Food cost is the least of my worries: a qualitative study exploring food and beverage purchasing decisions among parents enrolled in the WIC program

WIC Participants' Perspectives of Facilitators and Barriers to Shopping With eWIC Compared With Paper Vouchers

OBJECTIVES

(1) To describe facilitators and barriers to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food shopping via electronic benefits transfer (eWIC) compared with paper vouchers. (2) To explore suggestions that WIC participants had for modifying the program to enhance their overall WIC experience.

DESIGN

Qualitative, semistructured, in-depth interviews.

SETTING

WIC participants in East Tennessee.

PARTICIPANTS

Twenty-four primary food shoppers of WIC-participating households aged at least 18 years were recruited using a purposive sampling strategy.

PHENOMENON OF INTEREST

Perceived facilitators and barriers to use of eWIC as compared with paper vouchers.

ANALYSIS

Interview transcripts were analyzed using a grounded theory approach to identify emergent themes.

RESULTS

Participants identified several ways eWIC has improved their food shopping experience, including ad hoc redemption of WIC benefits and a quicker, more discrete checkout. Participants' chief complaint about eWIC was transaction errors at checkout. Participants identified other barriers to shopping for WIC foods that cannot be addressed by the card alone, such as difficulty identifying WIC items in-store. Participants reported changes to their benefit tracking behaviors and provided suggestions to improve WIC further.

CONCLUSIONS AND IMPLICATIONS

The transition to eWIC was viewed favorably among WIC participants, although participants identified a need for additional support in addressing transaction errors. This finding presents an opportunity to modify messages delivered to WIC participants by WIC nutrition educators and enhance collaboration between WIC agencies, retailers, and e-commerce technology providers.

Associations between Governmental Policies to Improve the Nutritional Quality of Supermarket Purchases and Individual, Retailer, and Community Health Outcomes: An Integrative Review

Supermarkets are natural and important settings for implementing environmental interventions to improve healthy eating, and governmental policies could help improve the nutritional quality of purchases in this setting. This review aimed to: (1) identify governmental policies in the United States (U.S.), including regulatory and legislative actions of federal, tribal, state, and local governments, designed to promote healthy choices in supermarkets; and (2) synthesize evidence of these policies' effects on retailers, consumers, and community health. We searched five policy databases and developed a list of seven policy actions that meet our inclusion criteria: calorie labeling of prepared foods in supermarkets; increasing U.S. Department of Agriculture (USDA) Supplemental Nutrition Assistance Program (SNAP) benefits; financial incentives for the purchase of fruit and vegetables; sweetened beverage taxes; revisions to the USDA Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food package; financial assistance for supermarkets to open in underserved areas; and allowing online purchases with SNAP. We searched PubMed, Econlit, PsycINFO, Web of Science, and Business Source Ultimate to identify peer-reviewed, academic, English-language literature published at any time until January 2020; 147 studies were included in the review. Sweetened beverage taxes, revisions to the WIC food package, and financial incentives for fruits and vegetables were associated with improvements in dietary behaviors (food purchases and/or consumption). Providing financial incentives to supermarkets to open in underserved areas and increases in SNAP benefits were not associated with changes in food purchasing or diet quality but may improve food security. More research is needed to understand the effects of calorie labeling in supermarkets and online SNAP purchasing.

Increasing Access to WIC through Discount Variety Stores: Findings from Qualitative Research

BACKGROUND

Many low-income neighborhoods do not include a full-service grocery store. In these communities, discount variety stores (DVS) can be convenient points of food access. However, no identified DVS are authorized to accept Special Supplemental Nutrition Program for Women, Infants, and Children Program (WIC) benefits.

OBJECTIVE

One national DVS retailer implemented WIC in 10 stores located in low-income communities in North Carolina over a 10-month pilot period to assess WIC feasibility.

METHODS

To better understand the facilitators and barriers to WIC implementation from the perspective of DVS staff, we analyzed 36 in-depth interviews with employees of this DVS chain at corporate, manager, and store clerk levels.

RESULTS

Most participants provided positive feedback about implementing and offering WIC. Many store employees had personal experience participating in WIC, which increased their understanding of the WIC shopping experience. Store staff's prior WIC participation and customers' proximity to DVS locations were facilitators to implementation. Primary barriers included limited choice of store products for customers, complicated or unclear labeling of WIC products, and difficulty training employees to process WIC vouchers.

CONCLUSIONS

These findings suggest that whereas most employees viewed WIC positively, barriers related to product selection and training must be addressed. Notably, North Carolina's recent change to an electronic system to process WIC transactions requires minimal manual employee training and should address several barriers to implementation. However, the computer system upgrades necessary to accept electronic WIC transactions may be a barrier for DVS to continued WIC acceptance. Future research is needed to evaluate implementation of electronic WIC transactions in DVS.

Food Purchasing Behaviors of a Remote and Rural Adult Solomon Islander Population

The aim of this study was to investigate the food purchasing behaviors of an adult Solomon Islander population within a transitioning food system in Auki, Malaita. Food purchasing behavior measures included; venue type and transportation for purchasing food, previous day expenditure on food purchases, number of weekly shopping experiences for store foods (generally long-life shelf and frozen items) and fresh foods (such as fruits and vegetables and fresh fish) and the importance of factors (i.e., price) on purchasing decisions. One hundred and thirty-three adults (aged 18 to 74 years; female: 63%, males: 37%) completed an interviewer administered questionnaire during December 2018. Food items were primarily sourced from Auki markets (n = 70) and stores (n = 40). Food purchasing differed between fresh and semi-perishable foods (store food). Participants reported similar shopping experiences for store food and fresh food (M = 3.87 and M = 3.25 times a week, respectively) and spending between $1 and $200 (M = $56.12) Solomon Island dollars on food in the previous day. The most reported purchased item was white rice (n = 117, 88%), with taste, freshness and family preference the most important factors reported as influencing food purchasing choices. While our findings are from a small sample in Auki, further research could build upon this work by investigating food purchasing behaviors at other times of the year, and more widely in the Solomon Islands and greater Pacific region.