SINTA

0.0

Impact

Scholar

6

H-Index

Journal of Health Innovation and Environmental Education

an Open Access Journal

Effectiveness of Health Education and Short Message Service Reminders Reminders on Iron Supplement Adherence among Pregnant Women

Nare Karapetyan
Yerevan State University ROR
Armenia
narekapyn@gmail.com
Lilit Toyonan
Yerevan State University (YSU)
Armenia
Michelle Steenvoorden
University of Copenhagen ROR
Denmark
Nour Albahri
Tishreen University
Syrian Arab Republic
Share

  • Purpose of the study: This study aimed to evaluate effectiveness structured health professional led education embedded within routine antenatal care in enhancing iron supplement adherence among pregnant women.

    Methodology: A quasi-experimental pretest–posttest control group design conducted among 120 pregnant women at Masis Maternity Hospital. Participants allocated to intervention group. receiving structured professional-led education with reinforcement or a control group receiving routine care. Primary outcome was iron supplement adherence (≥80% consumption), while secondary outcomes included knowledge score and hemoglobin level changes over 8 weeks. Data analyzed using chi-square tests, independent and paired t-tests, and logistic regression.

    Main Findings: After 8 weeks, adherence significantly increased to 81.0% in .intervention group compared with 51.7% in control group (p < 0.001). The intervention group was nearly five times more likely to achieve adequate adherence (AOR = 4.83; 95% CI: 2.01–11.61). Knowledge scores improved by +5.27 points in the intervention group versus +1.78 in controls (p < 0.001). Hemoglobin levels increased by 0.86 g/dL in intervention group icompared to 0.32 g/dL control group (p < 0.001).

    Novelty/Originality of this study: This study advances maternal health practice by reframing health education as a structured, professionally embedded care model rather than a single counseling encounter, demonstrating measurable behavioral and clinical impact within routine antenatal services.

  • How to cite

    Effectiveness of Health Education and Short Message Service Reminders Reminders on Iron Supplement Adherence among Pregnant Women. (2026). Journal of Health Innovation and Environmental Education, 3(1), 29-38. https://doi.org/10.37251/jhiee.v3i1.2672

    More Citation Formats

  • 101
    Abstract views
    105
    Downloads

    Metrics — Badges

    1. M. F. Young and U. Ramakrishnan, “Maternal undernutrition before and during pregnancy and offspring health and development,” Ann. Nutr. Metab., vol. 76, no. 3, pp. 41–53, 2020, doi: 10.1159/000510595. DOI: https://doi.org/10.1159/000510595
    2. S. Triunfo and A. Lanzone, “Impact of maternal under nutrition on obstetric outcomes,” J. Endocrinol. Invest., vol. 38, no. 1, pp. 31–38, 2015, doi: 10.1007/s40618-014-0168-4. DOI: https://doi.org/10.1007/s40618-014-0168-4
    3. A. Gruending et al., “Born too soon: Learning from the past to accelerate action in the next decade,” Reprod. Health, vol. 22, no. 2, pp. 106–114, 2025, doi: 10.1186/s12978-025-02044-8. DOI: https://doi.org/10.1186/s12978-025-02044-8
    4. M. Gayatri et al., “Risk factors for primary postpartum haemorrhage-related maternal deaths: Evidence from maternal verbal autopsy in jember district, Indonesia,” Bahrain Med. Bull., vol. 44, no. 4, pp. 1161–1171, 2022, doi: 10.1097/ms9.0000000000003224. DOI: https://doi.org/10.1097/MS9.0000000000003224
    5. A. A. Abneh, T. D. Kassie, and S. S. Gelaw, “The magnitude and associated factors of immediate postpartum anemia among women who gave birth in Ethiopia: Systematic review and meta-analysis, 2023,” BMC Pregnancy Childbirth, vol. 24, no. 1, p. 317, Apr. 2024, doi: 10.1186/s12884-024-06495-y. DOI: https://doi.org/10.1186/s12884-024-06495-y
    6. M. M. Daigavane, R. K. Jena, and T. J. Kar, “Perinatal outcome in sickle cell anemia: A prospective study from India,” Hemoglobin, vol. 37, no. 6, pp. 507–515, 2013, doi: 10.3109/03630269.2013.828301. DOI: https://doi.org/10.3109/03630269.2013.828301
    7. N. A. Quarderer et al., “Fostering the development of earth data science skills in a diverse community of online learners: A case study of the earth data science corps,” J. Stat. Data Sci. Educ., vol. 6, no.1, pp. 1–22, 2024, doi: 10.1080/26939169.2024.2362886. DOI: https://doi.org/10.31219/osf.io/w6crb
    8. S. N. Kazmi, A. Ali, and M. Issa, “Tunes of traditions in folk songs: Unravelling balti society’s fabrics through thematic analysis,” J. Soc. Res. Dev., vol. 5, no. 2, pp. 55–69, 2024, doi: 10.53664/JSRD/05-02-2024-05-55-69. DOI: https://doi.org/10.53664/JSRD/05-02-2024-05-55-69
    9. M. Siarudin, S. A. Awang, R. Sadono, and P. Suryanto, “Renewable energy from secondary wood products contributes to local green development: The case of small-scale privately owned forests in Ciamis regency, Indonesia,” Energy. Sustain. Soc., vol. 13, no. 1, pp. 1–19, 2023, doi: 10.1186/s13705-023-00383-7. DOI: https://doi.org/10.1186/s13705-023-00383-7
    10. R. Chatterjee, A. Shand, N. Nassar, M. Walls, and A. Z. Khambalia, “Iron supplement use in pregnancy – are the right women taking the right amount?,” Clin. Nutr., vol. 35, no. 3, pp. 741–747, 2016, doi: 10.1016/j.clnu.2015.05.014. DOI: https://doi.org/10.1016/j.clnu.2015.05.014
    11. F. O’Toole, R. Sheane, N. Reynaud, F. M. McAuliffe, and J. M. Walsh, “Screening and treatment of iron deficiency anemia in pregnancy: A review and appraisal of current international guidelines,” Int. J. Gynecol. Obstet., vol. 166, no. 1, pp. 214–227, 2024, doi: 10.1002/ijgo.15270. DOI: https://doi.org/10.1002/ijgo.15270
    12. O. Kaplan, “Cross-cultural control–value mechanisms on the detrimental effect of bullying on mathematics anxiety,” Behav. Sci. (Basel)., vol. 16, no. 1, pp. 31–40, 2025, doi: 10.3390/bs16010003. DOI: https://doi.org/10.3390/bs16010003
    13. M. Maral, “Research performance of higher education in OECD countries: A hybrid multi-criteria decision-making approach,” SAGE Open, vol. 14, no. 2, pp. 1–20, 2024, doi: 10.1177/21582440241257753. DOI: https://doi.org/10.1177/21582440241257753
    14. V. Batdı, Y. Doğan, and T. Talan, “Effectiveness of online learning: A multi-complementary approach research with responses from the COVID-19 pandemic period,” Interact. Learn. Environ., vol. 31, no. 7, pp. 4113–4146, 2023, doi: 10.1080/10494820.2021.1954035. DOI: https://doi.org/10.1080/10494820.2021.1954035
    15. R. N. Atmadani, A. Akrom, D. Ananda, L. Y. Saputri, A. A. Puspitasari, and S. Urbayatun, “Supports and barriers regarding the iron-folic acid supplementation adherence Level in anemic pregnant women: Indonesian’s perspective,” Media Kesehat. Masy. Indones., vol. 20, no. 2, pp. 46–56, J2024, doi: 10.30597/mkmi.v20i2.32569. DOI: https://doi.org/10.30597/mkmi.v20i2.32569
    16. S. Zakariah-Akoto et al., “Anaemia prevention among pregnant women: Views and experiences of pregnant women and antenatal care providers in Accra, Ghana,” World Nutr., vol. 15, no. 2, pp. 87–101, 2024, doi: 10.26596/wn.202415287-101. DOI: https://doi.org/10.26596/wn.202415287-101
    17. P. Lavanya, R. Jayalakshmy, S. Rajaa, and T. Mahalakshmy, “Adherence to iron and folic acid supplementation among antenatal mothers attending a tertiary care center, puducherry: A mixed-methods study,” J. Fam. Med. Prim. Care, vol. 9, no. 10, pp. 5205–5211, 2020, doi: 10.4103/jfmpc.jfmpc_721_20. DOI: https://doi.org/10.4103/jfmpc.jfmpc_721_20
    18. M. A. Durand, M. Bannier, M. A. Aim, and J. Mancini, “Adaptation and implementation of pictorial conversation aids for early-stage breast cancer surgery and reconstruction: A quality improvement study,” Patient Prefer. Adherence, vol. 17, no. 11, pp. 2463–2474, 2023, doi: 10.2147/PPA.S421695. DOI: https://doi.org/10.2147/PPA.S421695
    19. Chuleeporn Prompahakul and Elizabeth G Epstein, “Moral distress experienced by non-western nurses: An integrative review,” Nurs. Ethics, vol. 27, no. 3, pp. 778–795, Nov. 2019, doi: 10.1177/0969733019880241. DOI: https://doi.org/10.1177/0969733019880241
    20. M. S. Hsu, C. L. Yeh, S. J. Cheng, and C. P. Lin, “Integrating digital technologies in dental technician education: A comparative study of national examination in Asian countries,” J. Dent. Sci., vol. 20, no. 1, pp. 28–35, 2024, doi: 10.1016/j.jds.2024.10.017. DOI: https://doi.org/10.1016/j.jds.2024.10.017
    21. E. U. Alum, E. I. Obeagu, and O. P.-C. Ugwu, “Enhancing quality water, good sanitation, and proper hygiene is the panacea to diarrhea control and the attainment of some related sustainable development goals: A review,” Medicine (Baltimore)., vol. 103, no. 38, pp. 1-8, 2024, doi: 10.1097/MD.0000000000039578. DOI: https://doi.org/10.1097/MD.0000000000039578
    22. A. Azis, S. Utami, L. Cronin, and A. H. Al Sanie, “The influence of the school environment on the formation of children’s character,” J. Basic Educ. Res., vol. 5, no. 1, pp. 16–21, 2024, doi: 10.37251/jber.v5i1.850. DOI: https://doi.org/10.37251/jber.v5i1.850
    23. P. Kumar, “The role of ethics and moral values in teaching: A comprehensive examination,” Shodh Sari-An Int. Multidiscip. J., vol. 03, no. 01, pp. 99–112, 2024, doi: 10.59231/sari7659. DOI: https://doi.org/10.59231/SARI7659
    24. S. S. Kim and Y. J. Kim, “The effect of compliance knowledge and compliance support systems on information security compliance behavior,” J. Knowl. Manag., vol. 21, no. 4, pp. 986–1010, 2017, doi: 10.1108/JKM-08-2016-0353. DOI: https://doi.org/10.1108/JKM-08-2016-0353
    25. F. Akhter, M. R. Hossain, and Adiba Nazia, “Exploring the drivers of patient value co-creation behavior in online healthcare: A mediated model in the lens of the theory of planned behavior,” J. Risk Anal. Cris. Response, vol. 15, no. 4, pp. 27–39, 2025, doi: 10.54560/jracr.v15i4.678. DOI: https://doi.org/10.54560/jracr.v15i4.678
    26. H. Tjaraka, W. Hidayat, and R. Rusdiyanto, “The role of earning management as a mediator of the effect of the facial width to height ratio ceos on leverage,” Cogent Bus. Manag., vol. 9, no. 1, 2022, doi: 10.1080/23311975.2022.2115733. DOI: https://doi.org/10.1080/23311975.2022.2115733
    27. M. Karthika, J. Abraham, P. B. Kodali, and E. Mathews, “Emerging Trends of Chronic Diseases and Their Care Among older Persons Globally Bt - Handbook of Aging, Health and Public Policy: Perspectives from Asia,” Handbook of Aging, Health and Public Policy. Springer: Singapore, pp. 641–664, 2025,doi: 10.1007/978-981-99-7842-7_198. DOI: https://doi.org/10.1007/978-981-99-7842-7_198
    28. J. Balante, D. van den Broek, and K. White, “How does culture influence work experience in a foreign country? An umbrella review of the cultural challenges faced by internationally educated nurses,” Int. J. Nurs. Stud., vol. 118, pp. 1-9, 2021, doi: 10.1016/j.ijnurstu.2021.103930.
    29. J. Balante, D. van den Broek, and K. White, “How does culture influence work experience in a foreign country? An umbrella review of the cultural challenges faced by internationally educated nurses,” Int. J. Nurs. Stud., vol. 118, p. 103930, 2021, doi: 10.1016/j.ijnurstu.2021.103930. DOI: https://doi.org/10.1016/j.ijnurstu.2021.103930
    30. I. Asmal, M. A. Walenna, W. Nas, and Ridwan, “Application of local wisdom in handling waste in coastal settlements as an effort to minimize waste production,” Environ. Sustain. Indic., vol. 19, no. 1, pp. 10-28, 2023, doi: 10.1016/j.indic.2023.100283. DOI: https://doi.org/10.1016/j.indic.2023.100283
    31. M. Papadopoulou et al., “Bedtime routines in greek families: Characteristics, barriers, and facilitators for establishing and maintaining optimal routines,” Front. Sleep, vol. 3, no. 1, pp. 133–142, 2024, doi: 10.3389/frsle.2024.1339561. DOI: https://doi.org/10.3389/frsle.2024.1339561
    32. D. Murtezaj, V. Paneva, V. Distler, and F. Alt, “Public security user interfaces,” in Proceedings of the New Security Paradigms Workshop, New York, NY, USA: ACM, pp. 56–70, 2024, doi: 10.1145/3703465.3703470. DOI: https://doi.org/10.1145/3703465.3703470
    33. V. Schneider and A. Rohmann, “Arts in education: A systematic review of competency outcomes in quasi-experimental and experimental studies,” Front. Psychol., vol. 12, no. 2, pp. 1–13, April, 2021, doi: 10.3389/fpsyg.2021.623935. DOI: https://doi.org/10.3389/fpsyg.2021.623935
    34. J. Morgenstern, A. Kuerbis, P. Amrhein, L. Hail, K. Lynch, and J. R. McKay, “Motivational interviewing: A pilot test of active ingredients and mechanisms of change.,” Psychol. Addict. Behav., vol. 26, no. 4, pp. 859–869, 2012, doi: 10.1037/a0029674. DOI: https://doi.org/10.1037/a0029674
    35. Y. J. Oh, J. Zhang, M. L. Fang, and Y. Fukuoka, “A systematic review of artificial intelligence chatbots for promoting physical activity, healthy diet, and weight loss,” Int. J. Behav. Nutr. Phys. Act., vol. 18, no. 1, pp. 1–25, 2021, doi: 10.1186/s12966-021-01224-6. DOI: https://doi.org/10.1186/s12966-021-01224-6
    36. R. da S. Tiago and A. Mitchell, “Integrating digital transformation in nursing education: Best practices and challenges in curriculum development,” 2024, Emerald Publishing Limited. doi: 10.1108/978-1-83608-424-220241004. DOI: https://doi.org/10.1108/978-1-83608-424-220241004
    37. J. C. D. Gagne, E. Cho, P. S. Randall, H. Hwang, E. Wang, L. Yoo, S. Yamane, L. S. Ledbetter and D. Jung, “Exploration of cyberethics in health professions education: A scoping review,” Int. J. Environ. Res. Public Health, vol. 20, no. 22, pp. 43-50, 2023. doi: 10.3390/ijerph20227048. DOI: https://doi.org/10.3390/ijerph20227048
    38. P. M. I. Seraj and A. Rahmatullah, “Systematic literature review on the use of applications of smartphones for teaching english in EFL contexts,” J. English Educ. Teach., vol. 6, no. 3, pp. 347–366, 2022, doi: 10.33369/jeet.6.3.347-366. DOI: https://doi.org/10.33369/jeet.6.3.347-366
    39. C. Katrakazas, E. Michelaraki, M. Sekadakis, and G. Yannis, “A descriptive analysis of the effect of the COVID-19 pandemic on driving behavior and road safety,” Transp. Res. Interdiscip. Perspect., vol. 7, pp. 100-116, 2020, doi: 10.1016/j.trip.2020.100186. DOI: https://doi.org/10.1016/j.trip.2020.100186
    40. A. J. Linn, L. van Dijk, J. C. M. van Weert, B. G. Gebeyehu, A. A. v. Bodegraven, and E. G. Smit, “Creating a synergy effect: A cluster randomized controlled trial testing the effect of a tailored multimedia intervention on patient outcomes,” Patient Educ. Couns., vol. 101, no. 8, pp. 1419–1426, 2018, doi: 10.1016/j.pec.2018.03.017. DOI: https://doi.org/10.1016/j.pec.2018.03.017
    41. K. Elmusharaf, E. Byrne, and D. O’Donovan, “Strategies to increase demand for maternal health services in resource-limited settings: Challenges to be addressed,” BMC Public Health, vol. 15, no. 1, pp. 870–882, 2015, doi: 10.1186/s12889-015-2222-3. DOI: https://doi.org/10.1186/s12889-015-2222-3
    42. F. Tsandila-Kalakou, S. Wiig, and K. Aase, “Factors contributing to healthcare professionals’ adaptive capacity with hospital standardization: A scoping review,” BMC Health Serv. Res., vol. 23, no. 1, pp. 799-806, 2023, doi: 10.1186/s12913-023-09698-9. DOI: https://doi.org/10.1186/s12913-023-09698-9
    43. M. Kamau, W. Mirie, S. Kimani, and I. Mugoya, “Effect of community based health education on knowledge and attitude towards iron and folic acid supplementation among pregnant women in Kiambu County, Kenya: A quasi experimental study,” PLoS One, vol. 14, no. 11, pp. 2243–2258, 2019, doi: 10.1371/journal.pone.0224361. DOI: https://doi.org/10.1371/journal.pone.0224361
    44. P. Nahrisah, R. Somrongthong, N. Viriyautsahakul, P. Viwattanakulvanid, and S. Plianbangchang, “Effect of integrated pictorial handbook education and counseling on improving anemia status, knowledge, food intake, and iron tablet compliance among anemic pregnant women in Indonesia: A quasi-experimental study,” J. Multidiscip. Healthc., vol. 13, no. 1, pp. 43–52, 2020, doi: 10.2147/JMDH.S213550. DOI: https://doi.org/10.2147/JMDH.S213550
    45. Irwandi, S. Santoso, Sakroni, M. Lukitasari, and R. Hasan, “School-community collaboration in inquiry-based learning to strengthen religious character and improve learning outcome of students,” Int. J. Instr., vol. 15, no. 3, pp. 913–930, 2022, doi: 10.29333/iji.2022.15349a. DOI: https://doi.org/10.29333/iji.2022.15349a
    46. J. Maknun, “Implementation of guided inquiry learning model to improve understanding physics concepts and critical thinking skill of vocational high school students,” Int. Educ. Stud., vol. 13, no. 6, pp. 117-125, 2020, doi: 10.5539/ies.v13n6p117. DOI: https://doi.org/10.5539/ies.v13n6p117
    47. C. F. J. Pols, P. J. J. M. Dekkers, and M. J. de Vries, “What do they know? Investigating students’ ability to analyse experimental data in secondary physics education,” Int. J. Sci. Educ., vol. 43, no. 2, pp. 274–297, 2021, doi: 10.1080/09500693.2020.1865588. DOI: https://doi.org/10.1080/09500693.2020.1865588
    48. A. R. Karim and Arifuddin, “Strategy for strengthening the characteristics of students in tsanawiyah madrasa,” Pappaseng Int. J. Islam. Lit. Soc., vol. 1, no. 1, pp. 13–22, 2022, doi: 10.56440/pijils.v1i1.6. DOI: https://doi.org/10.56440/pijils.v1i1.6
    49. Lukman et al., “Effective teachers’ personality in strengthening character education,” Int. J. Eval. Res. Educ., vol. 10, no. 2, pp. 512–521, 2021, doi: 10.11591/ijere.v10i2.21629. DOI: https://doi.org/10.11591/ijere.v10i2.21629
    50. D. J. Hyman, V. N. Pavlik, W. C. Taylor, G. K. Goodrick, and L. Moye, “Simultaneous vs sequential counseling for multiple behavior change,” Arch. Intern. Med., vol. 167, no. 11, pp. 1152–1158, 2007, doi: 10.1001/archinte.167.11.1152. DOI: https://doi.org/10.1001/archinte.167.11.1152
    51. S. Gultom, A. F. Hutauruk, and A. M. Ginting, “Teaching skills of teacher in increasing student learning interest,” Budapest Int. Res. Critics Inst. Humanit. Soc. Sci., vol. 3, no. 3, pp. 1564–1569, 2020, doi: 10.33258/birci.v3i3.1086. DOI: https://doi.org/10.33258/birci.v3i3.1086
    52. M. M. Mugambi, “Inculcating values among learners in schools: An analysis of global practices and approaches,” J. Educ. Train., vol. 9, no. 2, pp, 78-85, 2022, doi: 10.5296/jet.v9i2.20055. DOI: https://doi.org/10.5296/jet.v9i2.20055
    53. G. X. L. Silvederio et al., “Gut microbiome composition and diversity of wild-caught and hatchery-bred milkfish (Chanos chanos) fry,” J. Genet. Eng. Biotechnol., vol. 23, no. 3, pp. 1-8, 2025, doi: 10.1016/j.jgeb.2025.100520. DOI: https://doi.org/10.1016/j.jgeb.2025.100520
    54. Y. Narny, A. Muhajir, and R. Cribb, “Disaster history as a reflection of human–environment relations: An ecological approach to disaster studies in Indonesia,” E3S Web Conf., vol. 677, no. 7, pp. 110–123, 2025, doi: 10.1051/e3sconf/202567711003. DOI: https://doi.org/10.1051/e3sconf/202567711003
    55. B. B. Bekele et al., “Effect of diabetes self-management education (DSME) on glycated hemoglobin (HbA1c) level among patients with T2DM: Systematic review and meta-analysis of randomized controlled trials,” Diabetes Metab. Syndr. Clin. Res. Rev., vol. 15, no. 1, pp. 177–185, 2021, doi: 10.1016/j.dsx.2020.12.030. DOI: https://doi.org/10.1016/j.dsx.2020.12.030
    56. E. K. Odjer and E. K. G. Mensah, “Maternal mortality and legal accountability: Examining government responsibility for preventable deaths,” J. Law Crim. Justice, vol. 13, no. 5, pp. 49–73, 2025, doi: 10.15640/jlcj.v13p4. DOI: https://doi.org/10.15640/jlcj.v13p4
    57. S. Nasir, “Context and reasons of preference for use of traditional birth attendant care in Indonesia and Ethiopia,” Afr. J. Reprod. Health, vol. 29, no. 6, pp. 40–57, 2025, doi: 10.29063/ajrh2025/v29i6.4. DOI: https://doi.org/10.29063/ajrh2025/v29i6.4
    58. P. Adatara, A. Afaya, E. A. Baku, S. M. Salia, and A. Asempah, “Perspective of traditional birth attendants on their experiences and roles in maternal health care in rural areas of northern Ghana,” Int. J. Reprod. Med., vol. 2018, no. 10, pp. 1–10, 2018, doi: 10.1155/2018/2165627. DOI: https://doi.org/10.1155/2018/2165627
    59. S. Sciacchitano et al., “To be frail or not to be frail: This is the question a critical narrative review of frailty,” J. Clin. Med., vol. 13, no. 3, pp. 721–730, 2024, doi: 10.3390/jcm13030721. DOI: https://doi.org/10.3390/jcm13030721
    60. C. A. Ameh, M. Mdegela, S. White, and N. van den Broek, “The effectiveness of training in emergency obstetric care: a systematic literature review,” Health Policy Plan., vol. 34, no. 4, pp. 257–270, 2019, doi: 10.1093/heapol/czz028. DOI: https://doi.org/10.1093/heapol/czz028