WIC NE State & Local - Phase II

APPENDIX TTT:
Site Staff Interview Guide Baseline

OMB Control Number: 0584-XXXX
Expiration date: XX/XX/XXXX

WIC Nutrition Education Study

Phase II Pilot Study: Site Staff Interview Guide—Baseline Interview

Site ID: ________________ Date:

Staff interviewed (names/titles):

Interviewer name:

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it ‎displays a valid OMB number. The valid OMB control number for this information collection is 0584-XXXX. The time required to ‎complete this information collection is estimated to average 45 minutes per response, including the time for reviewing instructions, ‎searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of ‎information.

Note to Interviewer:

Several of the items for this interview are included in the Phase I Site Survey but are included in this interview because the information may change during the period between the survey and start of the pilot. Prior to the interview, provide the site with a report of their Phase I survey responses and ask them to review it to prepare updates for the interview. The interviewee can make changes to the report and return it before the interview or share the changes with the interviewer during the interview, whichever they prefer. Additionally, request a copy of the current Local Agency Nutrition Education Plan for the site and, if applicable, a schedule of the group education topics for the site. Review these in advance of the interview to prefill any questions in the interview guide that can be completed with information in those resources and verify them during the interview.

Script

Hi. My name is _______________________. I work for Altarum Institute, and we are part of the study team for the WIC Nutrition Education Study or NEST.

Thank you for taking the time for this interview. The purpose of today’s interview is to hear from you about your WIC site and the nutrition education you provide. During this interview, I will ask you to provide updates for some of the information that we received from your site previously in a survey completed last summer. I’ll also ask for some additional background information about your site and how you provide nutrition education. We will be contacting you again in 6 months for updates to some of this information, which will take about 15 minutes. Our interview today will last no more than 45 minutes.

Do you have any questions before we begin? If not, let’s get started!

Note to reviewers: Several of the items for this interview are included in the Phase I Site Survey but are included in this interview because the information may change during the period between the survey and start of the pilot. We will provide the Phase II sites with a report of the Phase I survey responses in advance of the interview and ask them to review it to prepare updates for the interview. The interviewee can make changes and return it before the interview or go through the changes with the interviewer during the interview, whichever they prefer. Additionally, the interviewer will have a copy of their responses to help facilitate the interview so that this information is being “verified” rather than being requested again.

A. Background Information

1. Describe the site schedule (hours of operation, days of the week operating): __________________________________________________________________

2. On average, how many participants are served at your site each month? ________

3. [INTERVIEWER: VERIFY AND UPDATE INFORMATION PROVIDED ON
   QUESTION 9 IN SITE SURVEY]
   For each job classification/type of staff, enter the number of staff who currently provide nutrition education at the site who work full time and the number who work part time. (If a staff member works 32 or more hours/week on WIC, count them in the Full-Time Staff column and if less than 32 hours/week on WIC, count them in the Part-Time Staff column appropriate for the number of hours they work per week. If a staff member performs more than one role, count them only once in the job classification/type for their primary role.)

Job Classification/Type of Staff	Number of Full-Time Staff (work on WIC activities 32 or more hours per week)	Number of Part-Time Staff (work on WIC activities 21–31 hours per week)	Number of Part-Time Staff (work on WIC activities 20 or fewer hours per week)
WIC director/coordinator
Site/clinic supervisor
Registered dietitian (RD)
Degreed nutritionist, not RD
Trained nutrition paraprofessional (e.g., nutrition assistant, nutrition aid, competent paraprofessional authority, diet technician, social services technician)
Nurse
Nutrition education coordinator
Administrative/clerical/support staff
Lactation consultant/WIC-designated breastfeeding expert
Breastfeeding coordinator
Breastfeeding peer counselor
Other:_______________
Total

B. Scheduling Nutrition Education

Now I’d like to know how your site provides nutrition education.

4. [INTERVIEWER: VERIFY AND UPDATE QUESTION 5 FROM SITE SURVEY]
   During what types of visits does the site provide nutrition education contacts? (Select all that apply.)

• Certification visit (e.g., enrollment, recertification)

• Mid-certification visit (e.g., prenatal trimester visit, infant/child mid-certification, breastfeeding mid-certification)

• Secondary education follow-up visit (e.g., group classes, food issuance/pick-up, breastfeeding follow-up, low risk follow-up)

• High-risk follow-up visit (e.g. nutritionist visit, nutrition counseling visit, high-risk group classes)

• Other visits (describe):

5. [INTERVIEWER: VERIFY AND UPDATE INFORMATION PROVIDED FOR QUESTION 4 ON SITE SURVEY.]

In the first column, enter the number of nutrition education contacts the site offers (i.e., makes available) during a certification period for each participant category and time period. While the number of contacts varies based on individual needs, enter the number that is offered to the majority of participants in the category. (Count all contacts beginning with the certification visit; for example, if prenatal women who enroll in the 1^st trimester are offered 3 contacts during the prenatal certification period, enter “3.” Enter NA for any category/time period that is not applicable at the site.)

In the second column, enter the estimated percentage of participants who receive that number of nutrition education contacts during their certification period. (Please estimate based on your experience. You do not need to run a report or review participant records to answer this question.)

Participant Category and Time Periods	Number of Nutrition Education Contacts Site Offers during Certification Period	Estimated Percentage of Participants who Receive this Number of Contacts
Participants who are NOT high risk
Prenatal woman, enrolling in 1st trimester
Prenatal woman, enrolling in 2nd trimester
Prenatal woman, enrolling in 3rd trimester
Breastfeeding woman, 6-month certification period
Breastfeeding woman, 12-month certification period
Postpartum woman, not breastfeeding
Infant, 6-month certification period
Infant, 12-month certification period
Child, 6-month certification
Child, 12-month certification
Participants who are high risk and/or have nutritional risks requiring special attention
Prenatal woman, enrolling in 1st trimester
Prenatal woman, enrolling in 2nd trimester
Prenatal woman, enrolling in 3rd trimester
Breastfeeding woman, 6-month certification period
Breastfeeding woman, 12-month certification period
Postpartum woman, not breastfeeding
Infant, 6-month certification period
Infant, 12-month certification period
Child, 6-month certification period
Child, 12-month certification period

6. [INTERVIEWER: VERIFY AND UPDATE INFORMATION PROVIDED FOR QUESTION 7 ON SITE SURVEY.]

On average, how much time do staff members who provide nutrition education at the site spend providing nutrition education during each of the following types of WIC visits? Do not include time spent on eligibility (e.g., income and residency) or assessment (e.g., weighing/measuring, blood work, reviewing nutrition questionnaires).

Type of Visit	Less than 5 Min	5–10 Min	11–20 Min	21–30 Min	31–45 Min	46–60 Min	More than 60 Min	NA	Don’t Know
Enrollment Certification									
Recertification — Not high risk, 1 person									
Recertification — High risk, 1 person									
Recertification — 2 or more family members									
Mid-certification									
Secondary education follow-up (individual)									
Secondary education follow-up (group)									
High-risk follow-up									
Other									

7. Do you know what your attendance rate is, that is, the percentage of participants who come for nutrition education appointments?

• Yes

• No

• Not applicable, site does not schedule appointments (walk-in only)  GO TO Question 11

8. In a typical month, about what percentage of participants attend appointments (i.e., “show up”) for nutrition education at each type of appointment?

   Type of Appointment	Percent
   Certification	___
   Mid-certification	___
   Secondary education follow-up	___
   High-risk follow-up	___
   Other visits (describe): ________________	___

9. What methods, if any, does your site use to remind participants of their upcoming appointments, for example, reminder calls or text messages?

10. How does your site follow up with participants who miss their nutrition education appointments?

11. Which of the following medical or other services are offered to participants at this site in conjunction with WIC visits? [INTERVIEWER: READ LIST AND SELECT ALL THAT APPLY.]

• Immunizations

• Child health care (e.g., EPSDT, well child)

• Prenatal care

• Lead testing

• Family planning services

• SNAP registration

• Medicaid registration

• Head Start

• Other (describe):

C. Nutrition Education Modes

Next, I’d like to know more about the methods that your site uses to provide nutrition education. [INTERVIEWER: VERIFY AND UPDATE INFORMATION PROVIDED FOR QUESTION 6 AND QUESTIONS 10 THROUGH 14 (MODULE 2) ON SITE SURVEY. IF MODULE 2 WAS NOT COMPLETED THEN COLLECT THIS INFORMATION. SKIP QUESTION IF A VISIT TYPE IS NOT APPLICABLE.]

12. What methods are used to provide nutrition education? (Select all methods that are used for each type of visit.)

Method	Enrollment Certification	Recertification	Mid-certification	Secondary Education	High-Risk	Other
One-on-one counseling: Face to face (in WIC site)						
One-on-one counseling: Telephone						
One-on-one counseling: Video conferencing						
Group education sessions						
Technology-based nutrition education used by participants at site (e.g., computer, kiosk, tablet)						
Technology-based nutrition education used by participants offsite via Internet (e.g., web-based nutrition education modules)						
Other nutrition education activities (e.g., monthly topic, worksheets, videos, self-study modules)						

13. During certification visits (enrollment or recertification), how often does the site use the methods listed below to provide nutrition education? (Select one response for each method.)

    Method	Never	Rarely (<10%)	Occasionally (11–39%)	Some-times (40–59%)	Often (60–89%)	Almost Always (≥90%)
    One-on-one counseling: Face to face (in WIC site)						
    One-on-one counseling: Telephone						
    One-on-one counseling: Video conferencing						
    Group education sessions						
    Technology-based nutrition education used by participants at site (e.g., computer, kiosk, tablet)						
    Technology-based nutrition education used by participants offsite via Internet (e.g., web-based nutrition education modules)						
    Other nutrition education activities (e.g., monthly topic, worksheets, videos, self-study modules)						

14. During mid-certification visits, how often does the site use the methods listed below to provide nutrition education? (Select one response for each method.)

Method	Never	Rarely (<10%)	Occasionally (11–39%)	Some-times (40–59%)	Often (60–89%)	Almost Always (≥90%)
One-on-one counseling: Face to face (in WIC site)						
One-on-one counseling: Telephone						
One-on-one counseling: Video conferencing						
Group education sessions						
Technology-based nutrition education used by participants at site (e.g., computer, kiosk, tablet)						
Technology-based nutrition education used by participants offsite via Internet (e.g., web-based nutrition education modules)						
Other nutrition education activities (e.g., monthly topic, worksheets, videos, self-study modules)						

15. During secondary education follow-up visits, how often does the site use the methods listed below to provide nutrition education? (Select one response for each method.)

Method	Never	Rarely (<10%)	Occasionally (11–39%)	Some-times (40–59%)	Often (60–89%)	Almost Always (≥90%)
One-on-one counseling: Face to face (in WIC site)						
One-on-one counseling: Telephone						
One-on-one counseling: Video conferencing						
Group education sessions						
Technology-based nutrition education used by participants at site (e.g., computer, kiosk, tablet)						
Technology-based nutrition education used by participants offsite via Internet (e.g., web-based nutrition education modules)						
Other nutrition education activities (e.g., monthly topic, worksheets, videos, self-study modules)						

16. During high-risk follow-up visits, how often does the site use the methods listed below to provide nutrition education? (Select one response for each method.)

Method	Never	Rarely (<10%)	Occasionally (11–39%)	Some-times (40–59%)	Often (60–89%)	Almost Always (≥90%)
One-on-one counseling: Face to face (in WIC site)						
One-on-one counseling: Telephone						
One-on-one counseling: Video conferencing						
Group education sessions						
Technology-based nutrition education used by participants at site (e.g., computer, kiosk, tablet)						
Technology-based nutrition education used by participants offsite via Internet (e.g., web-based nutrition education modules)						
Other nutrition education activities (e.g., monthly topic, worksheets, videos, self-study modules)						

17. During other types of visits (not including certification, mid-certification, secondary education follow-up, and high-risk follow-up visits), how often does the site use the methods listed below to provide nutrition education? (Select one response for each method.)

    Method	Never	Rarely (<10%)	Occasionally (11–39%)	Some-times (40–59%)	Often (60–89%)	Almost Always (≥90%)
    One-on-one counseling: Face to face (in WIC site)						
    One-on-one counseling: Telephone						
    One-on-one counseling: Video conferencing						
    Group education sessions						
    Technology-based nutrition education used by participants at site (e.g., computer, kiosk, tablet)						
    Technology-based nutrition education used by participants offsite via Internet (e.g., web-based nutrition education modules)						
    Other nutrition education activities (e.g., monthly topic, worksheets, videos, self-study modules)						

18. Which of the following does your site use to reinforce the information provided in nutrition education contacts? [INTERVIEWER: READ LIST AND SELECT ALL THAT APPLY.]

• Brochures or written materials

• Bulletin boards with nutrition information

• Computer, kiosk, or tablet computer at the site

• Cooking demonstrations

• Display tables with nutrition information

• Educational props (e.g., food containers, breastfeeding dolls, physical activity items)

• Email messages with nutrition education content

• Food tasting

• Monthly or quarterly nutrition newsletters sent home

• Nutrition education videos/DVDs sent home

• Nutrition education videos/DVDs viewed at site

• Social media (e.g., Facebook, Twitter)

• Support groups (e.g., parenting or breastfeeding group)

• Technology-based education used outside of the site

• Telephone calls with nutrition education content

• Text messages with nutrition education content

• Other (describe):

19. a) What, if any, follow-up does your site do to assess if participants are using these reinforcement materials or options?

b) [ASK ONLY IF SITE IS ASSESSING USE OF REINFORCERS] What have you learned about how participants are using reinforcement materials?

20. [ASK ONLY IF SITE PROVIDES GROUP EDUCATION] How many months of future group session topics do you have planned?

21. I’m going to read a list of topics. Please tell me if you plan to cover the topic in group education for the upcoming months. [INTERVIEWER: READ LIST AND SELECT ALL THAT APPLY.]

• Breastfeeding

• Child feeding practices

• Cooking/meal preparation

• Dental health

• Fruit and vegetables

• Healthy snacks

• Healthy weight for child

• Healthy weight for mother

• Infant feeding practices

• Infant/child growth and development

• Introduction of solid foods

• Inappropriate/sometimes foods (e.g., high-fat foods, fast foods)

• Iron/anemia

• Milk (lower fat choices/consumption)

• Parenting

• Physical activity

• Picky eaters

• Portion sizes

• Prenatal nutrition/diet

• Shopping for and preparing healthy foods

• Sugar-sweetened beverages

• Water consumption

• Whole grains

• Weaning from the bottle

• Other (describe):

D. Site Space

Now, I have a few questions about the space available at your site for providing nutrition education.

22. a) Do you feel that there is adequate space for providing nutrition education at your site?

• Yes

• No

b) [If no] Please explain:

23. In your opinion, what features of your WIC site support high-quality and effective nutrition education?

24. If you could change one thing about your site’s space to improve the way you provide nutrition education, what would it be?

E. Staff Training

Next I have some questions about training for staff who provide nutrition education at this site.

25. During the past 6 months, about how many total hours of training on nutrition topics and/or nutrition education skills were provided to staff at your site who provide nutrition education? If there was one 4-hour training course and one 2-hour training course, then count 6 hours regardless of the number of staff who attended.

____________

26. I’m going to read a list of different types of nutrition education methods. For each one, tell me if staff at this site who provide nutrition education have received training on this method in the past 6 months. Include training that was provided by your own agency, State agency, and any outside training.

• 3-step counseling

• Facilitated group discussion

• Motivational interviewing

• Communication skills

• Goal setting

• Emotion-based counseling

• Value Enhanced Nutrition Assessment (VENA) skills/participant or learner-centered education skills

• None of the above

27. Now I’m going to read a list of different types of nutrition and health topics. For each one, tell me if staff at this site who provide nutrition education have received training on this topic in the past 6 months. Include training that was provided by your own agency, State agency, and any outside training.

• Breastfeeding

• Choosing lower fat milk

• Fruit and vegetables

• Physical activity

• Whole grains

• None of the above

F. Referrals

I’d like to know about referrals that your site provides to participants.

28. Are participants referred to other programs or organizations for help with achieving nutrition education, physical activity, or other health goals?

• Yes

• No  GO TO Question 31

To which programs/organizations do you routinely refer WIC participants?

a. ________________________________________________

b. ________________________________________________

c. ________________________________________________

d. ________________________________________________

29. Describe your referral process. For example, are referrals made by providing information to the participant, by phone or email to the referral organization, etc.?

30. What, if any, follow-up is done with the participant or with the referral organization after the referral is made?

G. Nutrition Education Support and Challenges

My last questions ask for your opinion about challenges in providing nutrition education and factors that support implementation of effective nutrition education.

31. What are the biggest challenges you experience in providing nutrition education?

32. a) What factors support your site in implementing effective nutrition education?

b) Describe how those factors support your site.

33. Is there anything else you would like me to know about how your site provides nutrition education?

34. Before we wrap up, can you please describe any special nutrition education activities or approaches used at your site?

That’s all of the questions that I have today. I will talk with you again in about 6 months. Thank you for taking the time for this interview.