Insights from Washington’s COVID-19 response: a mixed-methods evaluation of WIC remote services and expanded food options using the RE-AIM framework

Abstract

In March 2020, in response to the COVID-19 pandemic, Washington WIC (WA WIC) adopted federal waivers to facilitate transition to remote service delivery for both certification and education appointments. Due to challenges the WIC participants were facing when purchasing WIC-approved items in the stores during the pandemic, WA WIC also expanded the approved food list by more than 600 items. This study assessed the reach and effectiveness of the programmatic changes instituted by WA WIC during the pandemic; the processes, facilitators, and challenges involved in their implementation; and considerations for their continuation in the future. This mixed-methods study included virtual, semi-structured focus groups with WA WIC staff, virtual, semi-structured interviews WA WIC participants, and quantitative programmatic data provided by WIC agencies across the state of Washington. Fifty-two WIC staff from numerous agencies with various jobs and levels of practice participated in focus groups. Forty WIC participants of various races, ethnicities, urbanicities, languages, and experiences with WIC participated in interviews; 10 interviews were conducted in Spanish and 30 interviews were conducted in English. Thematic coding analysis with Dedoose (ver 8.3.45) was used to organize and interpret qualitative data, alongside quantitative analysis completed Microsoft Excel focusing on descriptive statistics. Compared to key months in 2019, overall participation on WIC increased, and completion rates for nutrition education and certification appointments increased in 2020 after WA WIC adopted the programmatic changes. Food benefit redemption also increased immediately after the food list was expanded in April 2020. Staff and participants were highly satisfied with remote service delivery, predominately via the phone, and participants appreciated the expanded food options. Staff and participants would like to continue having a remote appointment option in the future, and suggested various changes to improve service quality.