Leveraging Implementation Science to Identify and Address Facilitators and Barriers to WIC Enrollment, Participation, and Retention.

Abstract

Background: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) supports the health and nutrition status of low-income pregnant and postpartum people and young children. Despite its numerous benefits, WIC faces low enrollment, participation, and retention.

Objective: To identify facilitators and barriers to WIC enrollment, participation, and retention in Rhode Island, and develop an implementation blueprint to create tailored strategies to address barriers.

Methods: We conducted semi-structured qualitative interviews (N=41) in English and Spanish with WIC participants (n=13), individuals who no longer participate in WIC (n=11), and WIC staff (n=17). Using an inductive and deductive approach, we performed a rapid qualitative analysis guided by the Health Equity Implementation Framework (HEIF) to identify facilitators and barriers. Community advisory boards (CABs) consisting of individuals representing WIC and other community-based organizations categorized barriers based on their importance and feasibility. We then developed strategies to address "high" importance and "high" feasibility barriers. CAB members categorized these strategies based on impact and feasibility. Finally, we operationalized "moderate-high" or "high" impact and "high" feasibility strategies in the implementation blueprint.

Results: Interviews with participants revealed facilitators such as positive staff interactions and increased benefits during COVID-19. Barriers included limited program awareness, inconvenient clinic hours, stigma, and confusion over WIC product eligibility. The implementation blueprint described strategies to address identified barriers, such as social media campaigns, extended clinic hours, and optimizing referral networks.

Conclusions: Identified facilitators and barriers highlight the need for better communication, scheduling flexibility, accurate WIC product labeling, and enhanced staff roles. The implementation blueprint offers targeted recommendations and strategies to improve WIC participation and retention in Rhode Island and can serve as guidance for other WIC state and local agencies to ensure WIC's continued support for low-income families nationwide.