Is fatigue a cue to obtain iron supplements in Odisha, India? A mixed methods investigation

Abstract

ObjectivesThis study aims to understand if fatigue, the main symptom of anaemia, is a health concern that cues women and their referent groups to obtain iron folic acid supplements.DesignThis is a mixed methods study that consisted of a cross-sectional perceptual mapping and card sorting activity along with 16 focus group discussions with women of reproductive age, mothers-in-law and men. Participants of the perceptual mapping and card sorting activity were asked to compare images of anaemia-related items and concepts. Participants in the focus group discussions were asked about their daily life, aspirations and concerns among women and perceptions of anaemia and iron supplementation in the community. The quantitative data were analysed through multidimensional scaling and analyses of variance in SPSS. The qualitative data were analysed through applied thematic analysis using NVivo.SettingBhubaneswar, Odisha, India.ParticipantsWomen of reproductive age (n=30), mothers-in-law (n=30) and married men (n=30) were randomly selected to participate in the perceptual mapping and card sorting exercise. A separate sample of each group was randomly selected for the focus group discussions (n=148).Primary and secondary outcome measuresWe collected perceptions of dissimilarity between anaemia-related items, including fatigue and medical items; the extent to which these items were perceived as important to health or likable; and qualitative information about gender norms.ResultsCognitive maps and card sorting revealed that fatigue was conceptualised distinctly from items related to medical treatment and that perceptions around fatigue’s importance to health were low. Women from the focus groups reported that fatigue is a regular part of their daily life.ConclusionOur results indicate that fatigue is currently not an adequate cue to seek treatment, perhaps due to the normalisation of fatigue as a part of women’s daily life.

Iron and folic acid consumption and changing social norms: cluster randomized field trial, Odisha, India

“…Beginning in January of 2019, we first conducted a 6-month mixed-method formative research project in two out of eight blocks (Kishorenagar and Athmalik) in Angul district in Odisha, the site of our work. 20 , 21 Blocks are administrative units similar to a postal code. The findings of this research ( Box 2 ) informed the overall project intervention, which was delivered from the beginning of September 2019 until the end of February 2020.…”

Monitor to innovate with feedback loops: process evaluation protocol for an anemia prevention intervention

“…Approval to conduct the study was gained from The Institutional Review Board at The George Washington University (FWA00005945) and the Sigma Science and Research, an IRB located in New Delhi, India (10031/IRB/D/ [18][19]. This trial was registered with Clinical Trial Registry-India (CTRI) (CTRI/2018/10/016186) on 29 October 2018.…”

“…Several studies have examined supply side issues to IFA consumption [10][11][12][13] , but studies on demand side challenges including knowledge and social barriers are limited 14 . Recently, researchers have begun to ask questions about the role that community-level factors, such as social and gender norms, can play in women's IFA consumption [15][16][17][18] . The Reduction in Anemia Through Normative Innovations (RANI) project seeks to bridge this gap with a multilevel intervention focused on increasing demand for IFA by influencing anemia-related social norms 19 .…”

mHealth for Anemia Reduction: Protocol for an Entertainment Education–Based Dual Intervention

“…Low dietary iron intake, reduced iron absorption, and iron loss contribute to iron deficiency among women of reproductive age [ 2 ]. Anemia diminishes work productivity [ 3 , 4 ], increases the risk of adverse birth outcomes [ 5 ], and hinders the healthy development of children of pregnant mothers with anemia [ 6 ]. It is often not explicitly identified by women, but they do report high levels of fatigue [ 3 ].…”