Hierarchical Regression Research Articles

Burnt out and still single: Susceptibility to dating app burnout over time

Despite the ubiquity of dating apps, there is little longitudinal research examining the mental health and well-being of dating app users. To fill this void, this study takes a social compensation approach to exploring dating app users’ burnout experiences (i.e., emotional exhaustion, inefficacy, and depersonalization) over time. Four hundred ninety-three active single dating app users were surveyed over four waves across 12 weeks, with a final sample of 190. Multilevel growth curve models showed that dating app users experienced increased emotional exhaustion and inefficacy over time. Furthermore, depression, anxiety, and loneliness predicted more emotional exhaustion and inefficacy, while problematic dating app use predicted more emotional exhaustion and less inefficacy. The results suggest that dating apps may exacerbate existing difficulties with relationship initiation among vulnerable users by increasing their risk of burnout. Dating app burnout is a potential intervention target to improve users’ dating success.

Cognitive Health Benefits of Everyday Physical Activity in a Diverse Sample of Middle-Aged Adults.

Physical activity has been associated with a wide range of health benefits including long-term benefits for cognitive and brain health. Whether episodes of everyday physical activity are associated with immediate cognitive benefits remains unknown. The purpose of the current study was to examine whether episodes of physical activity, occurring over the course of participants' daily lives, are associated with short-term improvements in cognitive health. Participants completed a 9-day ecological momentary assessment protocol involving 5 daily assessments of self-reported physical activity and ambulatory cognitive assessments of processing speed and visuospatial working memory. Data were analyzed in a multilevel modeling framework to explore changes in performance on each task associated with physical activity during the period leading up to the assessment as well as individual differences in average frequency of physical activity. Results of MLMs indicated that engaging in physical activity during the period (~3.5hr) leading up to an assessment was associated with improvements in processing speed equivalent to 4 years of cognitive aging. Such improvements were observed for both light and moderate-to-vigorous physical activity levels. No association was observed for visuospatial working memory accuracy; however, response time during the working memory task reliably mirrored the association observed for processing speed. The short-term benefits were observed, particularly, for individuals with an overall higher frequency of reported physical activity. Our findings suggest that engaging in everyday physical activity of any intensity level may have short-term, acute benefits for cognitive health and point to new potential targets for intervention. NCT03240406.

Enhancing Metaphor Recognition of Literary Works in Applied Artificial Intelligence: A Multi-Level Approach with Bi-LSTM and CNN Fusion

ABSTRACT Understanding metaphorical language is essential for AI to interpret and communicate with humans accurately. However, current methods often struggle with the complexity of metaphors, making it difficult for AI systems to understand human language fully. Recognizing metaphors is challenging because they are frequently ambiguous and depend on context. In this study, we propose a new approach using a combination of Bi-directional Long Short-Term Memory (Bi-LSTM) networks, Convolutional Neural Networks (CNN), and uni-directional LSTM components to create a multi-level model for recognizing metaphors. Our model uses various features, including dependency, semantics, and part-of-speech, to improve its learning ability. Additionally, we introduce a new method for recognizing the emotional context of metaphors using a random walk model to determine the emotional tone of words. Our results show that this model improves performance in recognizing metaphors, enhancing AI’s ability to understand them.

Financial performance of emerging market companies during the COVID-19 pandemic: moderating role of sustainability performance

Purpose This study aims to investigate whether sustainability performance (SP) served as a safeguard for firm profitability (FP) and enhanced corporate resilience in emerging markets during the COVID-19 pandemic. Design/methodology/approach Using a sample of 1,091 firms in 25 emerging markets from 2017 to 2021, this study analyses the moderating role of SP on the relationship between FP and COVID-19 by using hierarchical linear modelling at three levels: (a) time-level; (b) firm-level; (c) country-level. Findings The results indicate that during the years 2020–2021, emerging market firms with robust SP showed better FP in the midst of the COVID-19 pandemic. The findings also indicate that all dimensions of sustainability, i.e. environmental, social and governance (ESG), have significantly affected the FP in the post-COVID period. Hence, adhering to ESG principles aids in alleviating adverse financial repercussions during times of crises. Practical implications This study provides valuable insights for companies and policymakers for finding solutions that may assist them in improving SP globally and enduring crises resiliently. The findings are also relevant to institutional investors that consider SP as an investment criteria. Although the COVID-19 pandemic was temporary, the lessons learned could protect firms from future similar global crises. Originality/value This study enhances the understanding of the contingency relationship between sustainability and financial performance by offering up-to-date empirical insights within the context of emerging markets during the pandemic. It demonstrates how different institutional frameworks influenced the SP–FP association during the crisis. Thus, this paper expands the understanding of crisis management literature and bridges the research void concerning the impact of SP on FP in an emerging market context.

Transferability of models for predicting potato plant nitrogen content from remote sensing data and environmental variables across years and regions

The use of remote sensing technologies to monitor the nitrogen nutrient status of crops is gradually becoming a more sensible choice, as traditional methods are time-consuming, labor-intensive, and destructive. However, most predictive models utilizing remote sensing data are statistical rather than mechanistic, making them difficult to extend at interannual and regional scales. This study explored the interannual and regional transferability of the potato plant nitrogen content (PNC) prediction models, which combined environmental variables (EVs, e.g. temperature, precipitation, etc.) with proximal hyperspectral vegetation indices (VIs). Two methodologies were implemented to fuse EVs and VIs. The first involved a multiple regression analysis utilizing a multivariate linear model and a random forest approach, with VIs and EVs treated as independent variables, respectively. The second, a hierarchical linear model (HLM), employed EVs to dynamically adjust the relationship between VIs and PNC for different experimental sites. The predictive outcomes demonstrated that (i) the conventional method relying solely on optical VIs exhibited limited accuracy and stability in interannual and regional PNC forecasting; (ii) albeit the multivariate regression approach significantly enhanced model accuracy within the calibration set, its scalability across years and regions remained suboptimal; (iii) the HLM method exhibited high precision and scalability across years and regions, with R2, RMSE, and NRMSE values of 0.68, 0.50 %, and 19.68 % in the validation set, respectively. Those findings corroborate that using a two-tier HLM method can automatically adjust for discrepancies in VIs response to PNC through EVs, thereby enhancing the model's stability. Provided that remote sensing data and EVs are sustainably acquired over the potato growth cycle, it will provide a particularly promising approach to potato nitrogen diagnostics as a decision-making tool for regional application of nitrogen fertilizer.

Navigating grief in unprecedented times: risk factors in the wake of pandemic loss and end-of-life care

ABSTRACT Coronavirus is an infectious disease that has left tens of millions of deaths around the world, and which has had social, economic, emotional, and psychological consequences. To mitigate the spread of the virus, several countries have adopted restrictive measures that impacted the way people experienced the end-of-life and the death of their loved one. This study aimed to identify the variables associated with prolonged grief symptoms in the context of both pandemic-related losses and the unique challenges related to end-of-life care. An anonymous online survey was disseminated widely through various channels including local press, social media, professional networks and hospitals. Socio-demographic information was collected, as well as information related to loss (cause of death, place of end-of-life care and death) and bereavement, and on the impact of the restrictions imposed by the pandemic. The participants were 163 bereaved who lost a loved one who received end-of-life care during the pandemic in Portugal. Most participants were female, married, professionally active and had lost their grandparents. A hierarchical multiple regression was performed to determine the factors associated with prolonged grief symptoms. The results showed that more prolonged grief symptoms were associated with less social support, worsening of the financial situation, greater psychological impact of restrictions on communicating with the deceased, and the deceas having received end-of-life care in a hospital. The early identification based on these factors of individuals at higher risk for more prolonged grief symptoms could allow for targeted interventions and support services. This study unveils crucial factors contributing to heightened grief amid pandemic-related losses and challenges in end-of-life care, which provide practical insights for healthcare practitioners. Highlight the importance of personalized interventions to fortify social connections, address financial challenges, and offer compassionate alternatives to hospital-centric care. Policymakers can leverage this information to optmise grief management during public health crises.

The Impact of Short-Form Video and Optimistic Bias on Engagement in Oral Health Prevention: Integrating a KAP Model.

College students are recognized as a demographic particularly susceptible to higher oral health risks due to irregular and unhealthy habits. While previous research has underscored these risks through descriptive studies within this group, a significant gap persists in the literature regarding the impact of contemporary media, specifically oral-health-related content, on the engagement in oral health prevention among Chinese college students. To address this gap, this study, guided by the extended knowledge-attitude-practice (KAP) theory model, explores the direct, mediated, and serially mediated mechanisms through which exposure to oral health short-form videos on Douyin influences their participation in oral health prevention. An empirical cross-sectional online survey was conducted, with valid data (N = 421) analyzed using descriptive statistics and hierarchical regression. Mediation and serial mediation analyses were also performed using SPSS version 25.0. The analysis revealed that exposure to oral health short-form videos had a positive direct effect on both oral health knowledge and the reduction of optimistic bias among Chinese college students. Furthermore, a significant serial mediation effect of oral health knowledge and oral health attitude was identified. The findings underscore the substantial applicability and explanatory power of the extended KAP theory model in understanding engagement in oral health prevention.

Dyadic cannabis use, alcohol use and relationship satisfaction: A daily diary study

ObjectiveIntimate relationships are important contexts for understanding individuals’ substance use patterns and trajectories. Using a dyadic daily diary design reporting over 14 consecutive days, the present study examined the association between cannabis use, alcohol use, and momentary relationship satisfaction among adult couples MethodEligible individuals on Prolific were invited to participate. We identified 33 couples where both partners participated. Participants completed a baseline survey and a 14-day daily diary study assessing their daily cannabis use, alcohol use, and relationship satisfaction. Multilevel modeling was used, within an Actor-Partner Interdependence Model (APIM), to evaluate the individual and interactive effects of one’s own use and their partner’s use on relationship satisfaction ResultsSignificant actor and partner effects of alcohol and cannabis use were found using both baseline and daily report data. For individuals who use cannabis more heavily among sampled couples, cannabis and alcohol co-use was associated with reduction in their own next-day relationship satisfaction while alcohol-only use was significantly associated with increased next-day satisfaction. There were no significant effects of one’s own or their partner’s effects for individuals who use cannabis more lightly. ConclusionsFindings replicate and extend prior research by demonstrating the dynamic nature of dyadic substance use and highlighting the unique impact of alcohol and cannabis co-use on daily relationship functioning.

Internet self-efficacy moderates the association of information technology ability with successful ageing among older employees in three African samples

The literature suggests that two distinct competencies [i.e., information technology ability (ITA), and internet self-efficacy] are necessary for the effective use of information technologies for successful ageing, but no study has examined the association of these skills on successful ageing and its domains (i.e., illness avoidance, functioning, and engagement with life). This study investigated whether Internet Self-Efficacy (ISE) moderates the potential association of ITA with successful ageing. The study adopted a cross-sectional design based on the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist and includes measures against confounding and common methods bias. The participants were 1186 older workers aged 50 years or older in three African countries (Kenya = 350; Nigeria = 260; Ghana = 576). The minimum sample size necessary was calculated, and data were analysed with hierarchical linear regression analysis. After controlling for the covariates, ITA and ISE had a positive association with successful ageing as well as illness avoidance, functioning, and engagement with life in the whole sample. ITA was also positively associated with successful ageing and its domains in Kenya and Ghana. The associations of ITA with successful ageing and its domains were positively moderated by ISE in the whole sample and within each of the three samples. Higher ITA can be associated with successful ageing among working older adults, and ITA positively influences successful ageing at different levels of ISE. Older adults with high ITA are more likely to avoid illness at a higher ISE.

GRRIS: A Real-time Intrasite Observation Scheduling Scheme for Distributed Survey Telescope Arrays

The distributed telescope array offers promise for conducting large-sky-area, high-frequency time-domain surveys. Multiple telescopes can be deployed at each observation site, so intrasite observation task scheduling is crucial for enhancing observation efficiency and quality. Efficient use of observable time and rapid response to special situations are critical to maximize scientific discovery in time-domain surveys. Besides, the competing scientific priorities, time-varying observation conditions, and capabilities of observation equipment, lead to a vast search space of the scheduling. So with the increasing number of telescopes and observation fields, balancing computational time with solution quality in observation scheduling poses a significant challenge. Informed by the seminal contributions of earlier studies on a multilevel scheduling model and global scheduler for a time-domain telescope array, this study is devoted to further exploring the site scheduler. Formulating the observation scheduling of multiple telescopes at the site as a cooperative decision-making problem, this paper proposes GRRIS, a real-time intrasite observation scheduling scheme for the telescope array using graph and reinforcement learning (RL). It employs a graph neural network to learn node features that can embed the spatial structure of the observation scheduling. An algorithm based on multi-agent RL is designed to efficiently learn the optimum allocation policy of telescope agents to field nodes. Through numerical simulations with real-world scenarios, GRRIS can achieve up to a 22% solution improvement over the most competitive scheme. It offers better scalability and subsecond decision speed, meeting the needs of observation scheduling control for future distributed telescope arrays.

The impact of emotion regulation on the establishment of the therapeutic alliance in post-divorce group intervention: A multilevel approach.

The present study focuses on the impact of emotion regulation on the establishment of the therapeutic alliance in a context of post-divorce group intervention. The study involved 177 divorced parents and 60 therapists and was developed through multilevel path analysis. The data showed an association between emotion regulation and therapeutic alliance across the difficulties of adaptation to divorce, although the results were different from the perspective of the participant and of the therapist and between the individual and the group level. The study highlights the relevant role of emotion regulation in post-divorce adaptation and in the success of the establishment of the therapeutic alliance, while clarifying the formation of the alliance from the viewpoints of the individual and the therapist. The study also highlights the need to understand the alliance at both the individual and the group level, in order to design therapeutic interventions.

State-level structural sexism and adolescent sexual violence victimization in the US

BackgroundAdolescent sexual violence victimization is a significant public health issue in the United States. Structural sexism, a form of gender inequality at the societal level, may play a crucial role in influencing the prevalence of sexual violence victimization among adolescents. ObjectiveThis study aims to examine the association between state-level structural sexism and sexual violence victimization among adolescents and to explore how this relationship varies between male and female adolescents. Participants and settingData was derived from a nationally representative sample of high school students in grades 9–12 across the United States who participated in the Youth Risk Behavior Surveillance System (YRBS) in 2017 and 2019. MethodsA state-level structural sexism index was created from nine different items to reflect the multidimensional nature of structural sexism. This study employs multi-level regression analysis to investigate the impact of state-level structural sexism on three types of sexual violence victimization: sexual violence, sexual dating violence, and physical dating violence. ResultsThis study revealed a significant interaction between structural sexism and gender. In states with higher levels of structural sexism, female adolescents reported increased likelihood of sexual violence (β = 0.013, p < .001), sexual dating violence (β = 0.006, p < .001), and physical dating violence (β = 0.006, p < .001) compared to males. Conversely, male adolescents in these states reported lower rates of victimization. ConclusionsThe results underscore the role of structural sexism in influencing sexual violence victimization among adolescents. Addressing structural sexism may be essential in mitigating the risk of sexual violence victimization, especially for female adolescents.

Learners’ speaking self-efficacy, self-efficacy sources and their relations in the traditional and flipped instructional modes

ABSTRACT The flipped instructional approach is gaining prominence in English as a foreign language (EFL) teaching. However, there is limited empirical evidence regarding its impact on students’ self-efficacy sources. This study aimed to investigate how EFL learners’ speaking self-efficacy sources – enactive mastery experience (EME), vicarious experience (VE), verbal persuasion (VP) and physiological and affective states (PAS) – change and function under the flipped instructional mode in comparison to the traditional mode. The study included 132 undergraduate students enrolled in two EFL-speaking classes at a Chinese university. The results of a multi-factor repeated ANOVA analysis revealed differences in the levels and changes of self-efficacy and self-efficacy sources between the two instructional modes, with the flipped classroom showing greater improvements. Hierarchical regression analysis provided support for the theoretical hypothesis regarding the contributions of the self-efficacy sources in the entire sample, with EME, VP, and PAS being significant contributors (VE was not). However, further analysis of the instructional modes indicated differences in the contributions. Qualitative data was also used to gain a more nuanced understanding of these relationships in the flipped instruction. At the end, this paper summarized the influence of the flipped instructional approach on EFL-speaking self-efficacy and its sources, and presents several pedagogical implications for foreign language instruction.

"First, Trust Needs to Develop": Hematologists' Perspectives on Factors Influencing Black Persons' Participation in Clinical Trials.

Cancer clinical trials are crucial for treatment standards and innovation but lack racial-ethnic diversity. Understanding physician perspectives on recruiting participants is critical due to their role in decision-making about trial candidacy and enrollment. From August 2021 to January 2022 we recruited 13 Academic hematologists experienced with treating blood cancers and enrolling clinical trial participants. Each hematologist participated in a 60-75-minute semistructured interview and completed a sociodemographic survey. Using the National Institute on Minority Health and Health Disparities multilevel model as a framework, we characterized hematologists' perceived barriers to clinical trial participation among Black persons. ATLAS.ti v9 and later v 23.2.1 was used for project management and to facilitate data analysis using the Sort and Sift, Think and Shift approach (ResearchTalk Inc). All hematologists were White, with 70% being male. Three factors influenced their perspectives on enrolling Black individuals in clinical trials: individual attitudes and beliefs, such as perceptions that Black or socioeconomically disadvantaged persons will be less willing or less compliant with the requirements for trial participation and follow-up. The need to build trusting relationships between themselves and patients prior to discussing clinical trials and the prevailing legacy of medical mistrust among the Black community. Trust was found to be the underlying factor in determining communication between hematologists and Black persons about clinical trials across all three levels. This study highlights how hematologists' attitudes, beliefs, biases, and views on trust in patient relationships influence their communication with Black individuals about clinical trials. It emphasizes the need for further research to develop interventions that address the lack of racial and ethnic diversity in trials.

Sociodemographic trends in special educational needs identification in Wales

AbstractIn the context of an emerging new additional learning needs (ALN) system in Wales, this research explores who was likely to be identified with special educational needs (SEN) under the previous system. Our study reveals analysis of linked Welsh education and health data on SEN identification in learners in mainstream education settings born between 2002/3 and 2008/9. Using longitudinal multilevel modelling, we explore (i) who is likely identified with SEN and (ii) whether there is evidence of social patterning in SEN identification. We find that 48% of those born in the year 2002/3 were identified with SEN at some point during their schooling years. Furthermore, when controlling for health‐related variables, those who are identified with SEN in Wales were more likely to be male, White, from a deprived background, with lower school attendance, had not experienced breastfeeding and were born later in the academic year. Taken together, the research findings suggest that SEN identification was influenced by a child's context. The study thus underscores the critical importance of examining the relationship between socioeconomic, environmental and biological factors in SEN identification, urging for a comprehensive and cross‐organisation approach to enhance outcomes for learners with diverse needs. It also highlights the need for follow‐up research to explore unfolding trends as the new ALN system in Wales becomes fully implemented and integrated over the coming years.

The Science of Teaching Reading is Incomplete without the Science of Writing: A Randomized Control Trial of Integrated Teaching of Reading and Writing

ABSTRACT Purpose We conducted a randomized control trial of an instructional program, SRSD Plus, which integrates reading for writing to inform, writing, oral language, spelling and handwriting for students in Grades 1 and 2. Method A total of 10 teachers and their 248 students in Grade 1 (n = 121) and Grade 2 (n = 127) in the southwestern part of the US participated. The teachers included 6 White individuals, 2 Asian Americans, 1 Hispanic individual, and 1 person from another racial or ethnic background. Among the students, 46% were Asian American, 33% were Hispanic, 14% were White, and 5% were identified as multiracial. Teachers were randomly assigned to the SRSD Plus or business-as-usual (BAU) condition; students were assessed at pretest and posttest on writing, oral language, transcription, and reading skills. Results Multilevel model results showed that students in the SRSD Plus condition outperformed those in the BAU condition in spelling, vocabulary, sentence proficiency, planning from source text, discourse knowledge, and writing productivity and writing quality in source-based informational genre (.14 ≤ Effect Size [ES] ≤ .72), but not in word reading or handwriting fluency. Furthermore, although not the target genre, there was a positive transfer effect on writing outcomes in the opinion genre (.22 ≤ ES ≤ .34). Conclusion Integrated reading and writing instruction in SRSD Plus can improve primary grade students’ writing, discourse knowledge, planning, oral language, and spelling skills. Theoretical and practical implications and future directions are discussed in the context of the Science of Teaching Reading.

Context matters: The importance of investigating random effects in hierarchical models for early childhood education researchers

This paper highlights the importance of examining individual, classroom, and school-level variables simultaneously in early childhood education research. While it is well known that Hierarchical Linear Modeling (HLM) in school-based studies can be used to account for the clustering of students within classrooms or schools, less known is that HLM can use random effects to investigate how higher-level factors (e.g., effects that vary by school) moderate associations between lower-level factors. This possible moderation can be detected even if higher-level data are not collected. Despite this important use of HLM, a clear resource explaining how to test this type of effect is not available for early childhood researchers. This paper demonstrates this use of HLM by presenting three analytic examples using empirical early childhood education data. First, we review school-level effects literature and HLM concepts to provide the rationale for testing cross-level moderation effects in education research; next we do a short review of literature on the variables that will be used in our three examples (viz., teacher beliefs and student socioemotional behavior); next we describe the dataset that will be analyzed; and finally we guide the reader step-by-step through analyses that show the presence and absence of fixed effects of teacher beliefs on student social outcomes and the erroneous conclusions that can occur if school-level moderation (i.e., random effects) tests are excluded from analyses. This paper provides evidence for the importance of testing for how teachers and students impact each other as a function of school differences, shows how this can be accomplished, and highlights the need to examine random effects of clustering in educational models to ensure the full context is accounted for when predicting student outcomes.

The associations between positive body image, well-being and psychological flexibility in breast cancer survivors

ABSTRACT In Italy, breast cancer survivors are increasing. Body image is a complex posttreatment concern for breast cancer survivors, particularly younger women. This population reports higher levels of body-image concerns associated with higher psychological distress and lower quality of life. Body image concerns and factors that can impact the body image of older breast cancer survivors remain an important but under-explored research area. The purpose of this study is to examine the association of negative and positive body image with both well-being and psychological inflexibility in a sample of breast cancer survivors. 114 women who have completed breast cancer treatment (±5 years) completed a questionnaire to measure the research variables. Hierarchical regressions and indirect effects were performed. Functionality appreciation and body compassion accounted for a significant percentage of the variance of well-being (34%) and psychological inflexibility (50%) of the participants. The indirect effect of body dissatisfaction on well-being and psychological inflexibility through body compassion was significant. The results emphasise the relevance of the positive aspect of body image on well-being and psychological inflexibility. Functionality appreciation and body compassion contribute to understanding the health-status description of these women and could be considered in future health-promotion interventions aimed at reducing psychological distress associated with body image concerns in older breast cancer survivors.

Through the eyes of my peers: Sharing perceptions of unequal treatment in ethno-racially diverse classrooms.

Perceptions of unequal treatment, especially when shared, can challenge the status-quo. Starting from the social grounding of shared perceptions, we ask when perceptions of inequality align and converge in ethno-racially diverse peer groups. We are especially interested when perceptions are shared among peers across ethno-racial group boundaries. Social-psychological research suggests asymmetric sharing: Ethno-racial minority group members often see less inequality with more majority contact, while in some cases ethno-racial majority members perceive more inequality with more minority contact. Therefore, we ask if perceptions of inequality are shared across minority and majority groups within time and if perceptions of inequality converge over time. We focus on schools as sites of inequality and cross-group interactions. First, we tested our predictions with 290 minority and 468 majority youth in 53 classes in the United States using multilevel modelling. Next, we implemented follow-up studies in Belgium with 1,800 minority and 1,700 majority adolescents in 433 classes using longitudinal multilevel models. In line with intragroup sharing, minority and majority youth shared their minority and majority peers' perceptions of inequality, respectively. Furthermore, we documented cross-group sharing: Majority youth also shared their minority peers' perceptions, especially in contexts with higher minority proportions. We found consistent evidence of sharing minority perceptions, so that both majority and minority youth would see inequality through their minority peers' eyes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Analyzing women’s knowledge of pregnancy complications in Ethiopia through a multilevel approach

Pregnancy complications can’t always be predicted. However, pregnant women must be aware of these pregnancy complications to avoid serious complications and begin treatment as soon as possible. Maternal mortality can be decreased by offering high-quality maternity services and educating women about the early warning signs of pregnancy. Therefore, the current study aimed to assess individual and community-level factors associated with women’s knowledge about pregnancy complications in Ethiopia based on the 2019 Ethiopian mini-demographic health survey data (EMDHS). The study analyzed data from the 2019 EMDHS, including a weighted sample of 1,655 reproductive-age women. Multilevel binary logistic regression analysis was used to fit the associated variables. Using the interclass correlation (ICC), deviance, proportional change variance (PVC), and median odds ratio (MOR), the comparison and fit of the models were evaluated. The significant variables associated with knowledge about complications during pregnancy were identified using an adjusted odds ratio (AOR) and a 95% confidence interval (CI). The proportion of mothers with good knowledge of pregnancy complications was 44.8% (CI 42.4%–47.2%). The multi-level analysis revealed that secondary education (AOR = 1.54, 95% CI = 1.04–2.29), a higher education level (AOR = 1.74, 95% CI = 1.11–2.72), four and above ANC Visits (AOR = 0.74, 95% CI = 0.49–0.98), women who lived in Amhara (AOR = 2.10, 95% CI = 1.24–3.55), and SNNPR (AOR = 3.92, 95% CI = 2.10–7.31) were positively associated with knowledge about pregnancy complications while, women residing in Harari (AOR = 0.20, 95% CI = 0.98–0.44) and Dire-Dawa (AOR = 0.48, 95% CI = 0.24–0.95) were negatively associated with knowledge about pregnancy complications. This study found that nearly half (44.8%) of the study participants demonstrated knowledge about pregnancy complications. This suggests a significant gap in awareness that could potentially impact access to obstetric care for women experiencing complications during pregnancy. Therefore, prioritizing enhancements in antenatal counseling services and community health education regarding pregnancy complications is crucial.