The Effect of Health Education on Knowledge, Attitude and Practice of Folic Acid Supplementation among Periconceptional Women at the Health Clinic in Kuala Lumpur


  • Norziyana Idris Institute Training Ministry of Health Malaysia 47000 Sungai Buloh, Selangor, Malaysia
  • Sofee Mohamed Akhlak Centre for Nursing Studies Faculty of Health Science, University Teknologi MARA 40450 Shah Alam, Selangor, Malaysia
  • Emad Adel Shdaifat Community Nursing Department, College of Nursing, Imam Abdulrahman Bin Faisal University (IAU), 31441 Dammam, Saudi Arabia
  • Nurul’ Ain Ahayalimudin Department of Critical Care Nursing, Kulliyah of Nursing, International Islamic University, Jalan Hospital Campus, 25710, Kuantan, Pahang, Malaysia



Background: Neural tube defects (NTDs) are congenital abnormalities of the central nervous system that can be prevented by consuming 400 µg of folic acid daily during conception until the twelfth week of pregnancy. Malaysia is experiencing an increase in NTD cases. Addressing women's knowledge, attitudes, and practices regarding folic acid- and folate-rich foods is crucial to reduce the incidence of NTDs.  Objectives: This study aimed to evaluate the impact of a health education program on improving knowledge, attitudes, and practices related to folic acid supplementation among periconceptional women in a community clinic. Methods: A pre- and post-quasi-experimental study was conducted among 114 periconceptional women in two groups. The intervention group received structured Folic Acid supplementation education, while the control group received routine antenatal care. Results: Regarding knowledge, the intervention significantly improved the scores of the intervention group, increasing from 13.40 to 15.39. This improvement was statistically significant, with a mean difference of 1.98 (p < 0.001), large effect size of 0.16, and strong statistical power of 0.89. Meanwhile for attitude, the intervention group experienced a more significant increase in scores, from 25.72 to 27.46. Statistically significant effects were observed (p = 0.031), along with a large effect size 0.26 and relatively high statistical power 0.99. In terms of practice, the intervention group showed a significant improvement, with scores increasing from 27.68 33.16. The findings were significant, with a mean difference of 5.47 (p < 0.001), extreme effect size of 0.74, and strong statistical power of 1.00.  Conclusion: A comprehensive health education program for pregnant women can significantly improve their understanding, attitude, and adherence to folic acid supplementation. In addition, it is essential to promote the consumption of folic acid-fortified foods.


Attitude, Folic Acid, Health Education, Pregnancy Planning, Supplementation, Women


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How to Cite

Idris, N., Akhlak, S. M. ., Shdaifat, E. A. ., & Ahayalimudin, N. A. . (2023). The Effect of Health Education on Knowledge, Attitude and Practice of Folic Acid Supplementation among Periconceptional Women at the Health Clinic in Kuala Lumpur. The Malaysian Journal of Nursing (MJN), 15(2), 59-68.