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How a key nutritional program adapted to the pandemic

Young family preparing meal
Washington’s WIC program supports low-income pregnant and postpartum women, infants and children. Photo: Solstock via istockphoto.

As the COVID-19 pandemic created economic hardship and food insecurity for many families, a key governmental program for nutritional support pivoted to offer remote services and more flexible food options.

As a result, participation and satisfaction with the program grew, according to findings from a new study by University of Washington researchers and the program, Washington’s Special Supplemental Nutrition Program for Women, Infants and Children (WIC).

To remove barriers to nutritional support during the pandemic, Washington’s WIC program made changes, including allowing participants to sign up for and receive food, health and education benefits through phone calls and videoconferencing rather than requiring in-person visits. The program also expanded the foods covered by the program’s benefits by over 600 products.

Read the study as a webflow or infographic.

The program, which served up to 135,000 people per month in 2019-2020, supports low-income pregnant and postpartum women, infants and children by providing nutritious foods, nutrition education, health assessments, breastfeeding support and referrals to health and social services.

“Our study found that WIC staff and participants were highly satisfied with remote services and found them convenient,” said Emilee Quinn, research scientist in the UW Nutritional Sciences Program and a co-principal investigator of the project. “Nearly all wanted some form of remote services to continue.”

Highights from study infographic showing COVID-19 left more families hungry and staff and participants were highly satisfied with remote services.
Infographic with two parts. On left, title: "COVID-19 LEFT MORE FAMILIES HUNGRY. Food Insecurity, April 2020." Infographic shows a circle with "FOOD INSECURITY" in the center and a blue line around 40% of the circle. Text: "40% Households with mothers with children 12 and under reported food insecurity. 1/5 Children were experiencing food insecurity in these households." Note at bottom: "Sources from Brauer, L. The Covid-19 crisis has already left too many children hungry in America. Brookings (2020)". Right graphic: Title: "STAFF AND PARTICIPANTS WERE HIGHLY SATISFIED WITH REMOTE SERVICES. Based on appointment completion rates and interviews with staff and participants." Below title there are two circle graphs. On left, circles have text inside "NUTRITION EDUCATION IMPROVED." Text: 96% June 2020 appointment completion rates. 78% June 2019 appointment completion rates." Graphic on right: Circles with text inside "WIC CERTIFICATION IMPROVED." Text on right: "77% June 2020 appointment show-rates. 72% June 2019 appointment show rates." The pandemic led to greater food insecurity (left), however remote services offered by WIC during the pandemic helped increase attendance and completion of appointments for services (right). Source: UW-WIC report.

Improving participation

For the study, UW researchers led by Quinn and Jennifer Otten, associate professor in the Department of Environmental & Occupational Health Sciences (DEOHS) and Nutritional Sciences, partnered with Washington’s WIC program to analyze program data and conduct interviews and focus groups with WIC participants and staff.

Jennifer Otten
DEOHS and Nutritional Sciences Associate Professor Jennifer Otten

They found that participation in Washington’s WIC program increased during the pandemic by about 6% from December 2019 to December 2020, and that participation increased among children by 11% during that time.

The greatest increases in participation were among children identifying as Native Hawai’ian or Pacific Islander (18%), Black or African American (17%) and multi-race (14%).

With remote access to benefits, WIC participants were also more likely to keep their appointments for support. In June 2020, some 77% of participants attended appointments to be certified for services, compared with 72% a year earlier. And 96% kept nutritional education appointments compared with 78% a year before.

“The WIC program pivoted so rapidly during the pandemic,” said Evelyn Morris, MPH student in Nutritional Sciences and a member of the research team. “The change to remote services meant that participants kept more appointments than before the pandemic and thus more services were able to be accessed.”

Reducing barriers to support

In interviews, participants commented on how remote services reduced barriers to their participation, including the need for child care, travel time and transportation costs, taking time away from work and safety considerations.

“It was more convenient for me to do it over the phone because, with my kids, that meant I didn’t have to bring them or find a babysitter for them,” one participant said in an interview. “I was able to just be at home and have all the info ready.”

Participants also enjoyed having more food options to buy with their WIC benefits in the midst of pandemic food shortages, particularly a wider variety of milk, yogurt, cereal and cheese.

“Participants appreciated that we were able to provide remote services and expand our program to include over 600 more food options for increased variety and flexibility during the pandemic,” said Jean O’Leary, nutrition coordinator for WIC. “Local agency staff appreciated the flexibility to reduce barriers to participation during the pandemic.”

What’s missing in remote access

Despite the many benefits of remote access, some participants missed aspects of in-person visits, such as the opportunity to see how their children were growing through height, weight and iron measurements, which were previously taken at in-person visits.

Emilee Quinn
Nutritional Sciences Research Scientist Emilee Quinn

Others spoke about a loss of social connection and privacy without in-person visits, where there was greater opportunity to share sensitive information such as domestic violence concerns.

Although WIC staff appreciated the increased access through remote options, some noted some challenges with remote appointments, including distractions among participants, difficulty in interpreting participants’ responses, and lack of comfort with videoconferencing.

Recommendations for the future

In the future, both participants and staff said they hoped the flexibility of remote access and expanded food options would continue even after the pandemic ends. Some suggested a hybrid format of in-person and remote support.

The research team made several other suggestions for improving the program, including collecting height, weight and iron measurements at home or through drop-in appointments, developing training support for video appointments and translating informational materials into more languages.

“We greatly valued the partnership with our state and local WIC agencies to conduct this project because it allowed us to design a project that met their needs and to coordinate to help paint a meaningful and rich picture of what was happening,” Otten said.

Story by Deirdre Lockwood, originally published by DEOHS.

December 1, 2021