Health Literacy of Postpartum Women and Family Planing

Prior to the collection of research data, written permission was obtained from the institution where the research was conducted. On the first page of the survey, which was prepared by the researchers based on the literature review, puerperal women were informed about the study and their written consent was received. Data collection instruments were applied through face-to-face interviews to puerperal women in their own rooms in the clinic, at an appropriate time period for the infants and themselves. The application took approximately 10 to 15 minutes for each participant.

Data collection instruments The Mother Introductory Information Form (MIIF), consisting of questions about sociodemographic and obstetric characteristics, and the last delivery of puerperal mothers, the Postpartum Family Planning Attitude Scale (PFPAS), and the Health Literacy Scale (HLS) were used for data collection.

The MIIF was prepared by the researchers in accordance with the literature (Berkman et al., 2011; Yee and Simon 2014., Maricic et al., 2020). The form consists of a total of 17 questions aim to determine the sociodemographic and reproductive characteristics of the mothers.

The PFPAS, developed by Varol in 2019, includes 27 items scored on a 5-Likert type scale. 16 of the items consist of positive statements, while 11 items consist of negative statements. In order to ensure consistency in the evaluation, negative statements are reverse coded. The scale items are scored ranging from 1 to 5. Positive statements are scored as 1=Strongly disagree, 2= Disagree, 3= Neutral, 4= Agree, and 5= Strongly agree, while negative statements are scored as 5=Strongly disagree, 4=Disagree, 3= Neutral, 2= Agree, and 1= Strongly agree. The scale consists of a total of six subscales as "Perceived Risk" (Items 1, 2, 3), "Perceived Seriousness" (Items 4, 5, 6), "Perceived Benefits" (Items 7, 8, 9, 10), "Perceived Obstacles" (Items 11, 12, 13, 14, 15, 16, 17, 18), "Taking Action" (Items 19, 20, 21, 22, 23), and "Self-Efficacy" (Items 24, 25, 26, 27). The lowest score to be obtained from the scale is 27, while the highest score is 135. Higher scores indicate higher level of health belief in terms of perceived risk, perceived seriousness, perceived obstacles, perceived benefits, taking action and self-efficacy, which is also associated with a positive attitude toward FP. The Cronbach's alpha coefficient of the original scale is 0.878 (Varol, 2019). The Cronbach's alpha coefficient calculated in the current study is 0.932.

The HLS, developed by Sorensen et al., (2013), consists of 47 items and two dimensions. It was then simplified by Toçi et al., (2013), and its validity and reliability were tested. The validity and reliability study of the Turkish version, consisting of 25 items, was conducted by Aras and Temel in 2017. The scale includes four subscales as Access to Information, Understanding Information, Appraisal / Assessment, and Application / Use. The items are scored on a 5-point range as "5: No difficulty, 4: A little bit of difficulty, 3: Moderate difficulty, 2: Quite a bit of difficulty, 1: Extreme difficulty or unable to perform activity". All items include positive statements. The lowest possible score to be obtained from the scale is 25, and the highest possible score is 125. Higher scores indicate higher level of HL, while lower scores indicate inadequate, problematic and weak level of HL. The Cronbach's alpha value of the original scale is 0.92, while it ranges between 0.62 and 0.79 in the subscales (Aras \& Temel, 2017). It has been found 0.920 in the current study.