NWA 2018 Research Needs Assessment
The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) has been an integral part of the nation’s nutrition safety net for over 40 years, serving tens of millions of low-income and nutritionally at-risk women, infants and young children. WIC aims to improve the overall health and nutritional well-being of families by increasing the availability and the consumption of healthy foods and providing nutrition education targeted to address nutritional risks that are common in pregnant and postpartum women, as well as infants and young children. Approximately 7 million individuals each month benefit from WIC services -- nutrition education and counseling, breastfeeding education and support, nutritious foods and referrals to health care and other social and community services. One mother from Texas wrote:
“WIC has been a crucial part in my success to exclusively breastfeed two of my three children. If it wasn't for such dedicated and wonderful staff, I am unsure that I would have breastfed this long with the breastfeeding challenges I have faced."
Methodologically rigorous qualitative and quantitative research studies are essential in order to document the program’s impact and identify areas for improvement. Anecdotes such as our Texas mother’s story illustrate the positive impact that program participants feel that WIC has had on their lives. WIC has a strong history of rigorous program evaluation and using data to inform both policy and program management decisions.
To support the communication of new research, best practices and methodologies, NWA is developing an online Research, Policy and Practice Hub. This will be an online interactive, searchable repository that will show-case innovations in WIC practice, policy and research.
A strong history of success supports the National WIC Association (NWA) in its role as the advocacy voice for the WIC program. NWA strongly encourages collaboration between researchers and WIC practitioners to conduct high quality research to support the program and identify innovative approaches to program improvement.
The Food and Nutrition Services (FNS) and the Economic Research Service (ERS) both branches of the U.S. Department of Agriculture (USDA) fund and conduct a number of important studies of WIC program services and outcomes. In recent years, FNS has funded both large and small-scale studies and has successfully supported university and WIC agency collaborations to explore specific research topics through grants and contracts. A detailed list of current USDA-ERS funded research can be found here and a detailed list of current USDA-FNS funded research can be found here.
The goal of the biennial Research Needs Assessment is to identify research areas that support NWA and WIC programs nationwide to (1) be responsive to emerging issues and (2) continue to explore, demonstrate and integrate evidence-based practices that improve the health and well-being of low-income families. The NWA Evaluation Committee has prioritized six research areas, including long-standing questions related to the health outcomes associated with WIC participation as well as those related to better understanding, and subsequently addressing, the shifting patterns of WIC participation. Newly identified areas of research include an expanded view of the economic impact of WIC, the impact of potential changes to the WIC food packages, aligning policies and procedures for systems-level innovation and understanding how WIC participants use technology.
Summaries of each research area are outlined below with a link to a more in-depth description of each specific research need.
The following methods will support many of the research recommendations in this document:
- Qualitative studies
- Ethnographic approaches
- Social network analysis
- Computer simulation modeling
- Research designs that reduce selection bias*
- Regression discontinuity designs
- Difference in differences or interrupted time series approaches
- Instrumental variables approaches
- Fixed effects approaches
- Randomized controlled trials
*See Appendix K of NASEM report for a full description.
- Health Outcomes Associated with WIC Participation
WIC is the only USDA nutrition assistance program with legislative and regulatory requirements to provide nutrition education. No other federal program offers the services of Registered Dietitians (RD), Breastfeeding Peer Counselors and International Board Certified Lactation Consultants (IBCLCs) that provide education, encouragement and support to participants. WIC emphasizes changing health behaviors and influencing health outcomes through its individualized nutrition education, preventive health screenings, healthcare referrals and food packages targeted to supplement the nutritional needs of women, infants and children. One primary area for research is to assess the impact of tailored approaches to nutrition education and breastfeeding support, and subsequent effects on participant health behaviors and health outcomes during pregnancy, infancy, early childhood and the inter-conception period.
- Economic Value of WIC Participation
Past research has shown that participation in WIC reduces poor birth outcomes, improves children’s health and helps young children improve and maintain a healthy weight. Few studies have addressed WIC’s impact on healthcare costs, although the seminal study on the topic published in 1992 showed a $1.77-$3.13 reduction in Medicaid costs for every $1 spent on WIC. Studies are needed that will update cost-saving estimates and further examine cost effectiveness of the program. Researchers are encouraged to work closely with WIC to quantify the true value of WIC participation.
- Impact of Potential Changes to WIC Food Packages
It is mandated in the 2010 Healthy, Hunger Free Kids Act that the WIC supplemental food packages undergo scientific review at least once every ten years. This was accomplished to ensure the foods provided meet the nutrient needs of pregnant, postpartum breastfeeding and non-breastfeeding women, infants and young children and that the decisions to include specific foods within the WIC food packages are based on the latest available nutrition science. The first major changes to the foods offered by WIC occurred in 2009, aligning the food packages with the 2005 Dietary Guidelines for Americans (DGAs) and adding a Cash Value Benefit (CVB) for fruits and vegetables for women and children. The most recent review and recommendations of the WIC Food Package by the National Academies of Science in Engineering and Medicine (NASEM), released in January 2017 and aligned with the 2015 DGAs, could lead to a further enhanced food package and provide more options and flexibility to WIC families. Understanding the perceived value of food package offerings is an essential area for study.
State WIC programs are required to implement Electronic Benefits Transfer (EBT) or e-WIC to replace paper food vouchers by 2020. The shift to EBT/e-WIC offers new opportunities to study nationwide food redemption patterns of WIC families. WIC also has a unique opportunity to influence access to healthy foods within low-income communities through its vendor stocking requirements of WIC-approved foods. Research on topics related to the food packages is needed, examining (1) how WIC families purchase and consume their WIC foods, (2) how increases in the value of the CVB for vegetables and fruits might influence purchasing, consumption and nutrient intake, and (3) how conversions to EBT influence redemption rates of WIC foods and experiences of participants in accessing and purchasing these foods.
- Aligning Policies and Procedures for Systems-Level Innovations
Referrals, one of the cornerstones of WIC success, help connect participants to health care and other social and community services. WIC referrals commonly rely on WIC participants to follow through, make connections to other providers, and report back to WIC staff. Streamlining of this cornerstone may be achieved through standardized policies and procedures enabling linkages between data systems associated with the different services WIC participants utilize. Among the goals of systems-level innovations like this include improving the experience of WIC participation by simplifying the referral process, reducing the burden on WIC participants, and improving program efficiency. Research on innovative approaches is needed to explore and demonstrate the effectiveness of aligning policies and procedures between various WIC stakeholders.
- Understanding How WIC Participants Use Technology and Considering Barriers to Technology Access
Many WIC programs are either in the process of implementing or have already implemented WIC technologies, such as mobile apps and text messaging services. Their goals include simplifying aspects of WIC participation such as scheduling appointments in the clinic or locating WIC-eligible foods in the grocery store. It is currently unclear how effectively these technologies impact the participant experience and continued participation. Evaluations of the impact and implementation of new technologies are needed. So too, are careful assessments of the ways in which WIC participants use technology in their daily lives.
- Understanding Changes in WIC Caseload to Target WIC Services to the Most At-Risk Families
A key observation in recent years has been a change in patterns of WIC participation—specifically, a decline in the number of children and pregnant women. While an improving economy and declining or leveling birthrates have contributed to fewer individuals being eligible for WIC, other factors may also play a role. There are currently research projects in the field that seek to understand why participation has been decreasing and what can be done to ensure eligible families enroll and continue to receive WIC benefits. Research is needed to demonstrate how WIC can successfully engage eligible mothers and their families and to further explore reasons why participation and coverage rates have decreased.