Articles

A Practical Framework for Selecting Health Literacy Measurement Tools in Rural and Agricultural Communities: A Narrative Review

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Health literacy is a key public health competency that enables individuals to access, understand, appraise, and apply health information in daily decision-making. Rural and agricultural communities require particular attention because health information is often delivered in contexts shaped by limited formal education, work-related hazards, restricted access to health services, uneven digital connectivity, and culturally diverse communication practices. Although many studies use well-known health literacy instruments, tool selection is often based on popularity rather than methodological fit for field conditions, respondent literacy level, cultural adaptation, occupational risk exposure, and interviewer burden. This narrative review aims to compare commonly used health literacy measurement tools and to propose a practical framework for selecting instruments for rural and agricultural populations, particularly in low- and middle-income countries. Literature was identified through targeted searches in PubMed/MEDLINE, Google Scholar, ScienceDirect, and official instrument sources, with priority given to validation studies, psychometric papers, reviews, and publications involving rural or agricultural populations. The review discusses multidimensional tools such as the European Health Literacy Survey instruments and the Health Literacy Questionnaire, functional and clinical tools such as TOFHLA, S-TOFHLA, and the Newest Vital Sign, digital tools such as eHEALS, and occupation-specific tools such as the Agricultural Safety and Health Literacy Tool. A purpose-based selection framework is proposed to guide the choice of instruments for community surveys, clinical screening, digital health assessment, agricultural safety, and intervention development. For rural and agricultural settings, the most feasible approach is often a short-validated tool, culturally adapted, administered with interviewer assistance, and supplemented with context-specific items on work-related health risks and access to health information.

Factors Influencing Low Utilization of Postnatal Care at Six Days Among Mothers in Rural Zambia: A Case of Siavonga District Hospital

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Postnatal care (PNC) is a critical intervention for reducing maternal and neonatal morbidity and mortality, yet its utilization remains low in many rural African settings. This study assessed factors influencing low attendance of postnatal mothers at six days at Siavonga District Hospital, Zambia. A cross-sectional study design was employed involving 384 postnatal women selected from Maternal and Child Health (MCH) registers. Data were collected using structured questionnaires and analysed using SPSS version 24. Descriptive statistics and Pearson’s chi-square tests were used to determine associations between socio-demographic variables and PNC attendance.

Only 14.2% of mothers attended postnatal services at six days, indicating critically low utilization. Significant factors associated with non-attendance included maternal age, parity, education level, distance to the health facility, and knowledge of PNC services. Social and cultural practices such as postpartum seclusion, negative perceptions of health workers, long waiting times, and limited partner support were also identified as key barriers.

The findings highlight the need for community-based awareness programs, improved quality of care at facilities, and strengthened male involvement strategies. Enhancing early postnatal follow-up services could substantially improve maternal and newborn health outcomes in rural Zambia.