WIC National Outreach Campaign Formative Focus Groups

OMB CONTROL NO.: 0584-0611

EXPIRATION DATE: 11/30/2025

OMB BURDEN STATEMENT: This information is being collected to assist the Food and Nutrition Service in developing a National Outreach Campaign to increase awareness of the health and nutrition benefits associated with specific programs. This is a voluntary collection and FNS will use the information to meet the needs and understand the mindsets of current program participants, as well as those individuals who are eligible but do not participate. This collection does not request any personally identifiable information under the Privacy Act of 1974. According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0584-0611. The time required to complete this information collection is estimated to average 2 hours 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. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: U.S. Department of Agriculture, Food and Nutrition Service, Office of Policy Support, 1320 Braddock Place, 5th Floor, Alexandria, VA 22306 ATTN: PRA (0584-0611). Do not return the completed form to this address.

Attachment D-1 WIC Participant Focus Group Guide (English)

Focus Group Moderator Guide

WIC Participant Groups

Target Time ≈ 90 minutes of discussion &

respondents asked to log on 30 minutes before start time

1. Introduction (15 minutes]

1. Moderator introduction

2. Remind respondents to be in a quiet place

3. If you need to step away, do so briefly and come back as soon as possible

4. Anonymity

5. Rules for participation online (all opinions count, no wrong answers)

6. Grab a few pieces of paper and a pen or pencil.

7. Introduction – Share your first name, where you live, with whom you live (people, pets, plants, etc.); [WHERE RELEVANT:] Also ask if participant is a first-time mom.

2. Warm-Up & Food Decision-Making (7 minutes)

1. To start, take a moment and think of your top 1-3 concerns for your family at this stage in life.

   1. [MODERATOR GO AROUND SCREEN, HAVE RESPONDENTS SHARE ANSWERS]

   2. What makes those your top concern(s)?

   3. [FOR PREGNANT/INFANT AND MIXED GROUPS- IF FEEDING FAMILY NOT MENTIONED] Where does “feeding your family” fall among your concerns? What makes you say that?

      1. What comes to mind when I say, “feeding your family”?

      2. In other words, what parts of “feeding your family” are a concern, if any? [PROBE: Cost, health, nutrition, access to food]

   4. [FOR AGE 1-4 AND MIXED GROUPS- IF FEEDING FAMILY NOT MENTIONED] Where does “feeding your family” fall among your concerns? What makes you say that?

      1. What comes to mind when I say, “feeding your family”?

      2. In other words, what parts of “feeding your family” are a concern, if any? [PROBE: Cost, health, nutrition, access to food]

2. Now I want to talk specifically about healthy eating. When I say, “healthy eating” what are the words and phrases that come to mind? Type all of the words and phrases that come to mind when I say that phrase in the chat box.

   1. [MODERATOR TO ALLOW UNAIDED RESPONSE VIA CHAT; ALSO NOTE IF RESPONDENTS SEEM CONFUSED ABOUT THE PHRASE “HEALTHY EATING”]

2. [GO AROUND SCREEN:] What were the first few words/phrases that came to your mind? Why those?

3. When, if at all, do you think about healthy eating?

   1. For yourself?

   2. For members of your family?

4. When you think about healthy eating, what, if anything, makes it hard for you (and your family) to do?

   1. [IF NECESSARY:] What are the barriers/challenges/obstacles that make it difficult for you and your child(ren) to eat healthy?

   2. What would help you and your child(ren) to eat healthier?

   3. What specific elements of eating healthy are you most concerned about?

   4. [LISTEN FOR COMPONENTS OF WIC: access to food/formula, nutrition education, breastfeeding support, but do not probe at this time]

5. Where do you go for help or support with healthy eating, if anywhere?

   1. [MODERATOR, PROBE ON: health care workers, word of mouth, online research, social media influencers/experts]

   2. [MODERATOR: Listen for WIC but do not follow-up at this point]

3. WIC Awareness and Brand Perceptions (10 minutes)

1. Now I want to shift gears a bit and talk about WIC.

2. I am going to show you a list of emojis on the screen. I want you to pick the emoji that best represents how you feel about WIC.
   

1. What made you choose that emoji?

   1. What does it say about WIC?

2. When other people are talking about WIC, what emoji(s) would represent how they talk about it?

   1. What made you select that emoji?

   2. What are they saying?

3. POLL: Next, I am going to share two statements. Please rate your agreement with each statement on a scale of 1 to 5, where a 1 means strongly disagree, and a 5 means strongly agree, and you can use any number from 1 to 5.

   1. [STATEMENT 1] WIC is for someone like me.

      1. [START WITH AGREE, THEN NEUTRAL, THEN DISAGREE] What makes you say that?

   2. [STATEMENT 2] WIC is a good value.

      1. [START WITH AGREE, THEN NEUTRAL, THEN DISAGREE] What makes you say that?

4. POLL: On a scale of 1 to 5, where a 1 means it is not at all helpful, and a 5 means it is very helpful, and you can use any number from 1 to 5, how helpful has WIC been to you and your family?

1. [BRIEFLY] What has made WIC helpful?

2. [BRIEFLY] Where/how could WIC have been more helpful? What makes you say that?

5. Have you ever recommended WIC to someone else? If so, to whom?

   1. What made you recommend WIC to them?

   2. What, specifically, did you tell them about WIC?

6. [BRIEF, AND ONLY IF TIME ALLOWS] I am going to show you a few phrases on the screen, and I want to get a quick sense of which one you prefer.

[SHOW ON SCREEN:]

WIC PARTICIPANTS WIC MEMBERS

WIC RECIPIENTS WIC MOMS/FAMILIES

WIC USERS WIC CLIENTS

1. [TAKE HAND COUNT ON PREFERENCE]

2. [MODERATOR: Get a few explanations for preferences]

3. Which one do you like the least?

4. What else would work? What term would you recommend instead?

4. Initial Eligibility and Enrollment Impressions (8 minutes)

1. Now we are going to talk about signing up for WIC.

2. Think back to when you first heard about WIC. Where did you learn about it?

   1. When did you first hear about it?

   2. What did you hear about it?

   3. What made you think about signing up?

3. From where or from whom would you like or have liked to hear about WIC?

1. When you think about the people/places you heard about WIC, do you think they were the best sources of information about WIC? What makes you say that?

2. [PROBE:] What about from health care providers/workers?

   1. [IF NOT PREVIOUSLY MENTIONED:] Have any health care providers/workers talked to you about WIC? What did they say?

   2. What did you learn from health care providers/workers about WIC?

   3. How, if at all was the information coming from health care providers/workers different than what you heard from friends or family members about WIC?

3. [IF DID NOT TALK TO HCPS/WORKERS ABOUT WIC:] If your health care provider recommended WIC to you, would that have made you more/less likely for you to enroll, or do you think it would not have had an impact on your decision? What makes you say that?

4. What do you remember about the enrollment process?

   1. What aspects of enrolling in WIC were easy?

      1. What helped to make the process easier?

   2. What aspects of enrolling were difficult?

      1. What made the process difficult?

      2. What would have made those aspects easier?

   3. About how long have you been in WIC?

5. Think back to when you were originally applying for WIC. Take a moment and type in the chat what you remember to be the requirements you had to meet in order to qualify for WIC. [REVIEW CHAT]

   1. What concerns, if any, did you have about meeting WIC’s requirements?

   2. What about the income requirement, specifically?

   3. [MODERATOR, ASK c – e AS TIME ALLOWS] I am now going to post some language in the chat that could be used to describe the income requirement for WIC. I want to get your reactions to it.

   4. [POST LANGUAGE]

WIC is open to many incomes and families. If you are pregnant, breastfeeding, just had a baby, or have a child or care for a child under age 5 and have low-to-medium income, you could qualify.

5. What do you think about this language?

   1. Does it sound accurate to you?

   2. If you read this statement when you first considered WIC, would you think that you might qualify? What makes you say that?

5. WIC Value and Benefits and Services (30 minutes)

1. Next let’s talk about the benefits and services WIC offers. We are going to make a list. In the chat box, type any benefits or services that WIC offers.

2. [IF NECESSARY:] WIC’s primary benefits and services are the foods available through WIC, breastfeeding support, nutrition education/counseling, and referrals to other healthcare and community or social services.

3. [POST POLL] Before we talk about each, please answer the poll you see in the chat. In the poll select which of these benefits/services you have used while participating in WIC. Then, we will briefly talk about each of them.

• foods available through WIC

• breastfeeding support

• personalized advice on nutrition

• referrals to other healthcare and community or social services

[ROTATE FOR EACH COMPONENT]

1. Let’s start with the benefit of receiving foods through WIC.

   1. [NOTE HOW MANY SELECTED IT IN THE POLL]

   2. What about this benefit stands out as a positive?

   3. What works well about the benefit of getting food through WIC?

   4. What doesn’t work as well?

   5. What, if anything, surprised you about this benefit/service?

   6. How important is it that WIC offers this benefit/service? What makes you say that?

   7. How valuable is this benefit/service? What makes you say that? What makes this benefit/service valuable or not valuable to you? [MODERATOR: emphasize value]

   8. How easy or difficult is it to receive this benefit/service through WIC? What makes you say that?

      1. What, if any, barriers are there to receiving this benefit/service?

2. What about breastfeeding support?

   1. [NOTE HOW MANY SELECTED IT IN THE POLL]

   2. What about this benefit/service stands out as a positive?

   3. What works well about this benefit/service?

   4. What doesn’t work as well?

   5. What, if anything, surprised you about this benefit/service?

   6. How important is it that WIC offers this benefit/service? What makes you say that?

   7. How valuable is this benefit/service? What makes you say that? What makes this benefit/service valuable or not valuable to you? [MODERATOR: emphasize value]

   8. How easy or difficult is it to receive this benefit/service through WIC? What makes you say that?

      1. What, if any, barriers are there to receiving this benefit/service?

      2. How easy or difficult would it be for you to receive this benefit/service outside of WIC (i.e., if you were not in WIC)? How do you know?

3. What about personal advice on nutrition?

   1. [NOTE HOW MANY SELECTED IT IN THE POLL]

   2. What about this benefit/service stands out as a positive?

   3. What works well about this benefit/service?

   4. What doesn’t work as well?

   5. What, if anything, surprised you about this benefit/service?

   6. How important is it that WIC offers this benefit/service? What makes you say that?

   7. How valuable is this benefit/service? What makes you say that? What makes this benefit/service valuable or not valuable to you? [MODERATOR: emphasize value]

   8. How easy or difficult is it to receive this benefit/service through WIC? What makes you say that?

      1. What, if any, barriers are there to receiving this benefit/service? [MODERATOR, LISTEN FOR/PROBE ON: missing work, transportation, childcare, time to get there, etc.]

      2. For your most recent meetings/discussions about nutrition, have you done them in-person or online? Which do you prefer? What makes you say that?

      3. How easy or difficult would it be for you to receive this benefit/service outside of WIC (i.e., if you were not in WIC)? How do you know?

4. What about referrals for health care and/or other community services? [MODERATOR, IF TIME IS SHORT, FOCUS ON a, e, f, g]

   1. [NOTE HOW MANY SELECTED IT IN THE POLL]

   2. What about this benefit/service stands out as a positive?

   3. What works well about this benefit/service?

   4. What doesn’t work as well?

   5. What, if anything, surprised you about this benefit/service?

   6. How important is it that WIC offers this benefit/service? What makes you say that?

   7. How valuable is this benefit/service? What makes you say that? What makes this benefit/service valuable or not valuable to you? [MODERATOR: emphasize value]

   8. How easy or difficult is it to receive this benefit/service through WIC? What makes you say that?

      1. [ONLY IF TIME ALLOWS] What, if any, barriers are there to receiving this benefit/service? [MODERATOR, LISTEN FOR/PROBE ON: missing work, transportation, childcare, time to get there, etc.]

      2. [ONLY IF TIME ALLOWS] How easy or difficult would it be for you to receive this benefit/service outside of WIC (i.e., if you were not in WIC)? How do you know?

[MODERATOR: Use “value section,” below, to build upon previous section. There may be some overlap, but it is important to gauge if respondents see a difference in the value of WIC at different stages—pregnancy, child’s infancy, child 1-4 years old.]

3. Has the value of WIC changed to you throughout your time participating in WIC?

   1. If so, how has it changed?

   2. [FOR PREGNANT/INFANT] Thinking about during pregnancy, how much value does WIC provide?

   3. How “worth it” is it to participate in WIC while pregnant? [MODERATOR, listen for differing opinions]

   4. [FOR NEWBORN TO AGE 4 AND MIXED GROUPS] Did you participate in WIC during your pregnancy?

      1. How “worth it” was it to participate in WIC during that stage? [MODERATOR, listen for differing opinions]

      2. IF NOT: Why did you not participate in WIC during your pregnancy?

   5. [FOR PREGNANT/INFANT] Thinking about when your child is an infant (under one year), how much value does WIC provide?

      1. How “worth it” is it to participate in WIC during this stage? [MODERATOR, listen for differing opinions]

   6. [FOR AGE 1-4 AND MIXED GROUPS] Did you participate in WIC when your child was an infant (under one year)?

      1. Thinking about those benefits and drawbacks, how “worth it” is it to participate in WIC during that stage? [MODERATOR, listen for differing opinions]

      2. IF NOT: Why did you not participate in WIC during that time?

   7. [FOR PREGNANT/INFANT] Thinking about the future, when your child is 1 to 4 years old do you think you will participate in WIC?

      1. What makes you say that?

      2. What would make WIC “worth it” for you when your child is that age?

   8. [FOR AGE 1-4 AND MIXED GROUPS] Thinking about this stage, when your child is ages 1-4, how much value does WIC provide? Is there more or less of a value when your child is ages 1-4 than other times? What makes you say that?

9. We’ve talked a lot about WIC and the benefits that are part of the program, but what is your favorite part about being in WIC? It might be something we already discussed, or it might be something we have not touched on yet. I’ll go around the screen and get everyone’s answer.

3. For a moment, let’s talk a bit more about the other side of the coin. What might be some reasons not to participate in WIC? What, if anything, makes it difficult to participate in WIC?

   1. What if I changed the question a bit…what might be some reasons not to participate in WIC when your child is 1-4 years old?

   2. What makes WIC less of a value when as your child gets older?

3. Thinking about your experiences with WIC and all you know about the program, if you were going to help WIC enroll new people, please type in the chat what would you tell them to get them to enroll? [TYPE IN CHAT, ENSURE RESPONSE FROM ALL]

   1. How would you describe the program to them? What would you say WIC is?

   2. What would you say are the reasons they should enroll?

6. WIC Frames/Reasons to Believe (20 minutes)

1. Next, we are going to look at some more information about WIC. First, I am going to show you 4 different ways to talk about WIC benefits/services. As you read through the information, on your scratch sheet of paper write down anything that jumps out at you in a positive or negative way. Also write down anything that seems confusing. Then, pick the one that stands out to you the most in a positive way.

[NOTE: THIS SECTION IS DESIGNED TO EXPLORE MESSAGE CONCEPTS/AVENUES AND FIND OUT WHAT COMPONENTS OF MESSAGES AND MESSAGING FRAMES ARE MOST COMPELLING. THIS INFORMATION WILL INFORM A CREATIVE AND MESSAGING BRIEF]

[ORDER OF CONTENT WILL BE ROTATED ACROSS GROUPS]

• V – WIC is a nutrition program that provides free benefits to pregnant women, new moms, and families with children up to age 5. All WIC members receive healthy foods, personalized nutrition advice (including those with specific dietary needs), 1-on-1 breastfeeding support, and referrals to health and social services at no cost.

• B – WIC touches the lives of nearly half of all babies born in the United States each year. Millions of new moms participate in WIC breastfeeding support and take advantage of personalized nutrition advice and healthy foods for the whole family, plus referrals to health and dental care or other community resources.

• E – Apply to Participate in WIC, and you will find a team committed to supporting you with the tools and assistance you need to make healthy choices in pregnancy and give your children up to age 5 a healthy start to life—1-on-1 breastfeeding support, healthy foods, personalized nutrition advice, and referrals to health care and other services.

• H – Pregnant or raising a child younger than 5 years old? WIC helps to make this time of life a little easier with nutritious foods, 1-on-1 breastfeeding support, personalized healthy eating guidance for the family—including specific dietary needs—and referrals to health care and social services. Let WIC lighten your load!

2. POLL FOR 1 THAT STANDS OUT IN A POSITIVE WAY – What about that statement made it stand out to you over the others?

3. POLL FOR 1 THAT STANDS OUT IN A NEGATIVE WAY – What about that statement made it fall to the bottom of the three statements?

1. [MODERATOR: Only ask for each statement as time allows:]

   1. What is your reaction to this? How do you feel after seeing it?

   2. What, if anything, do you like about it?

   3. What, if anything, do you dislike about it?

   4. What does this tell you about WIC?

2. What, if anything, did you find confusing in these statements?

3. Which, if any, of the statements were surprising to you? What makes you say that? [IF NOT MENTIONED, PROBE:]

   1. [B] What about the fact that WIC helps about ½ of all babies in the United States? Did you realize the program was that big? What, if anything does that mean to you?]

   2. [V] What do you think about the phrase, “at no cost”? How important is that aspect of WIC? What makes you say that?

   3. [H] Do you agree/disagree that WIC can help make this time in your and your child’s lives a little easier? What makes you say that?

   4. [E] Do you agree/disagree that WIC provides a team committed to supporting you? What makes you say that? Has that been your experience?

4. Now we have some more information about WIC. Again, as you read through the information, on your scratch sheet of paper write down anything that jumps out at you in a positive or negative way. Also write down anything that seems confusing. Then, on your scratch sheet of paper, write down the letters of up to 2 statements that are most convincing to you as reasons to participate in WIC.

[MODERATOR: Once everyone is done selecting their preferred messages, have respondents type the letters in the chat.]

[ORDER OF STATEMENTS WILL BE ROTATED ACROSS GROUPS]

• N – The healthy foods WIC provides at no cost to WIC participants are based on the latest nutrition guidelines to support your and your family’s health and well-being.

• P – WIC members have one-on-one meetings with WIC staff who are experts in nutrition for moms during pregnancy and breastfeeding, and for infants, toddlers, and preschoolers. These experts provide advice and resources based each member’s—and their child’s—personal needs.

• T – WIC has transitioned to electronic benefits. Your family will receive a debit-like card that covers the cost of WIC-approved foods for your family. The eWIC card makes shopping more convenient and more efficient.

• W – WIC is listening and is improving in many ways to help families. In addition to shopping with the eWIC card, many meetings with WIC staff can take place online.

• F – Today’s WIC helps families save even more money than before. WIC has increased the amount of money WIC families can use at the grocery store (online or in-store) for fruits and vegetables and still at no cost to them.

• C – WIC’s breastfeeding services include one-on-one coaching with breastfeeding experts, support groups, and access to free breast pumps.

• G – “I encourage my friends to get WIC. At WIC, I get personalized nutrition advice from experts who can give me ideas about meal planning for me and my family. They also help me to make sure my picky eaters are eating healthy.” – WIC Mom

• M – “WIC helps my family save money because the free, healthy foods give me room in my budget to pay other bills or buy other things my family needs.”– WIC Mom

• R – WIC helps get children ready to start school: studies have shown that children whose mothers participated in WIC have better scores on vocabulary tests.

5. POLL FOR UP TO 2 MOST CONVINCING TO PARTICIPATE IN WIC.

1. FOR THE MESSAGES THAT RANK HIGHEST IN THE POLL ASK:

   1. What is your reaction to this? How do you feel after seeing it?

   2. What do you like about it?

   3. What, if anything, do you dislike about it?

6. POLL FOR 1-2 LEAST CONVINCING TO PARTICIPATE IN WIC.

2. FOR THE MESSAGES THAT RANK LOWEST IN THE POLL ASK:

   1. What is your reaction to this? How do you feel after seeing it?

   2. What did you dislike about it?

   3. What, if anything, do you like about it?

7. [MODERATOR: Show full list of features and benefits statements on screen] Looking at this list of statements, is anything missing? Is there anything WIC should say about the program that is not included here?

1. Were any of these statements confusing?

2. Which, if any, of the statements were surprising to you? What makes you say that?

8. [MODERATOR: AFTER DISCUSSING eWIC MESSAGE ASK] Have you used EBT or eWIC for your to purchase WIC foods?

1. If so, how has that experience been?

2. How important is it to tell people who may be interested in WIC about EBT and eWIC? What makes you say that?

9. [MODERATOR: PROBE ON WIC MOM]:

1. You will notice that a few of the statements are written to show that it is information coming from a WIC mom. As you think about your current experience in WIC, how much, if at all, do you talk to other people in WIC about the program?

2. What information could other WIC participants provide that might be helpful to you?

3. How much would you be interested in sharing your knowledge and experience with people who may be new to WIC? What makes you say that?

4. Would you say that WIC is a community? What makes you say that?

5. Should it be a community? Why or why not?

10. POLL: Thinking about WIC in the future, on a scale of 1 to 5, where a 1 means you would definitely not recertify to continue participating in the program, and a 5 means you definitely would recertify to continue participating in WIC, and you can use any number from 1 to 5, how likely are you to recertify in WIC?

1. What makes you most want to recertify in WIC?

   1. What is the most important reason to do so?

2. What would keep you from wanting to stay in WIC? What would no longer make it “worth it” for you to continue to participate in WIC?

11. [IF NOT PREVIOUSLY MENTIONED:] One point we have not discussed is the fact that WIC is offered and run by USDA, the U.S. Department of Agriculture.

1. Did you know this information? [TAKE HAND COUNT]

2. What does that information mean to you?

3. To what extent, if at all, are you concerned about WIC being “a government program”? What makes you say that?

12. [IF NOT PREVIOUSLY MENTIONED] Earlier in our discussion we looked at emojis for how you feel about WIC and emojis to describe the way other people talk about WIC. In other conversations that I have held, I’ve heard some people have negative feelings about being associated with WIC, or that they think people look at them negatively for being on WIC.

1. What do you think about that? Have you ever felt that way or sensed those negative feelings from others?

2. When? How so? What made you feel that way?

3. What, if anything, did you do/say about it?

4. What, if anything, would you say to someone who is interested in applying for WIC, but is concerned about people looking at them in a negative way?

7. Wrap-up/False Close (5 minutes)

Thank you for all of the information you have provided.

1. WRITE: While I check with my colleagues to make sure they do not have any additional questions, please look at the screen and answer the question in the chat.

   1. MODERATOR READ AND SHOW ON SCREEN:

   2. In your own words, what is the most important information to share when trying to convince people to apply for WIC?

Thanks again! To thank you for your time, you will receive a $75 gift card as a token of appreciation. Have a great evening.