P3B174: A Mixed Methods Study of Key Stakeholders to Understand WIC Utilization and the Role of the Health Care Provider

Background: The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) provides nutritious foods, education, breastfeeding support, and referrals to health care and social services to families with low incomes.1 For over four decades, research has shown WIC is one of the nation’s most successful and cost effective nutrition intervention programs. WIC plays an important role in improving birth outcomes and diet quality across participants as well as reducing prevalence of households with food insecurity.2

Despite its benefits, there has been a nationwide downward trend in WIC participation, and enrollment in WIC has declined steeply as the child ages from 1-4 years.3

Quantitative studies have posited reasons why eligible families do not participate in WIC including stigma, misinformation about eligibility, difficulties applying for benefits, and challenges shopping for WIC foods.4 Yet fewer studies have examined these barriers using a first person qualitative approach to gain context and clarify perceived difficulties and challenges posited above.5 Additionally, few studies have evaluated the role of the primary health care provider as a trusted source of information in educating and referring WIC-eligible populations.

In this mixed-methods study, we seek to understand the role of the health care provider in linkages to WIC for eligible participants from key informants: pediatric health care providers survey, family focus groups and WIC staff semi-structured interviews. Our objective was to use key informants to understand the barriers and opportunities to WIC utilization and role of the health care provider in linkages to WIC.

Methods: Mixed-methods study in Washington DC.

Results: Provider Survey: 41 pediatric providers completed the survey. While 68% reported feeling at least somewhat confident in educating patients about WIC, only 24% reported that they had the materials they needed to do so. Of the 90% that refer to WIC, 47% do not complete a warm referral and advise the patients to apply on their own. See Figure 1.

Family focus groups: 30 individuals participated in 6 focus groups. Themes included a desire for their needs to be heard further by WIC staff and by providers and for improved communication between them. See Figure 2.

WIC Staff Interviews: 8 DC WIC staff were interviewed and expressed a need for improved communication with referring providers.

Conclusion: This study identified gaps in provider knowledge about WIC as well as their referring processes and aligned with families and WIC staff expressing a need for improved collaboration between health care providers and WIC. Workflow and technical challenges remain to bridge this gap.