WIC Staff Research Articles

WIC staff and healthcare professional perceptions of an EHR intervention to facilitate referrals to and improve communication and coordination with WIC: A qualitative study.

Participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has numerous benefits, yet many eligible children remain unenrolled. This qualitative study sought to explore perceptions of a novel electronic health record (EHR) intervention to facilitate referrals to WIC and improve communication/coordination between WIC staff and healthcare professionals. WIC staff in three counties were provided EHR access and recruited to participate. An automated, EHR-embedded WIC participation screening and referral tool was implemented within 8 healthcare clinics; healthcare professionals within these clinics were eligible to participate. The interview guide was developed using the Consolidated Framework for Implementation Research to elicit perceptions of this novel EHR-based intervention. Semi-structured interviews were conducted via telephone. Interviews were recorded, transcribed, coded, and analyzed using thematic analysis. Twenty semi-structured interviews were conducted with eight WIC staff, seven pediatricians, four medical assistants, and one registered nurse. Most participants self-identified as female (95%) and White (55%). We identified four primary themes: (1) healthcare professionals had a positive view of WIC but communication and coordination between WIC and healthcare professionals was limited prior to WIC having EHR access; (2) healthcare professionals favored WIC screening using the EHR but workflow challenges existed; (3) EHR connections between WIC and the healthcare system can streamline referrals to and enrollment in WIC; and (4) WIC staff and healthcare professionals recommended that WIC have EHR access. A novel EHR-based intervention has potential to facilitate healthcare referrals to WIC and improve communication/coordination between WIC and healthcare systems.

Women, Infants, and Children (WIC) Enrollment: Learning From Key Informants to Enhance Utilization.

Enrollment in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is suboptimal, particularly for eligible children aged 1 to 4 years. We used converged data from key informants from October 2021 to January 2023 to understand the barriers to and opportunities for WIC utilization and the role of the health care provider in links to WIC. Families and WIC staff identified gaps in provider knowledge and an expressed need for improved collaboration between health providers and WIC. (Am J Public Health. 2023;113(S3):S220-S223. https://doi.org/10.2105/AJPH.2023.307443).

A WIC-Based Behavior Change Intervention for Postpartum Women With Overweight and Obesity: A Pilot Feasibility Randomized Trial.

Background. Postpartum weight retention is a risk factor for obesity and is particularly important among Hispanic women who have an increased rate of obesity. Given its broad reach, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program provides an ideal setting to implement community-based interventions for low-income postpartum women. Purpose. To examine the feasibility, acceptability, and preliminary efficacy of a multicomponent intervention delivered by staff within the WIC program designed to promote behavior changes in urban, postpartum women with overweight/obesity. Method. This was a 12-week pilot trial randomizing participants to a health behavior change (Intervention) or control (Observation) group. The Intervention included monthly visits with trained WIC staff providing patient-centered behavior change counseling, with multiple touchpoints between visits promoting self-monitoring and offering health behavior change support. Results. Participants (n = 41), who were mainly Hispanic (n = 37, 90%) and Spanish-speaking (n = 33, 81%), were randomized to the Intervention (n = 19) or Observation (n = 22) group. In the Intervention group, 79% (n = 15) of eligible participants were retained for the study duration. All Intervention participants endorsed that they would participate again. Regarding physical activity, participant readiness to change and self-efficacy improved for Intervention participants. About one-quarter of women in the Intervention group (27%, n = 4) had a 5% weight loss compared with one woman (5%) in the Observation group; this difference was not statistically significant (p = .10). Conclusions. This pilot demonstrated the feasibility and acceptability of delivering a low-intensity behavior change intervention within the WIC setting for postpartum women with overweight/obesity. Findings support the role of WIC in addressing postpartum obesity.

A Systems Approach to Identify Factors Influencing Participation in Two Tribally-Administered WIC Programs.

Native American populations experience highly disproportionate rates of poor maternal-child health outcomes. The WIC program aims to safeguard health by providing greater access to nutritious foods, but for reasons not well understood, participation in many tribally-administered WIC programs has declined to a greater extent compared to the national average decline in participation over the last decade. This study aims to examine influences on WIC participation from a systems perspective in two tribally-administered WIC programs. In-depth interviews were conducted with WIC-eligible individuals, WIC staff, tribal administrators, and store owners. Interview transcripts underwent qualitative coding, followed by identifying causal relationships between codes and iterative refining of relationships using Kumu. Two community-specific causal loop diagrams (CLDs) were developed and compared. Findings from interviews in the Midwest yielded a total of 22 factors connected through 5 feedback loops, and in the Southwest a total of 26 factors connected through 7 feedback loops, resulting in three overlapping themes: Reservation and Food Store Infrastructure, WIC Staff Interactions and Integration with the Community, and State-level Administration and Bureaucracy. This study demonstrates the value of a systems approach to explore interconnected barriers and facilitators that can inform future strategies and mitigate declines in WIC participation.

“It’s Like Night and Day”: How Bureaucratic Encounters Vary across WIC, SNAP, and Medicaid

Research characterizes public assistance programs as stigmatizing and stressful (e.g., psychological costs) but obscures differences across programs or the features of policy design that contribute to varied bureaucratic encounters. Using 83 interviews with Supplemental Nutrition Assistance Program (SNAP), Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and Medicaid beneficiaries, and 60 interviews with staff from those programs, we examine how people differentiate their experiences across programs. We find that WIC staff members describe the program as facilitating, rather than constraining, personal interactions with clients. In contrast, SNAP and Medicaid workers report pressure to process clients expeditiously and accurately, leading several caseworkers to express frustration and suspicion of the information provided by recipients. WIC participants in all three programs described positive, supportive interactions with WIC staff and viewed the program as a source of social support. In contrast, participants reported stigmatizing encounters with SNAP and Medicaid staff and inaccessible caseworkers.

Human milk expression in the first year postpartum among persons with low incomes.

Expressing milk (i.e., human milk) is common in the USA, but practices are unknown among families in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). This study of a WIC population explores the practice of and reasons for expressing milk in the first year postpartum. We analysed data from a longitudinal study to examine milk expression at 1, 3, 5, 7, 9, 11, and 13 months postpartum among breastfeeding persons enrolled in WIC with term singletons. We cross-sectionally analysed the weighted prevalence of milk expression at each survey month and report reasons for milk expression in the first 7 months. Among the study participants who reported feeding human milk at Month 1, 70.4% expressed milk in the first 13 months postpartum. The prevalence of milk expression was 56.8% at Month 1 and decreased to 13.9% at Month 13 among those feeding any human milk that month. Reasons for expressing milk changed over time; in the first month, increasing milk supply, relieving engorgement, and having an emergency supply of milk were common. In later months, having a supply of milk available so that someone else could feed their infant was common. Clinicians, health educators, WIC staff, and others working with WIC families can promote optimal expressed milk feeding and storage practices. Extra attention and support may be especially important in the first months postpartum when milk expression is common. Support for persons who are expressing milk can be tailored for reasons of milk expression.

Forming the Perception of WIC Infant Feeding Recommendations: A Qualitative Study.

Nearly half of newborns in the United States are enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Promoting breastfeeding is a programmatic priority, although formula vouchers are provided for those who do not exclusively breastfeed. Previous literature suggests that participant perception of WIC's breastfeeding recommendations is a significant factor predicting breastfeeding initiation, duration, and exclusivity outcomes. However, little is known about how participants' perceptions of WIC's breastfeeding recommendations are formed. To address this knowledge gap, we conducted a qualitative pilot study in Nevada, interviewing 10 postpartum WIC mothers and 12 WIC staff who had interacted with participants regarding infant feeding. Results showed participants and staff reported various perceptions of what WIC recommends, the factors that contribute to these perceptions, and how these perceptions affect breastfeeding practices. Respondents also described that WIC has a negative legacy as the "free formula program," and that environmental factors, such as the recent formula recall, have had an impact on participants' infant feeding practices. More effective public campaigns and programmatic strategies are needed to target participants' prenatal self-efficacy and to communicate the availability of skilled lactation support in the early postpartum period to improve participants' perceptions of WIC's position on breastfeeding.

Antiracism Training for Nutrition Professionals in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC): a Promising Strategy to Improve Attitudes, Awareness, and Actions.

Women, Infants and Children (WIC) nutrition professionals serve as frontline providers for Black families who disproportionately experience poor perinatal outcomes. With racism driving inequities, we developed an antiracism training tailored to WIC. This report describes the training framework, design, components, and evaluation. In 2019, with feedback from WIC providers, we created a 3-h antiracism training for Philadelphia WIC nutrition professionals that included an identity reflection, key concept definitions, workplace scenario and debrief, a model for repair and disruption, and an action tool. We implemented this training in August 2019 and surveyed WIC staff trainees' awareness of racism and skills to address bias before, immediately after, and 6months post-training, comparing responses at each time point. Among 42 WIC staff trainees, mean age was 30years, 56% were white, 91% female, and 74% had no prior antiracism training. Before the training, 48% felt quite a bit or extremely aware of the role of racism in the healthcare system; this increased to 91% immediately after and was 75% 6months later. Similar increases in confidence identifying and addressing interactions that perpetuate racism were achieved immediately after training, although the magnitude decreased by 6months. One-third felt quite a bit or extremely confident the training improved participant interactions at the 6-month timepoint. Qualitative feedback reinforced findings. Results suggest antiracism training may improve WIC nutrition professionals' attitudes, awareness, and actions and could be valuable in efforts to advance health equity. More work is needed to examine how changes translate into improvements for WIC participants.

Retracted: Identifying Strategies to Improve Enrollment and Participation in Three Rural Native American WIC Programs

Abstract Objectives The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has a strong track record of improving birth and health outcomes in high-risk populations. For the past decade and a half, WIC enrollment among Native American women and children has declined by approximately 40% for reasons that have not yet been elucidated. The objectives of this work are to 1) Understand the individual-, household-, and community-level factors that facilitate and impede participation in three rural tribal WIC programs, and 2) Identify strategies for addressing significant unexplained declines in WIC participation. Methods We partnered with three tribal WIC agencies – two in the Southwest and one in the Midwest – to plan and conduct this formative research. In-depth qualitative interviews (n = 35) were conducted with current and former WIC participants, eligible non-participants, WIC staff, tribal health administrators, and managers of food store that accept WIC in each study community. Interview transcripts were inductively coded and crosscutting emergent themes across communities were identified by four researchers. Results Tribal WIC agencies are highly valued for their culturally-competent staff and the integration of traditional knowledge and values into their services. However, participation barriers related to internet and telephone connectivity have become amplified during the COVID-19 pandemic, and a complicated and often embarrassing food shopping experience is a major obstacle to WIC benefit redemption in small rural food stores. Dominant themes differed greatly by community, indicating that intervention strategies to address declines in WIC participation should be tailored to community-level infrastructure, policy, and cultural values, which are unique to each community. Conclusions This work represents an important step toward improving understanding of the strengths and weaknesses of the WIC program in rural Native communities and identifying key focus areas for future interventions. Funding Sources Robert Wood Johnson Foundation Healthy Eating Research Grant #77,235.

Developmental Monitoring and Referral for Low-Income Children Served by WIC: Program Development and Implementation Outcomes.

To develop, implement, and assess implementation outcomes for a developmental monitoring and referral program for children in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Based on Centers for Disease Control and Prevention's Learn the Signs. Act Early. campaign, the program was developed and replicated in two phases at 20 demographically diverse WIC clinics in eastern Missouri. Parents were asked to complete developmental milestone checklists for their children, ages 2months to 4years, during WIC eligibility recertification visits; WIC staff referred children with potential concerns to their healthcare providers for developmental screening. WIC staff surveys and focus groups were used to assess initial implementation outcomes. In both phases, all surveyed staff (n = 46) agreed the program was easy to use. Most (≥ 80%) agreed that checklists fit easily into clinic workflow and required ≤ 5min to complete. Staff (≥ 55%) indicated using checklists with ≥ 75% of their clients. 92% or more reported referring one or more children with potential developmental concerns. According to 80% of staff, parents indicated checklists helped them learn about development and planned to share them with healthcare providers. During thesecond phase, 18 of 20 staff surveyed indicated the program helped them learn when to refer children and how to support parents, and 19 felt the program promoted healthy development. Focus groups supported survey findings, and all clinics planned to sustain the program. Initial implementation outcomes supported this approach to developmental monitoring and referral in WIC. The program has potential to help low-income parents identify possible concerns and access support.

WIC Participants' Perceptions of COVID-19-Related Changes to WIC Recertification and Service Delivery.

Many Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinics implemented alternatives to in-person service delivery in response to the COVID-19 pandemic, including virtual visits and electronic document sharing. The objective of this cross-sectional study was to describe WIC participants’ experiences with remote service delivery and recertification during the pandemic. Participants included mothers and infants who participated in a WIC-based intervention between June 2019-August 2020. All participants (N = 246) were invited to complete a follow-up survey between November 2020-February 2021; 185 mothers completed the survey. The survey assessed sociodemographics, employment, food security, experiences with remote WIC recertification and service delivery, and experiences with obtaining WIC foods during the pandemic. Average age for mothers was 29.2 ± 6.3 years and for infants was 17.7 ± .2 months; 80% (n = 147) identified as Hispanic. Approximately 34% (n = 62) of participants reported very low or low food security and 40% (n = 64) had difficulties buying WIC foods during the pandemic. Among participants who recalled providing documentation of income and address virtually, the majority felt comfortable providing information via email (60%) and text messaging (72%). Participants reported high levels of satisfaction with remote methods of service delivery, as well as overall satisfaction with the WIC program during the pandemic. While ~ 25% of study participants preferred for all WIC services to remain remote, 75% still desired at least some in-person contact with WIC staff after the pandemic. In conclusion, remote methods of WIC service delivery addressed existing barriers to WIC participation and were well-received by study participants.

P62 Resilient Despite Poor Support: Breastfeeding Among Maltreated Young Mothers

<h3>Background</h3> In the US, young mothers are the least likely to breastfeed their children. Mothers who have a history of child abuse and neglect also face barriers when trying to breastfeed their children and are less likely to do so. Little is known about the experiences that young mothers who have a history of maltreatment face when making decisions around infant feeding. <h3>Objective</h3> To determine what challenges young maltreated mothers face when trying to breastfeed their children. <h3>Study Design, Settings, Participants</h3> In-depth semi-structured interviews (N = 23) were conducted with young maltreated mothers (ages 18-25), their caregivers, and the professionals that work with them. Mothers were on average 17.8 when they gave birth and most were African American (78%) followed by Latina (22%). All of the young mothers received WIC and 78% initiated breastfeeding. The median length of breastfeeding was 2.5 months (range: 3 days to 2 years). Professionals (mean age: 33.9) had worked with an average of over 40 parenting youth. <h3>Measurable Outcome/Analysis</h3> Interviews were transcribed verbatim and analyzed using a 5-step thematic analysis approach: familiarization with the data, initial coding, generation and refinement of themes and subthemes, and finalized themes. <h3>Results</h3> Participants discussed the lack of support both from health professionals and the mothers' communities. Main sources of support and information included obstetricians, WIC, and the internet, but resources were often insufficient. Reasons for breastfeeding cessation included lack of support, difficulties with breastfeeding, discomfort with feeding in public, and substance use. <h3>Conclusion</h3> Young mothers with a history of maltreatment face significant barriers yet show resilience in attempting to breastfeed their children. Many experienced a systemic lack of support and low expectations for continued breastfeeding. Initial findings suggest optimum opportunities for improving systemic support may be among medical professionals and WIC staff.

O47 Chat with Maya: Assessing the Usability of the Texas WIC Chatbot

<h3>Background</h3> To address declining participation rates in the Women, Infants, and Children (WIC) program, Texas WIC developed and deployed Maya, the Texas WIC chatbot, in June 2020. Maya is an automated software application that allows visitors of TexasWIC.org to ask questions about eligibility and begin the process of making an appointment. Maya has been developed within a user-centered design framework, with WIC clients, potential WIC clients, and WIC staff consulted throughout the ideation and design process. In continuation of this process, usability studies are ongoing. <h3>Objective</h3> The objectives of this study were to assess the usability of Maya and solicit user feedback on overall satisfaction. <h3>Study Design, Setting, Participants</h3> A Think Aloud interview methodology was employed to assess participants' real-time cognitive processes when using Maya. Participants (n = 9) were recruited after accessing Maya on TexasWIC.org. Interviews were conducted via Zoom with a moderator and assistant moderator. First, participants explored Maya's features with minimal input from the interviewer. Next, utilizing a semi-structured interview guide, the interviewer probed for participants' perceptions regarding how Maya may facilitate convenient information retrieval for WIC clients. <h3>Measurable Outcomes/Analysis</h3> Employing a 2-coder structure, interviews were recorded, transcribed, and themed. <h3>Results</h3> Maya's ability to immediately provide critical information about benefits, enrollment, recertification, and WIC-related frequently asked questions was described as efficient and highly useful. Additionally, participants approved of Maya's overall layout and expressed confidence in their ability to find what they needed. The few issues that were uncovered include minor confusion on how to return to Maya's main menu, some chat responses seeming long, and occasional glitches. <h3>Conclusion</h3> Maya was well-received with specific appreciation for her ability to efficiently provide information. However, some issues related to functionality indicate room for improvement. Enhancing Maya's usability to ensure easy usage has the potential further facilitate optimal information retrieval and program participation.

The Design of a Randomized Clinical Trial to Evaluate a Pragmatic and Scalable eHealth Intervention for the Management of Gestational Weight Gain in Low-Income Women: Protocol for the SmartMoms in WIC Trial.

BackgroundLess than one-third of women gain an appropriate amount of weight during pregnancy, which can influence the long-term health of both the mother and the child. Economically disadvantaged women are the most vulnerable to maternal obesity, excessive weight gain during pregnancy, and poor birth outcomes. Effective and scalable health care strategies to promote healthy weight gain during pregnancy specifically tailored for these women are lacking.ObjectiveThis paper presents the design and protocol of a biphasic, community-based eHealth trial, SmartMoms in WIC, to increase the adherence to healthy gestational weight gain (GWG) recommendations in low-income mothers receiving women, infant, and children (WIC) benefits.MethodsPhase 1 of the trial included using feedback from WIC mothers and staff and participants from 2 community peer advisory groups to adapt an existing eHealth gestational weight management intervention to meet the needs of women receiving WIC benefits. The health curriculum, the format of delivery, and incentive strategies were adapted to be culturally relevant and at an appropriate level of health literacy. Phase 2 included a pragmatic randomized controlled trial across the 9 health care regions in Louisiana with the goal of enrolling 432 women. The SmartMoms in WIC intervention is an intensive 24-week behavioral intervention, which includes nutrition education and exercise strategies, and provides the technology to assist with weight management, delivered through a professionally produced website application.ResultsPhase 1 of this trial was completed in July 2019, and recruitment for phase 2 began immediately thereafter. All data are anticipated to be collected by Spring 2023.ConclusionsThe SmartMoms in WIC curriculum was methodically developed using feedback from community-based peer advisory groups to create a culturally relevant, mobile behavioral intervention for mothers receiving WIC benefits. The randomized clinical trial is underway to test the effectiveness of a sustainable eHealth program on the incidence rates of appropriate GWG. SmartMoms in WIC may be able to offer an innovative, cost-effective, and scalable solution for GWG management in women served by WIC.Trial RegistrationClinicalTrials.gov NCT04028843; https://clinicaltrials.gov/ct2/show/NCT04028843International Registered Report Identifier (IRRID)DERR1-10.2196/18211

Qualitative Analysis of Maternal Barriers and Perceptions to Participation in a Federal Supplemental Nutrition Program in Rural Appalachian North Carolina.

BackgroundLittle is known about barriers to and perceptions of participation in the in Women, Infants, and Children (WIC) program in rural Appalachia.PurposeTo gain a deeper understanding of maternal barriers and perceptions related to WIC participation in rural AppalachiaMethodsPregnant women and mothers were recruited in-person and via flyers from WIC offices in three counties in Appalachian North Carolina. Four semi-structured focus groups were conducted between May to July 2018. Each focus group was approximately 60 minutes long and included open-ended questions about the overall WIC experience in rural Appalachia. Focus groups were audio-recorded, transcribed verbatim, and content analysis of transcripts was performed by two trained researchers. Identified themes were discussed and consensus was reached by the researchers to generate final themes for four areas of interest: (1) most valued aspects of WIC program, (2) barriers to program participation and benefit redemption, (3) experiences during appointments, and (4) suggestions for improving experiences in program.ResultsThe most valued aspects of participation were financial benefits and support/resources provided by WIC staff. In contrast, lack of variety of WIC-approved foods and social stigma were perceived as major barriers to participation and redeeming benefits.ImplicationsThis study contributes to a better understanding of the barriers and perceptions related to WIC participation in this geographically and culturally unique area of rural Appalachia. Findings are valuable for informing WIC state-agencies and policymakers whose efforts focus on the identification and development of effective recruitment and retention strategies for WIC-eligible families in rural Appalachia.

P42 Empower WIC Breastfeeding Experts: Use of Interactive Training Platform to Increase Staff Knowledge and Confidence in Breastfeeding Counseling

<h3>Objective</h3> To increase knowledge and confidence of WIC staff in Breastfeeding counseling and education through an interactive, visual breastfeeding curriculum platform. <h3>Use of Theory or Research</h3> Self-efficacy Theory is guiding the training to strengthen WIC staff confidence to train the trainer, promote and support breastfeeding WIC participants. Research suggests interactive learning opportunities provided through face-to-face learning, computer-based learning, and website design contribute to enhanced learning and retention, as well as improved relationship building. Furthermore, presenters who provide meaningful, full-screen imagery while verbally discussing content enhance their ability to engage participants. <h3>Target Audience</h3> WIC State and local breastfeeding coordinators across the United States. <h3>Program Description</h3> US Department of Agriculture, Food and Nutrition Service (FNS) new WIC Breastfeeding Curriculum was unveiled nationally via 7 regionally located in-person trainings to WIC staff. As a skills-based train-the-trainer approach, the trainings provided numerous opportunities for hands-on practice and application and trainer tips. Attendees accessed the interactive training platform as trainers provided orientation to the platform's visual design, including full-screen visuals, animations, videos, and other instructional components. This training empowers WIC staff to deliver effective breastfeeding counseling and education to participants. <h3>Evaluation Methods</h3> Training attendees completed surveys at the conclusion of the training. <h3>Results</h3> In spring 2019, FNS trained 358 WIC Staff for a total of 140 hours of training. All attendees completed the survey, of which 63% identified the training approaches as excellent and 25% as good. Case studies and role playing were identified as most useful. Approximately 41% rated very confident in their ability to understand and train others on content, and 39% rated confident. <h3>Conclusions</h3> Findings from the trainings suggest training approach is effective; there is a need for interactive, visual curriculum platforms to both increase knowledge and trainer confidence. The training strengthens WIC breastfeeding program and nutrition services delivery to participants.

P164 Rewiring Texas WIC: Informing the Development of a Chatbot to Strengthen Enrollment in Texas

<h3>Background</h3> Mirroring national trajectories, participation in Texas WIC has declined incrementally since 2015. In an attempt to mitigate this issue, Texas State University researchers have partnered with Texas WIC to support existing clients and facilitate enrollment of new applicants by developing a user-friendly, Texas WIC Chatbot. The success of any technological interface is predicated upon engaging stakeholders and intended users during the development process, involving a theoretical framework known as User-Centered Design. Soliciting perceptions from WIC staff on optimization of chatbot features is a crucial step in the design process. <h3>Objective</h3> Assess perceptions of facilitators and barriers among Texas WIC staff regarding user acceptance of a chatbot. <h3>Study Design, Setting, Participants</h3> Perception of chatbot user acceptance was studied through 8 group interviews, conducted via Zoom. Participants included WIC directors and clinic staff. A semi-structured interview guide was designed to solicit discussion regarding facilitators and barriers to optimal chatbot acceptance and usage among staff and clients. Interviews focused on perceptions of technology among WIC staff and clients. <h3>Measurable Outcome/Analysis</h3> Interview data were recorded, transcribed, and themed. <h3>Results</h3> Perceived facilitators of chatbot use among staff included: providing adequate training and information regarding the chatbot, a shared plan of chatbot management, and formally promoting benefits of staff chatbot use. Perceived barriers to chatbot use among staff included: lacking general technology knowledge, lack of experience with chatbots or similar technologies, and older age. Perceptions of client facilitators to chatbot acceptance included: familiarity with chatbots or similar technologies, perceptions of low time/effort investment, and a successful initial chatbot use. Finally, perceptions of client barriers to chatbot acceptance included: anxiety towards chatbot/technology use, demographically/culturally insensitive technology, and inability of chatbot to perform touted features. <h3>Conclusions</h3> User input from WIC staff indicated that staff perceive many benefits of chatbot implementation, staff are confident that clients will accept a chatbot, and staff barriers may be addressed with comprehensive chatbot training, prior to rollout.

Breastfeeding Duration Is Associated With WIC Site-Level Breastfeeding Support Practices

ObjectiveTo describe Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) site-level breastfeeding support practices and associations with breastfeeding outcomes. DesignSecondary analysis of WIC Infant and Toddler Feeding Practices Study–2, including data from interviews with caregivers of infants and interviews and surveys with staff from 27 WIC state agencies and 80 study sites. ParticipantsA total of 1,235 mothers of breastfed infants participating in the WIC Infant and Toddler Feeding Practices Study–2. Main Outcome MeasureAny and fully breastfeeding 2, 6, and 12 months postpartum. AnalysisDescriptive statistics described WIC site-level breastfeeding supports. Multilevel mixed modeling of breastfeeding at 2, 6, and 12 months, controlling for site- and participant-level characteristics. ResultsFive WIC site-level supports were significantly and independently associated with any and fully breastfeeding: access to breastfeeding peer counselors, access to International Board Certified Lactation Consultants, postnatal home visits, allowing any WIC staff member to provide breast pump education, and having a policy not to provide formula during the first 30 days postpartum. Likelihood of any and fully breastfeeding increased with each additional site-level support present (odds ratio = 1.09, 95% confidence interval, 1.06–1.12; and odds ratio = 1.26, 95% confidence interval, 1.21–1.31, respectively). Conclusions and ImplicationsPositive associations between site-level supports and breastfeeding at 2, 6, and 12 months were observed. Additional research is needed to understand how site-level supports interrelate and whether specific combinations are more effective, and to identify variations in implementation of breastfeeding supports.

Perinatal Depression in Low-Income Women: A Literature Review and Innovative Screening Approach.

This paper reviews literature on perinatal depression prevalence, consequences, and screening among low-income women and women of color. We introduce the Warm Connections program's innovative perinatal depression screening protocol and explore perinatal depression patterns among WIC participants. Perinatal depression negatively impacts maternal and child outcomes. Research shows mixed findings of perinatal depression prevalence rates among low-income women and women of color. The Warm Connections program supports the ability of WIC staff to administer the EPDS to WIC participants. Perinatal depression rates appeared lower in the Warm Connections program than in studies using less specific perinatal depression screening instruments with similar samples. Future research should continue to explore perinatal depression patterns among low-income women and women of color. Partnering with community-based settings such as WIC provides innovative opportunities to provide screening, referral, and treatment for low income women and women of color.

P196 Chat with WIC: Innovating WIC Services with a Chatbot

Background WIC serves low income pregnant, postpartum, and breastfeeding women and infants and children at nutritional risk by providing food packages and nutrition education. Texas WIC enrollment has declined by 24.1% since 2015. By offering continual availability to answer questions regarding eligibility and schedule appointments, an online chatbot has potential to improve enrollment and retention. Objective To inform the development of a Texas WIC Chatbot prototype by engaging WIC stakeholders and staff. Study Design, Settings, Participants This study involved three sets of group interviews conducted using Zoom with state-level stakeholders, WIC directors, and clinic staff. Participation was invited via email. Demographic surveys were completed before interviews. An interview guide prompted discussion regarding how a chatbot could expedite the WIC flow of services, what desirable chatbot features would be, and how barriers to successful implementation could be overcome. Measurable Outcome/Analysis Interview data were recorded, transcribed, and themed using the classic analysis strategy. Themes informed WIC Chatbot design. Results A total of 11 group interviews with 32 participants were conducted. Themes included support that a chatbot: could improve WIC services by adding flexibility so that clients could determine eligibility and be better prepared for clinic visits; would be most effective with a friendly, personable interface; and could potentially connect clients to other WIC information, such as nutrition education. Participants expressed concern that no chatbot could be a one-size-fits-all solution. Conclusion The prospect of a Texas WIC Chabot was well-received. A chatbot could ideally provide a logical interface aligned with the WIC flow of services, with a friendly and professional interface. Next steps will involve the development of a live-chat launched through the Texas WIC website to investigate user preferences. Collectively, these data will inform WIC Chatbot 1.0. After implementation of WIC Chatbot 1.0, the effect on enrollment and retention can be assessed. Funding Texas Health and Human Services Commission, WIC Program.