Mobile Health for Anemia Reduction: Study Protocol for an Entertainment Education-Based Dual Intervention (Preprint)

2021 ◽  
Author(s):  
Ichhya Pant ◽  
Rajiv N. Rimal ◽  
Hagere Yilma ◽  
Jeffrey B. Bingenheimer ◽  
Erica Sedlander ◽  
...  
Keyword(s):  
Folic Acid ◽  
Violence Against Women ◽  
Self Efficacy ◽  
Bystander Intervention ◽  
Reproductive Age ◽  
Inclusion Criteria ◽  
Entertainment Education ◽  
Women Of Reproductive Age ◽  
Iron Folic Acid ◽  
Parent Trial

BACKGROUND More than half of women of reproductive age (15-49 years old) are anemic in India. Uptake of and adherence to iron folic acid supplements remain low despite sustained efforts to increase use. With India’s burgeoning digital environment, mobile phones offer a potential medium to increase uptake, especially when combined with interactive voice-messages that deliver entertaining stories infused with norms-based educational messages. OBJECTIVE This study investigates whether a norms-based entertainment education mHealth intervention can increase self-efficacy for iron folic acid adherence among women of reproductive age in Odisha, India. mRANI is a randomized two-arm study that includes assessments before and after the intervention. METHODS All study participants are recruited from only the intervention arm of the parent RANI trial. Whereas the usual practice is to randomize participants either to a treatment arm or to a usual-care control arm, we are assigning the mRANI control group to another entertainment education-based treatment group – one designed to improve bystander intervention to reduce violence against women. Data collection for mRANI is embedded in the parent trial and will include baseline and end-line assessments. Primary outcomes are self-efficacy for iron folic acid adherence and violence against women-related bystander intervention. Inclusion criteria for mRANI is participation in the parent trial and phone ownership. Women (approximate n = 400) who meet mRANI inclusion criteria will be randomly assigned to the IFA arm or the bystander arm. Ordinary least squares regression with robust standard errors will be conducted to assess between-group comparisons at end-line. A mediation analysis will examine whether social norms and interactivity mediate the relationship between intervention exposure and primary outcomes in both arms. Real-time monitoring data will offer insights into intervention receptivity and audience engagement. RESULTS This study will provide evidence on whether an mHealth norms-based entertainment education intervention can increase self-efficacy for iron folic acid adherence and violence against women-related bystander intervention. CONCLUSIONS mRANI may provide an efficient and digital medium to reduce anemia and violence against women in an increasingly digital and socially distanced world owing to COVID-19. CLINICALTRIAL The parent trial (RANI) was registered with Clinical Trial Registry- India (CTRI) (CTRI/2018/10/016186) on 29 October 2018.

Government-Industry Partnership in Weekly Iron-Folic Acid Supplementation for Women of Reproductive Age in the Philippines: Impact on Iron Status

2005 ◽  
Vol 63 (12) ◽  
pp. 116-125 ◽  
Author(s):  
Imelda Angeles-Agdeppa ◽  
Lourdes S. Paulino ◽  
Adelisa C. Ramos ◽  
Unita Marie Etorma ◽  
Tommaso Cavalli-Sforza ◽  
...  
Keyword(s):  
Folic Acid ◽  
Iron Status ◽  
Folic Acid Supplementation ◽  
The Philippines ◽  
Reproductive Age ◽  
Women Of Reproductive Age ◽  
Acid Supplementation ◽  
Iron Folic Acid Supplementation ◽  
Iron Folic Acid

scholarly journals Examining the Multilevel Barriers and Facilitators to Iron Folic Acid Supplement Use and Anemia Reduction in Rural India (OR25-07-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Erica Sedlander ◽  
Rajiv Rimal ◽  
Michael Long ◽  
Ashita Munjral ◽  
Hagere Yilma ◽  
...  
Keyword(s):  
Folic Acid ◽  
Health Workers ◽  
Reproductive Age ◽  
World Health ◽  
Women Of Reproductive Age ◽  
Individual Level ◽  
Supplement Use ◽  
The Government ◽  
Iron Folic Acid ◽  
Health Organization

Abstract Objectives Over half of women of reproductive age in India are anemic so the World Health Organization recommends daily iron folic acid (IFA) for all women of reproductive age. The government has distributed free IFA for over four decades but initial uptake and adherence remain inadequate. Objectives 1) to understand the multilevel factors that hinder IFA use and adherence; and 2) to inform a behavioral intervention to increase IFA use to reduce anemia. Methods We conducted this study in four rural villages in the state of Odisha, India. We held 25 key informant interviews with front-line health workers, 16 focus groups with women of reproductive age, husbands, and mothers-in-law (n = 148) and 18 direct observations in health centers, pharmacies and women's groups. We purposively sampled key informants and randomly sampled focus group participants from an enumeration of all eligible residents of each village, and stratified them by sex, age and relation to a woman of reproductive age. We analyzed the data using applied thematic analysis and Nvivo software. Results At the individual level, we found that most people knew that IFA prevents anemia, but they did not recognize its widespread prevalence, believing instead that it was rare in their community. They also believed that taking too many IFA supplements during pregnancy would “make your baby big” causing a painful birth and possibly the need for a cesarean section. At the interpersonal level, mothers-in-law were not supportive of their daughters-in-law taking IFA too often because they themselves did not take them when they were younger. Husbands were more supportive. At the policy level, frontline health workers distribute IFA but are not incentivized to follow up on adherence. Finally, state and national policies are not consistent around which sub-populations should take IFA (e.g., whether all non-pregnant women of reproductive age should take them). Conclusions To address these multilevel barriers to IFA use and adherence, interventions should take a normative approach that includes a woman's social network and targets both descriptive norms (ideas about how many women in the community have anemia and are taking IFA) and injunctive norms around who should be taking IFA (e.g., all women of reproductive age). Funding Sources The Bill and Melinda Gates Foundation. Supporting Tables, Images and/or Graphs

scholarly journals ‘After they finish their meals, I have my meal from the leftovers; I have to adjust:” Examining How Gender Norms Affect Anemia Rates in Odisha India (P04-122-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Erica Sedlander ◽  
Chandni Ladwa ◽  
Sameera Talegawkar ◽  
Rohini Ganjoo ◽  
Rajiv Rimal
Keyword(s):  
Folic Acid ◽  
Focus Group ◽  
Pregnant Women ◽  
Gender Norms ◽  
Reproductive Age ◽  
Deficiency Anemia ◽  
Women Of Reproductive Age ◽  
Iron Supplements ◽  
Rich Food ◽  
Iron Folic Acid

Abstract Objectives Half of women of reproductive age in India have iron deficiency anemia compared to only 23% of men. Most research focuses on biological reasons for this discrepancy and access to iron-folic acid and iron-rich foods. However, recent research in India shows that inequitable gender norms may affect a woman's ability or desire to take iron supplements and to eat iron-rich food. The objective of this study is to examine how and why gender norms may be affecting high and persistent rates of anemia in India. Methods We conducted 25 key informant interviews and 16 focus group discussions with women of reproductive age, adolescents, husbands and mothers-in-law (n = 148) in Odisha, India. We purposively sampled key informants and randomly sampled focus group participants. We analyzed the data using applied thematic analysis in Nvivo software. Results Our data shows that unequal gender norms impact behaviors that are directly related to high rates of anemia. Women are often serving their husband, children, and in-laws first and “adjusting” to whatever is leftover which may be poor in nutritional qualities and less iron rich. Men are also the main breadwinners but often spend their money on alcohol, money that could be spent on iron-rich food for the household. Women reported that extreme fatigue is a normal part of being a woman and that a woman's plight is to take care of her family at any cost. Given that fatigue, the primary symptom of anemia is normalized; women may be less likely to seek treatment. Women tend to prioritize the health of their family over her own which could affect her ability or desire to go to the health center to get tested for anemia or to obtain iron supplements. Pregnant women are more likely to take iron supplements for the health of the baby, not her own health. While non-pregnant women of reproductive age who were not diagnosed with anemia were not focused on preventive health, only major illnesses and thus, were not taking supplements at all. Conclusions More upstream barriers, like gender norms, may be impinging on a woman's ability to take iron folic acid and to eat iron rich foods. Understanding how gender norms contribute to anemia could change the narrative from a biomedical issue to a social justice issue. Funding Sources The Bill and Melinda Gates Foundation. Supporting Tables, Images and/or Graphs

scholarly journals Unpacking How a Social Norms-Based Intervention Affects Iron Folic Acid Supplement Use Among Rural Indian Women

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 685-685
Author(s):  
Erica Sedlander ◽  
Ichhya Pant ◽  
Jeffrey Bart Bingenheimer ◽  
Lipika Patro ◽  
Hagere Yilma ◽  
...  
Keyword(s):  
Folic Acid ◽  
Reproductive Age ◽  
Iron Supplement ◽  
Folic Acid Supplement ◽  
Women Of Reproductive Age ◽  
Community Based ◽  
Group Education ◽  
Iron Supplements ◽  
Supplement Use ◽  
Iron Folic Acid

Abstract Objectives More than a third of women worldwide and more than half of women in India have iron deficiency anemia. In 2012, the World Health Assembly made a global target of a 50% reduction in anemia among all women of reproductive age by the year 2025. Based on formative research, the Reduction in Anemia through Normative Innovations (RANI) project designed a social norms-based intervention to increase iron folic acid supplement use among women of reproductive age in Odisha, India. The objective of this paper is to examine midline data to understand which intervention components had the most effect on taking iron supplements and to suggest intervention modifications accordingly. Methods We collected and analyzed longitudinal data at baseline from the control and treatment arms and again from the same two arms at midline, six months later (n = 1,966 and n = 1,987). For this analysis, our sample includes non-pregnant women of reproductive age (15 – 49 years old). Using nested models, we analyzed data from the different intervention components: monthly community-based testing for anemia, attending participatory group education sessions, and watching locally made videos targeted at different referent groups. We also examined if age, caste, education, and communicating about the intervention moderated the effect of the intervention on iron supplement use. Results After controlling for iron supplement use at baseline, we found that simply being in the treatment arm increased the odds of taking supplements by more than 16 times (OR = 16.73; p = < .001). Being exposed to each of the intervention components separately and as reported here, all together, also increased use. Getting tested for anemia increased a woman's odds of taking iron supplements by 38% (OR = 1.38; p = < .001) followed by watching videos which increased the odds by 26% (OR 1.26; p < .001).Participating in group education sessions had the smallest effect (OR = 1.09; p = < .01). There was not a significant difference in how the intervention affected iron supplement use by age, caste, or education level. Similarly, interpersonal communication did not have an effect. Conclusions While all intervention components increased iron supplement use, community-based anemia testing had the greatest effect. In the final stage of this trial, more resources will go towards anemia testing. Funding Sources The Bill and Melinda Gates Foundation.

Sign in / Sign up

Export Citation Format

Share Document