Qualitative Analysis of Maternal Barriers and Perceptions to Participation in a Federal Supplemental Nutrition Program in Rural Appalachian North Carolina

Background: Little is known about barriers to and perceptions of participation in the in Women, Infants, and Children (WIC) program in rural Appalachia. Purpose: To gain a deeper understanding of maternal barriers and perceptions related to WIC participation in rural Appalachia Methods: Pregnant women and mothers were recruited in-person and via flyers from WIC offices in three counties in Appalachian North Carolina. Four semi-structured focus groups were conducted between May to July 2018. Each focus group was approximately 60 minutes long and included open-ended questions about the overall WIC experience in rural Appalachia. Focus groups were audio-recorded, transcribed verbatim, and content analysis of transcripts was performed by two trained researchers. Identified themes were discussed and consensus was reached by the researchers to generate final themes for four areas of interest: (1) most valued aspects of WIC program, (2) barriers to program participation and benefit redemption, (3) experiences during appointments, and (4) suggestions for improving experiences in program. Results: The most valued aspects of participation were financial benefits and support/resources provided by WIC staff. In contrast, lack of variety of WIC-approved foods and social stigma were perceived as major barriers to participation and redeeming benefits. Implications: This study contributes to a better understanding of the barriers and perceptions related to WIC participation in this geographically and culturally unique area of rural Appalachia. Findings are valuable for informing WIC state-agencies and policymakers whose efforts focus on the identification and development of effective recruitment and retention strategies for WIC-eligible families in rural Appalachia

Barriers, perceptions, and dietary intakes of women participating in a federal nutrition program: the rural Appalachian experience

Over the last decade, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has been transitioning to electronic benefits (eWIC) in efforts to reduce participation barriers. The North Carolina Appalachian Region was among the last to implement this transition, yet little is known about attitudes, barriers, and perceptions of WIC participation in this region and whether eWIC influenced experiences and barriers to participation in rural areas. The primary aims of this formative study were to 1) explore maternal attitudes, barriers, and perceptions of WIC program participation and shopping experiences in rural Appalachian North Carolina; 2) examine maternal shopping characteristics, perceptions, and experiences among WIC participants using paper benefits (PB) as well as those using eWIC; and 3) examine dietary intake among WIC pregnant women and mothers in this region. The study utilized both qualitative and quantitative methodologies. For aim 1, WIC participants were recruited for focus groups from WIC offices across three rural counties. Data from four semi-structured focus groups were analyzed using content analysis to identify emerging themes related to perceptions, barriers, and experiences related to WIC participation. For aim 2 and 3, two surveys that included items on perceived barriers and experiences, Dietary Screener Questionnaire (DSQ), and Fruit and Vegetable Screener (FV Screener) were administered to pregnant women and mothers enrolled in the WIC program (n=207). The first survey was completed when the WIC program was using PB (Phase 1) and the second survey was administered when the program was fully transitioned to eWIC (Phase 2). WIC participants perceived a lack of variety of WIC-approved foods and social stigma as major barriers to participation and redeeming benefits. No significant differences in maternal shopping characteristics or barriers to full benefit redemption were detected between survey respondents who were using PB versus those using eWIC benefits (p>0.05). However, a greater proportion of participants who were using eWIC reported that they perceived using WIC food benefits to be easy and convenient “always/most of the time” compared to those who were using PB (p<0.05). Dietary intakes of WIC mothers did not differ based on pregnancy status or age of their child(ren). Mean dietary intakes of total FV, whole grains, dietary fiber, and dairy were all below national recommendations. This study contributes to a better understanding of the maternal barriers and perceptions related to WIC participation in rural Appalachian North Carolina and identifies specific areas of need that are necessary for informing future interventions and policy development within this region. Further research is needed to fully characterize the experiences (i.e. psychosocial, economic, geographic, cultural) of WIC mothers and pregnant women in rural Appalachia to enhance the utilization of WIC services in this culturally and geographically unique region