Adherence-Specific Social Support Enhances Adherence to Calcium Supplementation Regimens among Pregnant Women

Abstract

WHO guidelines recommend integrating calcium supplementation into antenatal care (ANC) alongside iron and folic acid (IFA) to reduce maternal mortality. However, supplementation programs face multiple barriers, and strategies to improve adherence are needed. An adherence partner is someone whom pregnant women ask to support adherence at home. This study ) assessed adherence partner acceptability, feasibility, and associations with calcium and IFA supplement adherence and) examined relations between social support and adherence. This secondary analysis is from a trial integrating calcium supplementation into ANC in Kenya. ANC providers were trained on calcium and IFA supplementation and counseling, provided with behavior change materials, and given adequate supplement supplies. Pregnant women from 16 government health facilities were recruited ( = 1036); sociodemographic and adherence data were collected at baseline and at 4- to 6-wk follow-up visits. Adherence was measured with pill counts and self-reports. Culturally adapted scales measured social support in general and specific to adherence. Mixed-effects regression analyses were used to examine factors associated with adherence partners, social support, and adherence. Most participants received information about adherence partners (91%) and had a partner at follow-up (89%). Participants with adherence partners reported higher adherence support (OR: 2.10; 95% CI: 1.32, 3.34). Mean ± SD adherence was high for calcium (88.3% ± 20.7%) and IFA (86.1% ± 20.9%). Adherence support was positively associated with calcium adherence at follow-up by using pill counts (OR: 2.2; 95% CI: 1.1, 2.6) and self-report data (OR: 1.9; 95% CI: 1.2, 2.9), but there was not a direct relation between adherence partners and adherence. Adherence support enhanced adherence to calcium supplements. The adherence partner strategy was highly acceptable and feasible but warrants further study. This research demonstrates the importance of adherence support and suggests that interventions to increase household-level support for antenatal micronutrient supplementation may be needed to implement the WHO guidelines. This trial was registered at clinicaltrials.gov as NCT02238704.

Factors influencing maternal nutrition practices in a large scale maternal, newborn and child health program in Bangladesh

“…In Bangladesh, men traditionally grow and/or purchase the food and are considered the most important decision-makers involving money spending [28], so they often determine what the family eats. Our findings corroborate other study results that documented the influence of husband and family support on micronutrient supplement adherence in Peru [36], Zimbabwe [37] and Kenya [38]. Thus, increasing husband’s and family support to procure and ensure adequate supplements and foods is critical.…”

With adaptation, the WHO guidelines on calcium supplementation for prevention of pre‐eclampsia are adopted by pregnant women

“…Prior studies in this population have demonstrated acceptability of encouragement from relatives (Martin et al, ). Addressing anticipated side effects and encouraging involvement of relatives through comprehensive counselling will be useful in facilitating acceptability and adoption in large scale antenatal supplementation programmes (Martin, Seim, et al, ).…”

“…Recommended calcium supplementation regimen is more complex and daily adherence to a medication regimen is usually affected by the number of times a day the regimen (number of pills) needs to be taken and the duration of medication. Moreover, our earlier research found that pregnant women found IFA supplements more acceptable when counselled about benefits, although they were not familiar with hypertension in pregnancy or pre‐eclampsia as a syndrome (Martin, Omotayo, et al, ). A study in Dhaka has examined relative acceptability of different delivery vehicles for calcium supplementation among pregnant women and concluded that conventional pills (hard tablets that need to be taken with water) were more acceptable than chewable pills in Bangladesh (Baxter et al, ).…”

Social support from nurses and non‐adherence with directly observed therapy (DOTS) maintenance phase among patients with tuberculosis in Metro Manila, Philippines

“…One way they can assist patients is to provide social support, which is defined as the “ transactional communicative process, including verbal and non‐verbal communication, which aims to improve an individual's feelings of coping, competence, belonging, and/or esteem” (Mattson & Hall, , p.184). Social support has shown several benefits related to disease outcomes, including lower stress, better medication intake, and disease screening (Hornstein & Eisenberger, ; Martin et al, ).…”