With today's increasing emphasis on patient-centered care, patient involvement, and health education, health literacy has become an important topic in health care. Broadly speaking, health literacy is used as a term to describe communication activities which can influence health outcomes via the access and use of health care services, patient-provider interactions, and personal management of health and illness (Nutbeam, 2000; von Wagner, Steptoe, Wolf, & Wardle, 2009). Numerous definitions of health literacy exist within the academic literature (e.g., Berkman, Davis, & McCormack, 2010; Nutbeam, 2000; Sorensen et al., 2012; Squiers, Peinado, Berkman, Boudewyns, & McCormack, 2012; von Wagner et al., 2009) and white papers (e.g., Agency for Healthcare Research and Quality, 2014; Institute of Medicine, 2004; United States Department of Health and Human Services, 2014; World Health Organization [WHO], 2013). While these definitions all attempt to describe this relatively new health construct, a standard definition of health literacy has not been agreed upon nor has it been consistently utilized in research (Berkman et al., 2004). Furthermore, the majority of these definitions have been confined to describing health literacy within developed countries. Thus, despite this burgeoning emphasis on health literacy in high resource countries (Sorensen et al., 2012); there is a dearth of literature on health literacy in low-resource and developing countries (von Wagner et al., 2009).

The concept of health literacy can be expanded upon to encompass a specific focus on maternal health literacy. According to Renkert and Nutbeam (2001), “maternal health literacy can be defined as the cognitive and social skills which determine the motivation and ability of women to gain access to, understand, and use information in ways that promote and maintain their health and that of their children” (p. 382). There is limited work focusing specifically on maternal health literacy. Past work has included assessing the relationship between maternal health literacy and (a) breastfeeding (Kaufman, Skipper, Small, Terry, & McGrew, 2001); (b) cervical and breast cancer screening (Scott, Gazmararian, Williams, & Baker, 2002); and (c) antenatal health behaviors between rural and urban women in one district in Ghana (Edum-Fotwe, 2012).

This paper focuses on the findings from a descriptive pilot study to assess the feasibility of providing focused antenatal care (FANC) in a group setting to improve patient-provider communication and patient engagement thereby improving health literacy. The construction and testing of this model is part of a larger NIH-funded study to determine whether exposure to the group FANC modules increases Ghanaian women's use of professional midwives for delivery and improves antenatal and birth outcomes