Knowledge, skills, and performance of maternal health literacy among Iranian midwives: a cross-sectional study in Kermanshah

Abstract Maternal health literacy is linked to improved pregnancy outcomes. This study quantifies knowledge, skills, and performance in maternal health literacy among practicing Iranian midwives. In this cross-sectional, descriptive-analytical study, 300 midwives from Kermanshah, Iran, were recruited by convenience sampling between December 2023 and May 2024. Data were collected using the standardized Instrument for Assessment of Knowledge, Skills, and Performance of Maternal Health Literacy among Midwives 15 , consisting of knowledge (5 items), skills (3 items), and performance (5 items) rated on 5-point Likert scales. Analyses were conducted using SPSS version 23. Descriptive statistics and inferential analyses, including independent t-tests, ANOVA, Spearman correlation, and multivariable linear regression analyses, were performed. Statistical significance was considered at p < 0.05. The mean age of participants was 39 ± 9 years (range: 23–65), and the mean work experience was 12.9 ± 8.7 years. The mean scores for knowledge, skills, and performance were 17.10 ± 3.35, 11.52 ± 2.10, and 20.80 ± 3.42, respectively. Work experience showed a significant inverse correlation with knowledge scores ( p = 0.026), whereas no significant correlations were observed between work experience and skills ( p = 0.913) or performance ( p = 0.461). Higher educational attainment was associated with higher knowledge scores ( p = 0.030). Skill level was the strongest predictor of performance in the multivariable linear regression model ( p < 0.001). Age was positively associated with performance ( p = 0.010), while midwives working in clinical care ( p = 0.048) and private sectors ( p = 0.010) had lower performance scores compared with those working in public health settings. Higher educational attainment was associated with knowledge scores, while age, skill level, and department of service were associated with performance scores among Iranian midwives; work experience showed only a weak inverse association with knowledge. These findings support targeted educational programs and improvements in workplace conditions that could be associated with improved maternal health literacy and quality of care.