Maternal health literacy in nutrition and food safety during pregnancy and its role in emotional appraisal and decision-making

Abstract

Optimal nutrition and food safety during pregnancy are central to maternal and foetal health; however, engagement with dietary guidance involves more than access to information. Framed through a health literacy lens, this qualitative study explored how pregnant women in Malta access, understand, appraise, and apply nutrition and food safety information within emotional, social, and structural contexts. Semistructured interviews were conducted with 11 purposely selected pregnant women across varying stages of pregnancy and gravidity, and data were analysed using reflexive thematic analysis. Findings suggest that participants demonstrated strong awareness of dietary recommendations and food safety risks, yet understanding was largely procedural and rule-based, with limited explanatory depth. Decision-making extended beyond knowledge to include emotional appraisal, moral responsibility towards the foetus, and risk-avoidance strategies. Health literacy was enacted relationally and influenced by gravidity, prior obstetric experiences, digital information environments, timing of professional guidance, and access to resources. Participants frequently relied on self-directed digital inquiry to compensate for perceived gaps in early antenatal care, highlighting both the importance of digital health literacy and the challenges of navigating inconsistent information. Socio-demographic factors, including professional background, financial capacity, and time constraints, further shaped confidence and engagement. These findings suggest that maternal nutrition and food safety practices reflect functional, interactive, and critical health literacy processes embedded within socio-structural conditions. Strengthening early, equitable, and context-sensitive antenatal education may support informed decisionmaking while reducing anxiety and improving maternal and foetal wellbeing.