Maternal health literacy programmes to improve self-care of pregnant women in Africa: A scoping review

Thabani M. Noncungu, Thandi Sibindi, Jennifer Chipps, Talitha Crowley

Abstract

Midwives are uniquely positioned to implement health literacy programmes, yet there is limited synthesis of existing midwife-led health literacy programmes for pregnant women in Africa. This scoping review maps the evidence on health literacy programmes to improve the self-care of pregnant women in Africa. Eight articles, published between 2015 and 2025, were included across African countries from six electronic databases, such as MEDLINE and one search engine: Google Scholar. Maternal health literacy programmes varied in mode of delivery, duration, components, and outcomes. Most programmes used a group antenatal care model, a combination of face-to-face and digital health tools, and focused on improving functional, interactive, and critical health literacy. Maternal health literacy programmes in African countries seem to be under-researched. More research is needed to strengthen the outcomes of programmes such as usability and acceptability, knowledge and awareness, and clinical outcomes. In addition, longer-term research is necessary to assess the implementation and sustained impact of these programmes.

Full Text:

PDF

References

Rezaei Z, Yazdanpanahi Z, Asadollahi A, Karimi M and Ghahremani L. Evaluating the impact of an educational self-care intervention on the empowerment of primigravida pregnant women covered by family medicine program in the Estahban City—an application of the Pender’s health promotion model. BMC Pregnancy and Childbirth. 2025;25(1):308.

Javanmardi M, Noroozi M, Mostafavi F and Ashrafi-Rizi H. Challenges to access health information during pregnancy in Iran: a qualitative study from the perspective of pregnant women, midwives and obstetricians. Reproductive health. 2019;16:1-7.

WHO. World health statistics 2023 – Monitoring health for the SDGs 2023 [cited 2025 11/7/2025]. Available from: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://cdn.who.int/media/docs/default-source/gho-documents/world-health-statistic-reports/2023/world-health-statistics-2023_20230519_.pdf.

Souza JP, Day LT, Rezende-Gomes AC, Zhang J, Mori R, Baguiya A, Jayaratne K, Osoti A, Vogel JP and Campbell O. A global analysis of the determinants of maternal health and transitions in maternal mortality. The Lancet Global Health. 2024;12(2):e306-e16.

Khalil A, Samara A, O'Brien P, Coutinho CM, Quintana SM and Ladhani SN. A call to action: the global failure to effectively tackle maternal mortality rates. The Lancet Global Health. 2023;11(8):e1165-e7.

Godfrey CM, Harrison MB, Lysaght R, Lamb M, Graham ID and Oakley P. Care of self–care by other–care of other: The meaning of self‐care from research, practice, policy and industry perspectives. International Journal of Evidence‐Based Healthcare. 2011;9(1):3-24.

Gomora A, Mukona D, Zvinavashe M and Dhaka A. The relationship between prenatal self care and adverse birth outcomes in young women aged 16 to 24 years. Journal of Nursing and Health Science. 2015;4(1):72-80.

Mottola MF, Davenport MH, Ruchat S-M, Davies GA, Poitras VJ, Gray CE, Garcia AJ, Barrowman N,

Adamo KB and Duggan M. 2019 Canadian guideline for physical activity throughout pregnancy. British journal of sports medicine. 2018;52(21):1339-46.

WHO. WHO recommendations on antenatal care for a positive pregnancy experience 2022 [cited 2025 11/06/2025]. Available from: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://iris.who.int/bitstream/handle/10665/250796/9789241549912-eng.pdf?sequence=1.

WHO. Health literacy 2024 [cited 2025 11/07/2025]. Available from:https://www.who.int/news-room/fact-sheets/detail/health-literacy?utm_source=chatgpt.com.

Dadipoor S, Mehraban M, Ziapour A and Safari-Moradabadi A. Causes of maternal mortality in Iran: a systematic review. International journal of pediatrics. 2017;5(12):6757-5770.

Bello C, Esan D, Akerele S and Fadare R. Maternal health literacy, utilisation of maternal healthcare services and pregnancy outcomes among newly delivered mothers: A cross-sectional study in Nigeria. Public Health in Practice. 2022;3:100266.

GATIMU W. Constraints facing promotion of health literacy among women in Kenya. East African Journal of Information Science. 2018.

Ickes SB, Hurst TE and Flax VL. Maternal literacy, facility birth, and education are positively associated with better infant and young child feeding practices and nutritional status among Ugandan children. The Journal of nutrition. 2015;145(11):2578-86.

Phommachanh S, Essink DR, Wright PE, Broerse JE and Mayxay M. Maternal health literacy on mother and child health care: A community cluster survey in two southern provinces in Laos. Plos one. 2021;16(3):e0244181.

Madaj B, Smith H, Mathai M, Roos N and Van Den Broek N. Developing global indicators for quality of maternal and newborn care: a feasibility assessment. Bulletin of the World Health Organization. 2017;95(6):445.

Zegeye B, Adjei NK, Idriss-Wheeler D and Yaya S. Individual and community-level determinants of knowledge of ovulatory cycle among women of reproductive age in 29 African countries: a multilevel analysis. BMC Women's Health. 2022;22(1):1-12.

Zibellini J, Muscat DM, Kizirian N and Gordon A. Effect of health literacy interventions on pregnancy outcomes: A systematic review. Women and Birth. 2021;34(2):180-6.

Meherali S, Punjani NS and Mevawala A. Health literacy interventions to improve health outcomes in low-and middle-income countries. HLRP: Health Literacy Research and Practice. 2020;4(4):e251-e66.

Essack S, Desta A, Abotsi R and Agoba E. Antimicrobial resistance in the WHO African region: current status and roadmap for action. Journal of public health. 2017;39(1):8-13.

Fox-Harding C. Maternal Health Considerations: Highlighting and advancing opportunities for improved maternal health. SAGE Publications Sage UK: London, England; 2024. p. 17455057241253931.

Hadie SNH. ABC of a scoping review: a simplified JBI scoping review guideline. Education in Medicine Journal. 2024;16(2).

Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, Moher D, Peters MD, Horsley T and Weeks L. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Annals of internal medicine. 2018;169(7):467-73.

Obeagu EI. An update on utilisation of antenatal care among pregnant Women in Nigeria. Int J Curr Res Chem Pharm Sci. 2022;9(9):21-6.

Somji A, Ramsey K, Dryer S, Makokha F, Ambasa C, Aryeh B, Booth K, Xueref S, Moore S and Mwenesi R. “Taking care of your pregnancy”: a mixed-methods study of group antenatal care in Kakamega County, Kenya. BMC health services research. 2022;22(1):969.

Khresheh R, Almalik M, Owies A and Barclay L. Implementation of a childbirth preparation program in the maternal and child health centres in Jordan. Midwifery. 2018;61:1-7.

Onambele L, Ortega-Leon W, Guillen-Aguinaga S, Forjaz MJ, Yoseph A, Guillen-Aguinaga L, Alas-Brun R, Arnedo-Pena A, Aguinaga-Ontoso I and Guillen-Grima F. Maternal mortality in Africa: Regional trends (2000–2017). International journal of environmental research and public health. 2022;19(20):13146.

WHO. Promoting health in the SDGs: report on the 9th Global conference for health promotion, Shanghai, China, 21–24 November 2016: all for health, health for all 2016 [cited 2025 11/07/2025]. Available from: https://www.who.int/publications/i/item/promoting-health-in-the-sdgs.

Convidence. Your reviews 2025 [cited 2025 20/02/2025]. Available from: https://app.covidence.org/reviews/active.

Nutbeam D and Lloyd JE. Understanding and responding to health literacy as a social determinant of health. Annual review of public health. 2021;42(1):159-73.

Essam N, Khafagy MA and Alemam DS. Health literacy of pregnant women attending antenatal care clinics in Mansoura district, Egypt. Journal of the Egyptian Public Health Association. 2022;97(1):24.

Meldgaard M, Gamborg M and Maindal HT. Health literacy levels among women in the prenatal period: A systematic review. Sexual & Reproductive Healthcare. 2022;34:100796.

Patil CL, Klima CS, Leshabari SC, Steffen AD, Pauls H, McGown M and Norr KF. Randomized controlled pilot of a group antenatal care model and the sociodemographic factors associated with pregnancy-related empowerment in sub-Saharan Africa. BMC pregnancy and childbirth. 2017;17(Suppl 2):336.

Adam M, Kwinda Z, Dronavalli M, Leonard E, Nguyễn VK, Tshivhase V, Bärnighausen T and Pillay Y. Effect of short, animated video storytelling on maternal knowledge and satisfaction in the perinatal period in South Africa: randomised controlled trial. Journal of Medical Internet Research. 2023;25(1):e47266.

Lori JR, Kukula VA, Liu L, Apetorgbor VE, Ghosh B, Awini E, Lockhart N, Amankwah G, Zielinski R and Moyer CA. Improving health literacy through group antenatal care: results from a cluster randomised controlled trial in Ghana. BMC Pregnancy and Childbirth. 2024;24(1):37.

Sakurai S, Mwilike B, Horiuchi S and Mushy SE. Effects of a Tanzanian prenatal group education program about preeclampsia/eclampsia: A quasi‐experimental study. Japan Journal of Nursing Science. 2025;22(2):e12652.

Shimpuku Y, Madeni FE, Horiuchi S, Kubota K and Leshabari SC. Evaluation of a family-oriented antenatal group educational program in rural Tanzania: a pre-test/post-test study. Reproductive Health. 2018;15(1):117.

Ndiaye B, Thiam L, Ham G, Choi Y, Lee E, Kang K and Yang Y. The effects of the maternal health improvement project in the Louga Region of Senegal. International Journal of Environmental Research and Public Health. 2021;19(1):396.

Shimpuku Y, Madeni FE, Horiuchi S, Kubota K and Leshabari SC. A family-oriented antenatal education program to improve birth preparedness and maternal-infant birth outcomes: A cross sectional evaluation study. Reprod Health. 2019;16(1):107.

Lacroze E, Frühauf A, Nordmann K, Rampanjato Z, Muller N, De Neve J-W, Andriamampianina R, Rajemison E, Bärnighausen T and Knauss S. Usability and acceptance of a mobile health wallet for pregnancy-related healthcare: A mixed methods study on stakeholders’ perceptions in central Madagascar. Plos one. 2023;18(1):e0279880.

Shimpuku Y, Madeni FE, Horiuchi S, Kubota K and Leshabari SC. A family-oriented antenatal education program to improve birth preparedness and maternal-infant birth outcomes: A cross sectional evaluation study. Reproductive Health. 2019;16(1):107.

Chen S, Yue W, Liu N, Han X and Yang M. The progression on the measurement instruments of maternal health literacy: a scoping review. Midwifery. 2022;109:103308.

Putri AP, AM AI and Lu YY. Development of Maternal Health Literacy Measurements: A Scoping Review. International Journal of Nursing and Health Services (IJNHS). 2023;6(2):154-64.

Khajeei D, Neufeld H, Donelle L, Meyer SB, Neiterman E, Ike NA and Li JZ. Maternal health literacy and health numeracy conceptualisations in public health: A scoping review. Health & Social Care in the Community. 2022;30(6):e3534-e46.

Chandrakar A, Ramasamy S, Galhotra A and Shenoy MS. Maternal Health Literacy (MHL) for Improved Maternal and Child Outcomes: A Scoping Review. Indian Journal of Community Medicine. 2025:10.4103.

Ramos NNV, Kielmann K, Martins MdRO and Fronteira I. Health literacy in African countries: a scoping review. 2023.

Araújo I, Junior IBN, Rodrigues Peixoto Quaresma F, Pontes-Silva A and Maciel EdS. A scoping review on health literacy in parental educational practices: What do we know about it? Health Education. 2025;125(1):85-90.

Beasant B, Anderson K, Lee G, Lotfaliany M, Tembo M, McCoombe S, Vaughan V, Pasco JA and Hosking SM. Health Literacy and Primary Prevention of Cardiovascular Disease: A Scoping Review. Public Health Reports®. 2025:00333549251322649.

Chen S, Bai Q, Zhu J and Liu G. Impact of functional, communicative, critical and distributed health literacy on self-management behaviors in chronic disease patients across socioeconomic groups. BMC Public Health. 2025;25(1):1776.

Nutbeam D. Improving health literacy: how to succeed. Public health research & practice. 2023;33(1):1-3.

Dlamini TM and Dlamini S. Perspectives of pregnant women on maternal health information handouts at KwaZulu-Natal sub-district. African journal of primary health care & family medicine. 2024;16(1):4158.

Pipio G, Sanyare FN and Tampah-Naah AM. Perspectives of women on opportunities and challenges on maternal health literacy in Ghana: a facility-based study. Cogent Public Health. 2024;11(1):2446098.

Sharma J, O’Connor M and Rima Jolivet R. Group antenatal care models in low-and middle-income countries: a systematic evidence synthesis. Reproductive health. 2018;15:1-12.

Tessema M, Abera M and Birhanu Z. Improving postnatal social support using antenatal group-based psychoeducation: a cluster randomised controlled trial. Frontiers in Global Women's Health. 2025;6:1510725.

Kukula VA, Awini E, Ghosh B, Apetorgbor V, Zielinski R, Amankwah G, Ofosu WK, James K, Williams JE and Lori JR. Effect of group antenatal care versus individualised antenatal care on birth preparedness and complication readiness: a cluster randomised controlled study among pregnant women in Eastern Region of Ghana. BMC Pregnancy and Childbirth. 2024;24(1):546.

Yang X, Li L, Zhou R, Xia J, Li M, Zhang C and Guo H. Effects of the online and offline hybrid continuous group care on maternal and infant health: a randomised controlled trial. BMC Pregnancy and Childbirth. 2023;23(1):629.

Cheraghalizadeh H, Adib-Rad H, Pasha H, Chehrazi M, Nasiri‑Amiri F and Omidvar S. Effectiveness of face to face and virtual education to promote breast self-examination based on the theory of planned behavior: a randomised controlled trial study. BMC cancer. 2025;25(1):548.

Holst C, Stelzle D, Diep LM, Sukums F, Ngowi B, Noll J and Winkler AS. Improving health knowledge through provision of free digital health education to rural communities in Iringa, Tanzania: nonrandomised intervention study. Journal of Medical Internet Research. 2022;24(7):e37666.

Ali SER, Abdraboo R, Abdelati I and Shalaby N. Effect of an Educational Program on Modifying Lifestyle among Pregnant Women with Mild Preeclampsia. Scholars International Journal of Obstetrics and Gynecology (Sch Int J Obstet Gynec). 2021;4(8):316-20.

Apriani A, Wijayanti W, Widyastuti DE, Andhikatias YR and Mareta MY. The Effect of Health Education with Videos and Flash Cards on Knowledge and Skills of Fetal Stimulation in Pregnant Women. Gaster. 2022;20(2):185-94.

Abd Rahman R, Idris IB, Md Isa Z and Abd Rahman R. The effectiveness of a theory-based intervention program for pregnant women with anemia: A randomised control trial. PloS one. 2022;17(12):e0278192.

Ogundairo YO, Thomas AO and Olufunmilola OA. Use of drama for improving breastfeeding initiation, exclusive breastfeeding and breastfeeding self-efficacy among rural pregnant women from selected communities in two Local Government Areas (LGAs) in Ibadan, Nigeria. Plos one. 2024;19(8):e0290130.

Shao Y, Hu H, Liang Y, Hong Y, Yu Y, Liu C and Xu Y. Health literacy interventions among patients with chronic diseases: A meta-analysis of randomised controlled trials. Patient Education and Counseling. 2023;114:107829.

Nutbeam D and Lloyd JE. Understanding and responding to health literacy as a social determinant of health. Annual review of public health. 2021;42(2021):159-73.

Sekarini NNAD, Yanti L and Pratiwi PI, editors. Knowledge and attitude factors as determinants of pregnant women’s participation in triple elimination program in North Bali. BIO Web of Conferences; 2025: EDP Sciences.

Tavananezhad N, Bolbanabad AM, Ghelichkhani F, Effati-Daryani F and Mirghafourv and M. The relationship between health literacy and empowerment in pregnant women: a cross-sectional study. BMC Pregnancy and Childbirth. 2022;22(1):351.

Amwonya D, Kigosa N and Kizza J. Female education and maternal health care utilisation: evidence from Uganda. Reproductive Health. 2022;19(1):142.

Vallely L, Emori R, Gouda H, Phuanukoonnon S, Homer C and Vallely A. Women's knowledge of maternal danger signs during pregnancy: Findings from a cross-sectional survey in Papua New Guinea. Midwifery. 2019;72:7-13.

Kazeem K, Ishola A and Raji M. An Analytical Study of the Relationship Between Perceived Quality of Health, Health Expectations, and Health-Seeking Behaviour of Health Workers. Journal of International Health Sciences and Management. 2025;11(21):25-33.

Elia EF and Ayungo J. Socio-demographic influence on the pregnant women's comprehension of maternal health information in Tanzania. Heliyon. 2023;9(12).

Barman B, Saha J and Chouhan P. Impact of education on the utilisation of maternal health care services: An investigation from National Family Health Survey (2015–16) in India. Children and Youth Services Review. 2020;108:104642.

Lee S, Kasibante S, Eminai A, Wani S, Opii DJ, Levine LD and Kanyike AM. Effectiveness of a community health worker-led education intervention on knowledge, attitude, and antenatal care attendance among pregnant women in Eastern Uganda. Journal of Health, Population, and Nutrition. 2025;44:232.

Agbi FA, Lulin Z and Asamoah EO. Quality of communication between healthcare providers and pregnant women: impact on maternal satisfaction, health outcomes, and shared decision-making. UJOG. 2023;2(1):3-10.

Timsin N and Wangpitipanit S. The effects of a health literacy promotion program for prevention of preterm birth among pregnant women who received antenatal care services in the hospital-based. Women and Children Nursing. 2025.

Yoseph A, Teklesilasie W, Guillen-Grima F and Astatkie A. Effect of community health education on mothers’ knowledge of obstetric danger signs and birth preparedness and complication readiness practices in southern Ethiopia: A cluster randomised controlled trial. PloS one. 2024;19(11):e0312267.

Muluya KM, Aremu AB and Rashid N, editors. Effectiveness of the Box Savings Initiative for Transport Costs on Health Facility-Based Deliveries: A Case Study of the Franchisor-Franchisee Transport Model in Busoga Region. Gynecol Reprod Health. 2025; 9 (2): 1-9. Correspondence: Kharim Mwebaza Muluya, Department of Research and Innovations, Busoga Health Forum, Jinja, Uganda Received; 2025.

Refbacks

  • There are currently no refbacks.