Nutritional Supplement Adherence among Women of Reproductive age Participating in a Randomized Controlled Trial in Northern Vietnam
Meredith Nechitilo *
Emory University, Rollins University of Public Health, Atlanta, GA, USA.
Ines Gonzalez-Casanova
Emory University, Rollins University of Public Health, Atlanta, GA, USA.
Reynaldo Martorell
Emory University, Rollins University of Public Health, Atlanta, GA, USA.
Phuong Nguyen
Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen, Vietnam and International Food Policy Research Institute, Hanoi, Vietnam.
Usha Ramakrishnan
Emory University, Rollins University of Public Health, Atlanta, GA, USA.
*Author to whom correspondence should be addressed.
Abstract
Objectives: Identify factors that influence adherence to consumption of micronutrient supplements before and during pregnancy among participants of a double-blind randomized controlled trial (PRECONCEPT) assessing the impact of weekly preconceptional multiple micronutrient supplements on maternal and child health outcomes in 20 rural communes in northern Vietnam.
Methods: In-depth interviews were conducted with PRECONCEPT participants, including 15 pre-pregnant women receiving weekly micronutrient supplements, 8 pregnant women receiving daily iron-folate supplements, 8 women who had delivered and 8 drop-outs. Domains of interest included participants' experiences with supplements and knowledge about nutritional needs, micronutrient deficiencies, and the study. Four focus groups (one per participating district) were also conducted with Village Health Workers who distributed the supplements. Data were transcribed, translated, and coded and analyzed using MAXQDA software, applying the principles of grounded theory.
Results: Knowledge about iron's value for maternal health was more widespread compared to other micronutrients. The importance of ensuring adequate "nutrient" levels during pregnancy for proper fetal development was also recognized, but supplements were considered as curative rather than preventive for maternal health. Functional support, positive reinforcement from health workers and family members, and perceived health benefits for mother and child were associated with improved adherence to supplement consumption, whereas misinformation and poor management of side effects may be associated with reduced adherence.
Conclusions: Programs that distribute micronutrient supplements should include counseling materials that emphasize the preventive value of supplements for maternal health. Additional efforts that incorporate strategies to improve social support will also help improve community trust, increase adherence, and reduce dropout rates.