{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T16:58:30Z","timestamp":1792429110595,"version":"4.5.0"},"reference-count":27,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2024,10,21]],"date-time":"2024-10-21T00:00:00Z","timestamp":1729468800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Maternal &amp; Child Nutrition"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    For decades, iron\u2010folic acid (IFA) supplements have been provided to pregnant women in Cambodia through antenatal care (ANC) services. However, mounting evidence suggests that multiple micronutrient supplements (MMS) are superior to IFA supplements in achieving positive pregnancy outcomes. The possibility of transitioning from IFA supplements to MMS in government\u2010run health centres is currently being assessed in Cambodia. A crucial component of this assessment involves identifying factors that can influence adherence to MMS, as low adherence can reduce supplement effectiveness. Consequently, this study aimed to explore the potential barriers and enablers to MMS adherence and identify the strengths and challenges of current ANC services. Data were collected through nine focus group discussions with pregnant women (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200919), family members (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200918) and midwives (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200918) and three in\u2010depth interviews with maternal and child health chiefs (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u20093) in Cambodia and analysed via content analysis. Factors found to influence MMS adherence included attitudes, perceptions and beliefs about MMS; knowledge related to supplementation; ANC counselling; family influence; physical health; access to ANC; supply of MMS; and supplementation norms. Noted strengths of ANC services were the quality of ANC materials, tailored patient education, midwife\u2013patient relationships and flexibility of provided services. Primary challenges related to poor availability of ANC materials, inadequate midwife training, heavy workload, limited funding and suboptimal physical spaces for delivering ANC services. To effectively promote MMS adherence, strategies must involve pregnant women, family members and community leaders; seek to address knowledge gaps and misconceptions related to MMS; and enhance the availability and accessibility of ANC services.\n                  <\/jats:p>","DOI":"10.1111\/mcn.13745","type":"journal-article","created":{"date-parts":[[2024,10,21]],"date-time":"2024-10-21T08:04:20Z","timestamp":1729497860000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Exploring factors affecting adherence to multiple micronutrient supplementation during pregnancy in Cambodia: A qualitative analysis"],"prefix":"10.1111","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6493-1339","authenticated-orcid":false,"given":"Jocelyne M.","family":"Labont\u00e9","sequence":"first","affiliation":[{"name":"Interdisciplinary School of Health Sciences University of Ottawa  Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mai\u2010Anh","family":"Hoang","sequence":"additional","affiliation":[{"name":"Helen Keller Intl, Asia Pacific Manila Philippines"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aishwarya","family":"Panicker","sequence":"additional","affiliation":[{"name":"Vitamin Angel Alliance Goleta California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hou","family":"Kroeun","sequence":"additional","affiliation":[{"name":"Helen Keller Intl, Cambodia Country Office, Phnom Penh  Cambodia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meng","family":"Sokchea","sequence":"additional","affiliation":[{"name":"Helen Keller Intl, Cambodia Country Office, Phnom Penh  Cambodia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sreang","family":"Sambo","sequence":"additional","affiliation":[{"name":"Helen Keller Intl, Cambodia Country Office, Phnom Penh  Cambodia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vin","family":"Sokhal","sequence":"additional","affiliation":[{"name":"Vitamin Angel Alliance Goleta California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cassandra","family":"Sauer","sequence":"additional","affiliation":[{"name":"Food, Nutrition and Health The University of British Columbia Vancouver Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary","family":"Chea","sequence":"additional","affiliation":[{"name":"Ministry of Health Phnom Penh Cambodia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Crystal D.","family":"Karakochuk","sequence":"additional","affiliation":[{"name":"Food, Nutrition and Health The University of British Columbia Vancouver Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,10,21]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/nyas.14121"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1037\/0003-066X.32.7.513"},{"key":"e_1_2_10_4_1","volume-title":"Focusing on multiple micronutrient supplements in pregnancy: Second edition","author":"Busch\u2010Hallen J.","year":"2023"},{"key":"e_1_2_10_5_1","volume-title":"Focusing on multiple micronutrient supplements in pregnancy: Second edition","author":"Dacius M.","year":"2023"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2648.2007.04569.x"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13063-023-07891-z"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD004905.pub6"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare11050713"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu8040172"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2020.103632"},{"key":"e_1_2_10_12_1","volume-title":"Focusing on multiple micronutrient supplements in pregnancy, (2nd ed., p. 45)","author":"Mwangi M. N.","year":"2023"},{"key":"e_1_2_10_13_1","unstructured":"National Institute of Statistics Cambodia Ministry of Health Cambodia & ICF. (2023).Cambodia demographic and health survey 2021\u201322[Final Report].https:\/\/dhsprogram.com\/pubs\/pdf\/FR377\/FR377.pdf"},{"key":"e_1_2_10_14_1","unstructured":"National Institute of Statistics Directorate General for Health & ICF International. (2015).Cambodia demographic and health survey2014.https:\/\/dhsprogram.com\/publications\/publication-FR312-DHS-Final-Reports.cfm"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD004736.pub5"},{"issue":"1","key":"e_1_2_10_16_1","first-page":"85","article-title":"Socio\u2010ecological model as a framework for overcoming barriers and challenges in randomized control trials in minority and underserved communities","volume":"3","author":"Salihu H. 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(2021).Formative research for the introduction of multiple micronutrient supplements in Bangladesh.https:\/\/hmhbconsortium.org\/knowledge-hub\/formative-research-for-the-introduction-of-multiple-micronutrient-supplements-in-bangladesh\/"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pgph.0001310"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu8050290"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1093\/jn\/nxy279"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2125.2012.04167.x"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0005814"},{"key":"e_1_2_10_27_1","unstructured":"World Health Organization. (2012).Guideline: Daily iron and folic acid supplementation in pregnant women.https:\/\/www.who.int\/publications-detail-redirect\/9789241501996"},{"key":"e_1_2_10_28_1","unstructured":"World Health Organization. (2020).WHO antenatal care recommendations for a positive pregnancy experience.Nutritional interventions update: Multiple micronutrient supplements during pregnancy.https:\/\/www.who.int\/publications\/i\/item\/9789240007789"}],"container-title":["Maternal &amp; Child Nutrition"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/mcn.13745","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,17]],"date-time":"2024-12-17T05:00:46Z","timestamp":1734411646000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/mcn.13745"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,21]]},"references-count":27,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,1]]}},"alternative-id":["10.1111\/mcn.13745"],"URL":"https:\/\/doi.org\/10.1111\/mcn.13745","archive":["Portico"],"relation":{},"ISSN":["1740-8695","1740-8709"],"issn-type":[{"value":"1740-8695","type":"print"},{"value":"1740-8709","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,21]]},"assertion":[{"value":"2024-05-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-10-01","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-10-21","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e13745"}}