Barriers and facilitators of adolescents’ adherence to iron and vitamin D supplementation: a qualitative study

Abstract

Iron and vitamin D deficiencies remain important public health concerns among adolescents. Despite the implementation of school-based supplementation programs in Iran, adherence to supplement use remains suboptimal. This study explored school health professionals’ perspectives on the barriers and facilitators influencing adolescents’ adherence to iron and vitamin D supplementation programs from the perspectives of school nurses and nutritionists. A qualitative study was conducted in Kermanshah, Iran, using conventional content analysis. Data were collected through semi-structured interviews with 18 healthcare providers, including school nurses and nutritionists. Interviews were transcribed verbatim and analyzed using MAXQDA software. Data trustworthiness was ensured using Lincoln and Guba’s criteria, and reporting followed COREQ. Analysis of the data resulted in two overarching themes, five categories, and seventeen subcategories. The overarching themes were barriers to adolescent supplement use and facilitators of adolescent supplement adherence. According to healthcare providers, the main perceived barriers included limited awareness, misconceptions, fear of side effects, forgetfulness, weak parental support, peer influence, limited provider–student communication, reliance on social media, and inconsistent program delivery. Key facilitators included needs-based education, trust-building communication, parental involvement, structured monitoring, reminder strategies, and support from teachers and student health ambassadors. Participants perceived that trust influenced several of the identified barriers and facilitators of adherence across different contexts. From the perspectives of school nurses and nutritionists, adolescents’ adherence appears to be influenced by interacting individual, interpersonal, school, and organizational factors by interacting individual, interpersonal, school, and organizational factors. These findings suggest that improving adherence requires multilevel interventions that strengthen health education, enhance communication among healthcare providers, schools, adolescents, and families, increase parental involvement, and support the consistent implementation of school-based supplementation programs. Future research should incorporate the perspectives of adolescents, parents, teachers, and policymakers to develop more comprehensive strategies for improving adherence.