Iron Supplementation Adherence and Satisfaction Among Adolescent Girls Following Point-of-Care Quality Improvement in an Indonesian Community Health Center Program: An Uncontrolled Pre–Post Study

Lani Gumilang,1 Raden Tina Dewi Judistiani,2 Meita Dhamayanti,3 Desy Linasari,4 Budi Handono51Doctoral Study Program, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia; 2Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia; 3Department of Child Health, Hasan Sadikin Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia; 4Department of Public Health, Faculty of Medicine, Universitas Jenderal Achmad Yani, Cimahi, West Java, Indonesia; 5Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, IndonesiaCorrespondence: Raden Tina Dewi Judistiani, Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Jalan Eyckman No. 38, Bandung, West Java, Indonesia, Tel +6281 1249 731, Email [email protected]: Indonesia has implemented a nationwide iron supplementation program for adolescent girls, supported by established government guidelines for many years, but adolescent anemia remains a major public health concern. This program struggled with low adherence to iron tablet consumption and other obstacles in the implementation. This study was conducted using the point-of-care quality improvement (POCQI) approach to address these obstacles through problem identification, selection of improvement efforts, and evaluation cycles involving students, teachers, community health center staff and local health authority staff.Purpose: To assess changes in adolescent girls’ adherence and satisfaction following POCQI implementation in a school–community health center program.Patients and methods: This uncontrolled quasi-experimental pre–post study included 144 girls aged 12– 14 years from four schools served by two community health centers in Cianjur Regency, West Java, Indonesia. The one-year study comprised baseline assessment, four months of POCQI implementation, and end-line evaluation. POCQI included training, Plan–Do–Study–Act activities, anemia education, supplementation and laboratory scheduling, and mentoring. Questionnaires assessed adherence and satisfaction. Rasch analysis estimated person and item measures, while Wilcoxon signed-rank tests assessed pre–post differences.Results: Mean Logit Value Person (LVP) increased for adherence from − 2.04 to 3.51 (+5.55 logits) and satisfaction from − 1.50 to 6.28 (+7.79 logits), with both differences significant (p< 0.001). Mean Logit Value Item (LVI) decreased for adherence from 2.57 to − 2.57 (− 5.15 logits) and satisfaction from 3.81 to − 3.81 (− 7.63 logits), also significant (p< 0.001), with lower end-line item locations corresponding to higher-frequency adherence responses and more favorable satisfaction responses.Conclusion: POCQI included anemia education, appropriate laboratory scheduling, guideline-based iron supplementation, and mentorship. Significant increases in adherence and satisfaction were observed following POCQI implementation; however, the absence of a control group precludes causal inference.Keywords: Adolescent health, anemia prevention, iron supplementation, POCQI, Rasch analysis