Associations between Maternal Health Literacy, Health-Seeking Behavior, and Maternal and Child Health Service Utilization: A Cross-Sectional Study

Background and Objective: In Indonesia, many women who are planning to conceive or have already given birth lack sufficient knowledge of health-related issues and seldom take the initiative to seek medical help. These two problems have prevented local pregnant and postnatal women from accessing the necessary medical services. This study aims to clarify the specific associations between the five domains of maternal health cognition, their behaviors of actively seeking health services, and the actual utilization of maternal and child health services. Materials and Methods: A cross-sectional study was conducted for this research, which collected relevant information from a group of people at the same time point for analysis. A total of 589 mothers were included, whose children were all aged between 0 and 59 months, with the youngest being newly born and the oldest less than five years old. The study used questionnaires to assess these mothers' level of health cognition, covering the cognitive domains of prenatal care, vaccination, breastfeeding, child growth monitoring, and Posyandu-related content. It also measured whether they would take the initiative to seek health help, as well as their actual utilization of health services. All collected data were analyzed using the generalized structural equation model (binomial logit model) in the STATA 17 software. Results: Multivariable analysis revealed that ANC literacy (B=0.72; p=0.008; OR=2.05; 95% CI=1.21-3.48), immunization literacy (B=0.42; p=0.037; OR=1.53; 95% CI=1.03-2.27), breastfeeding literacy (B=0.58; p=0.007; OR=1.79; 95% CI=1.17–2.74), child growth monitoring literacy (B=0.51; p=0.036; OR=1.66; 95% CI=1.03-2.67), Posyandu literacy (B=0.76; p=0.008; OR=2.14; 95% CI=1.23-3.75), and health seeking behavior (B=0.49; p=0.017; OR=1.62; 95% CI=1.09-2.42) were significantly associated with maternal and child health service utilization. GSEM showed a statistically significant association between child growth monitoring literacy and health-seeking behavior. Conclusion: Among mothers of children aged 0-59 months, a number of maternal health literacy and health-seeking behaviour categories were substantially correlated with the use of maternal and child health services.