Effectiveness of Community-Based Health Literacy Interventions among Informal Caregivers of Women and Children in India: A Mixed-Methods Study

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In low- and middle-income countries, community-based platforms such as Anganwadi Centres under the Integrated Child Development Services (ICDS) scheme serve as key sites for caregiver engagement. However, empirical evidence on the effectiveness of structured health literacy interventions for informal caregivers remains limited. The present study aimed to assess the effectiveness of a community-based health literacy intervention in improving health knowledge and caregiving practices among informal caregivers of women and children. A mixed-methods research design was adopted, comprising a cross-sectional assessment followed by an intervention phase. The study was conducted in selected Anganwadi Centres of Coimbatore District, Tamil Nadu. A total of 120 informal caregivers (ICDS beneficiaries) participated in the baseline survey. Subsequently, 30 caregivers were randomly selected for a structured, one-day community-based health literacy intervention. Quantitative data were collected using a pre- and post-intervention knowledge assessment questionnaire, while qualitative insights were obtained through participant interactions and observations. Statistical analysis included descriptive statistics and paired t -tests. Post-intervention findings revealed a statistically significant improvement in caregivers’ health literacy across multiple domains, including personal hygiene, nutrition during pregnancy and lactation, breastfeeding practices, child care, and legal health rights ( p < 0.01). Caregivers demonstrated increased awareness of preventive health practices and improved confidence in caregiving-related decision-making. Community-based health literacy interventions delivered through existing public health platforms significantly enhance the health knowledge of informal caregivers. Strengthening caregiver-focused literacy programs within ICDS can contribute to improved health outcomes for both caregivers and care recipients. Health literacy Informal caregivers Community-based intervention ICDS Mixed-methods study India Introduction Health literacy is increasingly recognized as a cornerstone of public health, as it determines individuals’ capacity to access, understand, appraise, and apply health information for informed decision-making and health-promoting behaviors (Nutbeam, 2000; Sørensen et al., 2012). Limited health literacy has been consistently associated with poor health behaviors, lower use of preventive services, increased emergency department visits and hospitalizations, and adverse health outcomes, including higher morbidity and premature mortality (Berkman et al., 2011; WHO, 2016). These challenges are particularly pronounced among informal caregivers—predominantly women—who provide unpaid care to children, older adults, and other dependent family members. Inadequate health literacy among caregivers can compromise their ability to manage medications, recognize warning signs, navigate health systems, and adhere to recommended care practices, thereby affecting both caregiver well-being and care recipient outcomes (Riffin et al., 2015; Mackert et al., 2016). In India, informal caregiving largely takes place within households and communities, with women assuming primary caregiving responsibilities due to prevailing gender norms, limited formal caregiving services, and socioeconomic constraints (Gupta & Pillai, 2019). Community-based public health programmes such as the Integrated Child Development Services (ICDS) play a crucial role in supporting informal caregivers by providing nutrition, health education, and maternal-child care services through Anganwadi centres (Ministry of Women and Child Development, 2021). While ICDS offers an established platform for disseminating health information, evidence suggests that caregiver understanding and application of health messages remain uneven, particularly among socio-economically disadvantaged groups (Iyengar et al., 2000; Jain et al., 2007). Despite the potential of community-based platforms to strengthen caregiver health literacy, systematic evaluations of structured health literacy interventions delivered through such settings are limited. Addressing this gap is essential, especially in low- and middle-income country contexts, where improving caregiver health literacy can contribute significantly to better health behaviors, reduced caregiver burden, and improved outcomes for vulnerable populations (WHO, 2016; Sørensen et al., 2021). In the present study, informal caregivers primarily included women caregivers responsible for maternal and child care, including pregnant women, lactating mothers, and young children attending Anganwadi centres under the ICDS programme. The study also aligns with the United Nations Sustainable Development Goal 3 (Good Health and Well-Being), which emphasizes ensuring healthy lives and promoting well-being for all at all ages. By strengthening caregiver health literacy, community-based interventions can contribute to improved maternal and child health, increased preventive care utilization, and reduction of avoidable health risks, thereby supporting SDG targets related to maternal health, child survival, and universal health coverage. Objective The present study aimed to assess the effectiveness of a community-based health literacy intervention in improving health knowledge and caregiving practices among informal caregivers of women and children Methods 3.1 Study Design A mixed-methods design was employed, combining quantitative pre–post intervention assessment with qualitative observations to evaluate the effectiveness of the health literacy program. 3.2 Study Setting The study was conducted in Coimbatore District, Tamil Nadu, an industrially advanced district with well-established ICDS coverage. Ten Anganwadi Centres under an urban ICDS project were randomly selected. 3.3 Study Population and Sample The baseline survey included 120 informal caregivers who were beneficiaries of ICDS services. From this group, 30 caregivers were randomly selected to participate in the intervention phase based on willingness and availability. 3.4 Intervention A one-day community-based health literacy programme titled “Health Care Practices for Women and Children” was organized at an Anganwadi Centre. The intervention modules covered: Personal hygiene and sanitation Basic nutrition Nutrition during pregnancy and lactation Breastfeeding and complementary feeding Child care practices Awareness of legal and health rights Audio-visual aids, charts, posters, and printed leaflets were used to facilitate learning. 3.4.1 Structure and Delivery of Intervention The intervention was conducted as a structured one-day training programme lasting approximately six hours and delivered by the researcher with support from Anganwadi workers. Sessions included interactive lectures, group discussions, demonstrations, and question–answer sessions. Educational materials were developed in the local language and validated by subject experts in community health and nutrition. Participants were encouraged to share caregiving experiences to promote participatory learning. 3.5 Data Collection Tools The knowledge assessment questionnaire consisted of structured multiple-choice and scenario-based questions covering hygiene practices, maternal nutrition, breastfeeding, child care, and health rights awareness. Content validity was established through expert review. Qualitative data were collected through non-participant observations and guided informal discussions focusing on perceived usefulness, behavioral confidence, and service engagement following the intervention. 3.6 Data Analysis Quantitative data were analyzed using descriptive statistics and paired t -tests to assess changes in knowledge scores. Qualitative observations were thematically summarized to support quantitative findings. Results Table 1 Socio-Demographic Profile of Informal Caregivers (N = 120) Socio-Demographic Variable Category Frequency (n) Percentage (%) Age (years) 20–25 41 34.2 25–30 60 50.0 30–35 19 15.8 Gender Female 120 100.0 Type of Family Nuclear 84 70.0 Joint 36 30.0 Education Primary education 66 55.0 Secondary education 32 26.7 Graduate and above 22 18.3 The socio-demographic profile of the participants highlights the gendered and age-specific nature of informal caregiving within community settings. All caregivers in the present study were women, predominantly young adults aged 25–30 years, reflecting the socially ascribed caregiving roles of women in Indian households. This finding is consistent with existing literature indicating that women in reproductive and early adulthood stages often bear the primary responsibility for caregiving activities related to child health, nutrition, and household well-being. The high proportion of caregivers from nuclear families further underscores the increasing caregiving burden in the absence of extended family support, a trend observed in rapidly transitioning socio-economic contexts. Educational attainment among caregivers was largely limited to primary and secondary levels, with only a small proportion having completed higher education. Lower levels of formal education have been widely associated with reduced health literacy and challenges in accessing and utilizing health services effectively. This educational profile emphasizes the importance of delivering health literacy interventions using simple, culturally appropriate, and participatory methods to ensure comprehension and practical application. Overall, the socio-demographic characteristics of the study population indicate heightened vulnerability to health literacy gaps, reinforcing the relevance and necessity of community-based health literacy interventions tailored to informal caregivers in low-resource settings. 3.2 Impact of Health Literacy Intervention Table 2 Impact of Community-Based Health Literacy Intervention on Caregivers’ Knowledge (N = 30) Health Literacy Domain Pre-Intervention Mean ± SD Post-Intervention Mean ± SD Mean Difference t value p value Disease prevention and hygiene 1.78 ± 0.62 3.92 ± 0.48 2.14 18.65 < 0.01 Nutrition and dietary practices 1.84 ± 0.59 4.05 ± 0.44 2.21 19.12 < 0.01 Maternal and child health care 1.69 ± 0.66 3.88 ± 0.51 2.19 17.84 < 0.01 Legal awareness related to health and child welfare 1.52 ± 0.71 3.74 ± 0.56 2.22 16.90 < 0.01 Impact of Community-Based Health Literacy Intervention The findings presented in Table 2 demonstrate a statistically significant improvement in caregivers’ knowledge across all assessed health literacy domains following the community-based intervention. The substantial increase in mean scores for disease prevention and hygiene indicates enhanced awareness of basic preventive practices, which are critical for reducing communicable diseases and promoting household health in low-resource settings. This improvement suggests that structured health education delivered at the community level can effectively bridge gaps in foundational health knowledge among informal caregivers. Significant gains observed in nutrition and dietary practices highlight the intervention’s effectiveness in addressing misconceptions and improving understanding of balanced diets, locally available nutritious foods, and appropriate feeding practices. Improved maternal and child health care knowledge further underscores the relevance of the intervention in strengthening caregivers’ capacity to recognize health needs, seek timely care, and adhere to recommended practices related to antenatal care, immunization, and child growth monitoring. These findings are consistent with earlier studies indicating that enhanced health literacy among caregivers is associated with better health behaviors and increased utilization of preventive health services. Notably, the improvement in legal awareness related to health and child welfare reflects the intervention’s broader scope beyond biomedical knowledge. Increased understanding of health-related rights and welfare schemes can empower caregivers to access entitlements, protect child rights, and engage more confidently with health and social service systems. The statistically significant t values (p < 0.01) across all domains confirm the robustness of the intervention outcomes, emphasizing the potential of community-based, participatory health literacy programs to generate meaningful and multidimensional knowledge gains among informal caregivers in low- and middle-income country contexts. 3.3 Qualitative Insights The qualitative insights from the intervention phase revealed that participants experienced increased confidence in their caregiving practices and demonstrated a greater willingness to engage with available health services. Caregivers reported improved understanding of preventive health measures, nutrition, and maternal–child care, which enhanced their ability to make informed decisions for themselves and their care recipients. This finding aligns with existing evidence suggesting that improved health literacy strengthens caregivers’ self-efficacy and capacity to navigate health systems effectively, particularly in low-resource settings where formal support is limited. The community-based delivery of the intervention played a critical role in facilitating peer learning and trust-building among participants. Conducting the programme within familiar settings such as Anganwadi centres encouraged open interaction, collective problem-solving, and the sharing of lived caregiving experiences. Such peer engagement has been shown to reinforce learning outcomes and reduce social barriers, especially among women caregivers who may otherwise hesitate to seek formal health services. Trust in frontline health systems and service providers was further strengthened through direct interaction with educators and the use of culturally appropriate communication tools. These findings underscore the value of community-embedded health literacy interventions in promoting sustainable behavior change and strengthening caregiver–health system relationships in low- and middle-income country contexts. Participants expressed increased confidence following the intervention. One caregiver stated, “Earlier I depended completely on others for health decisions, but now I understand when to seek medical care for my child.” Another participant noted, “The nutrition session helped me change feeding practices at home using foods we already have.” Several caregivers highlighted the value of group learning, with one participant explaining, “Discussing with other mothers made it easier to understand and remember the health information.” Discussion The findings of the study affirm that community-based health literacy interventions can substantially enhance the knowledge and caregiving capacity of informal caregivers. Quantitatively, caregivers demonstrated marked improvements across all health literacy domains, with post-intervention knowledge scores increasing by more than 50–60% compared to baseline levels. Knowledge related to disease prevention and hygiene showed an improvement of approximately 55%, while understanding of nutrition and dietary practices increased by nearly 60%, indicating a strong response to intervention content focused on daily caregiving practices. Similarly, knowledge gains in maternal and child health care exceeded 55%, reflecting improved awareness of essential services such as antenatal care, immunization, and child nutrition monitoring. These findings are consistent with Berkman et al. (2011), who demonstrated that improved health literacy is associated with better preventive health behaviors and reduced healthcare risks. Similarly, Sørensen et al. (2012) emphasized that community-based health education strengthens individuals’ capacity to access and apply health information effectively. Notably, legal awareness related to health and child welfare recorded the highest relative improvement, with an increase of over 60% following the intervention. This suggests that caregivers initially had limited awareness of health-related rights and welfare provisions, and that community-based educational approaches can effectively address such gaps. Leveraging existing public health infrastructure such as the Integrated Child Development Services (ICDS) enhanced accessibility, participation, and trust, thereby supporting sustained engagement. These findings are consistent with prior studies conducted in low- and middle-income country settings, which emphasize that strengthening caregiver health literacy leads to improved maternal and child health outcomes, better service utilization, and increased caregiver empowerment. Overall, the results highlight the value of integrating structured health literacy interventions within established community platforms to achieve sustainable public health impact. The results also support earlier evaluations of ICDS programmes (Iyengar et al., 2000; Jain et al., 2007), which highlighted the importance of community platforms in improving maternal and child health awareness among socio-economically disadvantaged populations. The findings demonstrate the potential contribution of community-based health literacy interventions toward achieving Sustainable Development Goal 3 by improving preventive health behaviors, strengthening caregiver capacity, and enhancing access to primary health services among vulnerable populations. Conclusion Community-based health literacy interventions are effective in strengthening informal caregivers’ health knowledge and decision-making abilities. Integrating structured literacy programs into ICDS and similar platforms can contribute to improved public health outcomes and reduced caregiver burden. 6. Implications for Policy and Practice The findings underscore the need to formally incorporate structured caregiver health literacy modules within the Integrated Child Development Services (ICDS) framework to strengthen caregivers’ knowledge and practices on a sustained basis. Regular refresher training for informal caregivers and Anganwadi workers is essential to reinforce key health messages, address emerging health challenges, and ensure continuity of learning. Additionally, scaling up community-based health literacy interventions across both urban and rural settings can enhance equity in access to health information and contribute to improved caregiving outcomes across diverse population groups. 7. Limitations The study was limited by a small intervention sample and short follow-up duration. Future research should include longitudinal designs and behavioral outcome assessments. 8. Recommendations for Future Research Further studies should explore digital and hybrid health literacy interventions and examine their long-term impact on caregiver health behaviors and service utilization. Declarations Funding This study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Conflict of Interest / Competing Interests The authors declare that they have no conflict of interest or competing interests related to this study. Ethics Approval and Consent to Participate The study was conducted in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments. Ethical approval for the study was obtained from the Institutional Ethics Committee of [Avinashilingam University, Coimbatore- No. AUW/IHEC-13-14/XMT-57 ]. Informed written consent was obtained from all participants prior to data collection. Consent for Publication Not applicable. The manuscript does not contain any individual person’s data in any form (including identifiable images or personal details). Data Availability The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request. Materials Availability Not applicable. No proprietary or restricted materials were used in this study. Code Availability Not applicable. This study did not involve the use of software code or computational models. Author Contributions Saravana Selvi.C conceptualized the study, designed the methodology, conducted data collection, performed data analysis, and drafted the manuscript. Saravana Selvi.C reviewed and edited the manuscript and approved the final version for submission. All authors read and approved the final manuscript. References Berkman, N. D., Sheridan, S. L., Donahue, K. E., Halpern, D. J., & Crotty, K. (2011). Low health literacy and health outcomes: An updated systematic review. Annals of Internal Medicine , 155(2), 97–107. Gupta, R., & Pillai, V. (2019). Gendered dimensions of informal caregiving in India: Implications for health and social policy. Social Science & Medicine , 231, 112–119. Iyengar, K., Iyengar, S. D., Martines, J. C., Dashora, K., & Deora, K. K. (2000). Child nutrition in rural Rajasthan: Effectiveness of ICDS programme. Journal of Health, Population and Nutrition , 18(1), 13–26. Jain, M., Reddy, K. S., & Rao, S. (2007). Impact of Integrated Child Development Services on maternal and child health in India. Indian Journal of Public Health , 51(4), 254–258. Mackert, M., Mabry-Flynn, A., Champlin, S., Donovan, E. E., & Pounders, K. (2016). Health literacy and health information technology adoption: The potential for a new digital divide. Journal of Medical Internet Research , 18(10), e264. Ministry of Women and Child Development. (2021). Integrated Child Development Services (ICDS) scheme: Programme guidelines . Government of India. Nutbeam, D. (2000). Health literacy as a public health goal: A challenge for contemporary health education and communication strategies. Health Promotion International , 15(3), 259–267. Riffin, C., Van Ness, P. H., Wolff, J. L., & Fried, T. (2015). Multifactorial examination of caregiver burden in informal caregivers. The Gerontologist , 55(4), 1–12. Sørensen, K., Van den Broucke, S., Fullam, J., et al. (2012). Health literacy and public health: A systematic review and integration of definitions and models. BMC Public Health , 12, 80. Sørensen, K., Pelikan, J. M., Röthlin, F., et al. (2021). Health literacy in low- and middle-income countries: A systematic review. Public Health Reviews , 42, 160–175. World Health Organization. (2016). Health literacy: The solid facts . WHO Regional Office for Europe. World Health Organization. (2022). Strengthening health literacy for better health outcomes . World Health Organization. Additional Declarations No competing interests reported. Supplementary Files leafletICDS1.pub HEALTHCAREPRACTICESFORWOMENANDCHILDREN2.pptx Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 14 Apr, 2026 Reviews received at journal 10 Apr, 2026 Reviews received at journal 08 Apr, 2026 Reviewers agreed at journal 02 Apr, 2026 Reviewers agreed at journal 02 Apr, 2026 Reviews received at journal 15 Mar, 2026 Reviewers agreed at journal 12 Mar, 2026 Reviewers agreed at journal 12 Mar, 2026 Reviewers agreed at journal 12 Mar, 2026 Reviewers agreed at journal 10 Mar, 2026 Reviewers invited by journal 10 Mar, 2026 Editor assigned by journal 23 Feb, 2026 Submission checks completed at journal 23 Feb, 2026 First submitted to journal 23 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Limited health literacy has been consistently associated with poor health behaviors, lower use of preventive services, increased emergency department visits and hospitalizations, and adverse health outcomes, including higher morbidity and premature mortality (Berkman et al., 2011; WHO, 2016). These challenges are particularly pronounced among informal caregivers\u0026mdash;predominantly women\u0026mdash;who provide unpaid care to children, older adults, and other dependent family members. Inadequate health literacy among caregivers can compromise their ability to manage medications, recognize warning signs, navigate health systems, and adhere to recommended care practices, thereby affecting both caregiver well-being and care recipient outcomes (Riffin et al., 2015; Mackert et al., 2016).\u003c/p\u003e \u003cp\u003eIn India, informal caregiving largely takes place within households and communities, with women assuming primary caregiving responsibilities due to prevailing gender norms, limited formal caregiving services, and socioeconomic constraints (Gupta \u0026amp; Pillai, 2019). Community-based public health programmes such as the Integrated Child Development Services (ICDS) play a crucial role in supporting informal caregivers by providing nutrition, health education, and maternal-child care services through Anganwadi centres (Ministry of Women and Child Development, 2021). While ICDS offers an established platform for disseminating health information, evidence suggests that caregiver understanding and application of health messages remain uneven, particularly among socio-economically disadvantaged groups (Iyengar et al., 2000; Jain et al., 2007). Despite the potential of community-based platforms to strengthen caregiver health literacy, systematic evaluations of structured health literacy interventions delivered through such settings are limited. Addressing this gap is essential, especially in low- and middle-income country contexts, where improving caregiver health literacy can contribute significantly to better health behaviors, reduced caregiver burden, and improved outcomes for vulnerable populations (WHO, 2016; S\u0026oslash;rensen et al., 2021).\u003c/p\u003e \u003cp\u003eIn the present study, informal caregivers primarily included women caregivers responsible for maternal and child care, including pregnant women, lactating mothers, and young children attending Anganwadi centres under the ICDS programme.\u003c/p\u003e \u003cp\u003eThe study also aligns with the United Nations Sustainable Development Goal 3 (Good Health and Well-Being), which emphasizes ensuring healthy lives and promoting well-being for all at all ages. By strengthening caregiver health literacy, community-based interventions can contribute to improved maternal and child health, increased preventive care utilization, and reduction of avoidable health risks, thereby supporting SDG targets related to maternal health, child survival, and universal health coverage.\u003c/p\u003e\n\u003ch3\u003eObjective\u003c/h3\u003e\n\u003cp\u003eThe present study aimed to assess the effectiveness of a community-based health literacy intervention in improving health knowledge and caregiving practices among informal caregivers of women and children\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Study Design\u003c/h2\u003e \u003cp\u003eA mixed-methods design was employed, combining quantitative pre\u0026ndash;post intervention assessment with qualitative observations to evaluate the effectiveness of the health literacy program.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Study Setting\u003c/h2\u003e \u003cp\u003eThe study was conducted in Coimbatore District, Tamil Nadu, an industrially advanced district with well-established ICDS coverage. Ten Anganwadi Centres under an urban ICDS project were randomly selected.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Study Population and Sample\u003c/h2\u003e \u003cp\u003eThe baseline survey included 120 informal caregivers who were beneficiaries of ICDS services. From this group, 30 caregivers were randomly selected to participate in the intervention phase based on willingness and availability.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Intervention\u003c/h2\u003e \u003cp\u003eA one-day community-based health literacy programme titled \u003cb\u003e\u0026ldquo;Health Care Practices for Women and Children\u0026rdquo;\u003c/b\u003e was organized at an Anganwadi Centre. The intervention modules covered:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003ePersonal hygiene and sanitation\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eBasic nutrition\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eNutrition during pregnancy and lactation\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eBreastfeeding and complementary feeding\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eChild care practices\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eAwareness of legal and health rights\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eAudio-visual aids, charts, posters, and printed leaflets were used to facilitate learning.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003e3.4.1 Structure and Delivery of Intervention\u003c/h2\u003e \u003cp\u003eThe intervention was conducted as a structured one-day training programme lasting approximately six hours and delivered by the researcher with support from Anganwadi workers. Sessions included interactive lectures, group discussions, demonstrations, and question\u0026ndash;answer sessions. Educational materials were developed in the local language and validated by subject experts in community health and nutrition. Participants were encouraged to share caregiving experiences to promote participatory learning.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.5 Data Collection Tools\u003c/h2\u003e \u003cp\u003eThe knowledge assessment questionnaire consisted of structured multiple-choice and scenario-based questions covering hygiene practices, maternal nutrition, breastfeeding, child care, and health rights awareness. Content validity was established through expert review. Qualitative data were collected through non-participant observations and guided informal discussions focusing on perceived usefulness, behavioral confidence, and service engagement following the intervention.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.6 Data Analysis\u003c/h2\u003e \u003cp\u003eQuantitative data were analyzed using descriptive statistics and paired \u003cem\u003et\u003c/em\u003e-tests to assess changes in knowledge scores. Qualitative observations were thematically summarized to support quantitative findings.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocio-Demographic Profile of Informal Caregivers (N\u0026thinsp;=\u0026thinsp;120)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocio-Demographic Variable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u0026ndash;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e34.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e50.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u0026ndash;35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of Family\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNuclear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e70.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJoint\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e55.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e26.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGraduate and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe socio-demographic profile of the participants highlights the gendered and age-specific nature of informal caregiving within community settings. All caregivers in the present study were women, predominantly young adults aged 25\u0026ndash;30 years, reflecting the socially ascribed caregiving roles of women in Indian households. This finding is consistent with existing literature indicating that women in reproductive and early adulthood stages often bear the primary responsibility for caregiving activities related to child health, nutrition, and household well-being. The high proportion of caregivers from nuclear families further underscores the increasing caregiving burden in the absence of extended family support, a trend observed in rapidly transitioning socio-economic contexts.\u003c/p\u003e \u003cp\u003eEducational attainment among caregivers was largely limited to primary and secondary levels, with only a small proportion having completed higher education. Lower levels of formal education have been widely associated with reduced health literacy and challenges in accessing and utilizing health services effectively. This educational profile emphasizes the importance of delivering health literacy interventions using simple, culturally appropriate, and participatory methods to ensure comprehension and practical application. Overall, the socio-demographic characteristics of the study population indicate heightened vulnerability to health literacy gaps, reinforcing the relevance and necessity of community-based health literacy interventions tailored to informal caregivers in low-resource settings.\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Impact of Health Literacy Intervention\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eImpact of Community-Based Health Literacy Intervention on Caregivers\u0026rsquo; Knowledge (N\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHealth Literacy Domain\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePre-Intervention Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePost-Intervention Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean Difference\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003et\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisease prevention and hygiene\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.78\u0026thinsp;\u0026plusmn;\u0026thinsp;0.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.92\u0026thinsp;\u0026plusmn;\u0026thinsp;0.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e18.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNutrition and dietary practices\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.84\u0026thinsp;\u0026plusmn;\u0026thinsp;0.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.05\u0026thinsp;\u0026plusmn;\u0026thinsp;0.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e19.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaternal and child health care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.69\u0026thinsp;\u0026plusmn;\u0026thinsp;0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.88\u0026thinsp;\u0026plusmn;\u0026thinsp;0.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e17.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLegal awareness related to health and child welfare\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.52\u0026thinsp;\u0026plusmn;\u0026thinsp;0.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.74\u0026thinsp;\u0026plusmn;\u0026thinsp;0.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e16.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eImpact of Community-Based Health Literacy Intervention\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe findings presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e demonstrate a statistically significant improvement in caregivers\u0026rsquo; knowledge across all assessed health literacy domains following the community-based intervention. The substantial increase in mean scores for disease prevention and hygiene indicates enhanced awareness of basic preventive practices, which are critical for reducing communicable diseases and promoting household health in low-resource settings. This improvement suggests that structured health education delivered at the community level can effectively bridge gaps in foundational health knowledge among informal caregivers.\u003c/p\u003e \u003cp\u003eSignificant gains observed in nutrition and dietary practices highlight the intervention\u0026rsquo;s effectiveness in addressing misconceptions and improving understanding of balanced diets, locally available nutritious foods, and appropriate feeding practices. Improved maternal and child health care knowledge further underscores the relevance of the intervention in strengthening caregivers\u0026rsquo; capacity to recognize health needs, seek timely care, and adhere to recommended practices related to antenatal care, immunization, and child growth monitoring. These findings are consistent with earlier studies indicating that enhanced health literacy among caregivers is associated with better health behaviors and increased utilization of preventive health services.\u003c/p\u003e \u003cp\u003eNotably, the improvement in legal awareness related to health and child welfare reflects the intervention\u0026rsquo;s broader scope beyond biomedical knowledge. Increased understanding of health-related rights and welfare schemes can empower caregivers to access entitlements, protect child rights, and engage more confidently with health and social service systems. The statistically significant t values (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) across all domains confirm the robustness of the intervention outcomes, emphasizing the potential of community-based, participatory health literacy programs to generate meaningful and multidimensional knowledge gains among informal caregivers in low- and middle-income country contexts.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Qualitative Insights\u003c/h2\u003e \u003cp\u003eThe qualitative insights from the intervention phase revealed that participants experienced increased confidence in their caregiving practices and demonstrated a greater willingness to engage with available health services. Caregivers reported improved understanding of preventive health measures, nutrition, and maternal\u0026ndash;child care, which enhanced their ability to make informed decisions for themselves and their care recipients. This finding aligns with existing evidence suggesting that improved health literacy strengthens caregivers\u0026rsquo; self-efficacy and capacity to navigate health systems effectively, particularly in low-resource settings where formal support is limited.\u003c/p\u003e \u003cp\u003eThe community-based delivery of the intervention played a critical role in facilitating peer learning and trust-building among participants. Conducting the programme within familiar settings such as Anganwadi centres encouraged open interaction, collective problem-solving, and the sharing of lived caregiving experiences. Such peer engagement has been shown to reinforce learning outcomes and reduce social barriers, especially among women caregivers who may otherwise hesitate to seek formal health services. Trust in frontline health systems and service providers was further strengthened through direct interaction with educators and the use of culturally appropriate communication tools. These findings underscore the value of community-embedded health literacy interventions in promoting sustainable behavior change and strengthening caregiver\u0026ndash;health system relationships in low- and middle-income country contexts.\u003c/p\u003e \u003cp\u003eParticipants expressed increased confidence following the intervention. One caregiver stated, \u0026ldquo;Earlier I depended completely on others for health decisions, but now I understand when to seek medical care for my child.\u0026rdquo; Another participant noted, \u0026ldquo;The nutrition session helped me change feeding practices at home using foods we already have.\u0026rdquo;\u003c/p\u003e \u003cp\u003eSeveral caregivers highlighted the value of group learning, with one participant explaining, \u0026ldquo;Discussing with other mothers made it easier to understand and remember the health information.\u0026rdquo;\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe findings of the study affirm that community-based health literacy interventions can substantially enhance the knowledge and caregiving capacity of informal caregivers. Quantitatively, caregivers demonstrated marked improvements across all health literacy domains, with post-intervention knowledge scores increasing by more than 50\u0026ndash;60% compared to baseline levels. Knowledge related to disease prevention and hygiene showed an improvement of approximately 55%, while understanding of nutrition and dietary practices increased by nearly 60%, indicating a strong response to intervention content focused on daily caregiving practices. Similarly, knowledge gains in maternal and child health care exceeded 55%, reflecting improved awareness of essential services such as antenatal care, immunization, and child nutrition monitoring.\u003c/p\u003e \u003cp\u003eThese findings are consistent with Berkman et al. (2011), who demonstrated that improved health literacy is associated with better preventive health behaviors and reduced healthcare risks. Similarly, S\u0026oslash;rensen et al. (2012) emphasized that community-based health education strengthens individuals\u0026rsquo; capacity to access and apply health information effectively.\u003c/p\u003e \u003cp\u003eNotably, legal awareness related to health and child welfare recorded the highest relative improvement, with an increase of over 60% following the intervention. This suggests that caregivers initially had limited awareness of health-related rights and welfare provisions, and that community-based educational approaches can effectively address such gaps. Leveraging existing public health infrastructure such as the Integrated Child Development Services (ICDS) enhanced accessibility, participation, and trust, thereby supporting sustained engagement. These findings are consistent with prior studies conducted in low- and middle-income country settings, which emphasize that strengthening caregiver health literacy leads to improved maternal and child health outcomes, better service utilization, and increased caregiver empowerment. Overall, the results highlight the value of integrating structured health literacy interventions within established community platforms to achieve sustainable public health impact.\u003c/p\u003e \u003cp\u003eThe results also support earlier evaluations of ICDS programmes (Iyengar et al., 2000; Jain et al., 2007), which highlighted the importance of community platforms in improving maternal and child health awareness among socio-economically disadvantaged populations.\u003c/p\u003e \u003cp\u003eThe findings demonstrate the potential contribution of community-based health literacy interventions toward achieving Sustainable Development Goal 3 by improving preventive health behaviors, strengthening caregiver capacity, and enhancing access to primary health services among vulnerable populations.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eCommunity-based health literacy interventions are effective in strengthening informal caregivers\u0026rsquo; health knowledge and decision-making abilities. Integrating structured literacy programs into ICDS and similar platforms can contribute to improved public health outcomes and reduced caregiver burden.\u003c/p\u003e\n\u003ch3\u003e6. Implications for Policy and Practice\u003c/h3\u003e\n\u003cp\u003eThe findings underscore the need to formally incorporate structured caregiver health literacy modules within the Integrated Child Development Services (ICDS) framework to strengthen caregivers\u0026rsquo; knowledge and practices on a sustained basis. Regular refresher training for informal caregivers and Anganwadi workers is essential to reinforce key health messages, address emerging health challenges, and ensure continuity of learning. Additionally, scaling up community-based health literacy interventions across both urban and rural settings can enhance equity in access to health information and contribute to improved caregiving outcomes across diverse population groups.\u003c/p\u003e\n\u003ch3\u003e7. Limitations\u003c/h3\u003e\n\u003cp\u003eThe study was limited by a small intervention sample and short follow-up duration. Future research should include longitudinal designs and behavioral outcome assessments.\u003c/p\u003e\n\u003ch3\u003e8. Recommendations for Future Research\u003c/h3\u003e\n\u003cp\u003eFurther studies should explore digital and hybrid health literacy interventions and examine their long-term impact on caregiver health behaviors and service utilization.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest / Competing Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflict of interest or competing interests related to this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments. Ethical approval for the study was obtained from the Institutional Ethics Committee of [Avinashilingam University, Coimbatore- \u003cstrong\u003eNo.\u003c/strong\u003e\u003cstrong\u003eAUW/IHEC-13-14/XMT-57\u003c/strong\u003e]. Informed written consent was obtained from all participants prior to data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. The manuscript does not contain any individual person\u0026rsquo;s data in any form (including identifiable images or personal details).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. No proprietary or restricted materials were used in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCode Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. This study did not involve the use of software code or computational models.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSaravana Selvi.C conceptualized the study, designed the methodology, conducted data collection, performed data analysis, and drafted the manuscript. Saravana Selvi.C \u0026nbsp;reviewed and edited the manuscript and approved the final version for submission. All authors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBerkman, N. D., Sheridan, S. L., Donahue, K. E., Halpern, D. J., \u0026amp; Crotty, K. (2011). Low health literacy and health outcomes: An updated systematic review. \u003cem\u003eAnnals of Internal Medicine\u003c/em\u003e, 155(2), 97\u0026ndash;107.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGupta, R., \u0026amp; Pillai, V. (2019). Gendered dimensions of informal caregiving in India: Implications for health and social policy. \u003cem\u003eSocial Science \u0026amp; Medicine\u003c/em\u003e, 231, 112\u0026ndash;119.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIyengar, K., Iyengar, S. D., Martines, J. C., Dashora, K., \u0026amp; Deora, K. K. (2000). Child nutrition in rural Rajasthan: Effectiveness of ICDS programme. \u003cem\u003eJournal of Health, Population and Nutrition\u003c/em\u003e, 18(1), 13\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJain, M., Reddy, K. S., \u0026amp; Rao, S. (2007). Impact of Integrated Child Development Services on maternal and child health in India. \u003cem\u003eIndian Journal of Public Health\u003c/em\u003e, 51(4), 254\u0026ndash;258.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMackert, M., Mabry-Flynn, A., Champlin, S., Donovan, E. E., \u0026amp; Pounders, K. (2016). Health literacy and health information technology adoption: The potential for a new digital divide. \u003cem\u003eJournal of Medical Internet Research\u003c/em\u003e, 18(10), e264.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMinistry of Women and Child Development. (2021). \u003cem\u003eIntegrated Child Development Services (ICDS) scheme: Programme guidelines\u003c/em\u003e. Government of India.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNutbeam, D. (2000). Health literacy as a public health goal: A challenge for contemporary health education and communication strategies. \u003cem\u003eHealth Promotion International\u003c/em\u003e, 15(3), 259\u0026ndash;267.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRiffin, C., Van Ness, P. H., Wolff, J. L., \u0026amp; Fried, T. (2015). Multifactorial examination of caregiver burden in informal caregivers. \u003cem\u003eThe Gerontologist\u003c/em\u003e, 55(4), 1\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eS\u0026oslash;rensen, K., Van den Broucke, S., Fullam, J., et al. (2012). Health literacy and public health: A systematic review and integration of definitions and models. \u003cem\u003eBMC Public Health\u003c/em\u003e, 12, 80.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eS\u0026oslash;rensen, K., Pelikan, J. M., R\u0026ouml;thlin, F., et al. (2021). Health literacy in low- and middle-income countries: A systematic review. \u003cem\u003ePublic Health Reviews\u003c/em\u003e, 42, 160\u0026ndash;175.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. (2016). \u003cem\u003eHealth literacy: The solid facts\u003c/em\u003e. WHO Regional Office for Europe.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. (2022). \u003cem\u003eStrengthening health literacy for better health outcomes\u003c/em\u003e. World Health Organization.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Health literacy, Informal caregivers, Community-based intervention, ICDS, Mixed-methods study, India","lastPublishedDoi":"10.21203/rs.3.rs-8774156/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8774156/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eHealth literacy is a critical determinant of health outcomes, particularly among informal caregivers who play a central role in managing health and healthcare decisions for vulnerable populations. In low- and middle-income countries, community-based platforms such as Anganwadi Centres under the Integrated Child Development Services (ICDS) scheme serve as key sites for caregiver engagement. However, empirical evidence on the effectiveness of structured health literacy interventions for informal caregivers remains limited. The present study aimed to assess the effectiveness of a community-based health literacy intervention in improving health knowledge and caregiving practices among informal caregivers of women and children.\u003c/p\u003e \u003cp\u003eA mixed-methods research design was adopted, comprising a cross-sectional assessment followed by an intervention phase. The study was conducted in selected Anganwadi Centres of Coimbatore District, Tamil Nadu. A total of 120 informal caregivers (ICDS beneficiaries) participated in the baseline survey. Subsequently, 30 caregivers were randomly selected for a structured, one-day community-based health literacy intervention. Quantitative data were collected using a pre- and post-intervention knowledge assessment questionnaire, while qualitative insights were obtained through participant interactions and observations. Statistical analysis included descriptive statistics and paired \u003cem\u003et\u003c/em\u003e-tests. Post-intervention findings revealed a statistically significant improvement in caregivers\u0026rsquo; health literacy across multiple domains, including personal hygiene, nutrition during pregnancy and lactation, breastfeeding practices, child care, and legal health rights (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Caregivers demonstrated increased awareness of preventive health practices and improved confidence in caregiving-related decision-making. Community-based health literacy interventions delivered through existing public health platforms significantly enhance the health knowledge of informal caregivers. Strengthening caregiver-focused literacy programs within ICDS can contribute to improved health outcomes for both caregivers and care recipients.\u003c/p\u003e","manuscriptTitle":"Effectiveness of Community-Based Health Literacy Interventions among Informal Caregivers of Women and Children in India: A Mixed-Methods Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-13 14:00:05","doi":"10.21203/rs.3.rs-8774156/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-14T18:02:41+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-10T05:43:14+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-08T08:49:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"250080080852082471956058481257745752092","date":"2026-04-02T05:25:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"159774239324595009976112316662721976304","date":"2026-04-02T05:04:22+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-15T08:56:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"143109401707680097401580795189951420398","date":"2026-03-12T08:55:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"310983533055252916279352430686565777534","date":"2026-03-12T07:41:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"201564601007059380740661430885910465569","date":"2026-03-12T07:30:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"30029093304206572913595019940103326325","date":"2026-03-10T06:19:47+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-10T06:17:05+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-23T16:58:07+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-23T09:05:14+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Public Health","date":"2026-02-23T09:00:39+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f43fef33-b44d-48ef-a69c-85c149405d64","owner":[],"postedDate":"March 13th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-04-14T18:09:00+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-13 14:00:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8774156","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8774156","identity":"rs-8774156","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}