95.

McKinn S, Linh DT, Foster K, McCaffery K. Distributed Health Literacy in the Maternal Health Context in Vietnam. HLRP: Health Literacy Research and Practice [Internet]. 2019 Jan [cited 2021 July 26th];3(1). Available from:

World Health Organization. Improving health literacy [Internet]. Improving Health Literacy. 2021 [cited 2021 June 24th]. Available from:

Ratna L, Widyakusuma NN, Wiedyaningsih C. Health Literacy and Self-management among pregnant women.pdf. Universitas Gadjah Mada Yogyakarta. 2018;

Handayani S, Mubarokah K. Health literacy pada Ibu hamil di wilayah kerja puskesmas Kota Semarang.pdf. Karya Ilmiah untuk Peningkatan Kesehatan Bangsa; 2018.

Effendi. Literasi kesehatan ibu hamil di Sukoharjo. Universitas Airlangga; 2020.

Gani NF, Kadar KS, Kaelan C. Health Literacy and Self-management among pregnant wome.pdf. Indonesian Contemporary Nursing Journal. 2020;1(2):94–100.

Glanz K, Rimer BK, Viswanath K. Theory, research, and practice in health behavior and health education. In: Health behavior and health education: Theory, research, and practice, 4th ed. San Francisco, CA, US: Jossey-Bass; 2008. p. 23–40.