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National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Food and Nutrition Board; Committee to Review WIC Food Packages. Review of WIC Food Packages: Improving Balance and Choice: Final Report. Washington (DC): National Academies Press (US); 2017 May 1.

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Review of WIC Food Packages: Improving Balance and Choice: Final Report.

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TABLE G-1Literature Findings on Barriers and Incentives to WIC Participation and Redemption

ArticleBarriersIncentives/Strategies
Bertmann et al., 2014Negative 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 CVVFind 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, 2011Underutilization of infant food benefits
  • Issue a CVV for V/F for caregivers who prefer preparing own infant foods
  • Implement targeted nutrition education to subpopulations with high nonuse 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:
    • Gaps in knowledge (determining the amount of V/F 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)
  • Vendors:
    • 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
  • Participants:
    • Use more than one check at a time when transportation is an issue
  • Vendors:
    • Adopt practices that will make it easier for participants to shop
  • WIC Staff:
    • 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 (CA example: LVL makes visits)
Najjar, 2013
  • Food package policies (e.g., container size)
  • Negative grocery store experiences and personal misunderstanding and embarrassment
  • Helpful vendors
  • 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
  • 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
USDA/ERS, 2010Of those exiting WIC at 1 year, transaction costs of participation may be a barrier: program requires too much effort and the benefits are not worth the time (26.2%) or they have scheduling or transportation problems (10%) Program requires too much effort, or scheduling, or transportation problems
USDA/ERS, 2012Improved national economic conditions generally reduce participation rates for WIC and other national assistance programsPoorer economic conditions and unemployment rates tend to improve participation rates when the program is fully funded

NOTES: CA = California; CVV = cash value voucher; V/F = vegetables and fruits; LVL = local vendor liaison.

From: Appendix G, Barriers to Participation and Redemption

Copyright 2017 by the National Academy of Sciences. All rights reserved.
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