Cultural Beliefs, Family Decision-Making, and Health Literacy in Preeclampsia Prevention Among High-Risk Pregnant Women in Rural Indonesia

Abstract

Preeclampsia remains one of the leading causes of maternal morbidity and mortality worldwide, particularly in low-resource settings where social and cultural contexts beyond biomedical care strongly influence preventive behaviors. This study explored how health literacy, cultural beliefs and practices, including local food practices, and family decision-making influence preeclampsia prevention among high-risk pregnant women in rural Indonesia. A qualitative exploratory design was employed, using focus group discussions with 29 participants: high-risk pregnant women (n = 10), women with a history of preeclampsia (n = 8), health workers (n = 5), and government stakeholders from the health, agriculture, fisheries, and livestock sectors (n = 6). Data were analyzed thematically using NVivo 12. The findings revealed that maternal understanding of preeclampsia was generally limited and largely symptom-based rather than risk-oriented; traditional food taboos, cultural interpretations of pregnancy-related symptoms, and delayed healthcare seeking shaped preventive behaviors. Family members—particularly husbands and mothers or mothers-in-law—played a dominant role in decisions regarding antenatal care, dietary practices, and referral compliance. Although nutrient-rich local foods were available, their utilization was constrained by cultural norms. This study extends existing maternal health research by integrating health literacy, cultural beliefs and practices, including local food practices, and family decision-making into a unified sociocultural framework for understanding preeclampsia prevention. The findings support the development of culturally responsive, family-centered, and community-based maternal health interventions for rural populations.

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