Examining intentions to take iron supplements to inform a behavioral intervention: The Reduction in Anemia through Normative Innovations (RANI) project.
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2021
2021
Historique:
received:
21
09
2020
accepted:
23
03
2021
entrez:
11
5
2021
pubmed:
12
5
2021
medline:
13
10
2021
Statut:
epublish
Résumé
More than half of women of reproductive age in India have anemia. Over the last decade, India has made some progress towards reducing anemia in pregnant women, but non-pregnant women, who make up the largest sub group of people with anemia, are largely disregarded. The objective of this paper is to examine intentions to take iron supplements and factors associated with intentions to inform a social norms-based behavioral intervention to increase uptake of iron supplements and reduce anemia in Odisha, India. We collected data from 3,914 randomly sampled non-pregnant women of reproductive age in 81 villages. We conducted a survey and took hemocue (anemia level) readings from each participant. We analyzed data using linear regression models beginning with demographics and social norms and adding other factors such as self-efficacy to take iron supplements, anemia risk perception, and knowledge about anemia in a subsequent model. 63% of women in our sample were anemic but less than 5% knew they were anemic. Despite national guidelines that all women of reproductive age should take weekly iron supplements to prevent anemia, less than 3% of women in our sample were currently taking them. While actual use was low, intentions were rather high. On a five point Likert scale where higher numbers meant more intentions to take supplements, average intentions were above the midpoint (M = 3.48, SD = 1.27) and intentions and iron supplement use were significantly correlated (r = .10, p < .001). Both injunctive norms and collective norms were associated with intentions to take iron supplements but descriptive norms were not. Other significant factors included age, breastfeeding, knowledge, self-efficacy, and outcome expectations. The final model accounted for 74% of the variance in iron supplement intentions. In this context, where the actual behavior is low but intentions to enact the behavior are high, starting an intervention with injunctive norms messaging (expectations around the behavior) and self-efficacy to enact the behavior is the step we recommend based on our results. As an intervention unfolds and iron supplement use increases, descriptive norms messaging (that people are indeed taking iron supplements) may add value.
Sections du résumé
BACKGROUND
More than half of women of reproductive age in India have anemia. Over the last decade, India has made some progress towards reducing anemia in pregnant women, but non-pregnant women, who make up the largest sub group of people with anemia, are largely disregarded.
OBJECTIVES
The objective of this paper is to examine intentions to take iron supplements and factors associated with intentions to inform a social norms-based behavioral intervention to increase uptake of iron supplements and reduce anemia in Odisha, India.
METHODS
We collected data from 3,914 randomly sampled non-pregnant women of reproductive age in 81 villages. We conducted a survey and took hemocue (anemia level) readings from each participant. We analyzed data using linear regression models beginning with demographics and social norms and adding other factors such as self-efficacy to take iron supplements, anemia risk perception, and knowledge about anemia in a subsequent model.
RESULTS
63% of women in our sample were anemic but less than 5% knew they were anemic. Despite national guidelines that all women of reproductive age should take weekly iron supplements to prevent anemia, less than 3% of women in our sample were currently taking them. While actual use was low, intentions were rather high. On a five point Likert scale where higher numbers meant more intentions to take supplements, average intentions were above the midpoint (M = 3.48, SD = 1.27) and intentions and iron supplement use were significantly correlated (r = .10, p < .001). Both injunctive norms and collective norms were associated with intentions to take iron supplements but descriptive norms were not. Other significant factors included age, breastfeeding, knowledge, self-efficacy, and outcome expectations. The final model accounted for 74% of the variance in iron supplement intentions.
CONCLUSIONS
In this context, where the actual behavior is low but intentions to enact the behavior are high, starting an intervention with injunctive norms messaging (expectations around the behavior) and self-efficacy to enact the behavior is the step we recommend based on our results. As an intervention unfolds and iron supplement use increases, descriptive norms messaging (that people are indeed taking iron supplements) may add value.
Identifiants
pubmed: 33974640
doi: 10.1371/journal.pone.0249646
pii: PONE-D-20-27062
pmc: PMC8112683
doi:
Substances chimiques
Hemoglobins
0
Iron
E1UOL152H7
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0249646Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
Soc Sci Med. 2002 Aug;55(4):529-44
pubmed: 12188461
Nutrition. 2021 Jan 24;86:111159
pubmed: 33636419
BMC Public Health. 2010 Jul 26;10:438
pubmed: 20659344
Indian J Public Health. 1999 Jan-Mar;43(1):3-5, 16
pubmed: 11243085
Matern Child Nutr. 2017 Jul;13(3):
pubmed: 27502366
Midwifery. 2014 Mar;30(3):e56-63
pubmed: 24246970
Health Psychol Rev. 2016 Jun;10(2):148-67
pubmed: 25089611
Lancet Glob Health. 2013 Jul;1(1):e16-25
pubmed: 25103581
J Lab Autom. 2013 Jun;18(3):198-205
pubmed: 22961038
BMC Public Health. 2020 Feb 7;20(1):203
pubmed: 32033546
Psychol Rev. 1977 Mar;84(2):191-215
pubmed: 847061
Alcohol Alcohol. 2018 May 1;53(3):326-332
pubmed: 29346480
Eur J Clin Nutr. 2003 Jan;57(1):52-60
pubmed: 12548297
Adv Nutr. 2015 Jan 15;6(1):134-5
pubmed: 25593153
BMC Public Health. 2020 Apr 6;20(1):457
pubmed: 32252698
Pers Soc Psychol Rev. 2016 Aug;20(3):245-68
pubmed: 26162771
Food Nutr Bull. 2009 Dec;30(4):355-69
pubmed: 20496626
Psychol Sci. 2007 May;18(5):429-34
pubmed: 17576283
Health Commun. 2013;28(5):443-51
pubmed: 22809467
Matern Child Nutr. 2012 Jan;8(1):1-18
pubmed: 21978181
J Nutr. 2013 Sep;143(9):1376-82
pubmed: 23884388
Health Commun. 2019 Nov;34(13):1619-1627
pubmed: 30198759
Health Psychol Rev. 2016 Sep;10(3):326-40
pubmed: 26878931
Glob Ment Health (Camb). 2018 Jan 17;5:e2
pubmed: 29435352
J Adolesc Health. 2019 Apr;64(4S):S31-S36
pubmed: 30914165
Public Health Nutr. 2013 Sep;16(9):1667-76
pubmed: 23343620
J Public Health Res. 2013 Jun 26;2(1):31-7
pubmed: 25170478