Adherence partners are an acceptable behaviour change strategy to support calcium and iron‐folic acid supplementation among pregnant women in Ethiopia and Kenya

Antenatal calcium and iron-folic acid (IFA) supplementation can reduce maternal mortality and morbidity. Yet, even when pregnant women have a stable supply of supplements, forgetting is often a barrier to adherence. We assessed the acceptability of adherence partners to support calcium and IFA supplementation among pregnant women in Kenya and Ethiopia. Adherence partners are a behaviour change strategy to improve adherence, where pregnant women are counselled to select a partner (e.g. spouse, relative) to remind them to take their supplements. We conducted trials of improved practices, a formative research method that follows participants over time as they try a new behaviour. We provided pregnant women in Ethiopia (n = 50) and Kenya (n = 35) with calcium and IFA supplements and counselling, and suggested selecting an adherence partner. For each participant, we conducted semi-structured interviews about acceptability and adherence during four interviews over six weeks. We analysed interview transcripts thematically and tallied numerical data. In Kenya, 28 of 35 women agreed to try an adherence partner; almost all selected their husbands. In Ethiopia, 42 of 50 women agreed to try an adherence partner; half asked their husbands, others asked children or relatives. Most women who did not select adherence partners reported not needing help or not having anyone to ask. Participants reported adherence partners reminded and encouraged them, brought supplements, provided food and helped address side-effects. Almost all women with adherence partners would recommend this strategy to others. Adherence partners are an acceptable, low-cost strategy with the potential to support antenatal micronutrient supplementation adherence.

[1]  Stephanie L Martin,et al.  Role of Social Support in Improving Infant Feeding Practices in Western Kenya: A Quasi-Experimental Study , 2016, Global Health: Science and Practice.

[2]  R. Stoltzfus,et al.  Calcium Supplementation to Prevent Preeclampsia: Translating Guidelines into Practice in Low-Income Countries. , 2016, Advances in nutrition.

[3]  G. Pelto,et al.  Identifying interventions to help rural Kenyan mothers cope with food insecurity: results of a focused ethnographic study , 2015, Maternal & child nutrition.

[4]  R. Stoltzfus,et al.  Cluster-Randomized Non-Inferiority Trial to Compare Supplement Consumption and Adherence to Different Dosing Regimens for Antenatal Calcium and Iron-Folic Acid Supplementation to Prevent Preeclampsia and Anaemia: Rationale and Design of the Micronutrient Initiative Study , 2015, Journal of public health research.

[5]  Gretchen L. Seim,et al.  Adapting the Trials of Improved Practices (TIPs) approach to explore the acceptability and feasibility of nutrition and parenting recommendations: what works for low-income families? , 2015, Maternal & child nutrition.

[6]  L. Gathigi.  Utilization of Folic Acid and Iron Supplementation Services by Pregnant Women Attending an Antenatal Clinic at a Regional Referral Hospital in Kenya , 2015 .

[7]  Gedefaw Abeje,et al.  Factors associated with compliance of prenatal iron folate supplementation among women in Mecha district, Western Amhara: a cross-sectional study , 2015, The Pan African medical journal.

[8]  Jo-Anna B. Baxter,et al.  Tablets are preferred and more acceptable than powdered prenatal calcium supplements among pregnant women in Dhaka, Bangladesh. , 2014, The Journal of nutrition.

[9]  Samson Gebremedhin,et al.  Coverage, compliance and factors associated with utilization of iron supplementation during pregnancy in eight rural districts of Ethiopia: a cross-sectional study , 2014, BMC Public Health.

[10]  L. Caulfield,et al.  Patterns of compliance with prenatal iron supplementation among Peruvian women. , 2014, Maternal & child nutrition.

[11]  P. von Dadelszen,et al.  Low-dose calcium supplementation for preventing pre-eclampsia: a systematic review and commentary , 2014, BJOG : an international journal of obstetrics and gynaecology.

[12]  D. Ansong,et al.  Forming a supplement intervention using a multi-theoretical behavior model. , 2013, American journal of health behavior.

[13]  Jai K. Das,et al.  Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? , 2013, The Lancet.

[14]  D. Woldeyohannes,et al.  Determinants of maternal health care utilization in Holeta town, central Ethiopia , 2013, BMC Health Services Research.

[15]  G. Pelto,et al.  Caregivers' responses to an intervention to improve young child feeding behaviors in rural Bangladesh: a mixed method study of the facilitators and barriers to change. , 2012, Social science & medicine.

[16]  Jeffrey N. Martin,et al.  Food insecurity, depression and the modifying role of social support among people living with HIV/AIDS in rural Uganda. , 2012, Social science & medicine.

[17]  S. Kaaya,et al.  How Treatment Partners Help: Social Analysis of an African Adherence Support Intervention , 2011, AIDS and Behavior.

[18]  Allison W. McCulloch,et al.  Developing and Using a Codebook for the Analysis of Interview Data: An Example from a Professional Development Research Project , 2011 .

[19]  R. Stoltzfus.  Iron interventions for women and children in low-income countries. , 2011, The Journal of nutrition.

[20]  Z. Bhutta,et al.  Role of calcium supplementation during pregnancy in reducing risk of developing gestational hypertensive disorders: a meta-analysis of studies from developing countries , 2011, BMC public health.

[21]  B. Södergård,et al.  Long-Term Adherence to Antiretroviral Treatment and Program Drop-Out in a High-Risk Urban Setting in Sub-Saharan Africa: A Prospective Cohort Study , 2010, PloS one.

[22]  Alicia C. Bunger,et al.  Outcomes for Implementation Research: Conceptual Distinctions, Measurement Challenges, and Research Agenda , 2010, Administration and Policy in Mental Health and Mental Health Services Research.

[23]  T. Sanghvi,et al.  Maternal Iron–Folic Acid Supplementation Programs: Evidence of Impact and Implementation , 2010, Food and nutrition bulletin.

[24]  A. Efron,et al.  Randomized controlled trial of trained patient-nominated treatment supporters providing partial directly observed antiretroviral therapy , 2010, AIDS.

[25]  B. Taiwo,et al.  Assessing the Viorologic and Adherence Benefits of Patient-Selected HIV Treatment Partners in a Resource-limited Setting , 2009, Journal of acquired immune deficiency syndromes.

[26]  S. Khatry,et al.  Determinants of compliance to antenatal micronutrient supplementation and women’s perceptions of supplement use in rural Nepal , 2009, Public Health Nutrition.

[27]  R. Jackson,et al.  Determinants of compliance with iron supplementation among pregnant women in Senegal , 2008, Public Health Nutrition.

[28]  J. Sankalé,et al.  Direct observation therapy-highly active antiretroviral therapy in a resource-limited setting: the use of community treatment support can be effective , 2007, International journal of STD & AIDS.

[29]  Gary Maartens,et al.  Treatment Supporter to Improve Adherence to Antiretroviral Therapy in HIV-Infected South African Adults: A Qualitative Study , 2006, Journal of acquired immune deficiency syndromes.

[30]  Kathleen C Insel,et al.  The Negative Association of Independent Personality and Medication Adherence , 2006, Journal of aging and health.

[31]  B. B. Jensen,et al.  The potential of schoolchildren as health change agents in rural western Kenya. , 2005, Social science & medicine.

[32]  A. Carballo-Diéguez,et al.  Couple-focused support to improve HIV medication adherence: a randomized controlled trial , 2005, AIDS.

[33]  Yacouba Sidibé,et al.  Acceptability of multiple micronutrient supplements by pregnant and lactating women in Mali , 2005, Public Health Nutrition.

[34]  J. W. Hussein,et al.  A CULTURAL REPRESENTATION OF WOMEN IN THE OROMO SOCIETY , 2004 .

[35]  P. Christensen.  The health-promoting family: a conceptual framework for future research. , 2004, Social science & medicine.

[36]  M. McCormick,et al.  Design of an intervention addressing multiple levels of influence on dietary and activity patterns of low-income, postpartum women. , 2002, Health education research.

[37]  L. Morison,et al.  Women's perceptions of iron deficiency and anemia prevention and control in eight developing countries. , 2002, Social science & medicine.

[38]  R. Yip.  Iron supplementation: country level experiences and lessons learned. , 2002, The Journal of nutrition.

[39]  W. Fawzi,et al.  Predictors of HIV-1 serostatus disclosure: a prospective study among HIV-infected pregnant women in Dar es Salaam, Tanzania , 2001, AIDS.

[40]  J. Sobal.  Sample extensiveness in qualitative nutrition education research. , 2001, Journal of nutrition education.

[41]  Eleanor McLellan,et al.  Codebook Development for Team-Based Qualitative Analysis , 1998 .

[42]  Stephanie L Martin,et al.  Translating formative research findings into a behaviour change strategy to promote antenatal calcium and iron and folic acid supplementation in western Kenya , 2017, Maternal & child nutrition.

[43]  Florence D. DiGennaro Reed,et al.  Evidence-Based Interventions , 2017 .

[44]  J. Aubel.  The role and influence of grandmothers on child nutrition: culturally designated advisors and caregivers. , 2012, Maternal and Child Nutrition.

[45]  F. Barg,et al.  Social determinants of iron supplementation among women of reproductive age: a systematic review of qualitative data. , 2012, Maternal & child nutrition.

[46]  F. Viteri,et al.  Daily oral iron supplementation during pregnancy. , 2012, The Cochrane database of systematic reviews.

[47]  B. Israel,et al.  Social networks and social support. , 2008 .

[48]  Á. Atallah,et al.  Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. , 2002, The Cochrane database of systematic reviews.