Retracted: Identifying Strategies to Improve Enrollment and Participation in Three Rural Native American WIC Programs

Abstract Objectives The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has a strong track record of improving birth and health outcomes in high-risk populations. For the past decade and a half, WIC enrollment among Native American women and children has declined by approximately 40% for reasons that have not yet been elucidated. The objectives of this work are to 1) Understand the individual-, household-, and community-level factors that facilitate and impede participation in three rural tribal WIC programs, and 2) Identify strategies for addressing significant unexplained declines in WIC participation. Methods We partnered with three tribal WIC agencies – two in the Southwest and one in the Midwest – to plan and conduct this formative research. In-depth qualitative interviews (n = 35) were conducted with current and former WIC participants, eligible non-participants, WIC staff, tribal health administrators, and managers of food store that accept WIC in each study community. Interview transcripts were inductively coded and crosscutting emergent themes across communities were identified by four researchers. Results Tribal WIC agencies are highly valued for their culturally-competent staff and the integration of traditional knowledge and values into their services. However, participation barriers related to internet and telephone connectivity have become amplified during the COVID-19 pandemic, and a complicated and often embarrassing food shopping experience is a major obstacle to WIC benefit redemption in small rural food stores. Dominant themes differed greatly by community, indicating that intervention strategies to address declines in WIC participation should be tailored to community-level infrastructure, policy, and cultural values, which are unique to each community. Conclusions This work represents an important step toward improving understanding of the strengths and weaknesses of the WIC program in rural Native communities and identifying key focus areas for future interventions. Funding Sources Robert Wood Johnson Foundation Healthy Eating Research Grant #77,235.