Improving health literacy through group antenatal care: results from a cluster randomized controlled trial in Ghana
Abstract Background Although the majority of Ghanaian women receive antenatal care (ANC), many exhibit low health literacy by misinterpreting and incorrectly operationalizing ANC messages, leading to poor maternal and newborn health outcomes. Prior research in low-resource settings has found group a...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-01-01
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| Series: | BMC Pregnancy and Childbirth |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12884-023-06224-x |
| _version_ | 1797362782125948928 |
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| author | Jody R. Lori Vida Ami Kukula Liya Liu Veronica E.A. Apetorgbor Bidisha Ghosh Elizabeth Awini Nancy Lockhart Georgina Amankwah Ruth Zielinski Cheryl A. Moyer John Williams |
| author_facet | Jody R. Lori Vida Ami Kukula Liya Liu Veronica E.A. Apetorgbor Bidisha Ghosh Elizabeth Awini Nancy Lockhart Georgina Amankwah Ruth Zielinski Cheryl A. Moyer John Williams |
| author_sort | Jody R. Lori |
| collection | DOAJ |
| description | Abstract Background Although the majority of Ghanaian women receive antenatal care (ANC), many exhibit low health literacy by misinterpreting and incorrectly operationalizing ANC messages, leading to poor maternal and newborn health outcomes. Prior research in low-resource settings has found group antenatal care (G-ANC) feasible for women and providers. This study aims to determine the effect of G-ANC on increasing maternal health literacy. We hypothesized that pregnant women randomized into G-ANC would exhibit a greater increase in maternal health literacy than women in routine, individual ANC. Methods A 5-year cluster randomized controlled trial was conducted in 14 rural and peri-urban health facilities in the Eastern Region of Ghana. Facilities were paired based on patient volume and average gestational age at ANC enrollment and then randomized into intervention (G-ANC) vs. control (routine, individual ANC); 1761 pregnant women were recruited. Data collection occurred at baseline (T0) and post-birth (T2) using the Maternal Health Literacy scale, a 12-item composite scale to assess maternal health literacy. Logistic regression compared changes in health literacy from T0 to T2. Results Overall, women in both the intervention and control groups improved their health literacy scores over time (p < 0.0001). Women in the intervention group scored significantly higher on 3 individual items and on overall composite scores (p < 0.0001) and were more likely to attend 8 or more ANC visits. Conclusion While health literacy scores improved for all women attending ANC, women randomized into G-ANC exhibited greater improvement in overall health literacy post-birth compared to those receiving routine individual care. Life-saving information provided during ANC must be presented in an understandable format to prevent women and newborns from dying of preventable causes. Trial Registry Ethical approval for the study was obtained from the Institutional Review Boards of the University of Michigan (HUM#00161464) and the Ghana Health Service (GHS-ERC: 016/04/19). |
| first_indexed | 2024-03-08T16:12:24Z |
| format | Article |
| id | doaj.art-7aadb46ccd754110b2c20cda7c400fde |
| institution | Directory Open Access Journal |
| issn | 1471-2393 |
| language | English |
| last_indexed | 2024-03-08T16:12:24Z |
| publishDate | 2024-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pregnancy and Childbirth |
| spelling | doaj.art-7aadb46ccd754110b2c20cda7c400fde2024-01-07T12:52:53ZengBMCBMC Pregnancy and Childbirth1471-23932024-01-012411910.1186/s12884-023-06224-xImproving health literacy through group antenatal care: results from a cluster randomized controlled trial in GhanaJody R. Lori0Vida Ami Kukula1Liya Liu2Veronica E.A. Apetorgbor3Bidisha Ghosh4Elizabeth Awini5Nancy Lockhart6Georgina Amankwah7Ruth Zielinski8Cheryl A. Moyer9John Williams10Department of Health Behavior and Biological Sciences, School of Nursing, University of MichiganDodowa Health Research Centre, Ghana Health ServiceDepartment of Health Behavior and Biological Sciences, School of Nursing, University of MichiganDodowa Health Research Centre, Ghana Health ServiceDepartment of Health Behavior and Biological Sciences, School of Nursing, University of MichiganDodowa Health Research Centre, Ghana Health ServiceDepartment of Health Behavior and Biological Sciences, School of Nursing, University of MichiganDodowa Health Research Centre, Ghana Health ServiceDepartment of Health Behavior and Biological Sciences, School of Nursing, University of MichiganDepartment of Learning Health Sciences, University of Michigan Medical School, University of MichiganDodowa Health Research Centre, Ghana Health ServiceAbstract Background Although the majority of Ghanaian women receive antenatal care (ANC), many exhibit low health literacy by misinterpreting and incorrectly operationalizing ANC messages, leading to poor maternal and newborn health outcomes. Prior research in low-resource settings has found group antenatal care (G-ANC) feasible for women and providers. This study aims to determine the effect of G-ANC on increasing maternal health literacy. We hypothesized that pregnant women randomized into G-ANC would exhibit a greater increase in maternal health literacy than women in routine, individual ANC. Methods A 5-year cluster randomized controlled trial was conducted in 14 rural and peri-urban health facilities in the Eastern Region of Ghana. Facilities were paired based on patient volume and average gestational age at ANC enrollment and then randomized into intervention (G-ANC) vs. control (routine, individual ANC); 1761 pregnant women were recruited. Data collection occurred at baseline (T0) and post-birth (T2) using the Maternal Health Literacy scale, a 12-item composite scale to assess maternal health literacy. Logistic regression compared changes in health literacy from T0 to T2. Results Overall, women in both the intervention and control groups improved their health literacy scores over time (p < 0.0001). Women in the intervention group scored significantly higher on 3 individual items and on overall composite scores (p < 0.0001) and were more likely to attend 8 or more ANC visits. Conclusion While health literacy scores improved for all women attending ANC, women randomized into G-ANC exhibited greater improvement in overall health literacy post-birth compared to those receiving routine individual care. Life-saving information provided during ANC must be presented in an understandable format to prevent women and newborns from dying of preventable causes. Trial Registry Ethical approval for the study was obtained from the Institutional Review Boards of the University of Michigan (HUM#00161464) and the Ghana Health Service (GHS-ERC: 016/04/19).https://doi.org/10.1186/s12884-023-06224-xGroup antenatal carePrenatal careGroup careHealth literacyMaternal healthNewborn health |
| spellingShingle | Jody R. Lori Vida Ami Kukula Liya Liu Veronica E.A. Apetorgbor Bidisha Ghosh Elizabeth Awini Nancy Lockhart Georgina Amankwah Ruth Zielinski Cheryl A. Moyer John Williams Improving health literacy through group antenatal care: results from a cluster randomized controlled trial in Ghana BMC Pregnancy and Childbirth Group antenatal care Prenatal care Group care Health literacy Maternal health Newborn health |
| title | Improving health literacy through group antenatal care: results from a cluster randomized controlled trial in Ghana |
| title_full | Improving health literacy through group antenatal care: results from a cluster randomized controlled trial in Ghana |
| title_fullStr | Improving health literacy through group antenatal care: results from a cluster randomized controlled trial in Ghana |
| title_full_unstemmed | Improving health literacy through group antenatal care: results from a cluster randomized controlled trial in Ghana |
| title_short | Improving health literacy through group antenatal care: results from a cluster randomized controlled trial in Ghana |
| title_sort | improving health literacy through group antenatal care results from a cluster randomized controlled trial in ghana |
| topic | Group antenatal care Prenatal care Group care Health literacy Maternal health Newborn health |
| url | https://doi.org/10.1186/s12884-023-06224-x |
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