The effect of health education program on maternal health literacy, health promoting behaviours and empowerment of rural pregnant women in China / Liu Yan Jia

Liu , Yan Jia (2024) The effect of health education program on maternal health literacy, health promoting behaviours and empowerment of rural pregnant women in China / Liu Yan Jia. PhD thesis, Universiti Malaya.

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Abstract

Health literacy has been identified as being globally inadequate, especially in developing countries. Pregnancy is a special stage in a woman’s lifetime with a high need for adequate health literacy and health-promoting behaviours to achieve healthy outcomes. In China, maternal health literacy is rather limited, and health-promoting behaviours are insufficient and even misled by confusing information. This study aimed to conduct a health education program to improve maternal health literacy, health-promoting behaviours, and empowerment among rural pregnant women in China. A series of quantitative studies were employed to answer the research questions, including three phases. In phase one, a cross-sectional study was implemented to translate and validate the empowerment scale of pregnant women. A cross-sectional study of phase two was conducted to assess the current status and influencing factors of maternal health literacy, health-promoting behaviours, and empowerment of rural pregnant women. A quasi-experimental study of phase three was tested with an intervention group (n=52) and a control group (n=53). The empowerment scale for pregnant women was validated with acceptable reliability and validity in phase one and used to collect the data in phase two and three. Health education and individual counselling guided by the health promotion model were conducted in the intervention group during the second to the seventh antenatal visit while the control group received routine health education. Descriptive statistics consisting of frequency distribution, mean, standard deviation, and range were applied to summarize data, while inferential statistics including Exploratory factor analysis, confirmatory factor analysis, the independent t-test, multiple linear regression, General Linear Model: Repeated measure Analysis of Variance were adopted. Rural pregnant women have insufficient maternal health literacy, health-promoting behaviours and empowerment. The social-demographic factors such as age, education, and household income could have an impact on maternal health literacy, health-promoting behaviours and empowerment. Furthermore, there were significant correlations between maternal health literacy, health-promoting behaviours, and empowerment (r, 0.386-0.630). The rural pregnant women in the intervention group had higher levels of maternal health literacy, health-promoting behaviours and stronger empowerment following the health education combined with individual counselling after 5 months (all p < 0.05). Compared to routine health education, there were more significant improvements in maternal health literacy (F=10.607, p < 0.001), health-promoting behaviours (F=4.736, p < 0.001) and empowerment (F =7.865, p < 0.001) among rural pregnant women. It recommended that further experimental studies should consider a larger sample size, the method of randomization and a longer duration until puerperium to evaluate the long-term effect of the health education program. Moreover, a qualitative study should be designed to further explore the experiences of pregnant women in acquiring health literacy and adopting health-promoting behaviours. Their insights could offer valuable perspectives and suggestions for future research and clinical practice. Overall, this empirical study demonstrated the importance and effects of health education combined with individual counselling in the enhancement of maternal health literacy, health behaviours and empowerment in rural areas.

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