Spring has sprung and WIC research is blooming! The value of WIC continues to be demonstrated through the publication of new research findings. In this edition of Research to Practice, we highlight the NWA 2016 Research Needs Assessment; provide details of seven research projects that are funded by an FNS grant to explore the relationships between WIC and periconceptional health; introduce the USDA Food and Nutrition Service 2016 Research and Evaluation Plan; and in our Researcher Spotlight we explore the importance of qualitative research in a Q&A with Oregon WIC Senior Research Analyst, Julie Reeder. As always, we provide links to upcoming conferences, and abstracts for the many WIC research studies that have published findings in the last three months.
The 2016 NWA Research Needs Assessment was completed in February 2016. This document is created by the NWA Evaluation Committee and this year outlines the need for focused research on women’s health, the impact WIC has on obesity, and improving the quality and use of WIC data. Each of the areas of focus serves to bolster the four pillars of WIC – nutrition education, breastfeeding support, referrals to health and social services, and the healthy food package.
Despite the wide range of research that supports WIC program effectiveness and efficiency, there is a need to focus on WIC’s unique opportunity to reach women during critical child-bearing years, and WIC’s impacts on obesity prevention. Cross-cutting the need for research on both maternal health and obesity, is the broader topic of how to make better use of WIC data. WIC program data is one of the program’s biggest resources, and, if utilized effectively and efficiently, has the potential to support and enhance the WIC participant experience.
WIC has benefited greatly from program evaluation and high quality quantitative and qualitative research focused on program impact. It is crucial that such research continues to update, reinforce, and expand the rigorous documentation of WIC’s positive effects on the women, infants and young children served by the program. The Research Needs Assessment guides researchers who are interested in studying WIC with subject areas that the Evaluation Committee recognizes as being current priorities for the program. In addition, the report lists the current research projects funded by USDA and the Census Bureau. The length of this list (over 20 studies!) is testimony to the current strides that are underway to support WIC through evaluation and research.
Some exciting work is being supported by USDA grants and contracts. Currently, the USDA is supporting focused research on how WIC impacts nutrition in the periconception period.
In August 2015, a group of researchers met at the USDA FNS headquarters to present initial research findings from a small FNS funded grant program, The Role of the WIC Program in Improving Periconecpional Nutrition. The grant program is managed by the University of California at Los Angeles, who awarded 7 grants in 2012. Grant guidelines included partnerships between academic researchers and WIC agencies on research that focuses on the role WIC plays in improving nutrition in the periconceptional period. The initial research findings demonstrated the unique opportunity that WIC has to engage with women between pregnancies. Publications from the research are expected later this year, some findings will be presented at the NWA 2016 Annual Conference. Below are short descriptions of each of the seven funded research projects.
“Association Between Interpregnancy Interval and Maternal Health Outcomes Among WIC Participants,” Baruch College – CUNY, Oregon Health and Science University, and Oregon WIC Program. The proposed study will use a mixed methods approach to analyze the relationship between the interpregnancy interval (IPI) and maternal health outcomes, including risk factors associated with a short interpregnancy interval, whether a short IPI is associated with negative maternal health indicators. It will also examine mothers’ views of birth spacing, periconceptional health behaviors, and WIC’s potential influence in both areas.
“E-Moms: A Personalized Telehealth Intervention For Health and Weight Loss in Postpartum Women,” Louisiana State University, Pennington Biomedical Research Center, East Baton Rouge Parish WIC Clinic, and Capitol City Family Health Center WIC Clinic at Family Roads. The objective of this study is to implement a personalized weight management program to overweight and obese postpartum women in WIC. It will use a randomized-controlled design, and deliver nutritional counseling through the WIC Clinic (control) or a personalized, postpartum health intervention delivered remotely via Smartphone (treatment). The study will examine the impact of the treatment on weight loss and nutrition practices at six-months post-partum. The study will also test the efficacy of the telehealth platform to deliver health messages targeting other behaviors such as smoking, alcohol and drug abuse, breastfeeding, postpartum depression and infant food intake.
“Peri-Conception Health in the San Luis Valley,” University of Colorado at Denver and San Luis Valley WIC Clinic. This study will examine the impact on periconceptional weight and nutrition behaviors of two interventions: the HeartSmartKids™ (HSK) electronic program – a bilingual kiosk and decision support system that assists providers in clinical care and that will be adapted for use with women in post-, inter- and pre-partum phases – and training WIC educators in motivational interviewing to support maternal health behavior change.
“Improving Periconceptional Health through the Prevention of Excessive Gestational Weight Gain: from Research to Intervention,” Pepperdine University and Public Health Foundation Enterprise (PHFE) WIC Program. This project will assess the impact on pregnancy weight gain of new individual and group educational materials focused on weight gain and the IOM recommendations for pregnant women. The purpose of this study is to develop, pilot and evaluate a generalizable and sustainable intervention to prevent excessive gestational weight gain among WIC participants in Southern California, a predominately Hispanic population.
“Short Inter-Pregnancy Interval and Weight Retention Among Massachusetts WIC Participants: Identifying Strategies to Improve Interconceptional Health,” Simmons College, Boston and Massachusetts WIC Program. The project will use 9 years of longitudinal Massachusetts WIC data to assess the impact of WIC on IPI among women who are WIC participants either prenatally or in the post-partum period of an initial pregnancy, determine the factors affecting weight retention (or loss) from one pregnancy to the next, and consider the degree to which weight retention is affected by the intensity of WIC nutrition education.
“Integrating Obstetrical Care and WIC Nutritional Service to Address Maternal Obesity and Postpartum Weight Retention: Altering the Life Course Trajectory,” Johns Hopkins University, Bloomberg School of Public Health and the WIC Nutrition in Pregnancy Clinic (NIP) in the Johns Hopkins Obstetrics and Gynecology Department. The purpose of this research is to develop and evaluate the impact of a cost-neutral model to completely integrate postpartum obstetrical care and WIC nutritional services to address maternal postpartum weight retention and overall periconceptional health. It will consider the impact of an intensive postpartum nutrition intervention referred to as WICNIP on weight and nutrition outcomes.
“Reaching High Risk Post-Partum Women for Nutritional Assessment and Counseling via a Telephone-Based Coaching Program,” The University of California at San Francisco (UCSF), Sonoma County WIC Program, and the San Francisco County WIC Program. The project will adapt a recently developed post-partum diabetes prevention intervention created by the partners for the WIC context. The program, Support via Telephone Advice and Resources (STAR-MAMA), is based on an Automated Telephone Self-Management Support system (ATSM) was developed for at-risk populations. The study will implement the modified STAR-MAMA system with WIC participants and consider its impact on nutritional risk and health behaviors.
In March, the USDA Food and Nutrition Service released their 2016 Research and Evaluation Plan. Each year FNS publishes this report to outline the research foci for the coming year. We are happy to see plans for both contract and grant based research projects on a range of important topics including:
All the research projects outlined in the plan are in the very early stages of planning. We’ll be sure to keep you informed of opportunities to engage with FNS research as they develop. Stay tuned!
Until you really understand what brings someone great joy or deep sadness it is hard to build a program or intervention that really addresses their needs.
For many of us, the concept of ‘WIC data’ may conjure up images of spreadsheets, charts and numbers. However, a crucial component to WIC data is words, feeling, and emotions – after all, WIC is a program that works with people and understanding what influences people – whether participants, corporate and cashier level vendor partners, farmers or clinic staff, is vital to better understanding how WIC can be an effective and efficient program.
Julie Reeder is Senior Research Analyst at Oregon WIC and member of the NWA Evaluation Committee. With close to 1000 hours of qualitative research experience within WIC, Julie talked to us about why she is passionate about qualitative research and how focusing on the emotional side of the WIC experience, is crucial to developing a more well-rounded understanding of the issues facing families that participate in the program. Julie also shared valuable insights on the importance of partnerships between academic researchers and State WIC staff.
What do you enjoy about conducting qualitative research?
Simply put, I love talking with people and hearing their stories! I feel honored and privileged when people share their honest truths with me. Qualitative research gives me the most well-rounded and complete understanding of what is happening in the lives of our WIC families.
Why is qualitative research important to WIC?
Quantitative research can tell you how many or how often, whether something is increasing or decreasing, whether one factor is associated with or predicts another, but it doesn’t tell you why that may be happening. Qualitative research gives you a unique window in to people’s decision making processes, the steps that lead up to a particular action or inaction. It also helps bring people’s feelings and matters of the heart in to the equation. Until you really understand what brings someone great joy or deep sadness it is hard to build a program or intervention that really addresses their needs.
Julie has a lot of experience partnering with university researchers to conduct WIC research, we asked, what added value does working closely with a university bring to the work of your work?
As an in-house WIC researcher, my greatest strength, being close to the program, can also be my greatest weakness. Having an academic partner who is not immersed in details of the program can bring a fresh perspective to the research questions I pursue, the study design, and possible policy and practice implications. It also allows me to partner with people with complementary skills or who can provide a completely new analytic perspective. I would highly recommend cultivating partnerships with academics outside the fields of nutrition or maternal and child health. Not only does it broaden my research horizons but it creates the opportunity for WIC to be discussed in an expanded circle of academic disciplines.
How do you develop academic partnerships?
Most evolved from what started as just casual conversations about what I learned from my years doing research in WIC, offered either in support or in sharp contrast to what the other person is stating. You’d be surprised how telling someone they are totally off base with their assumptions about WIC or WIC families can lead to a fruitful partnership.
I am also part of the Social Determinants of Health Initiative Community/ Academic Advisory Council, which is a joint venture of two of our State universities. I connect with people through that initiative and have had members of that group recommend to their academic colleagues that they contact me if we have a shared research interest. Finally I keep my researcher speed-dating skills sharp! For the last two years, I have attend the Building Interdisciplinary Research Careers in Women's Health (BIRCWH) conference. There is a research speed-dating session at the conference and I have two current academic partnerships that came directly from that.
We asked Julie what advice she would offer to academic researchers interested in studying WIC. Julie went straight to the horse’s mouth to see what current academic partners had learnt through their experience of conducting WIC research. The quote below is from a Pediatrician at Oregon Health Sciences University that Julie is currently partnering with to explore delays in developmental screenings in low-income and non-English speaking children. It is clear that working partnerships between academic researchers and state WIC staff are mutually beneficial and ensures research has optimal value for WIC.
It’s important to be clear with researchers from the beginning about what WIC’s goals are (and what they are not), as well as what is feasible in the WIC setting. WIC is not a medical setting, and it’s also not a research lab. Also, because WIC serves a vulnerable population it is vulnerable to “helicopter research” that doesn’t really end up benefitting WIC. We spent a lot of time talking about this in the beginning, and maybe it caused some exasperation on both sides, but I think it made the project better in the end, and I think it resulted in you and me having a more shared vision about what is feasible and acceptable to WIC.
As part of the FNS periconceptional health grants, Julie is currently working with colleagues at Baruch College CUNY to consider the association between interpregnancy interval and maternal health outcomes among WIC participants (see a project description here). Julie will be presenting findings from this important research at the National WIC Association Annual Conference next month.
Below is a selection of abstracts from WIC studies published in the last three months.
Food Package
Revised WIC Food Package and Children’s Diet Quality JM Tester, CW Leung, PB Crawford – Pediatrics, 2016.
WIC Participant and Program Characteristics 2014: Food Package Report. Patlan, K. L. & Mendelson, M. Prepared by Insight Policy Research under Contract No. AG‐3198‐C‐11‐0010. Alexandria, VA: U.S. Department of Agriculture, Food and Nutrition Service. 2016.
Where Do WIC Participants Redeem Their Food Benefits? An Analysis of WIC Food Dollar Redemption Patterns by Store Type L Tiehen, E Frazao - Economic Information Bulletin, 2016
Choice Architecture Increases WIC Fruit and Vegetable Purchases in a Latino Community: Randomized, Controlled Corner Store Intervention AN Thorndike, OJM Bright, MA Dimond, R Fishman, Levy D - Circulation, 2016
Prenatal and Postnatal Fruit and Vegetable Intake Among US Women: Associations with WIC Participation TL Stallings, JA Gazmararian, M Goodman, D Kleinbaum - Maternal and Child Health Journal, 2016
Gestational Weight Gain
Associations Among Leisure-Time Physical Activity, Gestational Weight Gain, and Postpartum Weight Retention With Varying Estimates of Prepregnancy Weight RA Schlaff, C Holzman, KS Maier, KA Pfieffer, Pivarnik JM - American Journal of Lifestyle Medicine 2016
Pre-Pregnancy Weight Status Is Associated with Diet Quality and Nutritional Biomarkers during Pregnancy D Shin, KW Lee, WO Song - Nutrients, 2016
Association of Provider Advice and Pregnancy Weight Gain in a Predominantly Hispanic Population J Liu, KM Whitaker, MY Stella, SM Chao, MC Lu - Women's Health Issues, 2016
Breastfeeding
Why invest, and what it will take to improve breastfeeding practices? NC Rollins, N Bhandari, N Hajeebhoy, S Horton - The Lancet, 2016
WIC Participation and Breastfeeding at 3 Months Postpartum EF Gregory, SM Gross, TQ Nguyen, AM Butz, Johnson SB - Maternal and Child Health Journal, 2016
If You Build It They Will Come: Satisfaction of WIC Participants With Online and Traditional In-Person Nutrition Education LE Au, S Whaley, K Gurzo, M Meza, LD Ritchie - Journal of Nutrition Education and Behavior, 2016
Screen Time Associated to Unhealthy Diets in Low-Income Children SC Lee, M Koleilat, LM Hernandez, SE Whaley, Davis JN - Journal of Food and Nutrition Research, 2016
Optimizing Nutrition Education in WIC: Findings From Focus Groups With Arizona Clients and Staff Y Greenblatt, S Gomez, G Alleman, K Rico, McDonals D, Hingle M - Journal of Nutrition Education and Behavior, 2016
Infant Mortality
The Impact of WIC on Birth Outcomes: New Evidence from South Carolina L Sonchak - Maternal and Child Health Journal, 2016
Participation
Concerns and Structural Barriers Associated with WIC Participation among WIC-Eligible Women. CH Liu, H Liu - Public Health Nursing, 2016