Effectiveness of a Health Belief Model-based educational intervention on iron-folic acid supplement intake among pregnant women in Southern Afghanistan: a quasi-experimental study

Background: Research indicates that educational interventions are effective in promoting adherence to iron-folic acid (IFA) supplementation during pregnancy. However, evidence from Afghanistan remains limited. This study aimed to assess the effect of a Health Belief Model (HBM)-based educational intervention on IFA supplement intake and related perceptions among pregnant women in Southern Afghanistan. Methods: A quasi-experimental study was conducted among 182 pregnant women attending four purposively selected healthcare centers between 10 December 2025 and 10 March 2026. Participants were non-randomly assigned to the intervention (n = 91) or the control (n = 91) group. The intervention consisted of HBM-based educational sessions, while the control group received routine antenatal care. Outcomes included self-reported weekly IFA supplement intake, HBM construct scores, and hemoglobin level, measured at baseline and post-intervention. Data were analyzed using chi-square tests, t-tests, and Generalized Estimating Equations (GEE). Results: After follow-up, 177 participants (intervention=89; control=88) were included in the analysis. The intervention was associated with a significant increase in weekly IFA supplement intake (β = 1.93, p < 0.001). Significant improvements were also observed in perceived benefits (β = 5.37), susceptibility (β = 3.16), severity (β = 2.18), self-efficacy (β = 3.61), and cues to action (β = 2.58) (all p < 0.001), while perceived barriers decreased significantly (β = −5.99, p < 0.001). On the other hand, the intervention effect on hemoglobin levels was not statistically significant, but the mean hemoglobin concentration (g/dl) in the intervention group (11.23 ± 1.04) was higher than in the control group (10.88 ± 1.20). Conclusion: The HBM-based educational intervention was associated with improved IFA supplement intake and favorable changes in health beliefs among pregnant women in Southern Afghanistan. These findings support the potential value of theory-driven educational interventions to promote maternal nutrition behaviors in low-resource settings.

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