ARTICLE INFO

Article Type

Original Research

Authors

Khanmohammadi   S. (1)
Karimi-Shahanjarini   A. (*2)
Farhadian   M. (3)
Rezapur-Shahkolai   F. (2)






(*2) ”Social Determinants of Health Research Center” and “ Public Health Department, Health Faculty”, Hamadan University of Medical Sciences, Hamadan, Iran
(1) Public Health Department, Health Faculty, Hamadan University of Medical Sciences, Hamadan, Iran
(3) Biostatistics Department, Health Faculty, Hamadan University of Medical Sciences, Hamadan, Iran

Correspondence

Address: Public Health Department, Health Faculty, Hamadan University of Medical Sciences, Shahid Fahmide Boulevard, Hamadan, Iran. Postal Code: 8138380509
Phone: +98 (81) 38380025
Fax: +98 (81) 38380509
karimi.a@umsha.ac.ir

Article History

Received:  January  26, 2019
Accepted:  August 22, 2019
ePublished:  December 21, 2019

BRIEF TEXT


Incomplete adherence to iron supplementation consumption program is one of the main causes of iron deficiency anemia during pregnancy.

[1]… The prevalence of iron deficiency anemia among pregnant women has been reported at 38.2% worldwide [2]. The prevalence of iron deficiency anemia in developing countries is estimated to be up to 40% [3]. The results of a systematic review in Iran showed that the prevalence of iron deficiency anemia among Iranian pregnant women was 17.9% [4]. … [5-8]. Previous studies have emphasized the effectiveness of training programs in improving adherence behaviors to iron supplementation among pregnant women [9-11]. For example, in the study by Sennanayak et al., a short-term training program caused a significant positive effect on iron supplementation and anemia [9]. … [12].

The purpose of this study was to investigate the effect of educational intervention on promoting adherence to different aspects of iron supplementation consumption program in pregnant women.

This research was a semi-experimental study with pretest-posttest design with control group.

This study was conducted on 100 pregnant women who referred to two health centers in Asadabad, Hamadan in 2017.

The subjects were selected using random sampling method and randomly divided into the intervention and control groups (50 subjects in each group). Sample size was determined based on the results of the study by Sennayak et al. [9] with test power of 90% and attrition of 10%.

Variables were measured using a 70-item questionnaire designed based on previous studies and the research team’s experience. Content validity of the instrument was evaluated based on the opinions of 10 reviewers and its content validity ratio (CVR) was approved. The educational intervention was designed based on the modifications of the protection motivation theory variables, including sending relevant text-image messages through the social media, self-monitoring using reminder sheets, and phone calls within one week after the intervention. In total, educational contents were prepared as 40 simple, informative and motivational short messages along with pictures. Hemoglobin and ferritin tests were performed according to the routine schedule of prenatal care in health care centers between 28 and 30 weeks of gestation. In addition, at the 34th week of gestation, the studied cases after checking the questionnaires were subjected to the post-test. Data were analyzed by SPSS 21 software using chi-square, independent T and paired T-tests.

Participants in both groups showed no significant difference in terms of demographic and contextual characteristics (Table 1).In pre-test, no significant difference was found between two groups in adherence to iron supplementation (p> 0.05). Intervention could significantly change the behavior of mothers of both groups regarding simultaneous consumption of iron supplement with vitamin C (p <0.001), however, in spite of improvement in the regular consumption of iron supplementation, no consumption of iron supplement with Ca2+ and no consumption of iron supplement with tea was not significant between the two groups (p> 0.05). The mothers of the two groups also had a significant difference in the amount of ferritin (p = 0.003; Table 2).Before intervention, there was no significant difference between two groups in anemia (p = 0.17). After the intervention and in the third trimester, as expected, anemia cases were increased in both groups compared with the first trimester, however, in the third trimester, the two groups did not differ significantly (p = 0.09; Table 3).Regarding the effect of intervention on constructs of protection motivation theory, the intervention caused a significant difference in the scores of knowledge and perceived susceptibility of pregnant women toward iron deficiency anemia (p <0.001). In addition, there was also a statistically significant difference in perceived cost and self-efficacy scores in all three studied behaviors. Regarding perceived effectiveness and behavioral intention, the scores of iron supplementation behaviors with vitamin C sources and no iron supplementation with calcium sources between the two groups showed a significant difference (Table 4).

A study by Hazawa et al. [10] reported no use of iron supplementation by mothers due to their belief in side effects of supplementation. In the present study, 74% of the intervention group reported gastrointestinal complication as the most important cause of irregular or no consumption of iron supplementation. … [11-15]. In this study, we sought to correct perceived barriers (costs) that resulting from incorrect beliefs or unfamiliarity with facing related issues, including gastrointestinal complications. The interventions by Baharzadeh et al. [16] and Khorramabad et al. [18] were associated with improved perceived costs for pregnant women. … [19].

In future studies, it is recommended to evaluate the effectiveness of the intervention in a larger and more heterogeneous sample.

The limitations of this study included measuring outcome variables through self-report and limiting each group to one center (limited number of clusters).

The intervention program designed based on the protection motivation theory is effective in promoting adherence to the iron supplementation consumption plan and reducing anemia in pregnant women.

The authors are grateful to the assistance of the Deputy of Research and Technology of Hamadan University of Medical Sciences, the respected staff of the health centers of Asadabad and the participants.

None declared.

This study was approved by the Ethics Committee of Hamadan University of Medical Sciences.

This study was extracted from a Master’s thesis approved by the Hamadan University of Medical Sciences (No.: 9504292185) and funded by the Social Determinants of Health Research Center.

TABLES and CHARTS

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CITIATION LINKS

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