{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T15:00:51Z","timestamp":1792681251921,"version":"4.5.0"},"reference-count":35,"publisher":"Wiley","issue":"S6","license":[{"start":{"date-parts":[[2023,11,22]],"date-time":"2023-11-22T00:00:00Z","timestamp":1700611200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Maternal &amp; Child Nutrition"],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Balanced energy protein (BEP) supplementation in pregnancy is recommended in the context of undernutrition for the reduction of small\u2010for\u2010gestational age neonates and stillbirths. To inform an effectiveness trial, we evaluated the acceptability of a packaged, ready\u2010to\u2010eat fortified BEP product among women of reproductive age and their health care providers (HCPs) in rural Bangladesh and explored the feasibility of adhering to daily supplementation. We implemented a formative study using focus groups discussions with women (<jats:italic>n<\/jats:italic>\u2009=\u200929) and HCPs (<jats:italic>n<\/jats:italic>\u2009=\u200917) to introduce the product and investigate components of acceptability. A \u201ctrials of improved practice\u201d activity was conducted in subset of women (<jats:italic>n<\/jats:italic>\u2009=\u200916) to evaluate adherence to BEP over a 2\u2010week period, followed by focus group discussions to identify challenges with adherence and strategies employed. Contributors to BEP acceptability included the product's sensory attributes, such as taste, smell and texture; the attractive packaging and informative labelling; and the perceived benefits of use. Participants also identified household and community level factors influencing the adoption of BEP, such as trust in the provider, cultural beliefs on supplement use in pregnancy, and family member tasting and approval. Over the 2\u2010week period, women consumed over 80% of the supplements provided to them and identified strategies for adherence, including visual aids and reminders from family members or providers. HCPs recommended targeted communication messages for mothers\u2010in\u2010law to foster a supportive home environment. Findings informed changes to the BEP product to improve acceptability and shaped the content of communication messages to optimise adherence in a forthcoming effectiveness trial.<\/jats:p>","DOI":"10.1111\/mcn.13587","type":"journal-article","created":{"date-parts":[[2023,11,24]],"date-time":"2023-11-24T00:19:39Z","timestamp":1700785179000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Acceptability of a balanced energy protein (BEP) supplement for pregnant women in Bangladesh"],"prefix":"10.1111","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8457-0259","authenticated-orcid":false,"given":"Eleonor","family":"Zavala","sequence":"first","affiliation":[{"name":"Department of International Health Bloomberg School of Public Health, Johns Hopkins University Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atiya","family":"Rahman","sequence":"additional","affiliation":[{"name":"Humanitarian Hub James P. Grant School of Public Health, BRAC University Dhaka Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6143-8634","authenticated-orcid":false,"given":"Anna","family":"Kalbarczyk","sequence":"additional","affiliation":[{"name":"Department of International Health Bloomberg School of Public Health, Johns Hopkins University Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary","family":"de Boer","sequence":"additional","affiliation":[{"name":"Department of International Health Bloomberg School of Public Health, Johns Hopkins University Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nazrana","family":"Khaled","sequence":"additional","affiliation":[{"name":"Humanitarian Hub James P. Grant School of Public Health, BRAC University Dhaka Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barnali","family":"Chakraborty","sequence":"additional","affiliation":[{"name":"Humanitarian Hub James P. Grant School of Public Health, BRAC University Dhaka Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hafizur","family":"Rahman","sequence":"additional","affiliation":[{"name":"The JiVitA Maternal and Child Health and Nutrition Research Project Rangpur Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hasmot","family":"Ali","sequence":"additional","affiliation":[{"name":"The JiVitA Maternal and Child Health and Nutrition Research Project Rangpur Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rezwanul","family":"Haque","sequence":"additional","affiliation":[{"name":"The JiVitA Maternal and Child Health and Nutrition Research Project Rangpur Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaniz","family":"Ayesha","sequence":"additional","affiliation":[{"name":"The JiVitA Maternal and Child Health and Nutrition Research Project Rangpur Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Towfida J.","family":"Siddiqua","sequence":"additional","affiliation":[{"name":"Department of International Health Bloomberg School of Public Health, Johns Hopkins University Baltimore Maryland USA"},{"name":"The JiVitA Maternal and Child Health and Nutrition Research Project Rangpur Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaosar","family":"Afsana","sequence":"additional","affiliation":[{"name":"Humanitarian Hub James P. Grant School of Public Health, BRAC University Dhaka Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Parul","family":"Christian","sequence":"additional","affiliation":[{"name":"Department of International Health Bloomberg School of Public Health, Johns Hopkins University Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew L.","family":"Thorne\u2010Lyman","sequence":"additional","affiliation":[{"name":"Department of International Health Bloomberg School of Public Health, Johns Hopkins University Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,11,22]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.12050"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.11648\/j.ajls.20130103.13"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1080\/03670240600846336"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2019-002186"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu10081073"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/cdn\/nzab046_037"},{"key":"e_1_2_10_8_1","unstructured":"Harding K. L. Matias S. L. Moniruzzaman M. Stewart C. P. Mridha M. K. Vosti S. A. &Dewey K. G.(2014).Rang\u2010Din Nutrition Study: Assessment of participant adherence to lipid\u2010based nutrient and iron\u2010folic acid supplements among pregnant and lactating women in the context of a study on the effectiveness of supplements in Bangladesh. Retrieved fromhttps:\/\/www.fantaproject.org\/sites\/default\/files\/resources\/Bangladesh-Adherence-LNS_Sept2014.pdf"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1368980017000672"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-3156.1996.d01-53.x"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40795-019-0298-3"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1177\/156482650502600402"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-016-1039-0"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.13134"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/nqac051"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.13336"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.13306"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.7717\/peerj.13633"},{"key":"e_1_2_10_19_1","unstructured":"Manoff Group. (2006).Trials of Improved Practices (TIPs): Giving participants a voice in program design. Retrieved fromhttps:\/\/www.manoffgroup.com\/slug\/tips-giving-participants-a-voice-in-program-design\/"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.12331"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.21955\/gatesopenres.1116379.1"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1368980008003765"},{"key":"e_1_2_10_23_1","volume-title":"Bangladesh Demographic and Health Survey 2017\u201318","author":"National Institute of Population Research and Training (NIPORT) & ICF","year":"2020"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0221691"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD000032.pub3"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.12244"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.2196\/37309"},{"key":"e_1_2_10_28_1","unstructured":"The World Bank Office Dhaka. (2005).The Bangladesh Integrated Nutrition Project\u2014Effectiveness and Lessons. Retrieved fromhttps:\/\/documents1.worldbank.org\/curated\/en\/592641468013784606\/pdf\/355580BDS80Bd01tionProject01PUBLIC1.pdf"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzm042"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1093\/cdn\/nzy080"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.13408"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2014.16819"},{"key":"e_1_2_10_33_1","volume-title":"Acceptability of a Lipid\u2010based Nutrient Supplement (LNS) in FDMN (Rohingya) camps, Cox's Bazar, Bangladesh","author":"World Food Programme","year":"2021"},{"key":"e_1_2_10_34_1","volume-title":"WHO recommendations on antenatal care for a positive pregnancy experience","author":"World Health Organization","year":"2016"},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.3945\/jn.109.113498"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.1186\/s41043-016-0059-8"}],"container-title":["Maternal &amp; Child Nutrition"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/mcn.13587","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,30]],"date-time":"2024-09-30T04:40:52Z","timestamp":1727671252000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/mcn.13587"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,22]]},"references-count":35,"journal-issue":{"issue":"S6","published-print":{"date-parts":[[2024,10]]}},"alternative-id":["10.1111\/mcn.13587"],"URL":"https:\/\/doi.org\/10.1111\/mcn.13587","archive":["Portico"],"relation":{},"ISSN":["1740-8695","1740-8709"],"issn-type":[{"value":"1740-8695","type":"print"},{"value":"1740-8709","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,22]]},"assertion":[{"value":"2023-07-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-10-24","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-11-22","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e13587"}}