{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T10:31:00Z","timestamp":1786703460529,"version":"build-2736575974"},"reference-count":48,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T00:00:00Z","timestamp":1786665600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T00:00:00Z","timestamp":1786665600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Advanced Nursing"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To examine longitudinal associations among maternal health literacy, psychological empowerment and health\u2010promoting behaviours across pregnancy among rural pregnant women.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Prospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Between 1 May 2023 and 15 January 2024, 694 rural pregnant women were assessed at 12, 24 and 32 gestational weeks (T1, T2 and T3). Descriptive, correlation and cross\u2010lagged panel analyses were used.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Significant reciprocal cross\u2010lagged associations were observed among maternal health literacy, psychological empowerment and health\u2010promoting behaviours across pregnancy. Maternal health literacy at T1 significantly predicted psychological empowerment at T2 (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.183,\n                      <jats:italic>B<\/jats:italic>\n                      \u2009=\u20090.056, 95% CI [0.036, 0.075],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and psychological empowerment at T2 predicted health\u2010promoting behaviours at T3 (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.256,\n                      <jats:italic>B<\/jats:italic>\n                      \u2009=\u20090.373, 95% CI [0.246, 0.500],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Longitudinal indirect pathway analysis showed that maternal health literacy at T1 was indirectly associated with health\u2010promoting behaviours at T3 through psychological empowerment at T2 (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.047,\n                      <jats:italic>B<\/jats:italic>\n                      \u2009=\u20090.021, 95% CI [0.010, 0.031],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Maternal health literacy, psychological empowerment, and health\u2010promoting behaviours were longitudinally and reciprocally associated across pregnancy. Psychological empowerment also carried the longitudinal indirect association between earlier maternal health literacy and later health\u2010promoting behaviours. Early gestation may represent an intervention window.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Implications for the Profession and\/or Patient Care<\/jats:title>\n                    <jats:p>Integrating literacy\u2010sensitive and empowerment\u2010based interventions into antenatal care may help rural pregnant women support sustained health\u2010promoting behaviours throughout pregnancy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Impact<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>Clarifies the longitudinal role of maternal health literacy.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Demonstrates a significant indirect longitudinal role of psychological empowerment.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Supports early\u2010stage capability\u2010based interventions within rural maternal healthcare.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Reporting Method<\/jats:title>\n                    <jats:p>This study is consistent with the STROBE statement for cohort studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patient or Public Contribution<\/jats:title>\n                    <jats:p>This study did not include patient or public involvement in its design, conduct or reporting.<\/jats:p>\n                  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