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Examining maternal health literacy as a mediator of the relationship between social vulnerability and caregiving practices for improving infant development

Examining maternal health literacy as a mediator of the relationship between social vulnerability and caregiving practices for improving infant development
Examining maternal health literacy as a mediator of the relationship between social vulnerability and caregiving practices for improving infant development
This study examined whether specific dimensions of maternal health literacy mediated the relationship between social vulnerability and maternal caregiving confidence, specifically breastfeeding self-efficacy and maternal beliefs about play, among 168 mothers of newborns in Soweto, South Africa. Social vulnerability was measured using an adapted Social Vulnerability Index, and structural equation modelling was used to assess direct and indirect associations between social vulnerability, maternal health literacy dimensions, and caregiving outcomes. Although most mothers in the sample were classified as socially vulnerable, material deprivation showed no direct association with breastfeeding self-efficacy or maternal beliefs about play. Three dimensions of maternal health literacy-engagement with healthcare providers, ability to find good health information, and ability to understand health information well enough to act-emerged as important pathways shaping mothers’ confidence and caregiving beliefs. The ability to engage with healthcare providers and to find good information partially mediated the effects of social vulnerability, while the ability to understand health information was a strong direct predictor of both outcomes, independent of deprivation. These findings indicate that relational and interpretive literacy skills play a more critical role in shaping maternal confidence than structural disadvantage alone. Strengthening these health literacy skills through targeted interventions may enhance mothers’ confidence in breastfeeding and in supporting healthy play and development in their children, even in contexts of socio-economic vulnerability.
Parenting, Early Childhood development, Breastfeeding, Play, Low-income context
1471-2458
Stuart, Lauren
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Hart, Claire
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Desai, Rachana
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Norris, Shane A.
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Bennin, Fiona
0a259724-37ce-4e0a-a7a4-b9db4f6b9e90
Theunissen, Helene
5a832573-d28b-4f0b-a07e-4216c81f7f4e
Prioreschi, Alessandra
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Stuart, Lauren
ef4fcfcb-170f-4ec7-9029-f09f7091a43f
Hart, Claire
87bb652f-3258-4f14-bcda-54876988a9c1
Desai, Rachana
9b5bacf9-32f1-4f3d-b0d4-29492533487b
Norris, Shane A.
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Bennin, Fiona
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Theunissen, Helene
5a832573-d28b-4f0b-a07e-4216c81f7f4e
Prioreschi, Alessandra
04875305-6e91-4199-98bb-8154707060c4

Stuart, Lauren, Hart, Claire, Desai, Rachana, Norris, Shane A., Bennin, Fiona, Theunissen, Helene and Prioreschi, Alessandra (2025) Examining maternal health literacy as a mediator of the relationship between social vulnerability and caregiving practices for improving infant development. BMC Public Health. (doi:10.1186/s12889-025-25756-9).

Record type: Article

Abstract

This study examined whether specific dimensions of maternal health literacy mediated the relationship between social vulnerability and maternal caregiving confidence, specifically breastfeeding self-efficacy and maternal beliefs about play, among 168 mothers of newborns in Soweto, South Africa. Social vulnerability was measured using an adapted Social Vulnerability Index, and structural equation modelling was used to assess direct and indirect associations between social vulnerability, maternal health literacy dimensions, and caregiving outcomes. Although most mothers in the sample were classified as socially vulnerable, material deprivation showed no direct association with breastfeeding self-efficacy or maternal beliefs about play. Three dimensions of maternal health literacy-engagement with healthcare providers, ability to find good health information, and ability to understand health information well enough to act-emerged as important pathways shaping mothers’ confidence and caregiving beliefs. The ability to engage with healthcare providers and to find good information partially mediated the effects of social vulnerability, while the ability to understand health information was a strong direct predictor of both outcomes, independent of deprivation. These findings indicate that relational and interpretive literacy skills play a more critical role in shaping maternal confidence than structural disadvantage alone. Strengthening these health literacy skills through targeted interventions may enhance mothers’ confidence in breastfeeding and in supporting healthy play and development in their children, even in contexts of socio-economic vulnerability.

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More information

Submitted date: 13 November 2024
Accepted/In Press date: 19 November 2025
Published date: 15 December 2025
Keywords: Parenting, Early Childhood development, Breastfeeding, Play, Low-income context

Identifiers

Local EPrints ID: 508236
URI: http://eprints.soton.ac.uk/id/eprint/508236
ISSN: 1471-2458
PURE UUID: b88a0abd-c160-4004-8a76-36d84d77d57b
ORCID for Shane A. Norris: ORCID iD orcid.org/0000-0001-7124-3788

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Date deposited: 14 Jan 2026 18:16
Last modified: 15 Jan 2026 02:57

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Contributors

Author: Lauren Stuart
Author: Claire Hart
Author: Rachana Desai
Author: Shane A. Norris ORCID iD
Author: Fiona Bennin
Author: Helene Theunissen
Author: Alessandra Prioreschi

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