A Review of Interventions to Increase WIC Enrollment and Participation

Abstract

Our goal was to identify strategies aimed at increasing Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) enrollment and participation rates. The WIC program provides many health benefits for pregnant women, mothers, and children. WIC offers nutrition education, formula, fruits and vegetables, and other food to pregnant and postpartum women and their children until they reach the age of five. Despite the availability of this program nationwide, enrollment and participation rates remain low across the country. Several states have tried various interventions to combat this deficiency of engagement with the goal of increasing WIC enrollment and participation. We conducted a scoping review to identify articles based on pre-specified inclusion and exclusion criteria. Two reviewers independently identified and screened articles. Subsequently, three reviewers independently extracted study details and outcomes related to WIC enrollment and participation rate changes. We included 14 studies reporting on 12 interventions from 3945 citations reviewed. Seven of these were published papers, while the others were final reports of USDA WIC Special Grant Projects. All the observed interventions had some success increasing WIC participation. Virtual interventions demonstrated the most success based on preliminary evidence. Successful interventions showed percentage gains in enrollment close to 8% and changes in participation over 9%. Overall, the literature surrounding WIC enrollment interventions reveal a mixed impact on improving participation. Many successful interventions involve an online or virtual engagement component which can provide educational resources on WIC benefits, nutrition, and living a healthy lifestyle. Supplementary Information The online version contains supplementary material available at 10.1007/s10900-022-01131-2.

Factors That Influence Children’s Exits from the Special Supplemental Nutrition Program for Women, Infants, and Children: A Systematic Review

“…In particular, mobile apps offer opportunities to improve WIC participants’ shopping experience and increase redemption rates of food packages [ 45 ] and may reduce stigma [ 33 ]. Further, virtual interventions that are single faceted and focus on direct and simple strategies (e.g., nutrition education or how to transition from paper vouchers to EBT) have been found to be the most successful at increasing enrollment and participation rates in WIC [ 46 ]. Future studies should consider examining similar factors found to be related to exits from the WIC program in the present review among diverse groups to elucidate characteristics (i.e., language spoken) that are unique to racial/ethnic families.…”

Views and preferences of food‐insecure pregnant women regarding food insecurity screening and support within routine antenatal care

“…34,35 Cited reasons for low uptake include administrative burdens for participants, 34 misconceptions about eligibility 36 and stigma. 37 Interventions that are 'internally' based in a healthcare setting are considered a viable option to screen and address food insecurity, to complement a referral to these established 'external' food assistance programmes. 27 Healthcare-based interventions are considered valuable by clinicians as well as patients, based on research in general, nonpregnancy healthcare settings.…”

“…Although there is good evidence to suggest that these programmes are effective at promoting dietary quality and food security, 31,32 uptake of WIC by eligible women is declining, 33 and below target for the Healthy Start programme 34,35 . Cited reasons for low uptake include administrative burdens for participants, 34 misconceptions about eligibility 36 and stigma 37 …”

“… 34 , 35 Cited reasons for low uptake include administrative burdens for participants, 34 misconceptions about eligibility 36 and stigma. 37 …”

WIC staff and healthcare professional perceptions of an EHR intervention to facilitate referrals to and improve communication and coordination with WIC: A qualitative study

“…A large body of prior research demonstrates the multitude of barriers to WIC participation. Challenges to participation are numerous and include misunderstandings about eligibility status, language and cultural barriers, negative WIC clinic experiences, difficulty redeeming benefits, lack of transportation to reach WIC clinics, and stigma, among other reasons [9][10][11]. Despite multiple waivers during the COVID-19 pandemic, such as the physical presence waiver, there were modest increases in WIC participation between March 2020 and March 2022 [12], demonstrating the need for cross-sector strategies to improve outreach and increase enrollment.…”