# The role of health literacy in the relationship between mothers’ knowledge and practices of iron supplementation in children (aged 12 to 24 months): A structural equation model

## TL;DR

This study explores how health literacy affects how well mothers understand and use iron supplements for their young children.

## Contribution

The study identifies health literacy as a mediator between mothers' knowledge and their practices regarding iron supplementation.

## Key findings

- 34.2% of mothers had good knowledge about iron supplementation.
- Health literacy and knowledge together predict 40% of changes in mothers' practices.
- Health literacy partially mediates the relationship between knowledge and practices.

## Abstract

Iron deficiency anemia represents the most common form of anemia globally and constitutes a significant public health concern, particularly in developing nations. Therefore, supplementation is one of the best strategies for protecting children from anemia. The objective of the study was to assess the level of knowledge and practices of mothers with children aged 12 to 24 months and to assess the mediating role of health literacy in this relationship.

This cross-sectional study was conducted on 435 mothers of children (aged 12 to 24 months) referred to Tehran healthcare centers. Information was collected through socio-demographic and reproductive checklists, knowledge and practice questionnaires, and health literacy questionnaires. The data were analyzed by SPSS26 and AMOS24 software and a significance level less than 0.05 was considered.

Among the participants, 18.4% had poor knowledge, 47.4% had moderate knowledge, and only 34.2% had good knowledge. The mothers’ practice score regarding iron drop feeding was moderate (8.22 ± 2.27). A total of 37.9%, 54.7%, and 7.4% had good, moderate, and poor performance, respectively. Pearson’s correlation coefficient indicated a significant positive association between mothers’ understanding of iron drop feeding and their corresponding practices, as well as the practices of mothers with children aged 12 to 24 months (P < 0.001, r = 0.421). According to the results, health literacy and mothers’ knowledge can predict 40% of the changes in mothers’ practices, which is partial or moderate. Health literacy plays a mediating role in the relationship between mothers’ knowledge and practices.

Considering the effect of anemia on children’s health, paying attention to mothers’ health literacy as an important factor to improve their performance is essential.