Skip to main content
ARS Home » Plains Area » Houston, Texas » Children's Nutrition Research Center » Research » Publications at this Location » Publication #372081
Title: Barriers to and facilitators of iron therapy in children with iron deficiency anemia

Author
item POWERS, JACQUELYN - Baylor College Of Medicine
item NAGEL, MARGARET - Texas Children'S Hospital
item RAPHAEL, JEAN - Baylor College Of Medicine
item MAHONEY, DONALD - Baylor College Of Medicine
item BUCHANAN, GEORGE - University Of Texas Southwestern Medical Center
item Thompson, Deborah - Debbe

Submitted to: Journal of Pediatrics
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 12/18/2019
Publication Date: 1/31/2020
Citation: Powers, J.M., Nagel, M., Raphael, J.L., Mahoney, D.H., Buchanan, G.R., Thompson, D.J. 2020. Barriers to and facilitators of iron therapy in children with iron deficiency anemia. Journal of Pediatrics. 219:202-208. https://doi.org/10.1016/j.jpeds.2019.12.040.
DOI: https://doi.org/10.1016/j.jpeds.2019.12.040

Interpretive Summary: Iron deficiency anemia in young children is associated with undesirable cognitive and health outcomes. Oral iron therapy helps avoid these outcomes, with most patients having a full recovery if they adhere to the treatment for 3-6 months. Unfortunately, adherence is low, often because of the taste and unpleasant effects. Little is known, however, about barriers and facilitators of treatment. Parents identified both barriers and facilitators to adherence. Barriers included difficulty in administering oral iron owing to side effects and poor taste. Facilitators included provision of specific instructions; support from healthcare providers and additional caregivers at home; motivation to benefit child's health, which was strengthened by strong emotional reactions (i.e. stress, anxiety) to therapy and follow-up; and an appreciation of child's improvement with successful completion of therapy. This work revealed that rather than focusing on knowledge content related to iron deficiency anemia, interventions should aim to increase parental motivation by emphasizing the health benefits of adhering to iron therapy and avoiding more invasive interventions.

Technical Abstract: The objective of this study was to characterize barriers to and facilitators of successful iron therapy in young children with iron deficiency anemia (IDA) from an in-depth parental perspective. This was a prospective, mixed methods study of children age 9 months to 4 years with a diagnosis of nutritional IDA by clinical history and laboratory criteria and their parents. Clinical data were obtained from the electronic health record. Semistructured interviews focused on knowledge of IDA, clinical effects, experience with iron therapies, and motivation were conducted with the parent who identified as the child's primary caregiver. Twenty patient-parent dyads completed the study; 80% (n=16) identified as Hispanic/Latino (white). Patients' median age was 23 months (50% male); median initial hemoglobin concentration was 8.2 g/dL and duration of oral iron therapy was 3 months. Parents' median age was 29 years (85% female); 8 interviews (40%) were conducted in Spanish. Barriers included difficulty in administering oral iron owing to side effects and poor taste. Facilitators included provision of specific instructions; support from healthcare providers and additional caregivers at home; motivation to benefit child's health, which was strengthened by strong emotional reactions (i.e. stress, anxiety) to therapy and follow-up; and an appreciation of child's improvement with successful completion of therapy. Our findings support the need for interventions designed to promote oral iron adherence in children with IDA. Rather than focusing on knowledge content related to IDA, interventions should aim to increase parental motivation by emphasizing the health benefits of adhering to iron therapy and avoiding more invasive interventions.