Maternal health literacy and empowerment in the United States: a scoping review

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.