Abstract：
Balanced energy protein (BEP) supplementation in pregnancy is recommended in the context of undernutrition for the reduction of small-for-gestational age neonates and stillbirths. To inform an effectiveness trial, we evaluated the acceptability of a packaged, ready-to-eat fortified BEP product among women of reproductive age and their health care providers (HCPs) in rural Bangladesh and explored the feasibility of adhering to daily supplementation. We implemented a formative study using focus groups discussions with women (n = 29) and HCPs (n = 17) to introduce the product and investigate components of acceptability. A \"trials of improved practice\" activity was conducted in subset of women (n = 16) to evaluate adherence to BEP over a 2-week period, followed by focus group discussions to identify challenges with adherence and strategies employed. Contributors to BEP acceptability included the product\'s sensory attributes, such as taste, smell and texture; the attractive packaging and informative labelling; and the perceived benefits of use. Participants also identified household and community level factors influencing the adoption of BEP, such as trust in the provider, cultural beliefs on supplement use in pregnancy, and family member tasting and approval. Over the 2-week period, women consumed over 80% of the supplements provided to them and identified strategies for adherence, including visual aids and reminders from family members or providers. HCPs recommended targeted communication messages for mothers-in-law to foster a supportive home environment. Findings informed changes to the BEP product to improve acceptability and shaped the content of communication messages to optimise adherence in a forthcoming effectiveness trial.
摘要：
在营养不足的情况下，建议在怀孕期间补充平衡能量蛋白（BEP），以减少胎龄较小的新生儿和死胎。为了告知有效性试验，我们评估了包装的可接受性，孟加拉国农村育龄妇女及其保健提供者（HCPs）的即食强化BEP产品，并探讨了坚持每日补充的可行性。我们使用焦点小组讨论与女性（n=29）和HCP（n=17）进行了形成性研究，以介绍产品并研究可接受性的组成部分。在女性亚组（n=16）中进行了“改进实践试验”活动，以评估2周内对BEP的依从性，接下来是焦点小组讨论，以确定依从性和采用策略的挑战。BEP可接受性的贡献者包括产品的感官属性，比如味道，气味和质地；有吸引力的包装和信息标签；以及使用的感知益处。参与者还确定了影响BEP采用的家庭和社区层面因素，比如对提供者的信任，关于怀孕期间使用补充剂的文化信仰，和家庭成员品尝和认可。在2周的时间里,女性服用了80%以上的补充剂，并确定了依从性策略，包括来自家庭成员或提供者的视觉辅助和提醒。HCP建议向岳母提供有针对性的交流信息，以营造支持性的家庭环境。研究结果为BEP产品的变更提供了信息，以提高可接受性，并塑造了通信消息的内容，以优化即将进行的有效性试验的依从性。
