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Impact of Iron-Folic Acid Education on Iron-Folic Acid Supplement Use among Women of Reproductive Age in Nigeria

Abstract

Iron and folic acid supplementation is an important component of maternal and reproductive health programmes because adequate iron and folate intake helps prevent nutritional deficiencies and supports healthy pregnancy outcomes. Women of reproductive age may be at increased risk of iron deficiency and folate deficiency because of menstrual blood loss, inadequate dietary intake, increased nutritional requirements during pregnancy, and other health and socioeconomic factors. Despite the availability of iron-folic acid supplements through healthcare and community programmes, consistent use may remain inadequate because of limited knowledge, misconceptions, concerns about side effects, forgetfulness, cost, limited access to health services, and inadequate counselling. Iron-folic acid education provides an opportunity to improve women's knowledge of the benefits, correct use, potential side effects, and importance of adherence to recommended supplementation. Against this background, this study investigates the impact of iron-folic acid education on iron-folic acid supplement use among women of reproductive age in Nigeria. The study will be anchored on the Health Belief Model, Social Cognitive Theory, and Theory of Planned Behavior. The Health Belief Model explains how women's perceptions of susceptibility to iron and folate deficiency, perceived severity of associated health consequences, perceived benefits of supplementation, perceived barriers, and cues to action may influence supplement use. Social Cognitive Theory emphasizes knowledge, self-efficacy, behavioural reinforcement, social support, and environmental factors in the adoption and maintenance of appropriate supplementation practices. The Theory of Planned Behavior explains how women's attitudes, subjective norms, perceived behavioural control, and behavioural intentions may influence their use of iron-folic acid supplements. Collectively, these theoretical perspectives provide a suitable framework for explaining how iron-folic acid education may influence supplement use among women of reproductive age in Nigeria. The study will adopt a quantitative quasi-experimental or analytical cross-sectional research design. The study population will comprise women of reproductive age attending selected primary healthcare centres, hospitals, maternal and reproductive health clinics, community health programmes, and other relevant settings across Nigeria. A multistage sampling technique will be used to select states, local government areas, communities, healthcare facilities, and eligible women. Iron-folic acid education will be assessed using indicators such as exposure to structured educational sessions, frequency and duration of education, information on the benefits of iron and folic acid, recommended use, timing and dosage as prescribed, possible side effects, management of side effects, consequences of inadequate intake, dietary sources of iron and folate, and the importance of adherence. Iron-folic acid supplement use will be assessed using indicators such as initiation of supplementation where indicated, frequency of use, adherence to prescribed or recommended supplementation, duration of use, missed doses, completion of recommended supplementation, and continuity of use where applicable. Data will be collected using structured questionnaires, supplement records, healthcare records, antenatal or reproductive health registers, and appropriate adherence assessment tools. Descriptive statistics will be used to summarize participants' characteristics, exposure to iron-folic acid education, and patterns of supplement use. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the impact of iron-folic acid education on supplement use. Where a quasi-experimental design is adopted, supplement-use levels before and after the educational intervention will be compared to determine changes associated with the intervention. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that iron-folic acid education has a significant positive impact on iron-folic acid supplement use among women of reproductive age in Nigeria. Women exposed to structured and evidence-based education are expected to demonstrate improved adherence to recommended iron-folic acid supplementation compared with women with limited exposure to supplementation education. Education may improve women's understanding of the importance of iron and folate, correct misconceptions, increase confidence in managing minor side effects, and encourage consistent use of supplements when indicated. Improved knowledge may also encourage women to discuss concerns about supplementation with healthcare providers rather than discontinuing use without professional guidance. However, side effects, supplement availability, financial constraints, forgetfulness, inadequate healthcare counselling, cultural beliefs, and inconsistent access to healthcare facilities may continue to affect supplement use. The study therefore expects accessible, culturally appropriate, practical, and regularly reinforced iron-folic acid education to contribute significantly to improved supplement use among women of reproductive age in Nigeria. The study is expected to contribute to the literature on iron-folic acid education, supplement use, nutritional health, anaemia prevention, folate deficiency prevention, women's reproductive health, maternal health, health education, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, hospitals, primary healthcare centres, healthcare providers, nutritionists, community health workers, women's health organizations, development partners, and policymakers regarding strategies for improving iron-folic acid supplementation. The study will also provide evidence-based recommendations for strengthening nutrition education and counselling, improving availability and accessibility of iron-folic acid supplements, training healthcare providers, addressing misconceptions and concerns about side effects, strengthening follow-up and adherence support, and integrating supplementation education into reproductive and maternal health programmes for women of reproductive age across Nigeria.

Keywords: Iron-folic acid education, iron-folic acid supplements, supplement use, adherence, women of reproductive age, anaemia prevention, folate deficiency, nutritional health, reproductive health, maternal health, Nigeria, public health.