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

Premature birth, defined as delivery before 37 weeks of gestation, is a critical global health issue that poses significant risks to maternal and neonatal well-being. Although substantial research has been conducted on interventions to prevent preterm births in high-income countries, evidence on culturally adapted strategies tailored for pregnant women in low- and middle-income settings, such as Thailand, remains limited. This study addresses this gap by evaluating a culturally tailored health literacy promotion program developed using Nutbeam's health literacy model to enhance health literacy and risk perception among Thai pregnant women. A quasi-experimental one-group pretest-posttest study was conducted from March to September 2024 ​at health promotion hospitals in Thailand. Thirty-one pregnant women receiving prenatal care were recruited through convenience sampling. The intervention was a 12-week health literacy program based on Nutbeam's health literacy model and prenatal care standards, emphasizing cognitive, behavioral, and motivational aspects of health literacy. The program included a care booklet, risk screening manual, assessment stickers, and educational materials. Weekly interactive "4-Checks" sessions (20–45 ​min) and personalized counseling every four weeks were central components. Health literacy and risk perception were assessed using validated questionnaires with a content validity index of 0.90 and high reliability (Cronbach's alpha ​= ​0.85, health literacy; 0.87, risk perception). Measurements were taken before and after the program to assess baseline levels and immediate effects of the intervention. Statistical analyses, including Wilcoxon signed-rank tests, were performed using IBM SPSS Statistics version 29.0.2.0. The mean age of participants was 30.23 years (SD ​= ​5.26), with 51.6% in their second or subsequent pregnancies. Key information sources included hospital staff, healthcare providers, relatives, and social media. The program significantly improved health literacy scores (0–64 to 40–80; Z ​= ​−4.01, P ​< ​0.001) and risk perception scores (10–50 to 33–50; Z ​= ​−3.54, P ​< ​0.001). The health literacy program effectively enhanced health literacy and risk perception among Thai pregnant women, providing a viable framework for reducing premature birth risks. Future research should incorporate control groups and longitudinal assessments to evaluate sustained effects and long-term program impacts.