The scale of the evidence base lends the findings considerable weight. The research team, led by Trishika Wickramarathne, searched five major databases—PubMed, MEDLINE, CINAHL, Scopus and Web of Science—for studies published over a decade, and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, the international standard for ensuring such reviews are conducted and reported transparently. The review was prospectively registered with PROSPERO, the international prospective register of systematic reviews, under registration number CRD420251218875, a step designed to guard against selective reporting. By combining a quantitative meta-analysis with a structured qualitative synthesis in what the authors describe as a convergent segregated design, the study captures both the magnitude of the problem and the lived experiences behind the statistics.

Maternal health literacy, the central concept of the review, is more than the ability to read a pamphlet. Researchers define it as the cognitive and social skills that determine a woman’s motivation and ability to gain access to, understand and use information in ways that promote and maintain the health of herself and her child during pregnancy and early parenthood. It shapes whether a woman books timely antenatal appointments, recognises warning signs of complications, follows medical advice, and feels confident asking questions of clinicians. When health literacy falters, the consequences cascade: missed appointments, delayed presentation of complications, poorer birth outcomes and deepening distrust of health services. For migrant mothers, who often arrive with interrupted healthcare histories, unfamiliarity with local systems and varying proficiency in the host country’s language, the stakes are especially high.

The quantitative pooling relied on random-effects meta-analysis, a statistical technique that accounts for the fact that individual studies differ in their populations, settings and measurement tools. Rather than assuming a single true effect size, random-effects models estimate a distribution of effects and produce wider, more honest confidence intervals. Even so, the intervals in this review tell a consistent story. The pooled estimate for difficulty understanding health information, at 22.9 percent, carries a 95 percent confidence interval of 14.7 to 33.9 percent; language barriers cluster at 29.8 percent with an interval of 19.6 to 42.6 percent; and navigation difficulties reach 31.2 percent with an interval of 19.5 to 45.9 percent. The breadth of these intervals reflects genuine heterogeneity across countries and cohorts, yet every lower bound remains clinically meaningful, indicating that even under the most conservative reading, a substantial minority of migrant mothers faces each of these barriers.

The qualitative strand of the review dug into why these barriers persist. Using deductive framework analysis and hybrid content analysis, the researchers identified six key determinants of maternal health literacy among migrant women: language proficiency, access to interpreters, educational attainment, cultural beliefs, socioeconomic constraints and pre-migration experiences. Each factor interacts with the others in ways that can compound disadvantage. A mother with limited formal education who is also learning a new language faces a double burden when a clinician explains a gestational diabetes screening protocol in rapid, jargon-laden speech. Pre-migration experiences, including trauma or healthcare systems in countries of origin that function very differently, can shape expectations and trust in ways that mainstream services rarely anticipate.

Barriers to actually accessing care clustered into four recurring themes: discrimination by healthcare providers, difficulties navigating complex systems, social isolation, and unmet need for professional interpreters. The interpreter finding is particularly striking because it represents a failure of infrastructure rather than of individual knowledge. Many high-income countries have policies mandating interpreter access, yet the review suggests that in practice, women frequently attend appointments without qualified interpretation, relying instead on family members, bilingual staff pulled from other duties, or nothing at all. Ad hoc interpretation by relatives raises its own concerns, from inaccurate translation of clinical information to the suppression of sensitive disclosures, particularly around mental health or domestic circumstances, when a husband or in-law is acting as the intermediary.

Against these barriers, the review also catalogued what works. Culturally responsive providers emerged as the most frequently reported facilitator of care access, followed by community support networks and family support. Culturally responsive care is not a vague aspiration; in the literature it concretely means clinicians who take time to understand a patient’s health beliefs, who use professional interpreters consistently, who adapt communication to the patient’s literacy level, and who demonstrate respect for cultural practices around pregnancy and birth. Community networks, including migrant community organisations and peer support groups, appear to function as bridges that translate not just language but the unwritten rules of a foreign health system—when to call, where to go, what to expect at each stage of pregnancy.

The finding that migrant women face 2.66 times higher odds of suboptimal antenatal care utilisation matters because antenatal care is one of the most powerful preventive interventions in public health. Regular check-ups during pregnancy allow clinicians to detect hypertension, gestational diabetes, anaemia and fetal growth problems before they become emergencies. When a third of a population group struggles to navigate the system and nearly a third cannot fully understand the information they receive, the pipeline from risk to detection to treatment is compromised at every link. The elevated dissatisfaction odds, at 1.77, add a relational dimension: women who feel unheard or disrespected are less likely to return, creating a feedback loop in which poor experiences drive disengagement, which in turn worsens outcomes and reinforces stereotypes about non-compliance.

The authors frame their conclusions within the United Nations Sustainable Development Goals, specifically Goal 3 on health and well-being and Goal 10 on reduced inequalities, arguing that improving maternal health literacy among migrant populations is essential to advancing equitable maternity care. Their recommendations point toward culturally and linguistically responsive maternity services, strengthened communication strategies, and policies that address structural inequities rather than placing the burden of adaptation solely on migrant women themselves. In practical terms, that could mean routine professional interpreter provision funded as core infrastructure, health materials designed for low-literacy and multilingual audiences, navigation programs that pair migrant mothers with trained guides through the pregnancy pathway, and cultural competence embedded in clinician training rather than treated as an optional extra.

What makes this review resonate beyond academic circles is the universality of its underlying message: a health system is only as effective as its ability to communicate with the people it serves. High-income countries pride themselves on some of the safest maternity care in the world, yet this synthesis of 81 studies shows that safety is unevenly distributed along lines of language, culture and migration history. The statistics—nearly one in four unable to understand health information, nearly one in three blocked by language, one in three lost in the system—are not abstractions but the aggregated experiences of hundreds of thousands of women giving birth far from the contexts in which they grew up. As migration continues to shape the demographics of wealthy nations, the review suggests that the measure of a maternity service is not how well it performs for those who already know how to use it, but how well it reaches those who do not.

Subject of Research: Maternal health literacy and healthcare access among migrant mothers in high-income countries

Article Title: Maternal health literacy and access to maternal healthcare among migrant mothers in high-income countries: a systematic review and meta-analysis

Article References: Wickramarathne, T., Baten, A., Nedeljkovic, M., Apputhurai, P., & Bhowmik, J. (2026). Maternal health literacy and access to maternal healthcare among migrant mothers in high-income countries: a systematic review and meta-analysis. BMC Public Health. https://doi.org/10.1186/s12889-026-29851-3

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29851-3

Keywords: maternal health literacy, migrant mothers, maternity care, antenatal care, health inequities, language barriers, systematic review, meta-analysis, high-income countries, culturally responsive care, interpreter services, public health

The research team, led by Zainab Al Kindi of the Department of Community and Mental Health Nursing, set out to address a persistent gap in nursing education. Global health challenges, including emerging infections, population mobility, climate-related health risks, noncommunicable diseases, and health inequities, increasingly shape day-to-day nursing practice. Yet evidence on whether structured, curriculum-embedded courses actually improve students’ perceived competency has remained limited, particularly in countries where global health education is still maturing within undergraduate nursing curricula.

To measure the effect, the researchers used a one-group pre-test–post-test design, one of the most direct ways to evaluate change within a cohort. Each of the eighty participating students completed a questionnaire before the course began and again after finishing it. The measurement instrument was a course-aligned adaptation informed by the Global Health Competencies for Nurses framework, covering seven distinct domains: global burden of disease, global health priorities, social and environmental determinants of health, professional practice, health equity and social justice, programme management, and economic, sociocultural, and political awareness.

The headline result was unambiguous. Overall perceived global health competency rose from a mean of 2.46 on the pre-test, with a standard deviation of 0.81, to a mean of 3.08 on the post-test, with a standard deviation of 0.44. That represents a mean increase of 0.62 points, with a 95 percent confidence interval of 0.40 to 0.84. The paired-samples t test yielded t(79) = 5.62 and p < .001, while the paired-samples effect size, Cohen’s dz, came in at 0.63, a medium-to-large effect by conventional standards. Notably, the drop in standard deviation from 0.81 to 0.44 suggests the course did not merely lift the average; it also narrowed the spread between students, bringing lower-scoring students closer to their peers.

The improvement was not confined to a single dimension of competency. Students showed significant gains across all seven domains of the adapted scale. The largest single improvement appeared in health equity and social justice, where the mean increased by 0.90 points, with a 95 percent confidence interval of 0.68 to 1.12, t(79) = 8.14, p < .001, and a Cohen’s dz of 0.91. An effect size approaching 1.0 in a paired design indicates that, for the average student, the shift in perceived understanding of equity and justice was substantial, not a marginal statistical artifact.

Why would equity and social justice show the steepest climb? The authors’ framework places these concepts at the heart of global health thinking, and they are often the least familiar territory for students entering nursing school. Concepts such as the social determinants of health, structural inequities, and the uneven distribution of disease burden across populations require a conceptual reframing that clinical training alone rarely provides. A dedicated course gives students the vocabulary, evidence base, and analytical tools to see health outcomes as products of social, economic, and political arrangements, not just individual biology or behavior. The data suggest that once that reframing occurs, students recognize it themselves in their self-assessed competency.

The study also uncovered an interesting baseline pattern. Students who had previously participated in global health activities, such as exchanges, volunteer work, or related extracurricular engagement, reported higher competency before the course even began. This aligns with a broader principle in competency development: prior exposure builds familiarity and confidence. However, by the post-test, competency scores did not differ significantly across participant characteristics. In other words, the course appears to have leveled the field, giving students without prior global health exposure the same measurable boost that brought them up to par with their more experienced classmates.

Methodologically, the one-group pre-test–post-test design has known limitations that the findings should be read against. Without a control group, it is impossible to fully rule out alternative explanations such as maturation, concurrent coursework, or test-retest effects. Self-reported perceived competency also measures confidence and self-assessment rather than directly observed skill. Nevertheless, the design is well suited to course evaluation, and the consistency of improvement across all seven domains, combined with conventional statistical rigor including confidence intervals and paired effect sizes, strengthens the case that the course itself drove the change. The study received ethical approval from the Research and Ethics Committee of the College of Nursing at Sultan Qaboos University and was conducted in accordance with the Declaration of Helsinki, with data collection handled by someone not involved in teaching or assessment to reduce pressure on students.

The implications extend beyond one university in Muscat. The authors argue that integrating global health education within undergraduate nursing curricula offers a scalable approach to preparing future nurses for equity-oriented, culturally responsive, and globally informed practice. Because the course was embedded in the existing curriculum rather than offered as an optional add-on, the model does not require students to find extra time or resources, making it attractive for nursing schools in low- and middle-income countries and beyond. As climate change alters disease patterns and populations grow more mobile, the demand for nurses who understand global health dynamics will only intensify.

There is also a broader policy dimension. The researchers note that strengthening perceived global health competency in nursing education may support progress toward the United Nations Sustainable Development Goals related to health and quality education. A workforce of nurses who grasp the global burden of disease, the economics of health systems, and the politics of health inequity is better positioned to deliver care that closes gaps rather than widening them. For a profession that makes up the largest share of the global health workforce, that shift in perspective, achieved in a single course, may prove to be one of the most cost-effective investments in health equity available to educators today.

Subject of Research: The effect of a structured global health course on perceived global health competency in undergraduate nursing students

Article Title: Enhancing perceived global health competency among undergraduate nursing students: a pre-test–post-test course evaluation

Article References: Kindi, Z. A., Yahyaei, A. A., Joseph, M., & Sabei, S. A. (2026). Enhancing perceived global health competency among undergraduate nursing students: a pre-test–post-test course evaluation. BMC Nursing. https://doi.org/10.1186/s12912-026-05412-2

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05412-2

Keywords: global health competency, nursing education, undergraduate nursing students, curriculum evaluation, health equity, pre-test post-test study, social determinants of health, Sultan Qaboos University, BMC Nursing, nursing workforce, culturally responsive care, sustainable development goals

The scale of the omission is striking. More than half of the surveyed educators reported that traditional health content is not taught at any level of their undergraduate programme, and only a small minority indicated that their institutions offer dedicated curriculum components on the subject. Foundational concepts, the values and belief systems underpinning traditional practice, the regulatory framework governing traditional health practitioners, and the professional roles nurses may play in relation to these systems were all reported as largely absent from teaching. In a country where traditional healing remains a first point of contact for many communities, the finding points to a deep structural disconnect between what nursing students learn and what their future patients believe and practise.

The research team approached the question with a quantitative, cross-sectional descriptive survey, representing the second phase of an exploratory sequential mixed-methods design. In the first phase, qualitative work informed the development of the questionnaire, ensuring that the survey instrument reflected the lived realities of educators rather than imposing externally derived categories. For the national phase, the researchers stratified public nursing education institutions by type, covering universities, universities of technology, and public nursing colleges, and collected responses from 408 nurse educators across the country. The questionnaire probed curriculum structure, the presence and depth of ATHKP-related content, teaching and assessment methods, and educators’ own perceptions of how important such teaching is.

The methodological rigour of the survey was supported by standard psychometric checks, including an assessment of sampling adequacy using the Kaiser-Meyer-Olkin measure, and the data were analysed with descriptive statistics. This design choice matters: rather than relying on anecdote or single-institution case studies, the study offers the first national-level evidence base on how, or whether, Indigenous health knowledge is woven into South African nursing education. Ethics approval was granted by the Faculty of Health Sciences Research Ethics Committee at the University of Pretoria, and participation was voluntary with informed consent obtained from all respondents.

What the numbers revealed was a curriculum gap with several distinct layers. Content was not merely thin; it was unevenly distributed and largely theoretical. Where traditional health topics did appear, educators described predominantly lecture-based, classroom-bound delivery, with little use of experiential learning approaches such as community engagement, clinical exposure, or dialogue with traditional practitioners. Formal assessment of ATHKP content was uncommon, meaning that even where material was taught, students faced little incentive to master it. In curriculum design terms, unassessed content is functionally optional, and the survey suggests that traditional health knowledge has been relegated to precisely that status.

The paradox at the heart of the findings is that nurse educators themselves do not dismiss the subject. Most respondents perceived the teaching of African traditional health knowledge as important and explicitly identified the need for educator development, clearer regulatory guidance, and structured curriculum support. In other words, the barrier appears to be institutional and systemic rather than attitudinal. Educators lack the training, the policy clarity, and the curricular scaffolding to translate their own recognition of the subject’s importance into classroom practice. This distinction is crucial for policymakers, because it reframes the problem from one of persuading sceptical faculty to one of equipping willing ones.

The clinical stakes of this gap are considerable. Nurses routinely care for patients whose health beliefs and practices are informed by Indigenous knowledge systems, including the use of herbal remedies, consultation with traditional health practitioners, and explanatory models of illness that differ from biomedical frameworks. Without formal preparation, graduates may respond to these practices with ignorance at best and cultural insensitivity or outright dismissal at worst. That carries risks in both directions: patients may conceal traditional treatments that interact pharmacologically with prescribed drugs, or may disengage from care entirely when their beliefs are met with hostility. Culturally responsive care, long championed by the World Health Organization’s emphasis on integrating traditional medicine into national health systems, requires practitioners who can navigate pluralistic health landscapes safely and ethically.

South Africa’s regulatory environment adds another layer of urgency. Traditional health practitioners in the country operate within a formal regulatory framework, and the survey found that content relating to this regulation, and to the professional roles nurses might occupy in relation to traditional practitioners, was largely missing from teaching. This means newly qualified nurses may enter the workforce without understanding the legal status of the healers their patients consult, the boundaries of their own professional responsibilities, or the referral pathways that could link the two systems. The educators surveyed flagged the absence of clearer regulatory guidance as a specific obstacle, suggesting that curriculum reform cannot proceed without parallel policy development from bodies such as the South African Nursing Council.

The study’s authors argue that strengthening curriculum content, pedagogical approaches, educator preparedness, and assessment practices related to ATHKPs could enhance culturally responsive nursing education and better prepare graduates to provide care within pluralistic healthcare systems. The recommendations are deliberately structural: educator development programmes to build faculty confidence and competence, clearer regulatory guidance to define what should be taught, and structured curriculum support to embed the material at multiple levels of the programme rather than leaving it to individual initiative. The finding that assessment practices lag behind even limited teaching suggests that any reform must address evaluation as well as delivery, since what is examined shapes what students take seriously.

For a country whose constitution recognises cultural diversity and whose health system serves a population that frequently combines biomedical and traditional care, the study reads as a wake-up call delivered with statistical precision. The gap it documents is not between nurses and their patients’ beliefs in the abstract, but between what 408 educators across the nation’s accredited public nursing institutions say matters and what their curricula actually contain. Closing that gap, the evidence suggests, will require more than goodwill; it will demand deliberate investment in teaching capacity, regulatory clarity, and curriculum design that treats African traditional health knowledge not as folklore at the margins of medicine, but as an essential competency for safe, ethical, and effective nursing practice in one of the world’s most pluralistic healthcare environments.

Subject of Research: Integration of African traditional health knowledge and practices into undergraduate nursing education in South Africa

Article Title: Teaching African traditional health knowledge and practices in undergraduate nursing education: a national survey of South African nurse educators

Article References: Teaching African traditional health knowledge and practices in undergraduate nursing education: a national survey of South African nurse educators. (n.d.). https://doi.org/10.1186/s12912-026-05431-z

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05431-z

Keywords: African traditional health knowledge, nursing education, South Africa, nurse educators, curriculum integration, Indigenous knowledge systems, traditional health practitioners, culturally responsive care, cross-sectional survey, BMC Nursing, health policy, undergraduate nursing