Health literacy levels among women in the prenatal period: A systematic review.

BACKGROUND: A pregnant woman's health literacy refers to her knowledge, motivation, and skills to access, understand, appraise, and apply health information to make decisions in everyday life concerning her health. Inadequate health literacy increases the risk of adverse pregnancy and birth outcomes. This systematic review aimed to explore existing evidence of women's health literacy levels in the prenatal period. METHODS: We searched four databases: MEDLINE, Embase, CINAHL, and PsycInfo. Study eligibility criteria were: 1) a study population of women in the prenatal period, 2) an English language text, and 3) a clear statement of health literacy assessment. We used the Joanna Briggs Institute (JBI) appraisal checklist for quality assessment of the included studies. We synthesized results using thematic synthesis in three stages 1) coding text, 2) developing descriptive themes, and 3) generating analytical themes. RESULTS: Of the 2,238 studies screened, we included forty-four in the systematic review. Most studies were conducted in the United States of America, some in Iran and Europe, and a few in Australia and Africa. We identified twenty different health-literacy measurement tools used in included studies. Four themes were synthesized: 1) socio-economy and determinants, 2) functional health literacy, 3) interactive health literacy, and 4) critical health literacy. CONCLUSIONS: Low health literacy is associated with socio-economy, including education, employment and ethnicity and age in the prenatal period. Most identified studies (n = 24) addressed functional health literacy including information, understanding, knowledge, oral health knowledge, perception, behavior, and lifestyle. Some studies addressed interactive health literacy (n = 13) including active technology engagement, social network, interaction with health professionals, and group prenatal care. Few studies addressed critical health literacy (n = 4). Evidence of critical health literacy in the prenatal period is sparse, and high-quality research warranted.

Health literacy and related behaviour among pregnant women with obesity: a qualitative interpretive description study.

BACKGROUND: Obesity in pregnant women is increasing worldwide, affecting the health of both mother and baby. Obesity may be associated with inadequate health literacy, a central competence when navigating antenatal health information and services. This study explores women's health literacy by examining their knowledge, motivation and skills to access, understand and evaluate health information and the related behaviour among a sample of pregnant women with a prepregnant body mass index (BMI) > 25 kg/m2. METHODS: An inductive, qualitative study using an interpretive description methodology. Data was collected through ten semi-structured interviews with pregnant women with a prepregnancy BMI > 25 kg/m2 attending antenatal care at the midwifery clinic at Aarhus University Hospital in the Central Denmark Region. RESULTS: Pregnant women with obesity understand general health information provided by health professionals, but translating this knowledge into specific healthy behaviours presents a challenge. Although difficulties navigating booking systems and available digital services contribute to this problem, apps can help facilitate navigation. However, successful navigation may depend on adequate e-health literacy. Conflicting information from health professionals, social media and families also present a challenge for pregnant women, requiring a broad skillset for critical evaluation and resolution. CONCLUSIONS: Adequate health literacy is necessary for pregnant women receiving antenatal care to (i) translate general health information into personalised healthy behaviour, (ii) access and navigate complex and digitalised systems, and (iii) critically evaluate conflicting information. Person-centred differentiation in the organisation of antenatal care may benefit vulnerable pregnant women with inadequate health literacy. TRIAL REGISTRATION: The study was registered cf. General Data Protection Regulation, Aarhus University Journal number 2016-051-000001, serial number 1934.

The Health Literacy in Pregnancy (HeLP) Program Study Protocol: Development of an Antenatal Care Intervention Using the Ophelia Process.

A pregnant woman needs adequate knowledge, motivation, and skills to access, understand, appraise, and apply health information to make decisions related to the health of herself and her unborn baby. These skills are defined as health literacy: an important factor in relation to the woman's ability to engage and navigate antenatal care services. Evidence shows variation in levels of health literacy among pregnant women, but more knowledge is needed about how to respond to different health literacy profiles in antenatal care. This paper describes the development protocol for the HeLP program, which aims to investigate pregnant women's health literacy and co-create health literacy interventions through a broad collaboration between pregnant women, partners, healthcare providers, professionals, and other stakeholders using the Ophelia (Optimising Health Literacy and Access) process. The HeLP program will be provided at two hospitals, which provide maternity care including antenatal care: a tertiary referral hospital (Aarhus University Hospital) and a secondary hospital (the Regional Hospital in Viborg). The Ophelia process includes three process phases with separate objectives, steps, and activities leading to the identification of local strengths, needs and issues, co-design of interventions, and implementation, evaluation, and ongoing improvement. No health literacy intervention using the Ophelia process has yet been developed for antenatal care.

Consumption of Sugar-Sweetened or Artificially Sweetened Beverages and Semen Quality in Young Men: A Cross-Sectional Study.

BACKGROUND: Existing literature suggests that frequent consumption of sugar-sweetened drinks may be associated with lower semen quality. Studies performed in mice suggest a dose-response relationship between intake of saccharin or aspartame, two artificial sweeteners, and sperm and testis function. METHODS: A cross-sectional study based on data from The Fetal Programming of Semen Quality (FEPOS) Cohort, including 1047 young men (mean age = 19 years) was performed. Each male participant completed an online questionnaire on health, health behavior and diet, and provided a semen sample. The associations between consumption of sugar-sweetened or artificially sweetened beverages (moderate ≥ 3 days/week; infrequent < 3 days/week) and semen quality were analyzed using a multivariable, negative, binomial regression model. RESULTS: Sugar-sweetened or artificially sweetened beverage consumption was not strongly associated with either semen volume, sperm concentration, total sperm count or total motility in young men. The proportion of morphologically normal sperm was 11% lower (0.89 (95% CI 0.76, 1.04)) for moderate (≥3 days/week) consumption of artificially sweetened beverages relative to infrequent (<3 days/week). CONCLUSION: Consumption of sugar-sweetened or artificially sweetened beverages, at the levels present in this study had limited effect on the measured markers of semen quality in young men.