Abstract
BackgroundIron deficiency anemia remains as one of the most common nutritional problems in Iran, especially in women and girls. A process evaluation study of the national iron supplementation program targeting girls attending high schools was conducted to examine degree of exposure and satisfaction of the targets with the intervention components, and to assess the delivery (quantity), fidelity (quality), and environmental mediators of the intervention.MethodsThree assessment tools were developed and used for the process evaluation. A total of 8 schools were selected using a simple randomization method. Data were collected from students (n = 658 of 661 participants), teachers (n = 80), and school principals (n = 7 of 8). For the qualitative measures semi-structured interviews were conducted with the three study groups.ResultsMean continuous compliance was 62.3%. Intolerance to pills and no water supply in classrooms accounted for 47.72% and 36.21% of the refusals, respectively. The refusal rate was significantly correlated (p < 0.001) with the absence of a classroom water supply, and with each student’s knowledge of iron deficiency issues (p < 0.05). The odds of refusal in the absence of a classroom water supply were 2.02 (95% CI 1 · 044 to 3 · 900) times greater than for those classrooms with a water supply. Student exposure to the program’s goal was satisfactory; however, delivery and fidelity of educational materials and training sessions were inadequate.ConclusionsThe findings suggest that the methods of delivery and the fidelity of the program components, education materials and training sessions were insufficient and need to be improved. Additionally, specific attention has to be given to contextual factors to ensure the success of the program.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2458-14-959) contains supplementary material, which is available to authorized users.
Highlights
Iron deficiency anemia remains as one of the most common nutritional problems in Iran, especially in women and girls
This paper describes a process evaluation of the Iron Deficiency Control Program (IDCP); reporting on the extent of exposure, reach and satisfaction of the study participants to program components, and identifies the contextual mediators, dose delivered, and fidelity of the intervention program
At the end of these training sessions, schools were requested to transfer the necessary information to the students and to distribute posters or leaflets prepared by the professional health care teams
Summary
Iron deficiency anemia remains as one of the most common nutritional problems in Iran, especially in women and girls. The burden of disease attributable to nutritional insufficiencies has remained substantial in recent decades. In this cluster of diseases, iron deficiency is one of the two leading individual contributors. From the 1970s numerous countries have conducted intervention programs to reduce anemia in pregnant internal factors such as limited access to public health services, insufficient health knowledge, and intolerance to the distributed pills have contributed to a reduction in the efficiency of iron supplemental programs [6,7,8,9]. Many of these interventions have been using only semi-trained staff to deliver the program in various field settings, including schools
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