Volume 23, Issue 2 (6-2026)
J Res Dev Nurs Midw 2026, 23(2): 24-32 |
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Gomes Falcão E, Alves de Sousa Filho A, Maria Araújo E, de Jesus Silva Bezerra dos Anjos S. Use of information and Communication Technologies to improve health literacy among pregnant women: A scoping review. J Res Dev Nurs Midw 2026; 23 (2) :24-32
URL: http://nmj.goums.ac.ir/article-1-2287-en.html
URL: http://nmj.goums.ac.ir/article-1-2287-en.html
Emanuela Gomes Falcão1 
, Antônio Alves de Sousa Filho2 , Edina Maria Araújo3 , Saiwori De Jesus Silva Bezerra dos Anjos2
, Antônio Alves de Sousa Filho2 , Edina Maria Araújo3 , Saiwori De Jesus Silva Bezerra dos Anjos2
1- Programa de Pós-graduação em Cuidados Clínicos em Enfermagem e Saúde (PPCCLIS), Universidade Estadual do Ceará (UECE), Fortaleza, CE, Brazil , emanuela.falcao@aluno.uece.br
2- Programa de Pós-graduação em Cuidados Clínicos em Enfermagem e Saúde (PPCCLIS), Universidade Estadual do Ceará (UECE), Fortaleza, CE, Brazil
3- Programa de Pós-graduação da Universidade Aberta do Brasil, Universidade Estadual de Roraima (UERR), Roraima, RO, Brazil
2- Programa de Pós-graduação em Cuidados Clínicos em Enfermagem e Saúde (PPCCLIS), Universidade Estadual do Ceará (UECE), Fortaleza, CE, Brazil
3- Programa de Pós-graduação da Universidade Aberta do Brasil, Universidade Estadual de Roraima (UERR), Roraima, RO, Brazil
Keywords: Pregnant Women, Pregnancy, Prenatal Care, Antenatal Care, Health Literacy, EHealth, Digital Health Literacy, Information Technology
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Primary and secondary studies employing quantitative, qualitative, or mixed-methods designs were included if they addressed pregnant women or populations receiving prenatal/perinatal care; the use of Information and Communication Technologies; and the relationship of these technologies with health literacy, digital literacy, health education, self-care, decision-making, or access to health information. Studies published in any language and available in full text were included, with no restriction on publication period.
Exclusion criteria
The following were excluded: editorials, letters to the editor, commentaries, study protocols without results, conference abstracts, duplicate records, studies unrelated to pregnancy, and studies that did not address the intersection of ICTs and health literacy. Technical studies with no application to clinical, educational, or care settings in maternal health were also excluded.
Study selection
References were exported to EndNote, where duplicate records were removed. The remaining records were then imported into Rayyan QCRI for screening. The selection process comprised two stages: (1) title and abstract screening; and (2) full-text review. Two reviewers conducted the process independently. Disagreements were resolved by consensus, and a third reviewer was consulted when necessary.
Data charting and extraction
Data were extracted independently by two reviewers using a standardized spreadsheet that had been pilot-tested. The following data were extracted: authors and year, country, study design, study objective, number of participants, ICT-related opportunities, and challenges. To minimize errors, a double-checking procedure was applied, including comparison of the extraction sheets and resolution of discrepancies by consensus or consultation with a third reviewer.
Data analysis and presentation
Data were analyzed using descriptive synthesis and thematic analysis. Initially, the studies were grouped by year, country, and study design. The findings were then organized into two main themes: (1) opportunities for using ICTs to enhance health literacy among pregnant women; and (2) barriers and challenges to implementation. The results were presented in a summary table and discussed in relation to the scientific literature.
Results
As shown in Figure 1, a total of 293 records were identified through the databases: MEDLINE/PubMed (n = 51), LILACS (n = 2), EMBASE (n = 57), Scopus (n = 2), and ScienceDirect (n = 181). Before screening, 118 duplicate records were removed, leaving 175 records for title and abstract screening.
After the initial screening, 89 studies were excluded because they did not address the research question, resulting in 86 articles being assessed in full text. At this stage, 62 studies were excluded because they did not meet the predefined eligibility criteria, leaving 24 studies.
In addition to the database searches, a complementary snowballing strategy was applied by reviewing the reference lists of the included studies. This strategy identified 11 additional records, of which 4 were duplicates. Thus, 7 studies were assessed for eligibility, and 6 were excluded because they did not address the research question, resulting in 1 additional included study.
At the end of the identification, screening, eligibility, and inclusion process, the final sample of this scoping review comprised 25 studies, of which 24 were identified through database searching and 1 through snowballing.
Table 2 presents the characteristics of the included studies in terms of authors/year, country of origin, methodological design, and the reported opportunities and challenges associated with the use of Information and Communication Technologies to promote health literacy among pregnant women.
The studies were published between 2007 and 2026, with a higher concentration from 2023 onward, highlighting the recent growth of research on digital health, eHealth literacy, and mHealth technologies in maternal health.
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Introduction
Pregnancy and childbirth are critical periods in a woman’s life, requiring a comprehensive understanding of physiological processes and care-related information to support appropriate clinical practices and safer decision-making (1). In this context, health literacy plays a fundamental role and is understood as a multidimensional construct encompassing the knowledge, motivation, and competencies required to access, understand, appraise, and apply health information when making decisions and navigating health systems.
According to Sørensen et al. (2), health literacy comprises three interrelated domains: healthcare, disease prevention, and health promotion. More recent reviews have expanded this understanding by emphasizing that health literacy is not limited to acquiring information but also includes the ability to translate it into concrete actions suited to individual contexts and healthcare system demands (3). In maternal health, Putri, Irawan, and Lu (4) highlight that this construct is essential for empowering pregnant women, thereby contributing to greater autonomy, improved self-care, and more informed decisions concerning their own health and that of their babies.
Digital health is a broad term encompassing the application of digital technologies to health, including telemedicine, Information and Communication Technologies (ICTs), and emerging fields such as artificial intelligence, genomics, and big data. In this context, ICTs refer to resources used to produce, store, process, transmit, and share information, including computers, smartphones, laptops, emails, cameras, webcams, mobile applications, websites, social networks, text messaging, and digital health platforms (5,6).
In obstetric care, these technologies have considerable potential to enhance health literacy among pregnant women by facilitating access to reliable information and real-time support resources (7,8). However, despite the growing number of such interventions, the literature remains fragmented regarding the types of technologies used, their effects on health literacy, and the barriers to their effectiveness, underscoring a gap in the synthesis of the available evidence (8).
In addition, the use of ICTs in maternal health presents important challenges, including inequalities in internet access, limited digital literacy, cultural and linguistic barriers, and concerns about privacy and data security, particularly among pregnant women in socially vulnerable contexts (9,10). These factors may compromise equitable access to these technologies and adversely affect health outcomes.
Given the diversity of approaches, technologies, and contexts described in the literature, a scoping review is an appropriate method for broadly mapping existing evidence, identifying knowledge gaps, and informing future research and interventions (11). Specifically, there is no consolidated synthesis of how ICTs are used to strengthen health literacy during pregnancy or of their limitations, effectiveness, and implications for obstetric nursing practice. Therefore, this study aimed to map and analyze the available evidence on the use of Information and Communication Technologies during pregnancy and their implications for obstetric nursing.
Methods
Study design
This descriptive and exploratory scoping review was conducted in accordance with the methodological guidelines of the Joanna Briggs Institute (JBI) (12) and reported following the PRISMA-ScR extension (13), ensuring rigor and transparency throughout the identification, screening, eligibility, and study-synthesis stages. To ensure reproducibility and methodological traceability, the review protocol was registered in advance on the Open Science Framework (OSF) under DOI 10.17605/OSF.IO/XJP53, before data collection and evidence analysis began.
Research question identification
The review used the PCC mnemonic to formulate the research question, considering the following elements: population - pregnant women; concept - Information and Communication Technologies (ICTs) applied to health literacy; and context - pregnancy and childbirth. The guiding question was: What are the possibilities and challenges of using ICTs during pregnancy to enhance health literacy in the context of pregnancy and childbirth?
Search strategy
The search strategy was developed using controlled and uncontrolled descriptors identified in the Medical Subject Headings (MeSH), EMBASE Subject Headings (Emtree), and Descritores em Ciências da Saúde (DeCS) vocabularies, together with free-text terms related to the topic.
The strategies were individually adapted to each database to account for differences in syntax, indexing, search fields, and Boolean operators, thereby ensuring greater sensitivity and specificity. The following terms were used: pregnant women, pregnancy, antenatal care, prenatal care, health literacy, eHealth literacy, digital health literacy, and information technology.
An initial search was conducted in December 2023, and the search strategies were updated in May 2026. The searches covered publications indexed from the inception of each database through May 2026, with no restrictions on language, country, or study design. The databases searched were MEDLINE (PubMed), EMBASE, LILACS, Scopus, and ScienceDirect, accessed through the CAPES Journal Portal, as shown in Table 1.
Pregnancy and childbirth are critical periods in a woman’s life, requiring a comprehensive understanding of physiological processes and care-related information to support appropriate clinical practices and safer decision-making (1). In this context, health literacy plays a fundamental role and is understood as a multidimensional construct encompassing the knowledge, motivation, and competencies required to access, understand, appraise, and apply health information when making decisions and navigating health systems.
According to Sørensen et al. (2), health literacy comprises three interrelated domains: healthcare, disease prevention, and health promotion. More recent reviews have expanded this understanding by emphasizing that health literacy is not limited to acquiring information but also includes the ability to translate it into concrete actions suited to individual contexts and healthcare system demands (3). In maternal health, Putri, Irawan, and Lu (4) highlight that this construct is essential for empowering pregnant women, thereby contributing to greater autonomy, improved self-care, and more informed decisions concerning their own health and that of their babies.
Digital health is a broad term encompassing the application of digital technologies to health, including telemedicine, Information and Communication Technologies (ICTs), and emerging fields such as artificial intelligence, genomics, and big data. In this context, ICTs refer to resources used to produce, store, process, transmit, and share information, including computers, smartphones, laptops, emails, cameras, webcams, mobile applications, websites, social networks, text messaging, and digital health platforms (5,6).
In obstetric care, these technologies have considerable potential to enhance health literacy among pregnant women by facilitating access to reliable information and real-time support resources (7,8). However, despite the growing number of such interventions, the literature remains fragmented regarding the types of technologies used, their effects on health literacy, and the barriers to their effectiveness, underscoring a gap in the synthesis of the available evidence (8).
In addition, the use of ICTs in maternal health presents important challenges, including inequalities in internet access, limited digital literacy, cultural and linguistic barriers, and concerns about privacy and data security, particularly among pregnant women in socially vulnerable contexts (9,10). These factors may compromise equitable access to these technologies and adversely affect health outcomes.
Given the diversity of approaches, technologies, and contexts described in the literature, a scoping review is an appropriate method for broadly mapping existing evidence, identifying knowledge gaps, and informing future research and interventions (11). Specifically, there is no consolidated synthesis of how ICTs are used to strengthen health literacy during pregnancy or of their limitations, effectiveness, and implications for obstetric nursing practice. Therefore, this study aimed to map and analyze the available evidence on the use of Information and Communication Technologies during pregnancy and their implications for obstetric nursing.
Methods
Study design
This descriptive and exploratory scoping review was conducted in accordance with the methodological guidelines of the Joanna Briggs Institute (JBI) (12) and reported following the PRISMA-ScR extension (13), ensuring rigor and transparency throughout the identification, screening, eligibility, and study-synthesis stages. To ensure reproducibility and methodological traceability, the review protocol was registered in advance on the Open Science Framework (OSF) under DOI 10.17605/OSF.IO/XJP53, before data collection and evidence analysis began.
Research question identification
The review used the PCC mnemonic to formulate the research question, considering the following elements: population - pregnant women; concept - Information and Communication Technologies (ICTs) applied to health literacy; and context - pregnancy and childbirth. The guiding question was: What are the possibilities and challenges of using ICTs during pregnancy to enhance health literacy in the context of pregnancy and childbirth?
Search strategy
The search strategy was developed using controlled and uncontrolled descriptors identified in the Medical Subject Headings (MeSH), EMBASE Subject Headings (Emtree), and Descritores em Ciências da Saúde (DeCS) vocabularies, together with free-text terms related to the topic.
The strategies were individually adapted to each database to account for differences in syntax, indexing, search fields, and Boolean operators, thereby ensuring greater sensitivity and specificity. The following terms were used: pregnant women, pregnancy, antenatal care, prenatal care, health literacy, eHealth literacy, digital health literacy, and information technology.
An initial search was conducted in December 2023, and the search strategies were updated in May 2026. The searches covered publications indexed from the inception of each database through May 2026, with no restrictions on language, country, or study design. The databases searched were MEDLINE (PubMed), EMBASE, LILACS, Scopus, and ScienceDirect, accessed through the CAPES Journal Portal, as shown in Table 1.
|
Table 1. Search strategies used in the selected databases and information sources
.PNG) Source: Prepared by the authors (2026) |
Primary and secondary studies employing quantitative, qualitative, or mixed-methods designs were included if they addressed pregnant women or populations receiving prenatal/perinatal care; the use of Information and Communication Technologies; and the relationship of these technologies with health literacy, digital literacy, health education, self-care, decision-making, or access to health information. Studies published in any language and available in full text were included, with no restriction on publication period.
Exclusion criteria
The following were excluded: editorials, letters to the editor, commentaries, study protocols without results, conference abstracts, duplicate records, studies unrelated to pregnancy, and studies that did not address the intersection of ICTs and health literacy. Technical studies with no application to clinical, educational, or care settings in maternal health were also excluded.
Study selection
References were exported to EndNote, where duplicate records were removed. The remaining records were then imported into Rayyan QCRI for screening. The selection process comprised two stages: (1) title and abstract screening; and (2) full-text review. Two reviewers conducted the process independently. Disagreements were resolved by consensus, and a third reviewer was consulted when necessary.
Data charting and extraction
Data were extracted independently by two reviewers using a standardized spreadsheet that had been pilot-tested. The following data were extracted: authors and year, country, study design, study objective, number of participants, ICT-related opportunities, and challenges. To minimize errors, a double-checking procedure was applied, including comparison of the extraction sheets and resolution of discrepancies by consensus or consultation with a third reviewer.
Data analysis and presentation
Data were analyzed using descriptive synthesis and thematic analysis. Initially, the studies were grouped by year, country, and study design. The findings were then organized into two main themes: (1) opportunities for using ICTs to enhance health literacy among pregnant women; and (2) barriers and challenges to implementation. The results were presented in a summary table and discussed in relation to the scientific literature.
Results
As shown in Figure 1, a total of 293 records were identified through the databases: MEDLINE/PubMed (n = 51), LILACS (n = 2), EMBASE (n = 57), Scopus (n = 2), and ScienceDirect (n = 181). Before screening, 118 duplicate records were removed, leaving 175 records for title and abstract screening.
After the initial screening, 89 studies were excluded because they did not address the research question, resulting in 86 articles being assessed in full text. At this stage, 62 studies were excluded because they did not meet the predefined eligibility criteria, leaving 24 studies.
In addition to the database searches, a complementary snowballing strategy was applied by reviewing the reference lists of the included studies. This strategy identified 11 additional records, of which 4 were duplicates. Thus, 7 studies were assessed for eligibility, and 6 were excluded because they did not address the research question, resulting in 1 additional included study.
At the end of the identification, screening, eligibility, and inclusion process, the final sample of this scoping review comprised 25 studies, of which 24 were identified through database searching and 1 through snowballing.
Table 2 presents the characteristics of the included studies in terms of authors/year, country of origin, methodological design, and the reported opportunities and challenges associated with the use of Information and Communication Technologies to promote health literacy among pregnant women.
The studies were published between 2007 and 2026, with a higher concentration from 2023 onward, highlighting the recent growth of research on digital health, eHealth literacy, and mHealth technologies in maternal health.
.PNG)
.PNG)
|
Table 2 (Continued)
.PNG) .PNG) |
|
Table 2 (Continued)
.PNG) .PNG) Source: Prepared by the author (2026) |
The geographic distribution showed a predominance of studies from Iran, the United States, China, Australia, and Brazil, with additional contributions from Canada, the Netherlands, South Korea, India, Greece, the United Kingdom, Turkey, Indonesia, and Taiwan.
A wide variety of methodological designs was identified, including cross-sectional, qualitative, quasi-experimental, and mixed-methods studies; clinical trials; systematic and narrative reviews; methodological studies on instrument development and validation; bibliometric analysis with meta-synthesis; and academic dissertations. This methodological heterogeneity reinforces the appropriateness of a scoping review for mapping the breadth of existing evidence on the topic.
Discussion
The analysis of the studies included in this review provides a clearer understanding of the potential and challenges associated with using ICTs to strengthen health literacy among pregnant women in the context of pregnancy and childbirth. Overall, the findings indicate that although ICTs improve access to health information, their effectiveness depends on factors such as digital literacy, information reliability, and structural conditions of access. The discussion is organized around thematic axes that emerged from the data analysis: health literacy in maternal care, types of ICTs used, acceptance, barriers, positive outcomes, gaps, and implications. Critical interpretation of the findings is prioritized over the isolated description of individual studies.
Health literacy in maternal care: a multidimensional concept
From a conceptual standpoint, the findings of this review should be understood in light of the health literacy model proposed by Sørensen et al. (2), in which health literacy is defined as a multidimensional construct involving knowledge, motivation, and competencies to access, understand, evaluate, and apply health information across the interrelated domains of healthcare, disease prevention, and health promotion.
In maternal health, Putri, Irawan, and Lu (4) emphasize that this construct is fundamental to empowering pregnant women, contributing to greater autonomy, enhanced self-care, and more informed decision-making concerning their own health and that of their babies.
This review indicates that ICTs can facilitate each of these domains; however, their effectiveness is contingent on a triad of interdependent factors: (a) the user's digital literacy, which encompasses the technical and cognitive skills needed to navigate, select, and evaluate information; (b) the reliability of the information accessed; and (c) the integration of these technologies into professional healthcare. This finding shifts the focus from the technology itself to users' competencies and the quality of professional mediation in the care process.
The literature analyzed shows that access to information alone does not automatically translate into improved health literacy. Carolan (14) previously noted that even with extensive access to information, many pregnant women have difficulty interpreting it critically, which may result in uncertainty in decision-making and information overload. This finding is supported by Gourounti et al. (15), who emphasize that although multiple information sources broaden the available range of information, they also hinder the critical evaluation of online information, thereby compromising evidence-based decision-making.
Accordingly, ICTs emerge as tools that mediate health literacy rather than as direct determinants of it. Their effectiveness depends on social, cognitive, and institutional conditions that must be considered when planning, developing, and implementing digital interventions in maternal health.
Types of ICTs used by pregnant women to acquire health information
The included studies demonstrate the diversity of technological resources used by pregnant women to seek health information, particularly smartphones, mobile applications, websites, and social networks. Nabovati et al. (16) report high smartphone uses for internet access, although their specific use to obtain prenatal information remains limited, revealing a gap between technological access and effective health-related use.
Similarly, Dorst et al. (17) found that pregnant women use various digital sources as part of their informational support systems, with a strong preference for websites, applications, and social networks. Hughson et al. (18) further note that pregnancy applications offer features such as gestational monitoring, data recording, and personalized information, thereby increasing access to digital care. In the Brazilian context, Sousa (19) demonstrates the potential of mobile applications developed to promote maternal health, although the lack of clinical validation and effectiveness assessment limits their practical application.
However, the quality of the information available on these platforms varies, as highlighted by Hughson et al. (18) and Overdijkink et al. (20). This heterogeneity raises concerns about the reliability and safety of decisions based on unvalidated digital content, particularly during a sensitive period such as pregnancy. Hsieh et al. (8) support this finding by demonstrating that although mHealth interventions improve access to information and adherence to prenatal care, variability in interventions and outcomes reduces comparability across studies.
Acceptance of ICTs for health literacy
Pregnant women’s acceptance of ICTs is strongly associated with their level of digital literacy and the perceived usefulness of the technology. Rahdar et al. (21) demonstrate a positive association between eHealth literacy and technology acceptance, indicating that pregnant women with greater digital competence tend to share more personal information in digital health environments and use these tools more effectively.
Hughson et al. (18) report high acceptance of digital technologies across different international contexts, indicating that pregnant women recognize the potential of these tools to support prenatal care. However, Dorst et al. (17) observe that their use as a primary information source remains limited, suggesting that acceptance does not necessarily translate into continuous or structured use. Foster et al. (22) further show that although mobile messaging interventions are initially accepted, adherence tends to decline over time, indicating limited sustained engagement.
Acceptance is therefore a relational phenomenon that depends not only on the technology itself but also on its perceived relevance, its suitability for the pregnant woman’s clinical and cultural context, and trust in the information source. Interventions that do not account for these dimensions risk perpetuating inequalities by benefiting only users with greater cultural and digital capital.
Barriers related to the use of ICTs
The studies analyzed identify numerous barriers that limit the adoption and effective use of ICTs by pregnant women. These barriers can be grouped into three interrelated dimensions: structural, cognitive, and institutional.
At the structural level, barriers include the lack of continuous internet access, device instability, and financial constraints, as highlighted by Pierce et al. (23) and Levey et al. (24). These barriers disproportionately affect low-income populations, reinforcing the so-called "double barrier" described by Hung et al. (9), which combines geographic and digital access difficulties. Choudhury et al. (25) support this finding by showing that dependence on technological infrastructure and low digital literacy limit the scalability of interventions in vulnerable populations.
The cognitive dimension encompasses low digital literacy, difficulty understanding content, and an inability to evaluate information critically. Hughson et al. (18) emphasize that cultural and linguistic barriers hinder understanding of digital health content, whereas Wieland et al. (26) note that inadequate institutional dissemination limits the adoption of electronic health portals. Gourounti et al. (15) highlight concerns about the reliability of online information and reluctance to share personal data, while Asadollahi et al. (10) identify structural, cultural, and technological barriers that compromise the equitable implementation of ICTs.
The institutional dimension encompasses the lack of integration of ICTs into health services, limited institutional dissemination, and the absence of specific regulations. Overdijkink et al. (20) and Hsieh et al. (8) emphasize that methodological heterogeneity and variability among interventions hinder the comparison of results and the generalizability of the evidence. Mulyani et al. (27) support this conclusion by showing that although ICTs strengthen maternal health education, heterogeneity in the evidence limits the development of practical recommendations.
Overcoming these barriers requires an integrated approach that combines investment in infrastructure, the development of digital competencies, and the strengthening of health systems to incorporate ICTs into routine care.
Positive outcomes of ICT application
Despite the barriers identified, several studies demonstrate important positive effects of ICTs on maternal health, particularly in terms of access to information, enhanced self-care, and adherence to prenatal care.
Choudhury et al. (25) show that mHealth applications increase knowledge of warning signs and preventive practices, even among populations with low literacy. This finding is particularly relevant because it suggests that well-designed technologies can overcome cognitive barriers and improve health literacy in historically excluded populations. Chung et al. (28) demonstrate that pregnant women use digital information to complement professional care, particularly when they perceive the sources as reliable.
Foster et al. (22) emphasize that mobile messages support adherence to prenatal care and the organization of self-care through appointment reminders and health guidance. Karamolahi et al. (29) show that educational applications significantly improve maternal health literacy in the short term, while Naderi et al. (30) demonstrate that digital interventions improve self-care and sleep quality during pregnancy.
Zhou et al. (31) further report that digital health literacy increases readiness for childbirth through self-efficacy, while Korkmaz Aslan et al. (32) identify an association between eHealth literacy and healthier lifestyle behaviors during pregnancy. Xu et al. (33) demonstrate that eHealth literacy directly influences the ability of pregnant women with specific clinical conditions to interpret and apply online information.
These findings suggest that ICTs have the potential to strengthen maternal health literacy, particularly when integrated into professional care and adapted to users' contexts. However, the available studies are predominantly short-term, and an important gap remains regarding the sustainability of these effects and their impact on objective clinical outcomes, such as reductions in maternal and neonatal morbidity and mortality, as noted by Karamolahi et al. (29) and Asadollahi et al. (34).
Critical synthesis and conceptual contribution
The main contribution of this review is the systematization of the evidence, which supports the proposal of a conceptual model in which the potential of Information and Communication Technologies (ICTs) to promote health literacy among pregnant women depends on the interaction among three interdependent pillars.
The first pillar is the user's digital literacy, which encompasses the technical and cognitive skills required to navigate, select, and evaluate information, as demonstrated by Rahdar et al. (21), Xu et al. (33), and Zhou et al. (31). Pregnant women with greater digital competence tend to use ICTs more consistently and make more informed decisions, whereas those with low digital literacy have difficulty discerning the quality of the information they access.
The second pillar is information reliability, which requires validation criteria and regulation of the content available on digital platforms, as highlighted by Hughson et al. (18), Overdijkink et al. (20), and Zhao et al. (35). The absence of specific regulations compromises information reliability and limits the safety of clinical use, exposing pregnant women to unvalidated content that may generate uncertainty and lead to misguided decisions.
The third pillar is integration into professional care, which requires ICTs to be used as an extension of care rather than as substitutes for the professional-user relationship, as demonstrated by Wieland et al. (26), Hughson et al. (18), and Asadollahi et al. (34). Professional mediation is essential for guiding the selection of reliable sources and the appropriate interpretation of information, thereby ensuring that technologies are incorporated effectively and safely into prenatal care.
Accordingly, ICTs should be understood not as direct determinants of health literacy but as tools that mediate this process, with their impact depending on social, cognitive, and institutional conditions.
Implications for practice, education, and public policies
The evidence from this review indicates that ICTs can support nursing and obstetric nursing practice by strengthening health literacy among pregnant women and improving access to information, self-care, and recognition of warning signs. In this context, nurses and obstetric nurses play a central role in mediating the critical use of digital technologies by helping pregnant women select reliable information and interpret health content appropriately.
Digital literacy assessment should be incorporated into clinical practice, particularly in vulnerable contexts, with consideration given to cultural, social, and technological barriers. Furthermore, professional training in the ethical use of ICTs is essential, with attention to privacy and data security and to the development of digital competencies in undergraduate and graduate nursing and obstetrics curricula.
The findings of Zhao et al. (35), who developed a specific instrument to measure eHealth literacy among pregnant women, highlight the need for cross-cultural validation and application in different contexts, which could support clinical practice by providing standardized tools. In the Brazilian context, Moreira (36) demonstrates the importance of health literacy among pregnant women but notes its limited integration with digital health technologies, reinforcing the need for public policies that promote such integration.
Finally, ICTs should be used as complementary tools to in-person care rather than as substitutes for the professional-user relationship. Integrating technologies into obstetric care requires a paradigm shift in professional training and the organization of health services, together with investment in infrastructure, training, and regulation.
The methodological heterogeneity of the included studies is an important limitation because it restricts direct comparison and quantitative synthesis of the findings. Furthermore, the predominance of observational studies limits the ability to draw causal inferences. The strengths of the review include its broad geographic and methodological scope, the inclusion of studies with different designs, and the use of a comprehensive and structured search strategy, which increases the representativeness of the evidence analyzed.
Conclusion
The findings of this review indicate that ICTs play an important role in supporting maternal care and strengthening health literacy during pregnancy. However, their effectiveness depends on the interaction among digital literacy, information reliability, and professional mediation rather than merely on access to technologies.
The review proposes a conceptual model based on these three pillars, demonstrating that ICTs do not exert an isolated effect but are influenced by inequalities in access, cognitive limitations, and the absence of health-information regulation. In this context, the role of nursing in mediating digital care is particularly important, as are the integration of digital literacy into professional training and the implementation of public policies aimed at reducing digital inequalities and improving the quality of health information.
Future studies should investigate the longitudinal impact of digital interventions and their effects on maternal-perinatal outcomes, as well as develop validated instruments for measuring digital health literacy.
Acknowledgement
Not applicable.
Funding Sources
Not applicable.
Ethical Statement
Because this study was based on secondary data from publicly available sources, ethical approval was not required. Nevertheless, the principles of scientific integrity, transparency, and proper source citation were strictly observed.
Conflicts of Interest
The authors declare that they have no conflicts of interest.
Author Contributions
E. F., A. F., E. A., and S. A. contributed to the conception and design of the review, the literature search and study selection, data extraction and charting, data analysis and interpretation, manuscript drafting, and critical revision for important intellectual content. All authors read and approved the final version of the manuscript and agreed to be accountable for all aspects of the work.
Data Availability Statement
All data generated or analyzed during this review are included in this article and its supplementary files. The data-charting form and additional extraction materials are available from the corresponding author upon reasonable request.
Use of Artificial Intelligence
OpenAI's ChatGPT was used to assist with English-language editing, improve clarity, and support formatting during manuscript revision. It was not used to select studies, extract or analyze data, or make scientific interpretations.
A wide variety of methodological designs was identified, including cross-sectional, qualitative, quasi-experimental, and mixed-methods studies; clinical trials; systematic and narrative reviews; methodological studies on instrument development and validation; bibliometric analysis with meta-synthesis; and academic dissertations. This methodological heterogeneity reinforces the appropriateness of a scoping review for mapping the breadth of existing evidence on the topic.
Discussion
The analysis of the studies included in this review provides a clearer understanding of the potential and challenges associated with using ICTs to strengthen health literacy among pregnant women in the context of pregnancy and childbirth. Overall, the findings indicate that although ICTs improve access to health information, their effectiveness depends on factors such as digital literacy, information reliability, and structural conditions of access. The discussion is organized around thematic axes that emerged from the data analysis: health literacy in maternal care, types of ICTs used, acceptance, barriers, positive outcomes, gaps, and implications. Critical interpretation of the findings is prioritized over the isolated description of individual studies.
Health literacy in maternal care: a multidimensional concept
From a conceptual standpoint, the findings of this review should be understood in light of the health literacy model proposed by Sørensen et al. (2), in which health literacy is defined as a multidimensional construct involving knowledge, motivation, and competencies to access, understand, evaluate, and apply health information across the interrelated domains of healthcare, disease prevention, and health promotion.
In maternal health, Putri, Irawan, and Lu (4) emphasize that this construct is fundamental to empowering pregnant women, contributing to greater autonomy, enhanced self-care, and more informed decision-making concerning their own health and that of their babies.
This review indicates that ICTs can facilitate each of these domains; however, their effectiveness is contingent on a triad of interdependent factors: (a) the user's digital literacy, which encompasses the technical and cognitive skills needed to navigate, select, and evaluate information; (b) the reliability of the information accessed; and (c) the integration of these technologies into professional healthcare. This finding shifts the focus from the technology itself to users' competencies and the quality of professional mediation in the care process.
The literature analyzed shows that access to information alone does not automatically translate into improved health literacy. Carolan (14) previously noted that even with extensive access to information, many pregnant women have difficulty interpreting it critically, which may result in uncertainty in decision-making and information overload. This finding is supported by Gourounti et al. (15), who emphasize that although multiple information sources broaden the available range of information, they also hinder the critical evaluation of online information, thereby compromising evidence-based decision-making.
Accordingly, ICTs emerge as tools that mediate health literacy rather than as direct determinants of it. Their effectiveness depends on social, cognitive, and institutional conditions that must be considered when planning, developing, and implementing digital interventions in maternal health.
Types of ICTs used by pregnant women to acquire health information
The included studies demonstrate the diversity of technological resources used by pregnant women to seek health information, particularly smartphones, mobile applications, websites, and social networks. Nabovati et al. (16) report high smartphone uses for internet access, although their specific use to obtain prenatal information remains limited, revealing a gap between technological access and effective health-related use.
Similarly, Dorst et al. (17) found that pregnant women use various digital sources as part of their informational support systems, with a strong preference for websites, applications, and social networks. Hughson et al. (18) further note that pregnancy applications offer features such as gestational monitoring, data recording, and personalized information, thereby increasing access to digital care. In the Brazilian context, Sousa (19) demonstrates the potential of mobile applications developed to promote maternal health, although the lack of clinical validation and effectiveness assessment limits their practical application.
However, the quality of the information available on these platforms varies, as highlighted by Hughson et al. (18) and Overdijkink et al. (20). This heterogeneity raises concerns about the reliability and safety of decisions based on unvalidated digital content, particularly during a sensitive period such as pregnancy. Hsieh et al. (8) support this finding by demonstrating that although mHealth interventions improve access to information and adherence to prenatal care, variability in interventions and outcomes reduces comparability across studies.
Acceptance of ICTs for health literacy
Pregnant women’s acceptance of ICTs is strongly associated with their level of digital literacy and the perceived usefulness of the technology. Rahdar et al. (21) demonstrate a positive association between eHealth literacy and technology acceptance, indicating that pregnant women with greater digital competence tend to share more personal information in digital health environments and use these tools more effectively.
Hughson et al. (18) report high acceptance of digital technologies across different international contexts, indicating that pregnant women recognize the potential of these tools to support prenatal care. However, Dorst et al. (17) observe that their use as a primary information source remains limited, suggesting that acceptance does not necessarily translate into continuous or structured use. Foster et al. (22) further show that although mobile messaging interventions are initially accepted, adherence tends to decline over time, indicating limited sustained engagement.
Acceptance is therefore a relational phenomenon that depends not only on the technology itself but also on its perceived relevance, its suitability for the pregnant woman’s clinical and cultural context, and trust in the information source. Interventions that do not account for these dimensions risk perpetuating inequalities by benefiting only users with greater cultural and digital capital.
Barriers related to the use of ICTs
The studies analyzed identify numerous barriers that limit the adoption and effective use of ICTs by pregnant women. These barriers can be grouped into three interrelated dimensions: structural, cognitive, and institutional.
At the structural level, barriers include the lack of continuous internet access, device instability, and financial constraints, as highlighted by Pierce et al. (23) and Levey et al. (24). These barriers disproportionately affect low-income populations, reinforcing the so-called "double barrier" described by Hung et al. (9), which combines geographic and digital access difficulties. Choudhury et al. (25) support this finding by showing that dependence on technological infrastructure and low digital literacy limit the scalability of interventions in vulnerable populations.
The cognitive dimension encompasses low digital literacy, difficulty understanding content, and an inability to evaluate information critically. Hughson et al. (18) emphasize that cultural and linguistic barriers hinder understanding of digital health content, whereas Wieland et al. (26) note that inadequate institutional dissemination limits the adoption of electronic health portals. Gourounti et al. (15) highlight concerns about the reliability of online information and reluctance to share personal data, while Asadollahi et al. (10) identify structural, cultural, and technological barriers that compromise the equitable implementation of ICTs.
The institutional dimension encompasses the lack of integration of ICTs into health services, limited institutional dissemination, and the absence of specific regulations. Overdijkink et al. (20) and Hsieh et al. (8) emphasize that methodological heterogeneity and variability among interventions hinder the comparison of results and the generalizability of the evidence. Mulyani et al. (27) support this conclusion by showing that although ICTs strengthen maternal health education, heterogeneity in the evidence limits the development of practical recommendations.
Overcoming these barriers requires an integrated approach that combines investment in infrastructure, the development of digital competencies, and the strengthening of health systems to incorporate ICTs into routine care.
Positive outcomes of ICT application
Despite the barriers identified, several studies demonstrate important positive effects of ICTs on maternal health, particularly in terms of access to information, enhanced self-care, and adherence to prenatal care.
Choudhury et al. (25) show that mHealth applications increase knowledge of warning signs and preventive practices, even among populations with low literacy. This finding is particularly relevant because it suggests that well-designed technologies can overcome cognitive barriers and improve health literacy in historically excluded populations. Chung et al. (28) demonstrate that pregnant women use digital information to complement professional care, particularly when they perceive the sources as reliable.
Foster et al. (22) emphasize that mobile messages support adherence to prenatal care and the organization of self-care through appointment reminders and health guidance. Karamolahi et al. (29) show that educational applications significantly improve maternal health literacy in the short term, while Naderi et al. (30) demonstrate that digital interventions improve self-care and sleep quality during pregnancy.
Zhou et al. (31) further report that digital health literacy increases readiness for childbirth through self-efficacy, while Korkmaz Aslan et al. (32) identify an association between eHealth literacy and healthier lifestyle behaviors during pregnancy. Xu et al. (33) demonstrate that eHealth literacy directly influences the ability of pregnant women with specific clinical conditions to interpret and apply online information.
These findings suggest that ICTs have the potential to strengthen maternal health literacy, particularly when integrated into professional care and adapted to users' contexts. However, the available studies are predominantly short-term, and an important gap remains regarding the sustainability of these effects and their impact on objective clinical outcomes, such as reductions in maternal and neonatal morbidity and mortality, as noted by Karamolahi et al. (29) and Asadollahi et al. (34).
Critical synthesis and conceptual contribution
The main contribution of this review is the systematization of the evidence, which supports the proposal of a conceptual model in which the potential of Information and Communication Technologies (ICTs) to promote health literacy among pregnant women depends on the interaction among three interdependent pillars.
The first pillar is the user's digital literacy, which encompasses the technical and cognitive skills required to navigate, select, and evaluate information, as demonstrated by Rahdar et al. (21), Xu et al. (33), and Zhou et al. (31). Pregnant women with greater digital competence tend to use ICTs more consistently and make more informed decisions, whereas those with low digital literacy have difficulty discerning the quality of the information they access.
The second pillar is information reliability, which requires validation criteria and regulation of the content available on digital platforms, as highlighted by Hughson et al. (18), Overdijkink et al. (20), and Zhao et al. (35). The absence of specific regulations compromises information reliability and limits the safety of clinical use, exposing pregnant women to unvalidated content that may generate uncertainty and lead to misguided decisions.
The third pillar is integration into professional care, which requires ICTs to be used as an extension of care rather than as substitutes for the professional-user relationship, as demonstrated by Wieland et al. (26), Hughson et al. (18), and Asadollahi et al. (34). Professional mediation is essential for guiding the selection of reliable sources and the appropriate interpretation of information, thereby ensuring that technologies are incorporated effectively and safely into prenatal care.
Accordingly, ICTs should be understood not as direct determinants of health literacy but as tools that mediate this process, with their impact depending on social, cognitive, and institutional conditions.
Implications for practice, education, and public policies
The evidence from this review indicates that ICTs can support nursing and obstetric nursing practice by strengthening health literacy among pregnant women and improving access to information, self-care, and recognition of warning signs. In this context, nurses and obstetric nurses play a central role in mediating the critical use of digital technologies by helping pregnant women select reliable information and interpret health content appropriately.
Digital literacy assessment should be incorporated into clinical practice, particularly in vulnerable contexts, with consideration given to cultural, social, and technological barriers. Furthermore, professional training in the ethical use of ICTs is essential, with attention to privacy and data security and to the development of digital competencies in undergraduate and graduate nursing and obstetrics curricula.
The findings of Zhao et al. (35), who developed a specific instrument to measure eHealth literacy among pregnant women, highlight the need for cross-cultural validation and application in different contexts, which could support clinical practice by providing standardized tools. In the Brazilian context, Moreira (36) demonstrates the importance of health literacy among pregnant women but notes its limited integration with digital health technologies, reinforcing the need for public policies that promote such integration.
Finally, ICTs should be used as complementary tools to in-person care rather than as substitutes for the professional-user relationship. Integrating technologies into obstetric care requires a paradigm shift in professional training and the organization of health services, together with investment in infrastructure, training, and regulation.
The methodological heterogeneity of the included studies is an important limitation because it restricts direct comparison and quantitative synthesis of the findings. Furthermore, the predominance of observational studies limits the ability to draw causal inferences. The strengths of the review include its broad geographic and methodological scope, the inclusion of studies with different designs, and the use of a comprehensive and structured search strategy, which increases the representativeness of the evidence analyzed.
Conclusion
The findings of this review indicate that ICTs play an important role in supporting maternal care and strengthening health literacy during pregnancy. However, their effectiveness depends on the interaction among digital literacy, information reliability, and professional mediation rather than merely on access to technologies.
The review proposes a conceptual model based on these three pillars, demonstrating that ICTs do not exert an isolated effect but are influenced by inequalities in access, cognitive limitations, and the absence of health-information regulation. In this context, the role of nursing in mediating digital care is particularly important, as are the integration of digital literacy into professional training and the implementation of public policies aimed at reducing digital inequalities and improving the quality of health information.
Future studies should investigate the longitudinal impact of digital interventions and their effects on maternal-perinatal outcomes, as well as develop validated instruments for measuring digital health literacy.
Acknowledgement
Not applicable.
Funding Sources
Not applicable.
Ethical Statement
Because this study was based on secondary data from publicly available sources, ethical approval was not required. Nevertheless, the principles of scientific integrity, transparency, and proper source citation were strictly observed.
Conflicts of Interest
The authors declare that they have no conflicts of interest.
Author Contributions
E. F., A. F., E. A., and S. A. contributed to the conception and design of the review, the literature search and study selection, data extraction and charting, data analysis and interpretation, manuscript drafting, and critical revision for important intellectual content. All authors read and approved the final version of the manuscript and agreed to be accountable for all aspects of the work.
Data Availability Statement
All data generated or analyzed during this review are included in this article and its supplementary files. The data-charting form and additional extraction materials are available from the corresponding author upon reasonable request.
Use of Artificial Intelligence
OpenAI's ChatGPT was used to assist with English-language editing, improve clarity, and support formatting during manuscript revision. It was not used to select studies, extract or analyze data, or make scientific interpretations.
Type of study: Review Article |
Subject:
Midwifery
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