Educational and Behavioral Factors Associated with Iron Deficiency Anemia: A Systematic Review and Bibliometric Synthesis

Abstract

Iron deficiency anemia remains a persistent public health concern worldwide, particularly among adolescents, women of reproductive age, and pregnant women, despite long-standing prevention efforts. While biomedical interventions such as iron supplementation and dietary diversification are well established, their effectiveness is strongly influenced by behavioral and contextual factors. This systematic review synthesized peer-reviewed evidence on knowledge, attitudes, and practices related to iron deficiency anemia to better understand these behavioral dimensions. Following PRISMA guidelines, a comprehensive search of Scopus and Web of Science identified 587 records, of which eleven studies met inclusion criteria for qualitative synthesis after de-duplication, screening, and eligibility assessment. The review integrated thematic analysis with bibliometric mapping to examine both conceptual patterns and intellectual structure of the literature. Findings revealed consistent gaps between general awareness of anemia and actionable knowledge required for effective prevention. Attitudes toward iron supplementation were frequently ambivalent, shaped by fear of side effects, social norms, and trust in health systems. Preventive practices were further constrained by socioeconomic conditions, food availability, household decision-making dynamics, and weaknesses in delivery systems. Educational and programmatic interventions improved knowledge but produced limited and inconsistent effects on sustained behavior when implemented in isolation. Bibliometric analyses corroborated these findings by demonstrating fragmentation between biomedical research, behavioral studies, and implementation-focused work. Overall, the evidence indicates that iron deficiency anemia persists not due to lack of awareness alone, but because of the complex interaction between knowledge, attitudes, structural constraints, and health system factors. Addressing anemia effectively therefore requires integrated strategies that combine practical education, supportive delivery mechanisms, and context-specific behavioral approaches.