Appendix I4 FNS Response to NASS Comments

Appendix I4: FNS Response to NASS Comments

FNS Response to:

Review of

WIC Nutrition Assessment and Tailoring Study (WIC-NATS)

Food and Nutrition Service (FNS)

Reviewer - Anthony Fischer – Mathematical Statistician

Methodology Division – Census Data Section

National Agricultural Statistics Service, Washington, DC 20250

Phone: (202) 720-0791

[email protected]

SSA – WIC NATS:

Page 5 – The abbreviation “SA” is used before it is clarified that it stands for State Agency. I recommend indicating earlier that SA means State Agency

• FNS Response: Spelled out State Agency before first use of SA.

Page 21 – Estimated Frequency of Responses per Respondent and Non-Respondent: This is not clear to me. Will respondents be continuously interviewed (i.e. 4.57 times) or will they be interviewed once? I am under the impression that respondents will be interviewed once. This question appears to be addressed in Appendix B, the OMB Burden Table, but I think that it is a good idea to mention that different instruments will require different frequencies of response. Clarify, for example, that although WIC participants will only be interviewed once, the frequency of responses per respondent number (4.57) also includes contacting SA and LA staff, reminder e-mails, informed consent, and other response burdens.

• FNS Response: The Frequency of Responses per Respondent examples cited refer to an aggregate count across all instruments and respondent groups. The OMB Burden Table in Appendix B is provided to explain response burden per item per respondent. I added a footnote to the page in question that explains this and points the reader to Appendix B.

SSB – WIC NATS:

Page 5 – The document mentions that the study team will purposively select 10 SAs. Will there be a systematic process to determine which SAs will be contacted? There are several criteria given later in the Supporting Statement for how the SAs and LAs will be stratified, but will there be a selection process to determine which agencies will be sampled once it is determined which agencies meet the criteria?

• FNS Response: Systematic selection steps have been added to SSB to explain how eligible SAs and LAs will be sampled.

Page 10 – Regarding the estimation procedure, what is the final product? A dataset or a publication? Is the brochure considered the publication? If there is a publication, it is not clear what will be published: most popular WIC services? Or will the results be used entirely internally at FNS?

• FNS Response: The planned final product is a public report that will address the research objectives and questions in Appendix A3. A public use dataset may be available upon request, but this data is not collected with the intention of being weighted to be nationally representative.

Page 10 – The document mentions that the information collection procedure are described in Section A.2. Section A.2., however, describes the purpose and use of the information and gives a background of the types of operations that comprise the sample, but there is no mention of the estimation procedure, degree of accuracy, etc. I recommend adding a sentence to clarify that further information is included in section B.2.

• FNS Response: The sentence in question is referring to previous sections of the supporting statement that describe how information will be collected from sources and respondents. Information concerning sampling, estimation procedure, etc. is provided in B.2. Rephrased sentence to clarify.

Page 14 – The document mentions WIC clinics will be offered a gift in return for completing the survey. Will the clinics be made aware of the participation incentives during the recruitment process? Or only after they agree to participate?

• FNS Response: Clinics are notified during the recruitment process (Appendix G3) that if they participate in the site visits, then they will be offered a gift in appreciation for their participation. This is also explained in page 16 of Supporting Statement B. There is no gift for the LA survey.

Appendix A – Research Questions:

Page 4 – Objective 4d, what is clinic flow, and is there a way to measure that clinic flow has objectively improved? If yes, reference these methods or studies here.

• FNS Response: “Clinic flow” is broadly used to define the movement of patients (or in our case, WIC participants) through the various steps involved with their clinic visit. This is the first study of its kind to document the nutrition risk assessment and benefit tailoring process, so observers will use their notes to construct flow diagrams of the processes at each clinic. Researchers will document the time that it takes for participants to move from one step of the clinic flow to the next as well as waiting time in between. Objective 4d is asking for participant and staff suggestions to improve clinic flow. The site director interview (Appendix C6), clinic staff interview (Appendix C8), and WIC participant interview (Appendix C9/9a) all ask about satisfaction with clinic flow and suggestions for improvements.

Appendix C2

Page 2 – Question 3, the routing instruction in the ‘No’ answer option for Question 3 (GO TO QUESTION 4) seems unnecessary. Both yes and no answers will go to question 4 after question 3 unless instructed otherwise. Should ‘Yes’ answers go to another question? The routing can be verified against the web instrument routing (Appendix C2A)

• FNS Response: Agreed, this was an error and it is now corrected.

Page 4 – Instructions prior to Question 8. Should this read ‘FOR EACH TRAINING TOPIC SELECTED IN QUESTION 7 ABOVE’? Question 6 is not about training topics.

• FNS Response: Agreed, this was an error and it is now corrected.

Appendix C6

Page 5 – Regarding the previous point about clinic flow, the series of questions from 13-16 may be a good place to ask about metrics used to gauge clinic flow and how they can be improved. For example, the average time spent in the site per WIC participant, the average time spent visiting with a participant per staffer, etc.

• FNS Response: Agreed. Instead of asking clinic staff to give us the averages, the field researchers will observe and document these timestamps for the days they present at the clinic (Appendix C7).

Appendix C7

Page 5 – The last item on the page ‘Did the WIC CPA explain the participant’s growth/weight gain pattern to participant caregiver? chart)’ appears to need rewording or rephrasing. The reference to the chart is not clear

• FNS Response: Agreed, this was an error and it is now corrected.

Appendix C9

Page 9 – Starting in Question 6, the routing must be corrected. If a respondent answers that the questionnaire was difficult, then they are routed to Question 8. As the questionnaire is currently routed, there are no circumstances where the respondent answers Question 7. Please thoroughly review and correct the routing numbers from Questions 6 through 14.

• FNS Response: Agreed, this was an error and it is now corrected.

Appendix D3

Page 2 – Timeline of Activities, the first sentence should start ‘Data collection is expected to begin in…’

• FNS Response: Agreed, this was an error and it is now corrected.

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