This study is performed to explore the relationship between self-care behaviors during pregnancy and HLC in Iranian pregnant women. According to the study findings, P-HLC had the highest mean score among pregnant women, followed by the I-HLC and C-HLC. P-HLC is reflected in the pregnant woman’s perception of how much physicians or other healthcare personnel; family; relatives or friends affect the health of her fetus and pregnancy outcome. The belief that a pregnant woman is responsible for her own actions during pregnancy and the health of her unborn child is known as I-HLC. Lastly, the C-HLC concerns whether or not the pregnant woman believes luck plays a role in her and her fetus’ health during pregnancy [21]. Similar to our findings, the results of a cross-sectional study by Bay et al. on 156 pregnant women in Turkey showed that, the average health locus of control scores were P-HLC, I-HLC, and C-HLC, respectively [22]. Also, Sachit et al. performed another study in Iraq on pregnant teenage women and found that they had a higher score on the P-HLC dimension [23]. These findings may indicate that in developing countries, the HLC in pregnant women may be greatly perceived by external sources such as spouse, physicians, or other healthcare staff. This perception can stem from various factors. The absence of reliable and comprehensive information about pregnancy, childbirth, and postpartum care can result in pregnant women to rely heavily on the recommendations of healthcare professionals. Also, the tendency of some women to seek unnecessary specialized care may increase the score of P-HLC. For example, in our study, 25% of pregnant women received their routine prenatal care from private centers (with a specialist physician), even though they had no specific problems and all pregnancy services were provided in public health centers (with midwives or health care providers). So, healthcare providers who interact with women are in a unique position to provide informational support and education regarding a healthy lifestyle that can improve pregnancy outcomes and enabling pregnant women to more effectively manage their health [24]. In addition, cultural beliefs and practices can greatly influence women’s perceptions of their health throughout pregnancy. The cultural environment surrounding women, insufficient social support, and low self-esteem contribute to their reduced involvement in health-related decisions and a lack of responsibility for their own health [25]. Therefore, it’s crucial to foster a collaborative approach where women feel empowered to participate in decisions about their health.
In our study, although I-HLC score in pregnant women was slightly lower than the P-HLC, there is still a need to enhance it. The results of the study by Delale et al. on 302 healthy women 18 to 28 weeks of gestation in Croatia [26] showed that I-HLC scores were much higher than either type of external locus of control. It is important to recognize that pregnant women are unlikely to change their unhealthy habits if they do not perceive a connection between their behavior and health outcomes. Therefore, establishing internal control in woman should also be the goal of health professionals [27]. Smith et al. suggested that strategies designed to increase self-efficacy can be useful in enhancing I-HLC of pregnant women [28]. Finally, the C-HLC dimension had the lowest score which can be beneficial for pregnant women. Previous research consistently shows that women who participate in health risk behaviors indicate a greater likelihood of chance-related health locus of control. Because previous studies have repeatedly demonstrated that women with higher chance-related HLC are more likely to engage in health-risk behaviors [29].
The study findings showed that there was a significant direct correlation between self-care and I-HLC and P-HLC dimensions. However, there was no significant correlation between self-care and the C-HLC dimension. After controlling for demographic variables and some pregnancy-related factors, the odds of increasing self-care in pregnant women with high I-HLC were 1.13 times higher than those with low I-HLC. The relationship between HLC and self-care in pregnant women has not been extensively studied or one specific health behavior was only taken into account in some studies. For example, Murnan et al. investigated relationships between fetal health locus of control (FHLC) and maternal marijuana use during pregnancy. They revealed that the mean score of the internal FHCL was higher in those who did not use marijuana (with adjusted OR = 0.95), but the mean score of powerful others FHCL (with adjusted OR = 1.08) and chance-related FHCL (with adjusted OR = 1.04), was reported higher in those who used marijuana during pregnancy [21]. Also Aikpitanyi et al. found women with external locus of control were less likely to utilize antenatal care, skilled birth care, and completion of child vaccination when compared with women with internal locus of control [30]. This highlights the significant I-HLC and an increased sense of accountability for health and self-care in the mothers involved in this research. Pregnant women who hold strong internal beliefs are more inclined to modify their lifestyle and embrace healthier habits. Therefore, it is essential to enhance the internal locus of control regarding health through targeted interventions that promote adherence to healthy behaviors during pregnancy, ultimately leading to positive birth outcomes. A multidimensional approach including increasing knowledge, developing coping skills, and making informed decisions about one’s own health and the birth process can be beneficial in this regard. Health care providers should focus on providing printed and in-person pregnancy educational resources that take into account linguistic and cultural differences. Peer education initiatives that focus on empowering pregnant women through the use of positive role models can enhance their accountability in making health-conscious choices. Furthermore, personalized counseling provided by healthcare professionals to address specific problems enhances the coping and adaptation strategies among pregnant women. Ultimately, it is essential for a support network to be established for the pregnant woman by significant individuals in her life, such as her physician, healthcare professionals, and family members, enabling her to effectively manage her health.
Here, also the odds of increasing self-care in pregnant women with high P-HLC were also reported to be 1.11 times higher than those with low P-HLC. Additional evidence indicates that the P-HLC significantly influences individuals facing health-related issues. For example, according to the research conducted by Holroyd et al., pregnant women experiencing health-related issues were significantly more likely to attribute their health to the influence of others, reflected in their higher Powerful Others scores [31].This suggests that those with lower Powerful Others scores may be motivated to gain a clearer understanding of pregnancy-related testing, believing that healthcare experts are predominantly responsible for the outcomes affecting both mother and fetus.
Additional results from the research revealed a significant association between self-care and several demographic variables, such as mother’s age, level of education, planned pregnancy, gestational age, and the place of prenatal care. Other research findings suggest that various self-care measures, encompassing having a healthy diet, adequate physical activity, and stress management during pregnancy, are influenced by the social and economic backgrounds of individuals. For example, Kundu et al. stated pregnant women with no formal education or below primary education were more likely to be inactive during pregnancy [32]. This is probably because women with higher education usually have better access to information sources about maintaining pregnancy health. Additionally, Uzan et al., noted that pregnant women, with an average age of 30 years, who predominantly possessing higher education degree, had planned their pregnancies, and were in their third trimester, exhibited a greater tendency to engage in health-promoting behaviors. These behaviors included maintaining a nutritious diet, supplementing with folic acid and vitamin D, abstaining from smoking and alcohol consumption, and remaining physically active throughout their pregnancy [33].
Older women or those in the later stages of pregnancy with planned pregnancy, generally report feeling more comfortable and are more likely to adopt self-care routines. This tendency may stem from their extensive experience with the healthcare system and a stronger attachment to their fetus.
Healthy habits established during pregnancy can be sustained into the postpartum phase and further, enhancing the well-being of both mothers and their children [34]. Therefore, educational initiatives can be customized for minority groups, considering the demographic characteristics of women.
This study’s strengths lie in its investigation of the relationship between various self-care behaviors and health locus of control among pregnant women, an area with scant existing research. However, the study is not without its limitations. Being cross-sectional, it does not allow for causal conclusions to be drawn. Longitudinal studies are recommended to investigate causal relationships. Additionally, the sample was restricted to urban women, which raises the possibility that the results may not be applicable to rural populations. Rural populations can possess differing levels of access to health care resources. Furthermore, the sociocultural context surrounding them may impact self-care behaviors and their HLC in unique manners. Further studies to examine these associations in rural populations and evaluating the effectiveness of interventions designed to strengthen the internal HLC in Iranian pregnant women could be beneficial. Also, this study relied on self-administered questionnaires. This introduces the potential for biases (such as social desirability bias and recall bias) and may not fully reflect lived experiences of this population. Therefore, it is recommended that the present study be conducted using interviews and qualitative research methods.