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- Title
A Systems Approach to Identify Factors Influencing Participation in Two Tribally-Administered WIC Programs.
- Authors
Estradé, Michelle; Alarcon Basurto, Samantha Grace; McCarter, Abbegayle; Gittelsohn, Joel; Igusa, Takeru; Zhu, Siyao; Poirier, Lisa; Gross, Susan; Pardilla, Marla; Rojo, Martha; Lombard, Kevin; Haskie, Henry; Clark, Veronica; Swartz, Jacqueline; Mui, Yeeli
- Abstract
Native American populations experience highly disproportionate rates of poor maternal-child health outcomes. The WIC program aims to safeguard health by providing greater access to nutritious foods, but for reasons not well understood, participation in many tribally-administered WIC programs has declined to a greater extent compared to the national average decline in participation over the last decade. This study aims to examine influences on WIC participation from a systems perspective in two tribally-administered WIC programs. In-depth interviews were conducted with WIC-eligible individuals, WIC staff, tribal administrators, and store owners. Interview transcripts underwent qualitative coding, followed by identifying causal relationships between codes and iterative refining of relationships using Kumu. Two community-specific causal loop diagrams (CLDs) were developed and compared. Findings from interviews in the Midwest yielded a total of 22 factors connected through 5 feedback loops, and in the Southwest a total of 26 factors connected through 7 feedback loops, resulting in three overlapping themes: Reservation and Food Store Infrastructure, WIC Staff Interactions and Integration with the Community, and State-level Administration and Bureaucracy. This study demonstrates the value of a systems approach to explore interconnected barriers and facilitators that can inform future strategies and mitigate declines in WIC participation.
- Subjects
MIDWEST (U.S.); SOUTHWESTERN United States; PATIENT participation; FOOD relief; FOOD security; INTERVIEWING; MEDICAL care; COMMUNITIES; SYSTEM analysis; CHILD health services; INTERPERSONAL relations; RESEARCH funding; GROCERY industry
- Publication
Nutrients, 2023, Vol 15, Issue 5, p1210
- ISSN
2072-6643
- Publication type
Article
- DOI
10.3390/nu15051210