Abstract
<title>Abstract</title> <p>Background Maternal health literacy is a key determinant of informed decision-making, self-care, and pregnancy outcomes. It encompasses women’s ability to access, understand, appraise, and apply health information during pregnancy. This study aimed to validate the Portuguese version of the Maternal Health Literacy Inventory in Pregnancy (MHELIP). Methods This methodological validation study followed established procedures for cross-cultural adaptation, including forward translation, synthesis, back-translation, expert committee review, and pretesting. The Portuguese MHELIP was administered to 886 pregnant women. Psychometric evaluation included confirmatory factor analysis, item reliability assessment, internal consistency analysis, and evaluation of convergent and discriminant validity. Results Confirmatory factor analysis supported a four-factor structure for the Portuguese version of the MHELIP. After item refinement, the final instrument comprised 23 items and demonstrated acceptable model fit (χ²/df = 4.41; GFI = 0.91; CFI = 0.90; RMSEA = 0.062; RMR = 0.024; SRMR = 0.047). A second-order hierarchical model further supported the representation of maternal health literacy as a multidimensional construct. Internal consistency was excellent for the total scale (ω = 0.92) and acceptable across subscales (ω = 0.75–0.82). Convergent validity was supported for three of the four domains, while the Maternal Health Decision-Making and Behaviour domain showed an AVE below the recommended threshold. Discriminant validity was generally satisfactory, although a high conceptual overlap was observed between the Search for Maternal Health Information and Assessment of Maternal Health Information domains. Conclusions The Portuguese MHELIP demonstrated satisfactory psychometric properties and provides a shorter and theoretically coherent measure of maternal health literacy during pregnancy. Its brevity may facilitate its use in antenatal care settings and research. Further studies should examine temporal stability, predictive validity, and performance in more diverse Portuguese populations. Trial registration: Not applicable.</p>