WIC Online with eWIC: Implementation and Evaluation of WIC Online Using a New Technology Service and Electronic Benefit Delivery (2018-2021)

By 2020, all WIC programs are required to have an electronic benefit delivery system that will allow clients to receive their benefits without the need to come into clinics. To take full advantage of the integration of electronic benefits, WIC programs need comprehensive information about the value of providing online nutrition education to clients in both individual and group sessions. The UC Davis Human Lactation Center is partnering with Arizona WIC to study the use of online, facilitated group discussions to complete more nutrition education contacts in an effort to decrease clinic congestion, and wait times for in-person appointments and increase client satisfaction. If successful, WIC Online will provide online video nutrition education with remote benefit delivery that is both sustainable and scalable to other WIC programs.

WIC Online: A Qualitative Evaluation (2016 – 2017)

The UC Davis Human Lactation Center Partnered with Arizona WIC to conduct the qualitative evaluation of “WIC Online”, a study supported by a WIC Special Projects Grant (2015-2017) and designed to offer group education through online facilitated video discussions. This approach eliminated the pressure on clinic space while providing clients with a convenient alternative to traveling to the clinic for education. The results indicate that providing participant-centered education via online video chat is feasible and well-received by those who participated. However, participation was limited by several barriers for clinics, staff, and clients. A follow-up project addressing the most common barriers to participation and re-evaluating the approach is planned for 2017.

Expanding the “Baby Behavior” Intervention to Improve Toddler Feeding Practices in Arizona (2015 – 2017)

The aim of this project was to refine the approach and further evaluate the impact of the
“TOTT” intervention, an extended Baby Behavior intervention to include messages for parents of older infants and toddlers (7 to 18 months of age).  By expanding the Baby Behavior training and education designed to promote positive parent-child interaction and healthy feeding practices, we hoped to prevent the establishment of feeding behaviors that are strongly associated with childhood overweight and obesity. This project was made possible through collaboration among the University of California, Davis Human Lactation Center, the Arizona Department of Health Services WIC Program, Maricopa County WIC, Mountain Park Health Center WIC, and the California Department of Public Health WIC Division.

Baby Behavior in Child Care Settings (2015-2016)

To further our goal of promoting consistent messaging and enhanced exposure to the behavioral nutrition education messages developed in the “Baby Behavior” and “TOTT” studies, this project aimed to adapt the approach to the child care environment. Preliminary research was done to identify 1) child care providers’  observations about specific experiences that trigger over- or inappropriate feeding of older infants and toddlers and 2) child care providers’ perceptions of barriers and facilitators to sharing messages and materials about infant and toddler behavior with parents. The WIC-based “Baby Behavior” and “TOTT” curricula were modified to meet the needs of childcare providers and the families they serve. The adapted intervention aimed to increase providers’ knowledge of normal behavior in older infants and toddlers and to provide feasible alternatives, other than inappropriate feeding, that may be used by providers and shared with parents to address challenging infant and toddler behaviors. Providers reported feeling empowered to share key messages and materials with parents in an effective and inoffensive manner. The materials from this project will be available to help child care providers improve their own infant and toddler feeding practices and to share the information with parents of the children in their care.  This project was funded by a grant from the David and Lucile Packard Foundation.

Supporting Baby Behavior through Pediatric Offices (2014-2016)

In an effort to develop consistent messaging for WIC participants related to infant behavior, this project will test low-cost video trainings and tools targeted to medical staff in pediatric clinics serving low-income families in order to support ongoing Baby Behavior education for WIC participants. Age-specific messages and materials will be developed to help providers to effectively address parents’ most common questions related to infant feeding and behavior during each regularly scheduled well-baby check. Online surveys of providers, medical staff, and participants will be used assess knowledge transfer, acceptance, and feasibility of message delivery as well to evaluate the added value of provider education versus WIC-only Baby Behavior messages for participants. If successful, this collaborative effort between WIC and community health care providers could serve as a model for other health interventions by building a continuum of care to improve infant-feeding practices and reduce children’s risk for overweight and obesity. This study is funded by USDA Center for Collaborative Research on WIC Nutrition Education Innovations at the USDA/ARS Children’s Nutrition Research Center at Baylor College of Medicine and Texas Children’s Hospital.

TOTT STUDY -Targeting Behavioral Triggers of Overfeeding: Obesity Prevention in Older Infants and Toddlers at WIC (2010-2013)

The UC Davis Human Lactation Center partnered with the California WIC Program on a project designed to extend, expand, and evaluate behavioral nutrition education, using the materials developed as part of the Toddler Project, to address the needs of caregivers of older infants (7-12 months of age) and toddlers (to 18 months of age).  Through expansion of the “baby behavior” training and education, designed to promote positive parent-child interaction and healthy feeding practices, we aimed to prevent the establishment of feeding behaviors that are strongly associated with child overweight and obesity. The project assessed the impact of the intervention on knowledge, attitudes, and behaviors of staff and participants. The TOTT Study was funded through a USDA Special Project Grant.

Perceptions of Infant Formula Additives from Moms Participating in the California Women, Infants, and Children (WIC) Program (2010-2013)

Many women in the United States initiate breastfeeding, but less than half continue to breastfeed after three months. More specifically, exclusive breastfeeding rates are low among low-income women. At the same time, advertising of infant formula is prevalent and increasing. There are many external factors that influence a woman’s decision to breastfeed, including direct and indirect marketing of infant formulas. Such marketing strategies include magazine advertisements, prenatal formula promotion materials, and hospital discharge packs. Current research suggests that mass media marketing discourages breastfeeding by diffusing information about infant formula products and reinforcing factors that oppose breastfeeding. Formula was originated for infants who needed extra nourishment or whose mothers could not nurse. However, formula is now marketed to almost all women, especially low-income women who are less likely to breastfeed their children. The purpose of this study, conducted in partnership with the California WIC Association (CWA), was to characterize understanding of marketing claims related to infant formula additives and to determine the impact of infant formula marketing on this population.

“Just in Case” A Qualitative Study of Reasons Why Mothers Request Formula in the Hospital (2008-Present)

In 2008, staff of the UC Davis Human Lactation Center began a study aimed at learning more about why mothers of healthy breastfeeding infants request formula during their hospital stay. This project was initiated by Katie Bowman, MAS, IBCLC during her graduate studies at UC Davis. A series of focus groups were conducted at various WIC sites in Northern California, and we are currently in the process of analyzing and reporting the data. Results of this qualitative research will be used to inform policy and develop messages to support and assist mothers who have made the decision to breastfeed their infants.

Toddler Study – Triggers of Overfeeding among Older Infants and Toddlers (2010-2011)

Building upon the success of the FitWIC Baby Behavior Study, staff of the UC Davis Human Lactation Center are partnering with California WIC on a new project to identify triggers of overfeeding of infants and toddlers from 6 to 18 months of age. While crying and waking are likely to be triggers of overfeeding among parents of older infants and toddlers, reasons for crying and waking among older infants differ from those of of younger infants. In an effort to identify the concerns that drive parents of older infants and toddlers to believe that their children are hungry or need inappropriate foods and fluids, caregivers will be asked about their infant feeding decisions and materials and messages will be developed to address their concerns.

Modifying and Extending Fit WIC Materials to Start Obesity Prevention in Infancy (2006-2009)

Starting in the fall of 2006, staff of the UC Davis Human Lactation Center began a 3-year educational intervention project designed to increase WIC participants’ knowledge of normal infant behavior in order to 1) promote positive interactions among infants and caregivers and 2) prevent overfeeding in infancy. The intervention resulted in an increased satisfaction with WIC education, an increase in the use of the exclusive breastfeeding food package at intervention sites, and reductions in formula use, particularly in the first month (this study was conducted prior to the food package change). The final report and all materials developed for the intervention are available through the WICWorks site at http://www.nal.usda.gov/wicworks/Sharing_Center/gallery/FitWICBaby.htm

Cross-Case Comparison of Breastfeeding Support Models throughout California (2005)

In the summer of 2005, staff of the UC Davis Human Lactation Center conducted a cross-case comparison of various models of breastfeeding support currently used in California (including cost information). The objectives of this study were to 1) develop a detailed qualitative, descriptive summary for each program and to 2) identify key factors associated with successful programs. The ultimate goals of this study were 1) to expand the evidence-base related to optimal systems of health care for breastfeeding mothers and infants, 2) share key elements of active, successful programs with interested agencies and community members (which was done in October 2005), and 3) identify factors associated with successful programs for use in development of intervention trials.

Sources of Infant Feeding Information for Low Income Women (2005)

In the summer of 2005, staff of the UC Davis Human Lactation Center conducted a multi-center, qualitative study in Northern California as a follow-up to the original study conducted in 2003 (also funded by WIC), which examined the barriers to compliance with infant feeding recommendations among low-income women. The short-term goal of this study was to (1) obtain, through focus groups, sources of infant feeding information for low-income mothers and (2) how mothers decide what information is “credible’ and helpful to them.

For more information, refer to:  Heinig et al. Sources and Acceptance of Infant-Feeding Advice Among Low-Income Women. J Hum Lact 2009 May;25(2):163-72.

Examining Barriers to Compliance with Infant Feeding Recommendations among Low-income Women (2003-2004)

In the spring of 2003, staff of the UC Davis Human Lactation Center conducted a multi-center, qualitative study of WIC participants in the Sacramento area. The short-term goal of this study was to better understand why non-optimal infant feeding practices occur among low-income women despite extensive education and counseling provided by WIC agencies. The aim of this project was to conduct pilot focus groups among culturally diverse WIC participants, in order to determine whether or not the elements of the Theory of Planned Behavior (TPB) are relevant to this population and to identify culturally specific factors that affect infant feeding behavior in the first 6 months postpartum.

For more information, refer to:  Heinig et al. Barriers to Compliance With Infant-Feeding Recommendations Among Low-income Women. J Hum Lact 2006 Feb;22(1):27-38.

California Statewide Breastfeeding Needs Assessment

From October 2001 to May 2002, center faculty, in cooperation with the UC Davis Division of Agriculture and Natural Resources Maternal and Infant Nutrition Workgroup, conducted a needs assessment using the resources of the 37 active breastfeeding coalitions throughout the state of California; all but 2 agreed to participate. A survey was mailed to the designated contact person and the coalition members were asked to discuss and record their responses to the questions during one of their regular meetings. Approximately 320 people participated in the survey, representing a cross-section of providers of breastfeeding support including hospital nurses, public health nurses, lactation consultants, WIC nutritionists, clinical dietitians, social workers, and community health workers. The results represent these providers’ views on the state of breastfeeding support services in California.

WHO Multicentre Growth Study (1999)

In 1999, Human Lactation Center faculty and staff conducted a large prospective study of lactation and infant growth sponsored by the World Health Organization and co-funded by the USDA and National Institutes of Health. The City of Davis was the North American site of this worldwide effort to gather data for a new international child growth reference.

More information about this study is available at http://www.who.int/childgrowth/mgrs/en/.

Risk Factors Study (1999)

In this study, a community-based sample of all residents of Davis who gave birth in 1999, was used to examine risk factors for breastfeeding difficulties in the first month postpartum.

For more information, refer to: Dewey et al. Risk Factors for Suboptimal Infant Breastfeeding Behavior, Delayed Onset of Lactation, and Excess Neonatal Weight Loss. Pediatrics Vol. 112 No. 3 September 2003, pp. 607-619.