Maternal Health Literacy Inventory in Pregnancy (MHELIP)

Maternal Health Literacy Inventory in Pregnancy (MHELIP) is a 48-item measure of a person's health literacy regarding their pregnancy. Items cover 4 subscales: Maternal Health-Related Knowledge, Maternal Health Information Search, Assessment of Maternal Health Information and Maternal Health Decision Making and Behavior.


Geographies Tested: Iran

Populations Included: Female

Age Range: Adults


Maternal Health-Related Knowledge
1. I know natural physical changes during pregnancy.
2. I know natural psychological changes during pregnancy.
3. I know proper nutrition during pregnancy.
4. I know personal health care.
5. I know proper activity and status in pregnancy.
6. I know proper exercise during pregnancy.
7. I know pregnancy supplements (vitamins).
8. I know the appropriate referral timing for pregnancy examinations (visits).
9. I know diagnostic examination (ultrasound and tests) of maternal and fetal health in pregnancy.
10. I know the acceptable and normal amount of weight gain during pregnancy.
11. I know common pregnancy problems such as nausea, vomiting, lower back pain.
12. I know injecting safe (allowed) vaccines during pregnancy.
13. I know the proper sexual relation during pregnancy.
14. I know the normal number of fetal movements.
15. I know the factors affecting fetal health such as photography, medications, chemicals such as botox, etc.
16. I know risk signs in pregnancy.
17. I know pregnancy disease symptoms such as gestational diabetes, high blood pressure in pregnancy and other diseases.
18. I know childbirth such as the advantages and disadvantages of each of the natural delivery methods and cesarean section and their associated care.
19. I know the methods of pain relief in virginal delivery.
20. I know neonatal and infant care in the postpartum period.
21. I know required postpartum care of mother.

Response Options:
Not at all - 1
Rarely - 2
Sometimes - 3
Most often the times - 4
I know fully - 5

Maternal Health Information Search
22. I acquire information from written materials such as books, educational notes, pamphlets and medication brochures.
23. I acquire information from radio and television.
24. I acquire information from internet sources such as websites, instagram and telegram.
25. I acquire information from other pregnant women.
26. I acquire information from family, friends and acquaintances.
27. I acquire information from healthcare professionals such as a physician or midwife.

Assessment of Maternal Health Information
28. It is easy for me to read and pronounce pregnancy-related vocabulary from information sources such as books, educational booklets, internet, telegram and Instagram.
29. The information obtained from different sources of information are understandable for me.
30. I know valid and verified sources for getting the right pregnancy related information.
31. I ask of the doctor or midwife to make sure pregnancy related information.
32. I evaluate the accuracy of pregnancy-related information obtained from online sources such as websites, instagram and telegram.
33. I evaluate the accuracy of pregnancy-related information obtained from friends and relatives.

Maternal Health Decision Making and Behavior
34. I am able to controlmanage physical and psychological changes in pregnancy.
35. I implement a proper diet for pregnancy.
36. I implement necessary measures for personal care during pregnancy.
37. I adhere to the principles of activity and proper condition during pregnancy.
38. I take pregnancy supplements as prescribed by doctor or midwife.
39. I consult with the doctor or midwife for taking any type of medication during pregnancy (chemical and herbal).
40. I attend for prenatal care (examinations) as scheduled.
41. I perform ultrasound and tests in pregnancy recommended by healthcare professionals such as doctor or midwife.
42. I monitor and control the weight gain during pregnancy.
43. I use the appropriate methods of sexual relation during pregnancy.
44. I avoid taking actions that are harmful to pregnancy.
45. I see the doctor of midwife as soon as possible when any signs of danger in pregnancy is observed.
46. I ask the doctor or midwife for further explanation if the information and recommendations are not clear enough.
47. I participate in decision making about pregnancy issues with the doctor or midwife (providing personal opinions).
48. I pay attention to the accuracy and appropriateness of information given to other pregnancy women.

Response Options:
Not at all - 1
Rarely - 2
Sometimes - 3
Most often the times - 4
Always - 5

Scoring Procedures

The MHELIP score can be calculated by subscale or as one total score. Raw item scores are summed and transferred into a score from 0 to 100 using a formula as described in the primary citation. Scores are then ranked according to the following categories: 0-50=inadequate; 50.1-66=problematic; 66.1-84=sufficient; 84.1-100=excellent.

Original Citation

Taheri, S., Tavousi, M., Momenimovahed, Z., Direkvand-Moghadam, A., Tiznobaik, A., Suhrabi, Z., & Taghizadeh, Z. (2020). Development and psychometric properties of maternal health literacy inventory in pregnancy. PLoS One, 15(6), e0234305.

Psychometric Score

Ease of Use Score

Scoring breakdown

Formative Research

Qualitative Research

Existing Literature/Theoretical Framework

Field Expert Input

Cognitive Interviews / Pilot Testing








Criterion (gold-standard)



Ease of Use


Scoring Clarity


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