TABLE G-1 Literature Findings on Barriers and Incentives to WIC Participation and Redemption
|Bertmann et al., 2014||
Negative interactions in stores: annoyance or anger expressed by cashier or other shoppers
Confusion over WIC rules: fluctuation in enforcement of redemption rules store to store and week to week
Cashiers lack training: participants have to explain the rules
Feeling of embarrassment when using CVV
Find strategic choice of times and locations at which to shop
Choose particular cashiers
Pool CVV (using multiple vouchers at once)
|Christie et al., 2006||
Long duration of appointment wait time
Dissatisfaction with customer service
Dissatisfaction with the physical environment
Decrease wait times by extending clinic hours and/or changing clinic flow
High level of satisfaction with WIC personnel
|Gleason and Pooler, 2011||
Underutilization of infant food benefits
Issue a CVV for F/V for caregivers who prefer preparing own infant foods
Implement targeted nutrition education to subpopulations with high non-use of food instruments
|Gleason et al., 2011||
Maintaining food freshness (small WIC vendors)
Availability of products in allowable form (e.g., bread in approved size)
Continue and expand vendor training
Continue to engage food suppliers
Continue nutrition education of participants
Use state WIC data for internal program management, policy making, ongoing monitoring
Examine effect of minimum stocking requirements
|Gleason et al., 2014||Participants:||Participants:|
Gaps in knowledge (determining the amount of F/V with CVV)
Incorrect information provided by cashier
Limited selection of some WIC foods at local vendors and poor-quality produce
Lack of transportation (e.g., tribe located 30 minutes from a store)
Delivery of spoiled items
Difficulty anticipating demand and maintaining adequate supply of some WIC foods
Challenges in serving participants who lack knowledge
Challenges in communicating with local WIC agency
Use more than one check at a time when transportation is an issue
Adopt practices that will make it easier for participants to shop
Use open-ended question and probing to encourage discussion with participants
Expand nutrition education opportunities Inform participants of local vendors
Local WIC Directors:
Establish open lines of communication with vendors
Increase cross-program collaboration
State WIC Agencies:
Offer additional training opportunities to staff
Expand allowable WIC foods to include frozen and canned vegetables
Develop a formalized local vendor liaison (LVL) program (California example: LVL makes visits)
Food package policies (e.g., container size)
Negative grocery store experiences and personal misunderstanding and embarrassment
Vendor and participant understanding about the use of CVV and other WIC benefits
|Phillips et al., 2014||
Certain individual WIC foods have low rates of full redemption
Could not use certain foods (i.e., received too much)
Participants or their children disliked the food or did not know how to prepare them
Regardless of ethnicity, full redemption of WIC benefits is low
Implement targeted educational efforts to promote full utilization of WIC benefits
Tailor nutrition education to include foods that are commonly underused and focus on culturally relevant approaches to incorporating these foods into meals and snacks
Program requires too much effort, or scheduling, or transportation problems
Improved national economic conditions generally reduce participation rates for WIC and other national assistance programs
Poorer economic conditions and unemployment rates tend to improve participation rates when the program is fully funded
NOTE: CVV = cash value voucher; F/V = fruits and vegetables; LVL = local vendor liaison; SSI = Supplemental Security Income.
TABLE G-2 Changes in Fruit and Vegetable Availability and Selection Overall and by Vendor Type, Before Compared to After the 2009 WIC Food Package Changes
|Availability or Selection||Fresh||Canned||Frozen|
|Commonly Consumed FV||African American FV||Latino FV||Vegetables||Low-sodium Vegetables||Fruits||Vegetables||Fruits|
|Overall change||2.14 (1.31, 3.50)b||2.53 (1.31, 5.35)b||1.72 (0.84, 3.98)||NE||2.69 (1.17, 6.22)a||1.84 (0.91, 3.72)||1.97 (1.05, 3.70)a||2.15 (1.06, 4.37)a|
|Change by vendor type|
|Large||3.56 (1.22, 10.34)a||2.27 (1.31, 5.48)a||1.69 (0.94, 5.54)||1.62 (0.81, 3.25)||0.93 (0.25, 3.48)||1.01 (0.41, 2.48)||1.43 (0.91, 2.25)||2.10 (0.86, 5.12)|
|Small||1.07 (0.51, 2.24)||2.64 (1.09, 6.38)a||1.83 (0.65, 5.17)||1.18 (0.47, 2.94)||5.95 (1.74, 20.29)b||2.11 (0.95, 4.69)||2.80 (1.13, 6.93)a||1.93 (0.68, 5.53)|
|Pharmacy||NE||1.38 (1.02, 1.88)a||1.25 (0.92, 1.69)||NE||0.71 (0.12, 4.18)||1.06 (0.04, 25.53)||1.34 (0.34, 5.24)||2.24 (0.19, 25.74)|
|Overall change||1.67 (1.14, 2.47)b||1.14 (1.01, 1.42)||1.17 (1.02, 1.33)||1.22 (1.07, 1.40)b||1.13 (0.98, 1.30)||0.96 (0.77, 1.20)||1.09 (0.82, 1.46)||0.92 (0.69, 1.21)|
|Change by vendor type|
|Large||1.67 (1.03, 2.69)a||1.13 (1.01, 1.43)||1.22 (1.06, 1.36)a||0.84 (0.68, 1.04)||1.05 (0.91, 1.20)||0.88 (0.71, 1.09)||1.02 (0.74, 1.40)||0.93 (0.69, 1.25)|
|Small||1.71 (1.06, 2.76)a||1.17 (0.78, 2.19)||1.05 (0.73, 1.58)||1.32 (0.95, 1.85)||2.01 (1.03, 3.84)a||1.05 (0.53, 2.07)||1.34 (0.79, 2.29)||0.80 (0.33, 1.93)|
|Pharmacy||NE||1.04 (0.93, 1.20)||1.09 (0.95, 1.21)||1.58 (1.31, 1.91)b||1.17 (0.18, 7.45)||1.35 (0.06, 30.18)||0.81 (0.32, 2.08)||NE|
NOTES: Data presented as odds ratio (95% confidence interval); an odds ratio of 1.0 for this contrast indicates that the post-policy change from 2009 to 2010 was greater than the pre-policy change from 2008 to 2009; NE = odds ratio not estimated due to lack of variability in outcome by year. FV = fruits and vegetables.
a P < 0.05.
b P < 0.01.
SOURCE: Zenk et al., 2012 (used with permission).
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