Abstract
Iron deficiency anemia in pregnancy remains a major maternal health problem, particularly among women who combine pregnancy with paid work. Work schedules, fatigue, stress and limited access to individualized counseling may reduce adherence to iron supplementation. This study evaluated whether persuasive health education could improve iron supplement adherence among working pregnant women with anemia in Sidoarjo, Indonesia. A convergent parallel mixed-method design was used. The quantitative component applied a quasi-experimental pretestposttest control group design involving 120 working pregnant women with mild to moderate anemia, with 60 participants in the intervention group and 60 participants in the control group. Random allocation was not feasible because the education sessions were delivered through workplace and community health units. Therefore, matched allocation was used to reduce baseline imbalance. The intervention consisted of four small-group sessions designed from the Elaboration Likelihood Model and Social Cognitive Theory. These sessions used message relevance, visual explanation, storytelling, role-play, feedback, goal setting, peer support and WhatsApp reminders. Quantitative data were collected at baseline and four weeks after the intervention. Semi-structured interviews were conducted with 20 participants from the intervention group. ANCOVA and paired tests showed significant improvements in adherence, hemoglobin level, self-efficacy and perceived stress in the intervention group compared with the control group. Cohen’s d values ranged from 0.58 to 0.82, indicating moderate to large effects. Qualitative themes explained these results through message relevance, emotional resonance, self-efficacy, practical routine formation and peer support. The findings suggest that theory-based persuasive health education can strengthen short-term adherence behavior among working pregnant women with anemia.
Keywords: Iron Supplementation, Maternal Anemia, Persuasive Health Education, Self-efficacy, Working Pregnant Women.