Improved Information and Educational Messages on Outer Packaging of Micronutrient Powders Distributed in Indonesia Increase Caregiver Knowledge and Adherence to Recommended Use

The objective of this study was to examine the influence of improved information and educational messages on outer packaging of a micronutrient powder (MNP), locally known as " ", on knowledge and adherence to recommended use. A community-based cluster randomized controlled trial was conducted among 1149 caregivers and their children aged 6⁻36 months. Caregiver⁻child dyads were randomized by their villages to receive 30 sachets of with the: (i) original outer packaging; (ii) improved outer packaging; or (iii) improved outer packaging combined with cooking demonstrations. Adherence to use was assessed through caregiver interviews and observation of unused sachets during home visits; "high" adherence was defined as consuming 13⁻17 sachets in the previous month. Data collection included surveys and focus groups discussions. The majority of caregivers (>80%) preferred the improved packaging because it was more attractive and contained more comprehensive information. Caregivers who received the improved packaging had better knowledge regarding the recommended use of ( < 0.001) and higher adherence with the prescribed use of (43% with "high" adherence) ( < 0.001) than those who received the original packaging (29% with "high" adherence). Caregivers who participated in cooking demonstrations generally had better knowledge regarding the benefits of and recommended use, but this did not lead to higher adherence to recommended use. "Underconsumption" of (≤7 sachets) was much less prevalent than "overconsumption" (≥23 sachets), and original packaging users were more likely to consume daily instead of every two days as recommended. We conclude that the design of the outer packaging and comprehensiveness of information provided are important influencers of recommended MNP use by caregivers.