Impact of Interpersonal Communication Campaign on Knowledge, Attitude, Intention, and Consumption of Iron Folate Acid Tablets and Iron Rich Foods among Pregnant Indonesian Women

Summary:

Indonesia's system of community health posts, called posyandus, focuses on services such as prenatal care and supplementation. Despite accessibility to these services, compliance with supplementation remains low and childhood stunting rates remain high. To address undernutrition, a National Nutrition Communication Campaign (NNCC) using interpersonal communication (IPC) strategies was implemented to encourage consumption of iron-folic acid (IFA) supplements and iron-rich foods (ATIKA). The purpose of this study is to understand how exposure to the NNCC influenced knowledge, attitude/intention, and consumption of IFA supplements and ATIKA among Indonesian women. Data came from a cross-sectional survey of 766 pregnant women; the survey utilized all but 3 constructs (perceived barriers, susceptibility, and self-efficacy) from the Theory of Planned Behavior and Health Belief Model. Adjusted logistic and linear regression models were conducted to analyze the differences between women exposed and unexposed to the NNCC. Approximately 20% of women were exposed to information on IFA tablets and 18% were exposed to information on ATIKA. Results show statistically significant differences in knowledge of IFA tablets and ATIKA between the groups. Exposure was predictive of consumption of IFA tablets but not ATIKA. The study suggests that while interventions with low exposure can increase knowledge, they may have less direct influence on increasing positive attitudes/intentions or compliance. Additionally, interventions that overlook perceived barriers, susceptibility, and self-efficacy are less likely to promote behavior change. As such, future interventions should strive to ensure high exposure, address barriers, understand perceived susceptibility, and improve self-efficacy.

Background/Objectives

Child and maternal health services, such as antenatal care and micronutrient supplementation, are offered in Indonesia's community health centers (posyandus). Despite this exposure and access to supplements, compliance rates for iron folic acid (IFA) tablets remains low. Since deficiencies in iron and folic acid during pregnancy increases the risk of stunting, a National Nutrition Communication Campaign (NNCC) used interpersonal communication (IPC) strategies to encourage compliance with consumption of IFA supplements and iron-rich foods (ATIKA). The purpose of this study is to understand how the NNCC impacted knowledge, attitude, intention, and consumption of IFA supplements and ATIKA among Indonesian women.

Description Of Intervention And/or Methods/Design

Data came from a cross-sectional survey of 766 pregnant women; the survey utilized constructs from the Theory of Planned Behavior and the Health Belief Model. A composite variable was created to measure exposure to the three elements of the NNCC: counseling, mother classes, and health activities. Questions evaluating attitude/intention were categorized as disagree and agree. Knowledge variables were dichotomous, yes vs. no. Adjusted logistic regression models were conducted to analyze differences between the self-reported exposed and unexposed groups. Adjusted linear regression models were constructed to analyze ATIKA consumption, which was based on a 24-hour recall of how many times the respondent consumed an iron-rich food in the previous day (0-4 times).

Results/Lessons Learned

Approximately 20% of women were exposed to information on IFA tablets through IPC and 18% were exposed to information on ATIKA through IPC. Women exposed to the NNCC had increased, statistically significant odds of having correct knowledge: IFA benefits [OR=2.23], IFA side effects [OR=2.35], how to consume IFA [OR=2.12], when to consume IFA [OR=2.83], ATIKA benefits [OR=3.60], and consequences of iron deficiency [OR=3.74]. For attitude/intention, pregnant women who were exposed had statistically significant increased odds of believing they need to consume IFA [OR=1.79] and intent to consume IFA [OR=3.36]. There were no other differences in attitude/intention for IFA and ATIKA compared to those who were not exposed. Exposure was associated with consumption of IFA tablets but not consumption of iron-rich foods in the last 24 hours.

Discussion/Implications For The Field

Health behavior theories provided a framework for the development, analysis, and interpretation of this study. Findings suggest that while interventions with low exposure can increase knowledge, they may not be sufficient to increase positive attitudes/intentions or compliance. In this study, knowledge increased, but downstream impacts on behavior were not observed. As such, interventions designed to improve compliance with prenatal supplementation and ATIKA consumption should strive to ensure high exposure, address barriers, understand perceived susceptibility, and improve self-efficacy. These constructs, if not addressed, could greatly reduce the effectiveness of interventions designed to decrease stunting through the means of prenatal nutrition.

Abstract submitted by:

Emily Gamboa

Mary Linehan - IMA World Health

Eliza Broadbent - 

Sarah Callaway - 

Melissa Quintana - 

Paola Donoso -