Abstract
BACKGROUND: The health literacy and numeracy skills of women in Pakistan are very low compared to other low- and middle-income countries. OBJECTIVE: The aim of this study was to improve the health literacy and numeracy skills of unschooled women in Northern Pakistan by developing a Maternal and Child Health Calendar (MCHC). The MCHC utilizes locally contextualized icons to promote and enhance service utilization and maternal and child health (MCH) outcomes. METHODS: We conducted a qualitative exploratory study design to understand the experiences and usefulness of the MCHC among women. We recruited the participants using purposive sampling. Using a semi-structured interview guide, we conducted individual interviews with nine Key informants, that is, Agha Khan Rural Support Staff and Community-based savings group staff and five focus group discussions with unschooled women. We followed Braun and Clarke's steps to conduct an inductive thematic data analysis. RESULTS: The findings of our study are categorized into the following themes: (1) the benefits of using MCHC, (2) the usefulness of the MCHC in women's healthcare decision-making, (3) empowerment of poorly schooled women, (4) enabling numeracy and record-keeping skills, (5) MCHC implementation challenges, and (6) participants suggestions to improve the MCHC. Our findings revealed that the MCHC improved the health literacy and numeracy of illiterate or less educated women by using localized images to help them comprehend their own and their children's health. Additionally, it effectively empowered these women in their healthcare decision-making, such as discussing family planning with their husbands. Women also suggested modifying some images in the MCHC to enhance their clarity and usefulness. CONCLUSION: The MCHC has the potential to safely and sustainably build basic MCH literacy and numeracy skills among both literate and illiterate women in Northern Pakistan. Further research is needed to assess its potential as a stand-alone intervention to improve MCH outcomes.