Nechitilo Meredith, Nguyen Phuong, Webb-Girard Amy, Gonzalez-Casanova Ines, Martorell Reynaldo, DiGirolamo Ann, Ramakrishnan Usha
Department of Global Health, Emory University, Atlanta, GA, USA.
Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen, Vietnam
Food Nutr Bull. 2016 Dec;37(4):461-474. doi: 10.1177/0379572116647830. Epub 2016 May 5.
Initiation and adherence are both critical challenges for micronutrient supplementation programs, especially during the preconceptional period. This study examines factors influencing initiation of supplement use and continued adherence among women participating in PRECONCEPT, a double-blind randomized controlled trial of preconception micronutrient supplementation.
In-depth interviews were conducted with 39 participants during different periods (prepregnancy [n = 15], pregnancy [n = 8], postpartum [n = 8], and dropouts [n = 8]). We examined participants' knowledge about nutritional needs and micronutrient deficiencies, individual experience with nutritional supplements, and perceived benefits and side effects of supplements. Four focus groups were conducted with 24 village health workers (VHWs) to collect information on VHWs' perceptions of factors influencing participants' adherence and logistics of supplement distribution. Influences on initiation and adherence were examined within the Health Belief Model framework.
Primary barriers to initiation of supplement use were low perceptions of severity of nutrient deficiencies and personal susceptibility. These are associated with low knowledge and awareness around deficiencies. Perceived seriousness and susceptibility varied by nutrient: high for iron during pregnancy but low for all other micronutrient deficiencies, including iron outside pregnancy. Continued maintained adherence to an initiated regimen was influenced by the woman's perceptions of the health benefits of, and barriers to, regular supplement use.
Initiation of supplement use was influenced by perceived susceptibility and severity of nutrient deficiencies, while maintained adherence to consistent use was influenced by perceived benefits and barriers. Recognizing the influences on each stage may help improve adherence and maximize positive effects of future interventions.
对于微量营养素补充计划而言，起始服用和持续依从都是严峻的挑战，尤其是在孕前阶段。本研究考察了参与“孕前”（PRECONCEPT）这一孕前微量营养素补充双盲随机对照试验的女性中，影响补充剂使用起始及持续依从性的因素。
在不同阶段（孕前[n = 15]、孕期[n = 8]、产后[n = 8]及退出者[n = 8]）对39名参与者进行了深入访谈。我们考察了参与者对营养需求和微量营养素缺乏的了解、营养补充剂的个人使用经验，以及对补充剂的感知益处和副作用。与24名乡村卫生工作者（VHWs）进行了4次焦点小组讨论，以收集关于VHWs对影响参与者依从性因素及补充剂分发后勤情况的看法。在健康信念模型框架内考察了对起始使用和依从性产生的影响。
开始使用补充剂的主要障碍是对营养素缺乏严重程度和个人易感性的认知较低。这些与对缺乏症的低知识水平和认知度有关。对严重性和易感性的认知因营养素而异：孕期缺铁的认知度高，但对所有其他微量营养素缺乏（包括非孕期缺铁）的认知度低。对已开始的方案持续保持依从性受女性对定期使用补充剂的健康益处及障碍的认知影响。
补充剂使用的起始受对营养素缺乏易感性和严重性的认知影响，而持续保持一致使用则受感知益处和障碍的影响。认识到对每个阶段的影响可能有助于提高依从性，并使未来干预措施的积极效果最大化。
