Utilizing the Increased WIC Cash Value Benefit for Fruits and Vegetables: A Qualitative Study

ABSTRACT

Background: Addressing disparities in fruit and vegetable (FV) consumption in childhood is important for chronic disease prevention. During COVID, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) increased the Cash Value Benefit (CVB) for FV by ~$25/person/month. Our objectives were to understand barriers and facilitators to participants' uptake of this policy change and whether and how it influenced WIC households' FV consumption. Methods: We conducted 10 virtual focus groups with WIC participants (n=56) in North Carolina in March 2022. Sampled participants represented two subgroups (1) rural WIC participants (5 focus groups) (2) urban/suburban (5 focus groups). We used a semi-structured focus group guide to assess perceptions and awareness of the CVB change, barriers to using CVB, and perceived influence of the CVB change on FV consumption. Focus groups were recorded, transcribed, and open-coded. We used thematic analysis informed by social constructionist grounded theory to uncover consistencies within and between sampled groups. Results: Participants expressed favorable perceptions of the CVB increase and felt CVB was one of the most valued parts of the WIC food package. Participants stated the pre-COVID CVB amount was insufficient. Barriers to utilizing the increased CVB were finding WIC-eligible FV in stores, insufficient supply of appealing FV, and preferred stores for FV not accepting WIC. Facilitators were household preferences for FV and the variety of FV that can be purchased with the CVB. Many participants felt the CVB increase allowed them and their children to eat a wider variety of FV, serve FV more often, and worry less about food waste associated with trying new FV. Conclusions: The CVB increase was positively perceived by WIC participants in North Carolina and may reduce FV intake disparities, but barriers to CVB and WIC benefit utilization must be addressed. This study can inform future efforts to improve the WIC food package and access to FV.