Health literacy and its association with perception of teratogenic risks and health behavior during pregnancy

Abstract Objective Investigate the association between health literacy and perception of medication risk, beliefs about medications, use and non-adherence to prescribed pharmacotherapy during pregnancy, and whether risk perception and beliefs may mediate an association between health literacy and non-adherence. Methods This multinational, cross-sectional, internet-based study recruited pregnant woman between 1 October 2011 and 29 February 2012. Data on maternal socio-demographics, medication use, risk perception, beliefs, and non-adherence were collected via an on-line questionnaire. Health literacy was measured via a self-assessment scale. Mann–Whitney U test, Spearman's rank correlation, Generalized Estimating Equations and mediation analysis were utilized. Results 4999 pregnant women were included. Low-health literacy women reported higher risk perception for medications, especially penicillins (Rho: −0.216) and swine flu vaccine (Rho: −0.204) and more negative beliefs about medication. Non-adherence ranged from 19.2% (high-health literacy) to 25.0% (low-health literacy). Low-health literacy women were more likely to be non-adherent to pharmacotherapy than their high-level counterparts (adjusted OR: 1.30; 95% CI: 1.02–1.66). Risk perception and beliefs appeared to mediate the association between health literacy and non-adherence. Conclusion Health literacy was significantly associated with maternal health behaviors regarding medication non-adherence. Practice implications Clinicians should take time to inquire into their patients' ability to understand health information, perception and beliefs, in order to promote adherence during pregnancy.