Factors Influencing Acceptance of Microalgae-Based Iron Supplements in Romanian Adults With Self-Reported Iron-Deficiency Anemia: A Cross-Sectional Study.

Microalgae-derived iron preparations are entering clinical discourse as a potentially better-tolerated alternative to conventional ferrous salt supplementation, which fails a substantial proportion of the approximately 571 million women globally affected by iron-deficiency anemia (IDA) due to gastrointestinal adverse effects. Yet translational readiness requires more than biological efficacy data it requires knowing whether patients would actually accept such preparations under realistic informational conditions. No study has addressed this question in a defined IDA population. We conducted a cross-sectional online survey among 71 Romanian adults with physician-diagnosed IDA and prior oral iron experience, measuring informed acceptance assessed only after participants received standardized clinical information, including current evidence limitations, using a validated 5-item composite score (ACC_score; α = 0.801). Health Belief Model (HBM) constructs, complementary and alternative medicine (CAM) attitudes, motivators, adverse-effect burden, and physician trust were examined as predictors via Spearman correlations and ordinary least squares regression. Acceptance was high overall (ACC_score = 20.68, SD = 3.25) though concentrated near the scale ceiling (IQR = 19-23), limiting variability in the outcome and likely attenuating observed associations. The multivariate model explained 63.8% of variance (p < 0.001); self-efficacy showed the strongest standardized association in the primary OLS model (β = 0.384), followed by perceived barriers (β = -0.275), CAM attitudes (β = 0.248), and perceived susceptibility (β = 0.229) though self-efficacy did not reach statistical significance in a binary logistic sensitivity analysis (OR = 4.01, p = 0.058), most likely reflecting information loss from outcome dichotomization. Critically, among individual barrier items, only the lack of long-term evidence reached statistical significance a specific, addressable target for patient communication. Notably, safety concerns about current iron formulations were positively, not negatively, associated with acceptance, consistent with an activated patient profile in which dissatisfaction with tolerability motivates alternative-seeking. The sample was highly selected (95.8% female and 91.5% university educated), and the findings should be interpreted as hypothesis-generating and require confirmation in larger, clinically verified, and more representative IDA populations.