Feasibility and Acceptability of a "Click & Collect" WIC Online Ordering Pilot

Barriers and Facilitators to Online Grocery Shopping Among Supplemental Nutrition Assistance Program (SNAP) Participants: A Mixed Method Study

This mixed methods study explored online grocery shopping perceptions by surveying individuals who do and do not receive SNAP benefits (n = 129) and by conducting interviews with SNAP recipients (n = 26) who have grocery shopped online. T-tests assessed survey findings, codebook thematic analysis was used to identify qualitative themes, and results were interpreted collectively. Survey results found no differences in perceptions of online grocery shopping between SNAP and non-SNAP recipients (p-values = 0.2-1.0) and that 97% of SNAP recipients felt comfortable using SNAP online. Five qualitative themes were identified and provided context to the survey results. The study findings can inform policy actions within SNAP.

Vendors' Perceptions and Experiences with WIC Online Shopping Implementation

Background

Online shopping (OS) holds promise for improving the shopping experience for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). However, little is known about vendors' perspectives on implementing OS in the context of WIC.

Objectives

The present study aimed to understand vendors' experiences, needs, and barriers to WIC OS implementation.

Methods

We recruited vendors at various stages of WIC OS planning and implementation (n = 16). Semistructured interviews were conducted, transcribed, and coded using subconstructs of the i-PARIHS framework domains (e.g., Characteristics of the Innovation, recipient, context, and facilitation) to assess determinants related to adoption and implementation of WIC OS among vendors.

Results

Interviewees represented various organizations, including local (n = 5), regional (n = 4), and national (n = 5) entities, along with enablement platforms (n = 2). The interviews yielded themes related to experiences planning and implementing a WIC OS system (n = 7) and perceived needs and barriers (n = 3). Vendors drew on prior experiences with Supplemental Nutrition Assistance Program (SNAP) OS to inform WIC OS projects, stressing the importance of building relationships and collaborating, particularly in technical partnerships, during WIC OS implementation. They also highlighted the value of leveraging existing OS systems to implement WIC OS projects, discussed WIC OS perceived benefits, emphasized the role of educating staff and participants on its usage, and valued WIC OS implementation guidance provided by WIC agencies. Needs and barriers for vendors contemplating WIC OS implementation included the need for evidence of successful implementation of WIC OS projects, understanding current regulatory implications, and appraising existing priorities and financial considerations for adopting and implementing WIC OS.

Conclusions

WIC OS innovations are integral to modernizing the federal food assistance program. The present study highlights the role of vendor engagement, collaboration, guidance from WIC agencies, and knowledge sharing in ensuring WIC OS success. These insights can inform how WIC State agencies engage vendors to implement WIC OS.

A Mixed-Methods Study of Perceived Implementation Challenges for WIC Online Ordering and Transactions

BACKGROUND

Federal food assistance programs are working towards online grocery shopping. Online ordering in Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is emerging following successful implementation in Supplemental Nutrition Assistance Program (SNAP).

OBJECTIVE

To identify anticipated challenges, potential solutions, and expected costs of WIC online ordering.

DESIGN

Cross-sectional, mixed-methods, web-based, survey research.

SUBJECTS AND SETTING

Data were collected from December 2020 to January 2021. Purposeful and snowball sampling included WIC stakeholders involved in developing processes and systems required for WIC online ordering. Respondents represented diverse geographic areas, levels of intraorganizational authority, and WIC benefit card types.

STATISTICAL ANALYSES PERFORMED

The research team used a rapid analysis and lean coding approach to identify emergent themes from open-ended survey responses. Descriptive statistics were used to describe the distribution of responses across themes and stakeholder types.

RESULTS

Respondents (n = 145) described 812 anticipated challenges within 20 themes grouped into five topic areas: rules and regulations; shopping experience; security, confidentiality, fraud, and WIC State agency processes; training, assistance, and education; and equitable access and buy-in. Addressing anticipated regulatory issues were among the few concrete potential solutions described. The two most frequent costs reported were increased staff time and start-up and ongoing technology costs.

CONCLUSIONS

This study identified several, critical anticipated challenges and considerations that will help prepare WIC state agencies for opportunities to expand online ordering to WIC participants.

Perspectives From Urban WIC-Eligible Caregivers to Improve Produce Access

OBJECTIVES

The Farmer's Market Nutrition Program (FMNP) provides fresh, locally grown fruits and vegetables (FV) to eligible participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). However, redemption of FMNP benefits remains low. This qualitative study explores facilitators and barriers to produce access and FMNP redemption for caregivers of WIC-eligible children in Philadelphia during the COVID-19 pandemic.

METHODS

We conducted semistructured phone interviews with caregivers between August and December 2020 to understand experiences with produce access and programming preferences to increase benefit redemption and produce consumption. We used content analysis with constant comparison with code interviews inductively and identified emerging themes through an iterative process.

RESULTS

Participants (n = 30) wanted their children to eat more produce but described barriers to produce access, including limited availability, higher cost, and limited time. The Supplemental Nutrition Assistance Program and WIC benefits improved the ability to purchase produce, but difficulties with electronic benefit transfer and pandemic-related office closures limited use of WIC benefits. Similarly, lack of convenient market locations and hours prohibited use of FMNP benefits. Caregivers described that an ideal food program would be delivery based, low cost, offer a variety of FV, and provide recipes and educational activities.

CONCLUSIONS

WIC-eligible caregivers want their children to eat more produce; however, they face multiple barriers in redeeming their benefits to access fresh produce. Delivery-based, low-cost produce programs may lead to increased produce access as well as benefit use. Future study is needed on feasibility and acceptability of produce delivery options among WIC-eligible families.

Protecting Low-Income Consumers in the Era of Digital Grocery Shopping: Implications for WIC Online Ordering

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is now expected to allow participants to redeem their food benefits online, i.e., via online ordering, rather than only in-store. However, it is unclear how this new benefit redemption model may impact participants' welfare since vendors may have an asymmetric information advantage compared with WIC customers. The WIC online ordering environment may also change the landscape for WIC vendors, which will eventually affect WIC participants. To protect WIC consumers' rights in the new online ordering model, policymakers need an appropriate legal and regulatory framework. This narrative review provides that framework by reviewing the literature, legal treatises, and reports on enforceable laws and regulations in the U.S. relevant to digital marketing. The results identify key issues that may arise with adopting WIC online ordering. This paper suggests "privacy, transparency, and fairness" as guiding principles to protect the welfare of WIC participants in WIC online ordering.

Equity-Promoting Strategies in Online Grocery Shopping: Recommendations Provided by Households of Low Income

OBJECTIVE

To explore barriers and facilitators of online grocery shopping and identify community-driven strategies to promote equity in online food access.

DESIGN

This qualitative study used a purposive recruitment strategy to conduct 11 focus groups and 5 in-depth interviews between November 2020 and March 2021.

SETTING

Data collection was conducted virtually with participants residing in diverse (majority urban) regions of Maryland.

PARICIPANTS

44 primary household food purchasers with young children (aged < 8 years) eligible for the Supplemental Nutrition Assistance Program (SNAP).

PHENOMENON OF INTEREST

Barriers and facilitators of online grocery shopping and strategies elicited by the community to leverage SNAP and online food retailer services to reduce inequities in healthy food access.

ANALYSIS

We coded and analyzed transcripts on the basis of the Socioecological Model, Theory of Planned Behavior, and an Equity-Oriented Framework.

RESULTS

Overall, we identified 10 themes across all socioecological levels, all of which reflected both barriers and facilitators to online shopping: (1) individual: trust of shoppers, technology, (2) interpersonal: spousal/children needs, (3) community: safety and security, (4) organizational: retail experience and food quality, and (5) policy: SNAP and structural inequities. Participant recommendations included improving food access and communication with hired shoppers, implementing more payment/cost-saving options, and offering educational programming for SNAP participants on using benefits online.

CONCLUSIONS AND IMPLICATIONS

Households of low-income identified barriers and facilitators of online grocery shopping across the socioecological levels, emphasizing the need for a multilevel approach to equity promotion. We recommend future work to explore the suggested actionable pathways, which involve delivery providers, grocery stores, nutrition educators, and policymakers leveraging online grocery features (ie, meal planning support) and policies (ie, expansion of the SNAP Online Purchasing Pilot to more retailers) to reducing deterrents (ie, delivery fees waived) for an equity-promoting online grocery environment.

Federal Food Assistance Program Participation during the COVID-19 Pandemic: Participant Perspectives and Reasons for Discontinuing

This study aims to describe reasons for discontinuing participation and experiences participating in the Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC) during the COVID-19 pandemic. We analyzed data from a cross-sectional online survey distributed to a national sample, restricted to (1) households that discontinued participating in SNAP (n = 146) or WIC (n = 149) during the pandemic and (2) households that participated in SNAP (n = 501) or WIC (n = 141) during spring 2021—approximately one year into the pandemic. We conducted thematic analyses of open-ended survey questions and descriptive statistics for Likert-scale items. Themes raised by respondents who discontinued participating in SNAP or WIC included difficulty recertifying and virus exposure concerns. Former WIC participants reported the program was not worth the effort and former SNAP participants reported failing to requalify. Respondents participating in WIC or SNAP during the pandemic mentioned transportation barriers and insufficient benefit value. WIC participants had trouble redeeming benefits in stores and SNAP participants desired improved online grocery purchasing experiences. These results suggest that enhancements to WIC and SNAP, such as expanded online purchasing options, program flexibilities, and benefit increases, can improve program participation to ensure access to critical nutrition supports, especially during emergencies.

State Agencies' Perspectives on Planning and Preparing for WIC Online Ordering Implementation

Online ordering for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has the potential to alleviate some of the barriers faced by WIC participants when shopping with their WIC food benefits. WIC State agencies are the leaders in planning, preparing, implementing, maintaining, and expanding WIC online ordering. Cross-sectional web-based survey research was utilized to identify barriers to implementing WIC online ordering, as well as the support needed to overcome those barriers, from a WIC State agency perspective. Web surveys were administered to 81 WIC State agencies from 31 January 2022 to 1 April 2022. Descriptive statistics, independent samples t-test, and one-way analysis of variance were used to analyze the findings. Open-ended responses were analyzed using a qualitative iterative approach. WIC State agencies noted several barriers to implementing WIC online ordering, including limited staff capacity, WIC retailer interest, and technological capabilities.

Giving Families a Voice for Equitable Healthy Food Access in the Wake of Online Grocery Shopping

Understanding the views of families from low-income backgrounds about inequities in healthy food access and grocery purchase is critical to food access policies. This study explored perspectives of families eligible for the Supplemental Nutrition Assistance Program (SNAP) on healthy food access in physical and online grocery environments. The qualitative design used purposive sampling of 44 primary household food purchasers with children (aged ≤ 8), between November 2020–March 2021, through 11 online focus groups and 5 in-depth interviews. Grounded theory was used to identify community-level perceived inequities, including influences of COVID-19 pandemic, SNAP and online grocery services. The most salient perceived causes of inequitable food access were neighborhood resource deficiencies and public transportation limitations. Rural communities, people with disabilities, older adults, racially and ethnically diverse groups were perceived to be disproportionately impacted by food inequities, which were exacerbated by the pandemic. The ability to use SNAP benefits to buy foods online facilitated healthy food access. Delivery fees and lack of control over food selection were barriers. Barriers to healthy food access aggravated by SNAP included social stigma, inability to acquire cooked meals, and inadequate amount of monthly funds. Findings provide a foundation for policy redesign to promote equitable healthy food systems.

OUP accepted manuscript

Context

Online grocery services are an emerging component of the food system with the potential to address disparities in access to healthy food.

Objective

We assessed the barriers and facilitators of equitable access to healthy foods in the online grocery environment, and the psychosocial, purchasing, and dietary behaviors related to its use among low-income, diverse populations.

Data Sources

Four electronic databases were searched to identify relevant literature; 16 studies were identified.

Results

Barriers to equitable access to healthy food included cost and limited availability of online grocery services in food deserts and rural areas. The expansion of online grocery services and the ability to use nutrition assistance benefits online were equity-promoting factors. Perceived low control over food selection was a psychosocial factor that discouraged online grocery use, whereas convenience and lower perceived stress were facilitators. Findings were mixed regarding healthfulness of foods purchased online. Although few studies assessed diet, healthy food consumption was associated with online grocery use.

Conclusion

Researchers should assess the impact of online grocery shopping on low-income families’ food purchases and diet.

Systematic Review Registration

PROSPERO registration no. CRD: 42021240277