Research
Original Research
A Qualitative Exploration of Predominantly White Non-Hispanic Tennessee WIC Participants’ Food Retail and WIC Clinic Experiences During COVID-19

https://doi.org/10.1016/j.jand.2020.12.011Get rights and content

Abstract

Background

The novel coronavirus disease 2019 (COVID-19) has widened many existing nutrition disparities. In response, federal nutrition assistance programs have introduced flexibility waivers in programs, including the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), to rapidly respond to support the nutritional health status of income-eligible participants during COVID-19. Waivers were approved that permitted flexibilities in the WIC food package, WIC vendor guidelines, and WIC clinic experience. The impact of these waivers on WIC participants’ retail and clinic experiences remains unknown.

Objectives

Our aims were to understand the experiences of WIC participants in food retail settings and with WIC clinics during the COVID-19 pandemic and to explore WIC participants’ perceptions of the impact of COVID-19 on their family’s overall health, well-being, and daily lives.

Design

We conducted semi-structured phone interviews between April 30 and May 7, 2020.

Participants/setting

Participants were 24 adults in WIC-enrolled families residing in Tennessee.

Analysis

Using grounded theory as the analytical framework, 2 coders completed an iterative, data-driven analytic process within NVivo, version 12. Hierarchical maps, coding matrices, and concept maps were used to aid direct content analysis for theme detection.

Results

Five primary themes emerged, including shopping barriers (existing compounded with new), coping strategies, impact on mental and emotional health, social comparison, and unintended consequences of COVID-19 on WIC families.

Conclusions

COVID-19 created additional barriers to food security among WIC families and negatively affected their health and well-being. To meet the needs of this vulnerable population during and beyond the pandemic, the carryover of WIC flexibilities (ie, physical presence and food package substitution waivers) after COVID-19 may improve the ease of overall program participation.

Section snippets

Data Collection

A sample of adults living in WIC-participating households were recruited by phone and text message from an established WIC subject pool using purposive, then snowball, sampling methods.18,19 Participants who met the following inclusion criteria were invited to participate in the study: lives in WIC-participating household, primary food shopper for their household, 18 years or older, and willing and able to complete a phone interview for approximately 1 hour in English. A total of 27 people were

Participant Sample

Characteristics of the participants are summarized in the Table. Participants were primarily White, non-Hispanic women who had completed at least some post-secondary education. Although most of the sample reported not participating in government assistance programs other than WIC, most households screened as having food insecurity. Several participants reported a change in household income due to COVID-19.

Primary Themes

Five primary themes emerged from the interviews, including shopping barriers (existing

Discussion

This study presented the first empirical data investigating the perceived impact of COVID-19 on the daily lives of families who participate in the Tennessee WIC program and their experiences in WIC food retail and with their WIC clinics. The participants in this study were sociodemographically similar to other studies conducted with Tennessee WIC program participants,32, 33, 34 which is similar to the overall WIC population where the research was conducted.

This study identified dynamic,

Conclusions

This study explored the experiences of WIC families during the COVID-19 pandemic. The COVID-19 virus is creating additional barriers to food security and negatively affecting the health and well-being of WIC families. To meet the needs of this vulnerable population during and beyond the pandemic, WIC participants in this study suggested the carryover of WIC flexibilities (ie, physical presence and food package substitution waivers) after COVID-19 to enhance the ease of overall program

Acknowledgements

The authors would like to thank the study participants for sharing their COVID-19 experiences.

Author Contributions

All of the authors were involved in the conceptualization of the study and study design, development of methods, interpretation of findings and preparation of the manuscript. M. McElrone managed data collection, management, and analysis. All of the authors have reviewed and approved the complete manuscript. M. McElrone wrote the first draft with contributions from M. C. Zimmer and E. T. Anderson

M. McElrone is an assistant professor, Department of Health and Human Performance, The University of Tennessee, Chattanooga.

References (43)

  • S. Bleich et al.

    The impact of increasing SNAP benefits on stabilizing the economy, reducing poverty and food insecurity amid COVID-19 pandemic

  • V. Oliveira et al.

    The WIC program: Background, trends, and economic issues, 2015 edition. Economic Information Bulletin No. (EIB-134)

  • M. Koleilat et al.

    The role of WIC in obesity prevention

    Curr Pediatr Rep

    (2017)
  • M.I.G. Daepp et al.

    WIC food package changes: trends in childhood obesity prevalence

    Pediatrics

    (2019)
  • R. Hamad et al.

    Association of revised WIC food package with perinatal and birth outcomes: A quasi-experimental study

    JAMA Pediatr

    (2019)
  • K. Smith

    Fewer than half of WIC-eligible families receive WIC benefits

  • C.R. Payne et al.

    Can a better understanding of WIC customer experiences increase benefit redemption and help control program food costs?

    J Hunger Environ Nutr

    (2018)
  • Food and Nutrition Service. Tennessee: COVID-19 waivers & flexibilities

  • H. Bernard

    Research Methods in Cultural Anthropology

    (1988)
  • H. Bernard

    Research Methods in Anthropology: Qualitative and Quantitaive Approaches

    (2011)
  • J.W. Creswell et al.

    Research Design: Qualitative, Quantitative, and Mixed Methods Approaches

    (2018)
  • Cited by (14)

    • A Qualitative Examination of California WIC Participants’ and Local Agency Directors’ Experiences during the Coronavirus Disease 2019 Pandemic

      2022, Journal of the Academy of Nutrition and Dietetics
      Citation Excerpt :

      These findings that remote services have been well received by WIC participants and would benefit participants to maintain a hybrid model in the future are consistent with two other states, Tennessee and Washington, and Los Angeles County, that evaluated WIC participant experiences throughout the COVID-19 pandemic.8,10,11 The Tennessee study evaluated 24 WIC participants’ experiences during the early part of the pandemic and found that the carryover of WIC flexibilities, such as physical presence and food package substitution waiver, would improve WIC program participation.10 These findings are also consistent with a study of 52 Washington WIC staff and 40 WIC participants that found that both participants and staff were satisfied with remote services during the pandemic.11

    • Insights from Washington State's COVID-19 Response: A Mixed-Methods Evaluation of WIC Remote Services and Expanded Food Options Using the RE-AIM Framework

      2022, Journal of the Academy of Nutrition and Dietetics
      Citation Excerpt :

      Furthermore, having multiple coders code a subset of the transcripts, discuss discrepancies, and collaborate on themes enhanced the data triangulation process49,50 and confirmability of these results.26 The participant sample also captured a diversity of perspectives about the programmatic changes.36 Finally, in line with principles of rigor in qualitative research, the research team shared a preliminary synthesis of the results with WA WIC staff participants and discussed whether the findings resonated with their experiences.26

    View all citing articles on Scopus

    M. McElrone is an assistant professor, Department of Health and Human Performance, The University of Tennessee, Chattanooga.

    M. C. Zimmer is a Cancer Research Training Award Fellow, National Cancer Institute; at the time of the study, she was a graduate student, Department of Public Health, The University of Tennessee, Knoxville.

    E. T. Anderson Steeves is an assistant professor, Department of Nutrition, The University of Tennessee, Knoxville.

    STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.

    FUNDING/SUPPORT This study was internally funded by The University of Tennessee, Knoxville.

    View full text