Dietary folate education versus once-weekly iron folic acid supplementation for improving folate status in reproductive-aged women: a quasi-experimental study

Background: The folate status of women of reproductive age (WRA) in Thailand is suboptimal for reducing risk of neural tube defects (NTD). This research aimed to compare the effect of dietary folate education based on the health belief model and once-weekly iron folic acid (IFA) supplementation on folate status. Methods: This was a pre-post-test 12-week quasi-experimental study with three groups: (1.) dietary folate education program (30-min, once-weekly), (2.) 2.8 mg folic acid + 60 mg iron (IFA supplement, once-weekly), or (3.) comparison group (no intervention). Participants were WRA recruited from three factories. Knowledge, perceptions (susceptibility, severity, benefits, and barriers), self-efficacy, and cues to action in relation to folate and NTD, together with dietary folate intake, and red blood cell (RBC) folate concentration were evaluated at pretest (week 0) and post-test (week 13). The generalized estimated equation was used to analyze within-group and between-group differences at post-test, after adjusting for covariates. Results: Twenty-three, 25, and 18 participants completed the study in the dietary folate education, IFA supplementation and comparison groups, respectively. Perceived barriers remained unchanged in the folate education group at post-test, and the mean (95% CI) increase in dietary folate intake from pretest to post-test in the folate education group was only 53.0 µg/day, after adjustment for covariates. The change in RBC folate concentration at post-test in the folate education and comparison groups did not differ (-23.1 (-29.8, 67.5) nmol/L; p = 0.307). In contrast, the IFA supplementation group showed an increase in RBC folate concentration from pretest to post-test that was 49.2 (2.7, 95.6) nmol/L greater than the comparison group (p = 0.038). Conclusions: Folate status did not improve after a dietary folate education program for 12-weeks, which could have been partly because of the intervention’s limitations. Future education programs may consider a longer intervention duration and larger sample size. Reducing perceived barriers may also facilitate behavior change. Once-weekly IFA supplementation (2.8 mg folic acid per week) for 12 weeks might contribute to an improvement in folate status in non-pregnant women in a real-world setting. However, the findings should be interpretated with caution in view of study limitations. Trial registration: ISRCTN13360510 Registered 26/11/2025 Retrospectively registered.