{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T16:25:47Z","timestamp":1787934347360,"version":"build-2784847793"},"reference-count":33,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T00:00:00Z","timestamp":1770681600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"The Church of Jesus Christ of Latter-day Saints","award":["WE202400045"],"award-info":[{"award-number":["WE202400045"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background\/Objectives: Multiple micronutrient supplements (MMS) are more effective in improving maternal and birth outcomes compared to iron and folic acid (IFA) supplementation during pregnancy. High adherence to MMS is critical to achieving all the anticipated health benefits. Therefore, to ensure successful program implementation of transitioning to MMS in Cambodia, implementation research has been prioritized. The objective of this study was to assess the relevance, acceptability, utility and short-term, exploratory adherence outcomes of three behavioral interventions designed to support adherence to daily MMS intake and to promote healthy pregnancy practices. Methods: This mixed-methods study, conducted in four provinces in Cambodia, involved 12 focus group discussions (FGD) with 36 pregnant women who were exposed to three distinct behavioral interventions (family support, a tracking calendar, and educational videos). FGDs were held after three weeks of exposure to each intervention. Data was analyzed using a COM-B model, with inductive codes added to capture emerging themes. Results: Family support emerged as the most preferred and perceived as the most effective intervention, with participants consistently valuing the presence, encouragement, and practical assistance offered by husbands and other close family members. The second most preferred were educational videos, which were perceived to effectively convey key messages in an engaging, relatable way, overcoming literacy barriers. Finally, the calendar supported habit formation and appealed to first-time mothers but posed challenges for low-literacy users. Across interventions, findings reflect participants\u2019 perceived effectiveness and preferences rather than comparative efficacy. Conclusions: This study provided insights into Cambodian women\u2019s preferences and experiences with three distinct interventions designed to improve adherence over a short-term, 3-week exposure period per intervention. An integrated, multilevel approach that combines family-focused, educational, and system-level strategies is recommended for further piloting and scale-up, with longer-term studies needed to assess comparative efficacy for adherence and health outcomes.<\/jats:p>","DOI":"10.3390\/nu18040583","type":"journal-article","created":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T15:23:14Z","timestamp":1770736994000},"page":"583","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Exploring Behavioral Interventions to Enhance Adherence to Multiple Micronutrient Supplementation Among Pregnant Women in Cambodia: A Mixed-Methods Study"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-0866-7276","authenticated-orcid":false,"given":"Cassandra","family":"Sauer","sequence":"first","affiliation":[{"name":"Food, Nutrition & Health, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meng","family":"Sokchea","sequence":"additional","affiliation":[{"name":"Helen Keller Intl, Phnom Penh, #40, Street 348, Sangkat Toul Svay Prey 1, Khan Boeung Keng Kang, Phnom Penh 120106, Cambodia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sambo","family":"Sreang","sequence":"additional","affiliation":[{"name":"Helen Keller Intl, Phnom Penh, #40, Street 348, Sangkat Toul Svay Prey 1, Khan Boeung Keng Kang, Phnom Penh 120106, Cambodia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hou","family":"Kroeun","sequence":"additional","affiliation":[{"name":"Helen Keller Intl, Phnom Penh, #40, Street 348, Sangkat Toul Svay Prey 1, Khan Boeung Keng Kang, Phnom Penh 120106, Cambodia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vannary","family":"Hun","sequence":"additional","affiliation":[{"name":"Helen Keller Intl, Phnom Penh, #40, Street 348, Sangkat Toul Svay Prey 1, Khan Boeung Keng Kang, Phnom Penh 120106, Cambodia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aman","family":"Sen Gupta","sequence":"additional","affiliation":[{"name":"Helen Keller Intl, Bhyuti Marg, Lalitpur 44700, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kim","family":"Rattana","sequence":"additional","affiliation":[{"name":"National Maternal and Child Health Center, Ministry of Health, Phnom Penh 12202, Cambodia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary","family":"Chea","sequence":"additional","affiliation":[{"name":"National Nutrition Program, Ministry of Health, Phnom Penh 12000, Cambodia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mai-Anh","family":"Hoang","sequence":"additional","affiliation":[{"name":"Helen Keller Intl, One Dag Hammarskjold Plaza Floor, 2nd Ave, New York, NY 10017, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,10]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2016). 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