{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T13:33:54Z","timestamp":1787924034013,"version":"build-2784847793"},"reference-count":17,"publisher":"Belitung Raya Foundation","issue":"4","license":[{"start":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T00:00:00Z","timestamp":1783296000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"This study and its publication were supported by the Indonesian Education\nScholarship, administered by the Center for Higher Education Funding and\nAssessment, Ministry of Higher Education, Science, and Technology of the\nRepublic of Indonesia, and funded through the Indonesian Endowment Fund\nfor Education","award":[""],"award-info":[{"award-number":[""]}]}],"content-domain":{"domain":["belitungraya.org"],"crossmark-restriction":true},"short-container-title":["Belitung Nurs J"],"abstract":"<jats:p>Background: Iron deficiency anemia remains a significant public health concern among pregnant women, particularly in rural areas of low- and middle-income countries. Despite routine antenatal care services and iron\u2013folic acid supplementation programs, adherence to supplementation and effective anemia prevention remain challenging. Understanding how pregnant women and healthcare providers experience and respond to these challenges is essential for strengthening anemia prevention efforts in rural maternal health services.\nObjective: This study aimed to explore the experiences and support needs of pregnant women and healthcare providers in preventing iron deficiency anemia in rural Indonesia.\nMethods: A qualitative descriptive study was conducted in Seluma Regency, Bengkulu Province, Indonesia, between May and August 2025 using in-depth interviews and focus group discussions. A total of 30 participants (18 pregnant women and 12 healthcare providers, consisting of six midwives and six nutritionists) were recruited using purposive sampling through antenatal care services. Data were collected using semi-structured interview guides and analyzed using inductive thematic analysis following Braun and Clarke's approach.\nResults: Three themes emerged from the thematic analysis: (1) understanding anemia beyond symptoms, (2) challenges in maintaining consistent iron\u2013folic acid supplementation, and (3) perceived structural constraints in antenatal counseling. Pregnant women demonstrated limited understanding of anemia beyond physical symptoms, which was compounded by low educational levels prevalent in the sample. Barriers to consistent supplementation included forgetfulness, side effects, and uncertainty about proper tablet intake. Healthcare providers reported that high patient volumes and limited consultation time constrained their ability to deliver comprehensive counseling and follow-up support.\nConclusion: The findings demonstrate that the routine provision of iron\u2013folic acid supplements alone are insufficient to support consistent adherence. Strengthening continuous and practical support within antenatal care through nursing- and midwifery-led education and follow-up is essential to improve anemia prevention in rural maternal health services. Strategies should be tailored to address low health literacy, daily behavioral barriers, and structural service constraints to achieve meaningful improvements in maternal anemia prevention.<\/jats:p>","DOI":"10.33546\/bnj.4588","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T02:17:10Z","timestamp":1787883430000},"page":"544-552","update-policy":"https:\/\/doi.org\/10.33546\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Preventing iron deficiency anemia in rural Indonesia: Experiences and support needs of pregnant women and healthcare providers \u2014 a qualitative descriptive study"],"prefix":"10.33546","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7019-366X","authenticated-orcid":false,"given":"Erli","family":"Zainal","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1366-4431","authenticated-orcid":false,"given":"Sri","family":"Sulistyowati","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5591-8527","authenticated-orcid":false,"given":"Agung","family":"Wibowo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3953-0557","authenticated-orcid":false,"given":"Widiyanto","family":"Widiyanto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"19163","published-online":{"date-parts":[[2026,8,28]]},"reference":[{"key":"161201","doi-asserted-by":"crossref","unstructured":"Arsenault, C., Jordan, K., Lee, D., Dinsa, G., Manzi, F., Marchant, T., & Kruk, M. E. (2018). Equity in antenatal care quality: An analysis of 91 national household surveys. The Lancet Global Health, 6(11), e1186\u2013e1195. https:\/\/doi.org\/10.1016\/S2214-109X(18)30389-9","DOI":"10.1016\/S2214-109X(18)30389-9"},{"key":"161202","doi-asserted-by":"crossref","unstructured":"Balarajan, Y., Ramakrishnan, U., \u00d6zaltin, E., Shankar, A. H., & Subramanian, S. V. (2011). Anaemia in low-income and middle-income countries. The Lancet, 378(9809), 2123\u20132135. https:\/\/doi.org\/10.1016\/S0140-6736(10)62304-5","DOI":"10.1016\/S0140-6736(10)62304-5"},{"key":"161203","doi-asserted-by":"crossref","unstructured":"Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77\u2013101. https:\/\/doi.org\/10.1191\/1478088706qp063oa","DOI":"10.1191\/1478088706qp063oa"},{"key":"161204","doi-asserted-by":"crossref","unstructured":"Desta, M., Kassie, B., Chanie, H., Mulugeta, H., Yirga, T., Temesgen, H., Leshargie, C. T., & Merkeb, Y. (2019). Adherence of iron and folic acid supplementation and determinants among pregnant women in Ethiopia: A systematic review and meta-analysis. Reproductive Health, 16(1), 182. https:\/\/doi.org\/10.1186\/s12978-019-0848-9","DOI":"10.1186\/s12978-019-0848-9"},{"key":"161205","doi-asserted-by":"crossref","unstructured":"Hollowell, J., Oakley, L., Kurinczuk, J. J., Brocklehurst, P., & Gray, R. (2011). The effectiveness of antenatal care programmes to reduce infant mortality and preterm birth in socially disadvantaged and vulnerable women in high-income countries: A systematic review. BMC Pregnancy and Childbirth, 11(1), 13. https:\/\/doi.org\/10.1186\/1471-2393-11-13","DOI":"10.1186\/1471-2393-11-13"},{"key":"161206","unstructured":"Indonesia Ministry of Health. (2020). Pedoman pemberian tablet tambah darah (ttd) bagi ibu hamil [Guidelines for the administration of iron-folic acid (IFA) tablets to pregnant women]. https:\/\/promkes.kemkes.go.id\/pub\/files\/files99516TTD_BUMIL_OK2.pdf"},{"key":"161207","doi-asserted-by":"crossref","unstructured":"Kiwanuka, T. S., Ononge, S., Kiondo, P., & Namusoke, F. (2017). Adherence to iron supplements among women receiving antenatal care at Mulago National Referral Hospital, Uganda-cross-sectional study. BMC Research Notes, 10(1), 510. https:\/\/doi.org\/10.1186\/s13104-017-2834-z","DOI":"10.1186\/s13104-017-2834-z"},{"key":"161208","doi-asserted-by":"crossref","unstructured":"Lincoln, Y. S., Guba, E. G., & Pilotta, J. J. (1985). Naturalistic inquiry. International Journal of Intercultural Relations, 9(4), 438\u2013439. https:\/\/doi.org\/10.1016\/0147-1767(85)90062-8","DOI":"10.1016\/0147-1767(85)90062-8"},{"key":"161209","doi-asserted-by":"crossref","unstructured":"Means, R. T. (2020). Iron deficiency and iron deficiency anemia: Implications and impact in pregnancy, fetal development, and early childhood parameters. Nutrients, 12(2), 447. https:\/\/doi.org\/10.3390\/nu12020447","DOI":"10.3390\/nu12020447"},{"key":"161210","doi-asserted-by":"crossref","unstructured":"Sandelowski, M. (2000). Whatever happened to qualitative description? Research in Nursing & Health, 23(4), 334\u2013340. https:\/\/doi.org\/10.1002\/1098-240X(200008)23:4%3C334::AID-NUR9%3E3.0.CO;2-G","DOI":"10.1002\/1098-240X(200008)23:4<334::AID-NUR9>3.0.CO;2-G"},{"key":"161211","doi-asserted-by":"crossref","unstructured":"Sendeku, F. W., Azeze, G. G., & Fenta, S. L. (2020). Adherence to iron-folic acid supplementation among pregnant women in Ethiopia: A systematic review and meta-analysis. BMC Pregnancy and Childbirth, 20(1), 138. https:\/\/doi.org\/10.1186\/s12884-020-2835-0","DOI":"10.1186\/s12884-020-2835-0"},{"key":"161212","doi-asserted-by":"crossref","unstructured":"Septiono, W., Siagian, F. P., Lazuardi, L., Handayani, S., & Prasetyo, S. (2025). Lessons of practices of community-based maternal and child health surveillance system during and post COVID-19 in Indonesia. Global Health Action, 18(1), 2547438. https:\/\/doi.org\/10.1080\/16549716.2025.2547438","DOI":"10.1080\/16549716.2025.2547438"},{"key":"161213","doi-asserted-by":"crossref","unstructured":"Tong, A., Sainsbury, P., & Craig, J. (2007). Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 19(6), 349\u2013357. https:\/\/doi.org\/10.1093\/intqhc\/mzm042","DOI":"10.1093\/intqhc\/mzm042"},{"key":"161214","unstructured":"WHO. (2016). WHO recommendations on antenatal care for a positive pregnancy experience. Geneva: World Health Organization. https:\/\/www.who.int\/publications\/i\/item\/9789241549912"},{"key":"161215","unstructured":"WHO. (2017). Nutritional anaemias: Tools for effective prevention and control. https:\/\/www.who.int\/publications\/i\/item\/9789241513067"},{"key":"161216","unstructured":"World Health Organization [WHO]. (2025). Anaemia in women and children. https:\/\/www.who.int\/data\/gho\/data\/themes\/topics\/anaemia_in_women_and_children"},{"key":"161217","doi-asserted-by":"crossref","unstructured":"Young, M. F., Oaks, B. M., Tandon, S., Martorell, R., Dewey, K. G., & Wendt, A. S. (2019). Maternal hemoglobin concentrations across pregnancy and maternal and child health: A systematic review and meta\u2010analysis. 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