ArticleJournal of community genetics2026
Health literacy and prenatal screening acceptability for hemoglobinopathies in Tunisia: a pilot mediation study.
Article in Journal of community genetics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Hemoglobinopathies remain a major public health concern in Tunisia. Effective prevention depends on informed prenatal screening, yet the role of health literacy in screening acceptability is poorly documented in North Africa. This pilot study developed and culturally adapted a 9-item health literacy questionnaire based on Nutbeam's multidimensional framework and examined its direct and indirect associations, via perceived understanding, with screening acceptability. A cross-sectional pilot study was conducted at the national referral maternity center CHU La Rabta in Tunis with 256 pregnant women aged 18-49 years. The questionnaire was rigorously adapted to Tunisian Arabic dialect through forward-back translation and cognitive debriefing with five pregnant women. Health literacy was assessed using functional, interactive, and critical subscales (1-4 Likert scale). Screening acceptability and perceived understanding to decide were also measured. Data was analyzed with descriptive statistics, reliability testing (Cronbach's α), Spearman correlations, and bootstrapped mediation analysis. Mean global health literacy was 2.70 ± 0.77 (59.8% in the "high" category). The 9-item scale showed good reliability (Cronbach's α = 0.826). Interactive literacy scored highest (2.95 ± 0.92), while functional (2.58 ± 0.93) and critical (2.56 ± 1.00) dimensions were lower. The analysis revealed associations consistent with partial mediation: higher health literacy was associated with screening acceptability both directly (c' = 0.438, p = 0.042) and indirectly through perceived understanding (indirect effect = 0.314, 95% CI 0.128-0.562, p < 0.001), accounting for 41.8% of the total effect. After adjustment for age, education, and residence, global health literacy remained independently associated with screening acceptability (adjusted OR = 1.55, p = 0.041). A brief, culturally adapted health literacy tool proved feasible and reliable in the Tunisian prenatal context. Higher health literacy was associated with greater screening acceptability both directly and indirectly through improved perceived understanding. These findings provide a strong empirical basis for integrating health literacy assessment and targeted literacy-enhancing interventions into Tunisia's national hemoglobinopathy prevention program.
Indexed as
Identifiers
What Socratic holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.