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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

Authors Nahrisah P, Somrongthong R, Viriyautsahakul N, Viwattanakulvanid P, Plianbangchang S

Received 31 May 2019

Accepted for publication 13 December 2019

Published 15 January 2020 Volume 2020:13 Pages 43—52


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

Putri Nahrisah, 1, 2 Ratana Somrongthong, 1 Napaphan Viriyautsahakul, 1 Pramon Viwattanakulvanid, 1 Samlee Plianbangchang 1

1College of Public Health Sciences, Chulalongkorn University, Pathumwan, Bangkok 10330, Thailand; 2Health Office of Kota Langsa Municipality, Kota Langsa, Province of Aceh, Indonesia

Correspondence: Samlee Plianbangchang
College of Public Health Sciences, Chulalongkorn University, Institute Building 2-3, Soi Chulalongkorn 62, Phyathai Road, Pathumwan, Bangkok 10330, Thailand
Tel +66 2218 8193
Fax +66 2255 6046

Purpose: To determine the effect of individual education through a pictorial handbook on anemia in conjunction with counseling on improving hemoglobin and hematocrit level, birth weight, knowledge, iron-rich food and iron-folic acid (IFA) intake.
Patients and Methods: The study developed a pictorial handbook that was conceptualized based on the Health Belief Model and adjusted to some cultural and local contexts. A quasi-experimental pre-test–post-test control group design was used, purposefully conducted between two homogenous municipalities, each having a rate of anemic pregnancy that was 40% or greater. The sample consists of 140 anemic pregnant women randomly allocated via lottery into two groups; the intervention group (n=70), which received two home visits—one for education and another for a counseling session, and control group (n=70), which received routine antenatal care. A chi-square test and a Mann–Whitney U-test were conducted to compare the baseline socio-demographics. An analysis of covariance (ANCOVA), controlling some possible confounders, was performed to analyze the effect of intervention.
Results: The post-test means of hemoglobin F (1, 132) = 122, p-value < 0.001, and hematocrit levels F (1, 132) = 373, p-value < 0.001, were significantly different and higher in the intervention group compared to the control group. Similar results were found in knowledge, food frequency score, number of IFA intake (with p-value < 0.001), birth weight and daily iron intake from food (with p-value < 0.05). The intervention had a particularly large effect on food frequency score and number of IFA intake, and medium effect on hemoglobin and hematocrit levels.
Conclusion: Individual education through a pictorial handbook on anemia in conjunction with the counseling intervention program had a positive impact on hemoglobin and hematocrit levels for anemic pregnant women in their third trimester of pregnancy.

Keywords: anemia pictorial handbook, health believe model, hemoglobin

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