Bridging the health literacy gap: Women and community stakeholders' perspectives on maternal and child health communication in peri-urban Karachi, Pakistan.

Health literacy significantly influences health outcomes, particularly in Low-and Middle-Income Countries. Communication of maternal and child heath messages occurs via text messages, phone calls, television, newspaper articles, and home visits. An exploratory qualitative study was conducted in four peri-urban sites of Bin Qasim Town, Karachi to explore the perspectives of women and community stakeholders on effective health messaging strategies in peri-urban Karachi, Pakistan. Seven focus group discussions (FGDs) with women of reproductive age, and seven key informant interviews (KIIs) with the community stakeholders were conducted. Women were randomly selected from the surveillance database, while stakeholders were purposively sampled. Audio-recorded FGDs and KIIs were manually transcribed and analysed using thematic analysis. Three major themes emerged: (i) the growing but constrained role of digital platforms, (ii) facilitators and barriers of health message dissemination, and (iii) community-suggested solutions. While digital tools like WhatsApp and TV were popular among smartphone users, barriers included phone access low digital literacy and unreliable electricity. Door-to-door visits by trusted community health workers remained crucial especially for those without little access. Participants recommended hybrid strategies including public announcements, community theater and visual media. To conclude, a hybrid communication approach that integrates digital tools with traditional outreach is critical in peri-urban Karachi. Interventions must prioritize equitable digital access and culturally relevant strategies to bridge health literacy gaps and improve maternal and child health outcomes.