At the end of the study, among 140 pregnant women (70 pregnant women in the experimental group and 70 pregnant women in the control group), 10 women in the experimental group (1
participant due to unwillingness to continue participating in the study, 6 participants due to app deletion by themselves, 1 participant due to abortion and 2 participants due to not reading the app) and 17 participants in the control group (7 participants due to unwillingness to continue participating in the study, 9 participants due to abortion, and 1 participant due to ectopic pregnancy) were excluded from the study (Fig. 1).
The mean age of participants was 30.1 ± 5.66 years, the majority of participants had a diploma (38.05%) and were housewives (84.96%).
The mean age of the spouses was 33.6 ± 5.7 years. The majority of spouses had a high school education and diplomas (40.71%), and the majority of spouses were self-employed (76.11%). The monthly household income of the majority (46.90%) of the subjects had incomes between one to one and a half million.
According to the information in Table 1, before and after the intervention, the changes in the health literacy score are statistically significant. The mean score of health literacy before the intervention in the experimental group was 45.35 ± 6.75 and 42.02 ± 7.41 in the control group. Also, the mean score of health literacy after the intervention in the experimental group was 58.03 ± 6.57 and 42.23 ± 8.47 in the control group. The change in health literacy score before and after the intervention was 12.68 ± 6.31 in the experimental group and 0.21 ± 4.25 in the control group. In the study of intragroup changes, the changes were significant only in the experimental group based on the Wilcoxon test (p < 0.001).
Table 1
Comparison of health literacy of the two groups: before and after intervention
Health literacy | Study group | Significance level | Statistical test type |
Experimental | Control |
Before the intervention | M | 45.35 | 42.02 | *<0.014 | Independent t-test |
SD | 6.75 | 7.41 |
Median | 44 | 42 |
After the intervention | M | 58.03 | 42.23 | *<0.001 | Mann–Whitney U |
SD | 6.57 | 8.47 |
Median | 59 | 42 |
Health literacy score changes before and after the intervention | M | 12.68 | 0.21 | *<0.001 |
SD | 6.31 | 4.25 |
Median | 13 | 0.001 |
Significance level | *<0.001 | 0.609 | |
* Significance |
According to the inter-group comparison of the health literacy score before and after the intervention according to the age of the spouse using the Wilcoxon test, a statistically significant difference was observed in the age groups of 30 years and younger and 31 years and older (p < 0.001). According to the intragroup comparison of the health literacy score before the intervention in terms of the level of education of the spouse using a one-way analysis of variance test, a statistically significant difference was between the subjects (p = 0.004). According to the intergroup comparison, health literacy score before and after the intervention in terms of the spouse's education using Wilcoxon test, the score changes before and after the training intervention in the primary school (p = 0.014), elementary school (p = 0.001), high school and diploma groups (p < 0.001), Associate degree (p = 0.036) and bachelor and higher (p = 0.006) were significantly different.
According to the intragroup comparison of the health literacy score before the intervention according to the occupation of the spouse using a one-way analysis of variance test, a statistically significant difference was observed between the subjects (p < 0.001). According to the intergroup comparison of the health literacy score before and after the intervention in terms of the level of occupation of the spouse using the Wilcoxon test, a significant difference was between the subjects in the group of employee (p = 0.009), worker (p = 0.018) and self-employed (p < 0.001).
According to the intragroup comparison of the health literacy score before the intervention in terms of monthly household income using a one-way analysis of variance test, a statistically significant difference was observed between the subjects (p = 0.012).
According to the intergroup comparison of health literacy score before and after the intervention in terms of monthly household income using Wilcoxon signed-rank test, a significant difference was between the subjects in the group with income less than one million (p = 0.009), one to one and a half million (p < 0.001), one and a half to two million (p = 0.003), and two million and more (p = 0.005).
As shown in Table 2, a multiple regression model has been implemented using the step-by-step method, and the effect of training intervention after controlling health literacy score before training intervention, age of women and spouse, education level of women and spouse, occupation of women and spouse, monthly income and place of residence was still significant in the final linear regression model as a predictor variable related to health literacy (p < 0.001), so that the training intervention increased health literacy score by 13.4% (β ± SE = 13.4 ± 1). In addition to the effect of the training intervention, the health literacy score before the intervention also had a significant relationship with changes in health literacy score (p = 0.015). With increasing health literacy scores before the intervention, the rate of change in health literacy score reduces (β ± SE= -0.181 ± 0.073).
Table 2
Intervention effect on changes in health literacy score after controlling the effects of confounding variables
Variable | Unstandardized Coefficients | Standard error | Significance level | Beta 95% confidence interval |
Beta Regression coefficient | Regression coefficient standard error | Beta | Lower bound | Upper bound |
(Constant) | -12.268 | 1.652 | | 0.000 | -15.542 | -8.995 |
Intervention | 12.476 | 1.026 | 0.756 | 0.000 | 10.443 | 14.509 |
(Constant) | -3.358 | 3.141 | | 0.287 | -9.582 | 2.865 |
Intervention | 13.243 | 1.011 | 0.802 | 0.000 | 11.24 | 15.246 |
Health literacy scores before the intervention | -0.230 | -0.070 | -0.201 | 0.001 | -0.369 | -0.091 |
(Constant) | -3.066 | 3.099 | | 0.325 | -9.208 | 3.077 |
Intervention | 13.421 | 1 | 0.813 | 0.000 | 11.438 | 15.403 |
Health literacy scores before the intervention | -0.181 | 0.073 | -0.158 | 0.015 | -0.326 | -0.036 |
Education of spouse | -0.931 | 0.455 | -0.129 | 0.043 | -1.832 | -0.030 |
a. Dependent Variable: Health literacy score changes before and after the intervention R Square = ) 0.624 ) |
Also, spouse's education was another factor related to changes in health literacy score in this study, with increasing spouse education level, health literacy score reduced (β ± SE= -0.931 ± 0.455).