Caregiver Perspectives on Underutilization of WIC: A Qualitative Study

OBJECTIVES

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a federal program that improves the health of low-income women (pregnant and postpartum) and children up to 5 years of age in the United States. However, participation is suboptimal. We explored reasons for incomplete redemption of benefits and early dropout from WIC.

METHODS

In 2020-2021, we conducted semistructured interviews to explore factors that influenced WIC program utilization among current WIC caregivers (n = 20) and caregivers choosing to leave while still eligible (n = 17) in Massachusetts. By using a deductive analytic approach, we developed a codebook grounded in the Consolidated Framework for Implementation Research.

RESULTS

Themes across both current and early-leaving participants included positive feelings about social support from the WIC clinic staff and savings offered through the food package. Participants described reduced satisfaction related to insufficient funds for fruits and vegetables, food benefits inflexibility, concerns about in-clinic health tests, and in-store item mislabeling. Participants described how electronic benefit transfer cards and smartphone apps eased the use of benefits and reduced stigma during shopping. Some participants attributed leaving early to a belief that they were taking benefits from others.

CONCLUSIONS

Current and early-leaving participants shared positive WIC experiences, but barriers to full participation exist. Food package modification may lead to improved redemption and retention, including increasing the cash value benefit for fruits and vegetables and diversifying food options. Research is needed regarding the misperception that participation means "taking" benefits away from someone else in need.

Qualitative Evaluation of a Text-Based, Culturally-Tailored Nutrition Education Intervention for Hispanic/Latino Adults in Massachusetts, USA

Objectives

This study aimed to document the perspectives of past participants of a text- and website-based ethnic-specific healthy eating program delivered in 2019–2021 for 76 ethnically-diverse Latinos in Boston, MA. Following a healthy diet may help prevent excessive burden of disease; however, current programs fail to address distinctions by ethnicity. Formative research with community partners showed that the Latino community warranted deeply tailored dietary programs. Hence, we aimed to identify key facilitators and barriers to the program implementation and uptake, with the goal of improving future iterations, across diverse populations.

Methods

In 2021, a trained bilingual researcher conducted semi-structured phone interviews with 29% of past participants (n = 22). The interview guide and codebook were grounded in the RE-AIM framework. Coders employed a deductive analytic approach.

Results

Most participants were Spanish-speaking women over the age of 35, who graduated college and have lived in the U.S. over 20 years. Participants identified a need for ethnic-specific cultural tailoring and for recognizing similarities and differences across Latino cultures in nutrition programs. Motivations to participate included giving back to the Latino community, contributing to science, learning something new, and losing weight. Continued participation was driven by the value assigned to social interaction and discussion when learning about healthy eating strategies. Participants reported higher engagement with content delivered via text message than website, which presented barriers to access. Participants also appreciated receiving familiar content, which served as a “cue to action” for common health behaviors. Through participation, individuals reported increased autonomy and awareness of their dietary choices and physical changes.

Conclusions

There is a recognized need for ethnic-specific health promotion efforts among Hispanics/Latinos. To facilitate program uptake, interventions should deliver opportunities for social interaction, emphasize ease of access, and highlight opportunities for participant engagement to garner autonomy and awareness.

Funding Sources

Harvard University Rose Service Learning Fellowship; NIH/NCI; NIH/NHLBI.

Validation of a brief food parenting measure for fathers: A test of factorial validity, measurement invariance, internal reliability, and concurrent validity

Fathers are underrepresented in food parenting research partly due to the lack of succinct, theory-informed, and father-mother equivalent food parenting measurement tools. To address this, we 1) tested the factorial validity of a brief food parenting measure utilizing a subset of items from the Comprehensive Feeding Practices Questionnaire (CFPQ) to represent coercive control, structure, and autonomy support, 2) assessed the extent to which the brief tool works similarly in fathers and mothers (i.e., measurement invariance), and 3) evaluated its internal reliability and concurrent validity. Participants included 1071 fathers of children aged 2-6 years and 487 of their co-parents (mothers) from the Fathers & Families study. Fathers and mothers responded to 16 CFPQ items, and fathers reported on children's diets. Confirmatory factor analysis (CFA) was used to test factorial validity. Multi-group CFA was used to examine measurement invariance across fathers and mothers. Internal reliability was examined using Cronbach's alpha and the Spearman-Brown coefficient. Concurrent validity was assessed utilizing multiple logistic regressions to examine associations between the three food parenting factors and children's intakes of fruit, vegetables, sugar-sweetened beverages (SSBs), and fast food. CFA confirmed a three-factor model with 11 items, including coercive control (four items), structure (five items), and autonomy support (two items). Multi-group CFA indicated measurement invariance across fathers and mothers. Internal reliability was established. Concurrent validity was strong for structure, but weaker for coercive control and autonomy support. Further refinements are encouraged to enhance items' utility in characterizing fathers' food parenting practices, including in different social and cultural contexts.