Integrated Educational Session and Enhancing Compliance Behavior
Condition: Anemia; Iron-deficiency
MeSH terms: Anemia; Anemia, Iron-Deficiency; Iron Deficiencies
Study type: Interventional

Summary: 
      This study aimed to determine the effect of an integrated educational session on enhancing
      compliance behavior among pregnant women with iron deficiency anemia.The anemic pregnant
      women in the study group received an integrated health education in one session. While
      pregnant women who were allocated to the control group received the routine antenatal care
      and follow up.
    

Detailed description: 
      Data collection was conducted between April 2019 and December 2019.This study was grounded in
      the health compliance model(Heiby and Carlson, 1986) which proposed that elements of
      engagement between health care providers and patients involve activities that are likely to
      promote the development of information, produce productive emotions, and help develop the
      skills required to conduct health behavior. Such aspects of engagement include the healthcare
      provider listening to the patient's questions, engaging the patient in treatment decisions,
      and evaluating comprehension of the patient.

      For the first interview at 24 weeks' gestation, the pregnant women were re-informed about the
      purpose of the study and the schedule of follow-up. The baseline data that was gathered
      included test of the women's Hb levels during their routine antenatal visit,
      socio-demographic characteristics, and obstetric history. Three follow-up examinations were
      planned for pregnant women in both study and control groups at weeks 28, 32 and 36 of
      gestation. In the study group, pregnant women with anemia obtained an integrated health
      education in one session. The educational session was conducted by the principle investigator
      (PI) and was steered as 40-minutes session and provided individually to every participating
      woman. The content of the educational session included; disease specific knowledge, impact of
      anemia on maternal and neonatal outcomes, management opportunities, effectiveness, advantages
      and draw¬backs of treatment choices, iron-rich diet recognition, false eating patterns
      stopping iron absorption, and healthy diet. The PI has adopted the medical recommendations
      based on dietary guidelines for pregnancy(WHO, 2012). The pregnant women were given a chance
      to ask questions related to the session and its content. Furthermore, women were educated in
      recording all food and drink consumed inside and outside of the home, i.e. each meal/dish
      they got during the reporting duration of their diary, 24 hours of recall for seven days.
      They were also asked to report the exact portion size of the food by normal household
      measurements (e.g. plates, pots, cups, spoons, and glasses) or by kitchen scale.
      Additionally, each woman was advised to select the easiest way to remind her of her vitamin
      time.

      The pregnant women received an educational brochure at the end of the educational session
      which included all the information given in that session written in Arabic language. The
      literature-based educational brochure material was reviewed by three experts in the field of
      maternity nursing prior to the distribution. Each pregnant woman in both study and control
      groups was evaluated twice at 28 and 36 weeks' gestation for total dietary iron. The dietary
      iron intake recorded by women has been calculated using the IRONIC-FFQ and revised, when
      needed, by dietitian who was not involved in the study. In addition, the degree of the
      women's adherence to medication was measured by counting the total numbers of pills consumed
      between two scheduled appointments. For antenatal follow-up appointments for all women in the
      study and the control groups, phone calls were given monthly and women were reminded to
      record the iron intake diary seven days before their appointment. The participants returned
      their supplementary bottles with any unused capsules to the PI during their monthly visits to
      the antenatal clinic. Adherence to the supplementation scheme was determined based on the
      number of capsules left in the package after each return visit; adherence
      (percent)=[30-number of pills left in the package/number of days between the date of
      dispensation and the date of return]100. The equation was adopted based on the method used
      in(Cogswell et al., 2003).

      At the last data collection occasion at gestation week 36, the medication adherence scale was
      inserted along with check of Hb levels for all participating women. Pregnant women who were
      allocated to the control group received the routine antenatal care and follow-up, but no
      educational sessions or materials were provided to them

      Primary Outcome:

      Compliance degree

      Secondary Outcome:

      Iron food intake/mg, the hemoglobin level & ferritin levels
    

Intervention name(s): Integrated educational session
Intervention type(s): Behavioral
Intervention description(s): The educational session aimed to correct the pregnant women diatery habits and enhance the degree of compliance to the iron treatment and follow up instruction.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: there are two groups, the study group and the control group
Masking: Single (Participant)
Primary purpose: Supportive Care
Keywords: Iron deficiency; Moderate anemia; Compliance