Exploring Behavioral Interventions to Improve Adherence to Multiple Micronutrient Supplements Among Pregnant Women in Cambodia

Summary

The goal of this mixed method study is to learn how three different behavioral interventions can help pregnant women in Cambodia take a daily multiple micronutrient supplement (MMS) as recommended during pregnancy and to understand how acceptable and useful these interventions are for them. The main questions it aims to answer are:

* How do family support sessions, a tracking calendar, and short educational videos help pregnant women remember to take MMS every day and follow healthy pregnancy practices?
* Which of these three interventions do pregnant women find most helpful and acceptable for supporting daily MMS use?

Researchers will compare the three interventions (family support, tracking calendar, and educational videos) to see which approach best supports high MMS adherence and is most preferred by pregnant women.

Participants will:

* Take MMS tablets every day during pregnancy, starting from early pregnancy.
* Invite two family members to attend a one-hour group session at the health center about MMS and healthy pregnancy, including how families can support daily supplement use.
* Use a culturally tailored tracking calendar at home for three weeks to mark each day they take MMS and see reminders about clinic visits and healthy pregnancy behaviors.
* Receive one short motivational video per week for three weeks via Telegram, featuring midwives who explain MMS, answer common concerns, and encourage daily supplement use.
* Join focus group discussions after each intervention to share their experiences, preferences, and suggestions, and have remaining tablets counted to measure how many doses they took.

Conditions

• Adherence to Care

Interventions

BEHAVIORAL

Family support session

One 1 hour group session at the health center in Khmer for each participant and two self selected family members, facilitated by trained midwives and research staff, covering antenatal care, importance of daily MMS, and specific actions family members can take (reminders, workload support, healthy behaviors); includes interactive discussion and a summary handout for each family member.

BEHAVIORAL

Tracking Calendar

Culturally tailored wall calendar designed by a social marketing group, pretested with pregnant women, with daily visual tick boxes to mark MMS intake, reminders for ANC visits, and illustrated messages on recommended and discouraged pregnancy behaviors; provided with in person orientation on use and kept at home for at least 3 weeks.

BEHAVIORAL

MMS educational video package

Three short Khmer language videos (one per week over 3 weeks) sent via Telegram, featuring midwives providing counseling on daily MMS, managing side effects, healthy pregnancy practices, and the role of family support; scripts developed by the research team and maternal health experts and pretested with pregnant women.

Sponsors & Collaborators

• University of British Columbia

  collaborator OTHER

• Minstry of Health of Cambodia, National Maternal and Child Health Center

  collaborator UNKNOWN

• Ministry of Health of Cambodia, National Nutrition Program

  collaborator UNKNOWN

• Helen Keller International

  lead OTHER

Principal Investigators

• Mai-Anh Hoang, Master of Public Health · Helen Keller Intl

• Kim Rattana, Medical Doctor · Minstry of Health of Cambodia, National Maternal and Child Health Center

Study Design

Allocation

NON_RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

NONE

Model

SEQUENTIAL

Eligibility

Min Age

18 Years

Max Age

45 Years

Sex

FEMALE

Healthy Volunteers

No

Timeline & Regulatory

Start

2024-11-01

Primary Completion

2025-03-30

Completion

2025-03-30

Countries

• Cambodia

Study Locations