Assessment of the health literacy mediating role in the relationship between fatalistic tendency and family planning among women

Sümeyye Ahi, Fevziye Çetinkaya

Abstract

Promoting family planning is an essential public health goal for improving maternal and infant health; however, sociocultural barriers—particularly fatalism—continue to shape women’s behaviors and attitudes. This study examined the mediating role of health literacy in the relationship between women’s fatalistic tendencies and their family planning attitudes. Using a cross-sectional correlational design, data were collected from 657 married women aged 18–49 in Kırşehir, Türkiye, through 30-cluster sampling. Data were collected through face-to-face interviews conducted during home visits between February 28 and June 1, 2022, using structured questionnaires. Measures included the Fatalistic Tendency Scale, Family Planning Attitude Scale, and the Turkey Health Literacy Scale-32. Data were analyzed using IBM SPSS Statistics v23. Mediation analysis was conducted using PROCESS v3.5 with 5,000 bootstrap samples. Fatalistic tendency was negatively associated with health literacy, while health literacy showed a positive association with family planning attitudes. An indirect effect of fatalistic tendency on family planning attitudes through health literacy was identified. Findings highlight the importance of improving health literacy to mitigate fatalistic beliefs and support informed reproductive decision-making, emphasizing culturally sensitive, interdisciplinary interventions.

Full Text:

PDF

References

World Health Organization. Maternal mortality [Internet]. Geneva: World Health Organization; 2025 [cited 2026 Sep 2]. Available from: https://www.who.int/news-room/fact-sheets/detail/maternal-mortality

United Nations. The Sustainable Development Goals Report 2025 [Internet]. New York: United Nations; 2025 [cited 2026 Sep 2]. Available from: https://unstats.un.org/sdgs/report/2025/

Sakalli AE, Arikan S. The relationship of value dimensions in Turkish society with fatalistic tendencies, safety motivation, risk perception and safety performance. Heliyon. 2024;10(9):e30384. doi:10.1016/j.heliyon.2024.e30384.

Kassim M, Ndumbaro F. Factors affecting family planning literacy among women of childbearing age in the rural Lake Zone, Tanzania. BMC Public Health. 2022;22:646.

Yıldırım MS, Yıldız M, Okyar G. Family planning attitudes, religious orientation and fatalistic tendency levels: a descriptive-correlational study in Turkey. J Relig Health. 2021;60(6):4115-4131.

Kaya A, Bozkur B. Development of Fatalistic Tendency Scale: validity and reliability study. Mersin Univ J Fac Educ. 2015;11(3):935-946. doi:10.17860/efd.55137.

Kim TY, Haider M, Hancock GR, Boudreaux MH. The role of health literacy in family planning use among Senegalese women. J Health Commun. 2019;24(3):244-261.

Brown KE, Hayward AS. Exploring the effects of programmatic intervention on family planning health literacy and contraceptive utilization in eastern Uganda. Afr J Reprod Health. 2022;26(4):15-21.

Republic of Türkiye Ministry of Health, General Directorate of Health Promotion. Turkey Health Literacy Level and Associated Factors Study. Ankara: Ministry of Health; 2018.

Şahin S, Bulut ÖÜ, Ünsal A. Assessment of health literacy and use of contraceptive methods in married women aged 18 to 49 years. Turk J Fam Med Prim Care. 2024;18(1):64-71.

Mathias EG, Dhyani VS, Krishnan JB, Rani U, Gudi N, Pattanshetty S. Community-based health literacy interventions in India: a scoping review. Clin Epidemiol Glob Health. 2023;22:101310.

Nyakundi JB, Yonge S, Kiiru S, Gichangi P. Factors influencing contraceptive uptake among women of reproductive age in Kenya. Gates Open Res. 2024;8:32.

Yalçın Gürsoy M, Uçan Yamaç S. Health literacy and mammography screening behaviors among women living in a rural area of Turkey. Rural Remote Health. 2024;24:8602.

Rosenstock IM, Strecher VJ, Becker MH. Social learning theory and the health belief model. Health Educ Q. 1988;15(2):175-183.

Alyafei A, Easton-Carr R. The health belief model of behavior change. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2026 Sep 2]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK606120/

Singh J, Jain D, Sharma R, Verghese T. Evaluation of immunization coverage by lot quality assurance sampling compared with 30-cluster sampling in a primary health centre in India. Bull World Health Organ. 1996;74(3):269-274.

Örüklü C, Çakmak S. Women’s health within the framework of sustainable development goals. J Hum Sci. 2021;18(3):364-373.

Karaçalı M, Özdemir R. Factors affecting access to family planning services among married women aged 15-49 in Karabük, Turkey. Turk J Public Health. 2018;16(2):131-145.

Lori JR, Ofosu-Darkwah H, Boyd CJ, Banerjee T, Adanu RM. Improving health literacy through group antenatal care: a prospective cohort study. BMC Pregnancy Childbirth. 2017;17:228.

Wulifan JK, Brenner S, Jahn A, De Allegri M. A scoping review on determinants of unmet need for family planning among women of reproductive age in low- and middle-income countries. BMC Womens Health. 2016;16:2. doi:10.1186/s12905-015-0281-3.

Yadav K, Agarwal M, Shukla M, Singh JV, Singh VK. Unmet need for family planning services among young married women aged 15-24 years living in urban slums of India. BMC Womens Health. 2020;20:187.

Okyay P, Abacıgil F, Harlak H, Evci Kiraz ED, Karakaya K, Tüzün H, Baran Deniz E, Saruhan G, Gürsoy Turan S, Tontuş HÖ, Beşer E. A new health literacy scale: Turkish Health Literacy Scale and its psychometric properties. Eur J Public Health. 2015;25(Suppl 3):ckv175.220. doi:10.1093/eurpub/ckv175.220.

Orsal O, Kubilay G. Developing Family Planning Attitude Scale. Florence Nightingale J Nurs. 2007;15(60):155-164.

Zhang Y, Fan S, Hui H, Zhang N, Li J, Liao L, Ke C, Zhang D, Su S, Song Z, Zhang Y, Du Q, Liu L, Wang L, Yang L, Li J, Xu L, Xiao S, Shi L, Xiao X, Wang W, Sun N, He Q, Hao R, Wu J, Tian Z, Lou Y, Yao Q, Ming WK, Jiang F, Zhou X, Wang M, Sun X, Wu Y; Behavioral Epidemiology Education Working Commission of CMEA. Privacy protection for open sharing of psychiatric and behavioral research data: ethical considerations and recommendations. Alpha Psychiatry. 2025;26(1):38759. doi:10.31083/AP38759.

Tabachnick BG, Fidell LS. Using multivariate statistics. 6th ed. Boston (MA): Pearson; 2013.

Kalaycı Ş. Multivariate statistical techniques with SPSS applications. Ankara: Asil Publishing Distribution; 2010.

Egede LE, Campbell JA, Walker RJ, Fraser RA, Ekwunife O. Understanding the roles of fatalism and self-efficacy on clinical and behavioral outcomes for African American with type 2 diabetes: a systematic review. Curr Diab Rep. 2025;25:31. doi:10.1007/s11892-025-01586-2.

Duru G, Topatan S. A barrier to participation in cervical cancer screenings: fatalism. Women Health. 2023;63(6):436-444.

Sørensen K, Van den Broucke S, Fullam J, Doyle G, Pelikan J, Slonska Z, Brand H; HLS-EU Consortium. Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health. 2012;12:80.

Sørensen K, Pelikan JM, Röthlin F, Ganahl K, Slonska Z, Doyle G, Fullam J, Kondilis B, Agrafiotis D, Uiters E, Falcon M, Mensing M, Tchamov K, Van den Broucke S, Brand H; HLS-EU Consortium. Health literacy in Europe: comparative results of the European Health Literacy Survey (HLS-EU). Eur J Public Health. 2015;25(6):1053-1058.

Harsch S, Jawid A, Jawid E, Saboga-Nunes L, Sørensen K, Sahrai D, Bittlingmayer UH. Health literacy and health behavior among women in Ghazni, Afghanistan. Front Public Health. 2021;9:629334.

Aboul-Enein BH, Ballout S, Kelly PJ. Family planning interventions across the League of Arab States: a regional scoping review. Int Health. 2025;17(6):881-892.

Öztaş Ö, Artantaş AB, Tetik BK, Yalçıntaş A, Üstü Y, Uğurlu M. Knowledge, attitudes, and behaviors regarding reproductive health and contraception among married women aged 18-49 years. Ankara Med J. 2015;15(2):67-76.

Zegeye B, Ahinkorah BO, Idriss-Wheeler D, Olorunsaiye CZ, Adjei NK, Yaya S. Modern contraceptive utilization and its associated factors among married women in Senegal: a multilevel analysis. BMC Public Health. 2021;21:231.

Kilfoyle KA, Vitko M, O’Conor R, Bailey SC. Health literacy and women’s reproductive health: a systematic review. J Womens Health. 2016;25(12):1237-1255.

AlAteeq DA, Alenzi EO, Alamri RA, Aloraini AA, Alassaf DS, Almutlaq NI, Aloglla SS, Almajhad AA, Jahhaf RH. Women’s attitudes toward fertility and childbearing: a national cross-sectional study in Saudi Arabia. Healthcare (Basel). 2025;13(20):2616. doi:10.3390/healthcare13202616.

Jiregna B, Amare M, Dinku M, Nigatu D, Desalegn D. Women health literacy and associated factors on women and child health care in Ilu Ababor public health facilities, Ethiopia. Int J Womens Health. 2024;16:143-152.

Uzunçakmak T, Hepokur ŞN. Determining married women’s preferences and attitudes toward family planning methods. J Contin Med Educ. 2024;32(5):334-343..

Refbacks

  • There are currently no refbacks.