The acceptability of weekly iron-folic acid supplementation and its influencing factors among adolescent school girls in Yogyakarta city: a mixmethods study

Introduction: Indonesia has initiated the weekly iron-folic acid supplementation programme (WIFS) among adolescent school girls since 2016. However, its acceptability needs to be investigated. This study aimed to assess the acceptability of WIFS and its influencing factors. Methods: A mixed-methods study was conducted in six schools in Yogyakarta from January-April 2018. Totally, 211 participants aged 12-18 years were involved in the cross-sectional survey, followed by four focus group discussions (FGDs) and in-depth interviews (IDIs). Body mass index-for-age, haemoglobin, serum ferritin, habitual intake, and acceptability (defined as selfreported iron-folic acid tablet consumption) were assessed. Results: This study reported that 22.3 and 12.4 of the participants were categorised as iron deficient and anaemic, respectively. Almost 90 of participants had received the tablet, but only 62.0 of them reported consuming it. Logistic regression test indicated that the participants were more likely to take the tablet if it tasted good OR (95%CI): 4.66 (1.90-11.43). Meanwhile, motivation for tablet consumption declined when respondents perceived the odour of tablet was unpleasant, reported forgetfulness, lacked peer support, and experienced side effects, with OR (95%CI) of 0.23 (0.07- 0.77), 0.35 (0.13-0.95), 0.30 (0.08-0.58), and 0.04 (0.04-0.39), respectively. The results from FGD and IDIs strengthened the findings that the experience of nausea, organoleptic properties of iron-folic acid tablet, forgetfulness, and mother’s support play important roles in students’ acceptability. Conclusion: This study found moderate acceptability towards the WIFS programme. The inhibiting and reinforcing factors of WIFS acceptability in this study could be considered as inputs for programme improvements in the future.