WIC - Ralitsa_A_Holub

WIC was modeled on a program started in Baltimore, MD in 1969 by Dr. David Page from John Hopkins University and was intended to help poorer families by prescribing food as medicine. The national program began shortly afterward and has grown to include not only food distribution programs, but also nutritional education, breastfeeding education and support, malnutrition and anemia screenings, vaccination monitoring, and connections to other community resources such as mental health services, family violence protection, and many more. This case study truly began in 2015 when I worked on a one-year grant for the Wichita County Health Department. During this time, I was assigned to help improve the WIC shopping experience for customers in Wichita County. I interviewed fourteen grocery store managers, ten mothers who used WIC and participated in WIC classes and training. Recently, I have conducted a survey, user and store-employee interviews, and independent research on this issue. This has led me to define the problem.

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The WIC program receives a budget of $4.5 billion annually. The total amount distributed to the 6.2 million current users is estimated at around $744 million. The rest is used for training, administration, salaries, etc.

The WIC program’s food distribution section works as a means of proving nutrition as a form of medicine. Because of this, WIC is unique among other food assistance programs; each participant receives unique food packages based on their family’s individual needs and calculated by a nutritionist from the WIC program. These packages are explained in a rather generalized pamphlet that often does not contain pricing or availability in individual stores. This pamphlet shows the users the brands that WIC has approved for the year for items such as cereal, juice, and beans, but for staple items -such as bread, milk, and eggs- the users are instructed to buy what is known as the Least Expensive Brand, or LEB which are often indicated in stores with pink WIC stickers, but not consistently.

Although the WIC program has been a success in the past since 2010 the number of participants -and therefore funding- has been drastically declining. From 2010 to 2020 the number of WIC participants dropped by more than 3.7 million. Unfortunately, this is not due to a decreased need for the program. Studies have indicated the reason behind this decline in participation is due in large part to user dissatisfaction and other programs being more accessible.

We estimated the average WIC user spends the amount of about $38.50 on the products they purchase. However, the packages distributed from the WIC program start from around $45 and can go up to $400 for babies on formula.

The most average package offered is equivalent to around $81 for breastfed babies who make up around 70% of all WIC participants. This indicates that user utilization is low - in some cases up to 70% lower than the package allotted - and this, in my opinion, based on my research, is due to customer dissatisfaction.* If this problem were improved, and usage rates were increased, this would increase usage of the program and therefore increase funding, it could boost the US economy with an additional $700 million that will go to food production, farmers, and grocery stores, and, most importantly, it can improve the health of millions of women, infants, and children across the country.

During my time working for WIC, part of my job was to help determine the cause of this dissatisfaction in Wichita County. Unfortunately, this proved difficult to pin down. The WIC program employees blamed the stores and users, the store managers blamed the users, and the users generally blamed the store employees and, to a lesser degree, the program itself. I conducted many interviews, observations, and studies at this time.

Recently, I was drawn again to this issue and began my own independent research into the cause of the decline in WIC participation. I believe an independent study is necessary for this issue because there will be less conflict of interest.

Throughout its history, WIC has done a wonderful job of empathizing with its user base; the Texas branch even created an app to help its users find approved items, keep up with appointments, and maintain the balance of their benefits. In interviews, however, both in 2015 and recently, WIC participants have expressed dismay at the difficulties in finding their products in the store, and managers have stated that they are often frustrated with customers who take out their dismay on their employees. However, I have also learned that the LEB’s are only updated once a year by the grocery store's corporate offices. Herein lies the issue.

Stores are required to report their LEB’s and backup LEB’s to the National WIC Association once a year. However, only the main LEB is entered into the POS system for ease of use at check-out. Item availability is not always consistent and can vary week to week. If the main LEB is depleted, it is then the cashier’s job to manually override the price of each of the backup LEB items for every purchase. This is extra work for the already overwhelmed cashiers and can lead to confusion and frustration if not caught.

I was very happy when I learned that WIC had created an app for users. This was something I had pitched to the National WIC Association after creating individual brochures for the stores in Wichita County. I was glad to see that WIC was continuing to empathize with its participants. However, there seemed to be a lack of empathetic design geared toward the store managers and employees. In order to decrease the confusion and frustration surrounding LEBs, managers and employees need a more efficient way of updating LEB inventory on a weekly, daily, or even real-time basis.

Unfortunately, WIC is an analog watch in the internet age. LEB inventory should not be simply a yearly report. This data should be item-specific and inventory sensitive; in other words, it should be a dynamic cataloging program that tracks each store’s LEB and WIC-approved inventory availability in real-time, and send reminders when inventory is low.

(Disclaimer: Throughout this process, I have not collected any personal data, nor have I been able to verify with certainty the status of any of the recently surveyed individuals within the WIC program.)

As stated earlier, I began this case study in 2015 when I was employed as an Outreach Specialist for the Wichita County Health Department. At this point I did not know I was conducting “UX Research”, but since my training through Thinkful, I am certain now that is what I was doing.

I was originally assigned to help improve the WIC customer experience in Wichita County. I received training in the WIC program, visited all the stores in the county to speak to managers, employees, and customers, and I began noticing the problem at this time. I even designed and printed individual brochures for each WIC-participating store in the county to help bridge the gap between grocery stores and WIC users. Here are some of the steps I took during this time.

Collected surveys among WIC customers to indicate where they shop.
Collected Least Expensive Brand Forms from 12 stores.
Outreached to 12 stores including their corporate offices to get approval to run the program.
Made pictures of all of the items in the LEB forms.
Designed custom shopping brochure for each store that contains their specific LEB products.
Presented the Brochure to focus group of WIC clients
Presented the Brochure to focus group of store cashiers
Following store manager and cashiers opinion developed Baby Food Guide
Developed web page and mobile web page www.EatWellWichitaCounty.com (go to Easy Shopping for WIC guide on the top menu)
Created an Easy Shopping brochure for the WIC guide board in the local WIC agency Placed brochure holders on the wall in the local WIC agency making all of the brochures available to all of the WIC customers.
Distributed brochures to 12 stores.
Trained managers in 12 stores about the new brochures
Trained 26 Cashiers in 6 stores about the brochures in one-minute training.
Created QR code posters in the stores so customers can scan them and have instant access to the mobile online version of the Easy Shopping for WIC guide.
Advertised through Facebook of the new program.

Recently, I began my own, independent research into this matter. I began my user research with a survey.

The purpose of this survey is to define the overall user satisfaction in regards to the various WIC program technologies. In addition, we tried to understand how educated the users were about the WIC program, and what percentage of their benefits they utilize. There were also a few open-ended questions that were designed to learn more about the WIC user shopping experience and the users’ experience with WIC in general. Originally, I wanted to conduct the survey in person, but I was having trouble finding volunteers, so I tried Facebook advertising. I received 46 valid responses and had a budget of $200: I paid Facebook to advertise a campaign looking for women and parents of young children who use the WIC program in Texas and paid the users $2 for their time. I conducted this survey study under my Network Dreamer brand so that I had more credibility as representing an institution rather than some lady asking weird questions.

53.3% of survey participants said that, yes, they had received training, but the remaining 46.7% indicated they had either never received training or didn’t remember if they had. If this survey is indicative of the WIC shopper’s experience as a whole, this means that, while a simple majority of WIC users feel educated about shopping for WIC products, a very large percentage of the user population feel inadequacies in this regard. To confirm this, one of the screening questions was not intended to obtain the user’s opinion, it was actually used to determine if the users knew how to use WIC’s Least Expensive Brand (or LEB) Program:

As before, a simple majority of users indicated that they had no difficulty finding products, but a combined 44.4% said they either absolutely did have trouble or may have in the past. In fact, in another question, the participants were asked if they ever used a WIC app to aid in their shopping, then if they indicated “yes” they were given an open-ended question asking the participants to elaborate on their experience with the app. Most said that the app was easy to use, but about half said something like these users:

“It's definitely helpful but not 100% accurate in identifying WIC-approved items.” [sic]

“Helpful but when scanning it shows approved whether or not it's approved for your list. For example, whole milk will scan approved even if you can only get skim or 1%.” [sic]

These two questions show that, while half of WIC users are able to find their products with relative ease, the other half of WIC users experience some trouble in finding products.

The last question I will be highlighting in this analysis asks the participants if they have ever experienced a lack of support or a lack of help from their local store representatives when asking them to help find products:

48.9% of participants indicated they had either definitely experienced or may have experienced a lack of help finding WIC products from their local store representatives.

The results of these studies have led me to the conclusion that the biggest problems facing the WIC Shopping Program are as follows:

About half of WIC users require more education on the program and how to use it
About half of WIC users feel they have difficulty finding products
About half of WIC users do not feel supported by their local store representatives when attempting to locate WIC approved products

We were able to contact two of the survey participants and conducted Zoom interviews with them. The purpose of these interviews is to help build empathy not only with WIC customers, but with employees of grocery stores and other areas of the WIC program, and to gain insight into the problems they face when using WIC.

In 2015 and 2016, while I was working for the WIC program, I interviewed more than twelve store managers and forty-seven cashiers from various WIC stores, and 10 WIC users in Wichita County, Texas. I expanded my research by conducting behavioral observations during manager trainings on the topic of the WIC program in Wichita County. Recently I have begun revisiting my research from 2015-2016 by conducting a WIC user survey. Through the user survey, I was able to contact two WIC users who agreed to be interviewed through Zoom meetings. I was also able to interview two store managers in Texas; one from Walmart, and the other from Kroger.

Through these interviews, I have observed that the WIC program still suffers from many of the same issues that plagued it back when I was working for them in 2015 and 2016.

For my recent user interviews, I chose two parents of young children who participate, or have participated, in the WIC program. The first user told me that she uses WIC mainly for the formula for her five-month-old daughter, and has been participating in the WIC program since before her baby was born. She said that with her busy schedule, she finds it difficult to go up to the WIC office for the classes they offer and wishes she could perhaps participate in an online class. She was not aware that WIC offers many other benefits besides food and formula, and said that she only used WIC for formula because the other food items were too difficult to locate.

“With my daughter, my art, and my job, I don’t really have time to go to the WIC office. Can’t I just go to a Zoom class or something?! Besides, I only use WIC for the formula since it’s so expensive and the other stuff is too hard to find and I don’t want to waste time.”

The second user said that she’d been on the WIC program for two years with her two young boys and that she liked using the WIC app even though it was not accurate in identifying the WIC-approved items. She said she prefers the app because

“the grocery store employees don’t ever help you I guess ‘cause either they don’t know or they don’t want to help.”

However, she admits, the app needs work.

“As a WIC Customer, I’d like to be able to use my WIC app to find the correct approved items in my store in order to save money on my grocery list.”

My interview with the store manager produced some insights into how WIC participating store employees feel about the WIC program and its users. One of the managers expressed some exasperation with WIC users.

“The customers often get upset with us because they confused about which items they can buy using WIC. They should know this before coming to shop.”

The other manager told me that the store managers only update the WIC LEB’s (Least Expensive Brands) once a year and that if the store were to run out of stock on a certain LEB, the next LEB would have to be entered manually at the register by the cashier for each transaction.

The results of my recent interviews reflect the sentiments expressed in the many interviews I conducted with WIC users and store employees five years ago. It is very clear, in my opinion, that one of the main reasons for the decline in use and funding for WIC in recent years is due -at least in part- to both customer and store-employee dissatisfaction and/or under-eduction.

In one shocking observation I made during my behavioral observation study of WIC store manager trainings, I discovered one manager -of a very large not-to-be-named store chain, I might add- actually sleeping through the training. This shows a lack of engagement and understanding of the importance of the WIC program.

Using these interviews and survey answers, I was able to create three personas: two based on WIC customers, and one based on a WIC participating grocery store manager.

At this point, I conducted a competitive analysis with 2 other food benefit programs. The aim of the Food Accessibility Program Competitive Analysis is to compare three of the most popular governmental food accessibility programs to determine their ease of use and customer satisfaction: the WIC program, the SNAP Benefits program, and the TEFAP program. All of these programs are under the wing of the Feeding America organization. This analysis will be used to help find the strengths and weaknesses in the WIC program and help determine the problems WIC users are facing. This is significant as in the latest study conducted by WIC, the program lost two million users between the years of 2010 and 2018. We believe this is due mainly to customer dissatisfaction with the WIC shopping experience. The following chart illustrates the aim of each of these programs:

SNAP (or Supplemental Nutrition Assistance Program) is not targetted toward any specific gender or age and can be used widely by qualified participants to help buy just about any grocery food product, however, the application process can be time-consuming, requires a lot of documentation, and/or proof of income (or lack thereof), etc.

TEFAP (or The Emergency Food Assistance Program) provides food and funding to national food banks and is less restrictive in regard to who is allowed to participate in the program. Generally speaking, anyone in need can seek the assistance of a food bank, usually with few questions, and little to no proof of income, residence, or employment. There is, however, limited choice of food items and -often- limited access often restricting users to one visit per week or month.

WIC (or Women, Infants, and Children) is a supplementary nutrition program based on the idea that food can be described as medicine. It was originally intended to help young mothers in populations that are generally at higher risk of malnutrition feed themselves and their children combined with nutritional education, breastfeeding education, wellness checks, and other resources such as mental health assistance and anemia tests.

Competitive analyses

After conducting the competitive analysis, I created the wireframes for my prototype. I decided to test the low fidelity prototype before producing the high fidelity prototype to help reduce error.

Due to time constraints and a lower budget, I only had the opportunity to upload my low-fidelity prototype to UserCrowd where I invited two friends who happen to be employees in retail stores to test it. I did not want to do random testing because I did not feel as if the audience was broad enough to get proper results. I wanted to make sure the subject understood a POS inventory system and had some familiarity with the WIC program, and, more specifically, the Least Expensive Brand (LEB) system.

The first part of the app we wanted to test was the login section, and whether the users could navigate to the appropriate login page designated for managers, cashiers, or stocking crew. The navigation went smoothly, and both users were able to navigate to this section with ease, however, both users pointed out that the button for requesting an authorization code was misspelled in the Store Crew section:

… and in the Manager section:

Thanks to the users I was able to correct some of the issues in my design, however, I believe we will need much more testing and many more iterations until the app is ready. After testing the low fidelity prototype, I set to work on the branding for the WIC Inventory Wizard. The inspiration for the color palette and font used in the WIC Inventory Wizard comes from the same place as my inspiration for the project as a whole: children. I chose the colors from one of my favorite children’s stories, The Little Prince by Antoine de Saint-Exupéry.

I cannot say for sure this project will lead to the saving of the WIC program in general, but I believe it is a great step toward understanding their users. I believe with the funding they have, they should designate a much larger portion toward UX testing, research, and design, and should design not only with empathy for their customers but also with empathy for the store managers and employees who are one of the three necessary legs in the WIC program.

Based on my research, it is my opinion that WIC should invest in automation and the reduction of human error as part of the WIC inventory process.

Unfortunately, I was unable to receive cooperation from the National WIC Association in regard to my research, going so far as to tell me I must ask permission for collecting any official WIC data.

As a result, I decided against collecting personal data from my survey participants, and therefore I was unable to fully verify their demographics.

My conclusions here are based only on the survey answers I was given in the survey screened through questions designed to help identify actual WIC users.

I believe there needs to be much more additional research in cooperation with the National WIC association with actual WIC customers chosen from clinics across the country utilizing higher budgets and larger teams. My research here is only the first step in opening the conversation toward helping resolve the problems facing the WIC program today.

Thank you for taking the time to read through this case study!

Ralitsa Holub

TX

04/28/2021

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