Longitudinal Associations Among Maternal Health Literacy, Psychological Empowerment and Health-Promoting Behaviours in Rural Pregnant Women: A Cross-Lagged Panel Study.

Authors

Yanman Chen, Xiaotong Zhu, Mei Chan Chong, Congshu Ma, Fujuan Guan, Chong Chin Che, Yanjia Liu

Published in

Journal of advanced nursing. Aug 14, 2026. Epub Aug 14, 2026.

Abstract

To examine longitudinal associations among maternal health literacy, psychological empowerment and health-promoting behaviours across pregnancy among rural pregnant women.
Prospective cohort study.
Between 1 May 2023 and 15 January 2024, 694 rural pregnant women were assessed at 12, 24 and 32 gestational weeks (T1, T2 and T3). Descriptive, correlation and cross-lagged panel analyses were used.
Significant reciprocal cross-lagged associations were observed among maternal health literacy, psychological empowerment and health-promoting behaviours across pregnancy. Maternal health literacy at T1 significantly predicted psychological empowerment at T2 (β = 0.183, B = 0.056, 95% CI [0.036, 0.075], p < 0.001), and psychological empowerment at T2 predicted health-promoting behaviours at T3 (β = 0.256, B = 0.373, 95% CI [0.246, 0.500], p < 0.001). Longitudinal indirect pathway analysis showed that maternal health literacy at T1 was indirectly associated with health-promoting behaviours at T3 through psychological empowerment at T2 (β = 0.047, B = 0.021, 95% CI [0.010, 0.031], p < 0.001).
Maternal health literacy, psychological empowerment, and health-promoting behaviours were longitudinally and reciprocally associated across pregnancy. Psychological empowerment also carried the longitudinal indirect association between earlier maternal health literacy and later health-promoting behaviours. Early gestation may represent an intervention window.
Integrating literacy-sensitive and empowerment-based interventions into antenatal care may help rural pregnant women support sustained health-promoting behaviours throughout pregnancy.
Clarifies the longitudinal role of maternal health literacy. Demonstrates a significant indirect longitudinal role of psychological empowerment. Supports early-stage capability-based interventions within rural maternal healthcare.
This study is consistent with the STROBE statement for cohort studies.
This study did not include patient or public involvement in its design, conduct or reporting.

PMID:
42598788
Bibliographic data and abstract were imported from PubMed on 14 Aug 2026.

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