title: 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.
  
  
  CONCLUSIONS
  Health literacy was significantly associated with maternal health behaviors regarding medication non-adherence.
  
  
  CONCLUSIONS
  Clinicians should take time to inquire into their patients' ability to understand health information, perception and beliefs, in order to promote adherence during pregnancy.
authors.affiliation: School of Pharmacy, University of Oslo, Oslo, Norway. Electronic address: angela.lupattelli@farmasi.uio.no.
authors.forename: Angela
authors.initials: A
authors.lastname: Lupattelli
authors.affiliation: School of Pharmacy, University of Oslo, Oslo, Norway.
authors.forename: Marta
authors.initials: M
authors.lastname: Picinardi
authors.affiliation: The Motherisk Program, Hospital for Sick Children, Toronto, Canada.
authors.forename: Adrienne
authors.initials: A
authors.lastname: Einarson
authors.affiliation: School of Pharmacy, University of Oslo, Oslo, Norway; Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: Hedvig
authors.initials: H
authors.lastname: Nordeng
mesh_terms: D000014:Abnormalities, Drug-Induced / Q000523:psychology*; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D015438:Health Behavior; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy; D006801:Humans; D004366:Nonprescription Drugs / Q000008:administration & dosage; D010465:Perception; D011247:Pregnancy; D037841:Pregnant People / Q000523:psychology*; D055553:Prescription Drugs / Q000008:administration & dosage; D020377:Self Efficacy; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D064793:Teratogenesis; D016903:Drug Monitoring
chemical_list: D004366:Nonprescription Drugs; D055553:Prescription Drugs
keywords: Beliefs about medication; Drug utilization; Health literacy; Non-adherence; Pregnancy; Risk perception