Electronic Theses and Dissertations Archive

Date

2026

Document Type

Dissertation

Degree Name

Doctor of Philosophy

Department

Nursing

Committee Chair

Genae Strong

Committee Chair

Sohye Lee

Committee Member

Anapoorna Mary

Committee Member

Peter Ngutu

Committee Member

Ramona Phinehas

Abstract

Although the birth rate among adolescents aged 15–19 years in the United States (U.S.) has declined to 13.1 per 1,000 live births, it remains higher at 20.7 per 1,000 live births in Tennessee, U.S. Adolescent pregnancies are high risk because they delay prenatal care due to psychosocial barriers, increasing the risk of adverse maternal and fetal outcomes. Limited health literacy may hinder prenatal self-efficacy and shared decision-making, but technology-based, literacy-tailored interventions can improve prenatal care. The purpose of this study was to evaluate the effect of a literacy-tailored text-messaging intervention on prenatal self-efficacy and shared decision-making among pregnant adolescents. A single-site, one-group quasi-experimental pretest–posttest design was used. A convenience sample of 53 adolescents aged 10–20 years, between 9 and 37 weeks’ gestation, English-proficient, and smartphone users participated in a 10-week literacy-tailored text-messaging intervention at an urban medical center. Non-English proficient participants, with elective or spontaneous abortion, and non-consenting participants were excluded. Health literacy, prenatal self-efficacy, and shared decision-making were measured using validated instruments. Data were analyzed using descriptive statistics, paired-sample t tests, Wilcoxon signed-rank tests, and Spearman’s rho correlations. Pender’s Health Promotion Model guided the study. At baseline, 49.1% of participants read at or above 10th-grade level (mean = 7.80). Post-intervention analyses did not demonstrate statistically significant improvements in prenatal self-efficacy (PSES) (p = 0.54), general self-efficacy (GSES) (p = 0.17), or shared decision-making (SDM) (p = 0.35). Spearman rank-order correlations to examine associations among baseline literacy, post-test GSES, PSES, and SDM did not show any associations. Spearman correlations to assess participants’ program evaluation ratings were not positively associated with GSES (ρ = -.14), PSES (ρ = -.15), or MADM (ρ = .23). A moderate positive correlation was observed between GSES and SDM (ρ = .50), indicating that higher GSES was associated with greater autonomy in SDM. These findings suggest that literacy-tailored text-messaging interventions are feasible and align with Healthy People 2030 objectives to improve maternal health and address health literacy as a social determinant of health. Findings suggest that literacy-tailored text-messaging interventions are a feasible and effective strategy to improve GSES and SDM among pregnant adolescents. Keywords: Adolescent pregnancy, self-efficacy, shared decision making, text messaging, health literacy

Comments

Data is provided by the student.”

Library Comment

Dissertation or thesis originally submitted to ProQuest/Clarivate.

Notes

Embargoed until 03-25-2028

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Available for download on Saturday, March 25, 2028

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