Research Original Research| Volume 119, ISSUE 3, P416-424.e2, March 2019

WIC Recipients in the Retail Environment: A Qualitative Study Assessing Customer Experience and Satisfaction

Published:November 27, 2018DOI:



      The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program is an important intervention for prevention and treatment of obesity and food insecurity, but participation has dropped among eligible populations from 2009 to 2015. Program satisfaction is integral to participant retention, and the retail experience is a vital component of program satisfaction.


      This article applies behavioral economics principles to explore the retail experience of WIC participants and ways in which it may be improved.


      The authors designed and conducted semistructured interviews and focus groups with WIC participants.


      A convenience sample of WIC participants aged 18 years and older were recruited through WIC clinics in Texas, North Carolina, Oregon, and Illinois (n=55, 27 participants from four focus groups and 28 individual interviews).

      Statistical analysis conducted

      Responses were analyzed qualitatively using principles of content analysis.


      Challenges in identifying WIC-allowable items throughout the store as well as perceived stigmatization during the checkout process were the chief complaints. Study participants described a learning curve in successful use of WIC in retail environments over time. Study participants also reported acceptance of restrictions, such as a requirement to purchase the least expensive brand.


      Dissatisfaction with the retail experience may lead to the underutilization of WIC benefits or program exit. Behavioral economics strategies that facilitate a better shopping experience, such as creating a section for WIC items in the store or improving in-store education, may improve the retail experience for WIC customers. Further research is needed to ensure such strategies are effective and do not contribute to stigma.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the Academy of Nutrition and Dietetics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Ogden C.L.
        • Carroll M.D.
        • Kit B.K.
        • Flegal K.M.
        Prevalence of obesity and trends in body mass index among US children and adolescents, 1999-2010.
        JAMA. 2012; 307: 483-490
        • Hales C.M.
        • Fryar C.D.
        • Carroll M.D.
        • Freedman D.S.
        • Ogden C.L.
        Trends in obesity and severe obesity prevalence in US youth and adults by sex and age, 2007-2008 to 2015-2016.
        JAMA. 2018; 319: 1723-1725
      1. Fryar CD, Carroll MD, Ogden CL. Prevalence of overweight, obesity, and extreme obesity among adults aged 20 and over: United States, 1960-1962 through 2013-2014. National Center for Health Statistics. Health E Stats. 2016 (July). Accessed April 20, 2018.

        • Schultz D.J.
        • Byker Shanks C.
        • Houghtaling B.
        The impact of the 2009 Special Supplemental Nutrition Program for Women, Infants, and Children food package revisions on participants: A systematic review.
        J Acad Nutr Diet. 2015; 115: 1832-1846
        • US Department of Agriculture
        National and State-Level Estimates of Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Eligibles and Program Reach, 2015.
        United States Department of Agriculture, Food and Nutrition Services, Washington, DC2018 (Accessed April 20, 2018)
        • National Academies of Sciences, Engineering and M
        Review of WIC Food Package: Improving Balance and Choice: Final Report.
        National Academies Press, Washington, DC2017
      2. National WIC Association. WIC Program Overview and History. Accessed February 25, 2015.

        • Richards M.R.
        • Sindelar J.L.
        Rewarding healthy food choices in SNAP: behavioral economic applications: rewarding healthy food choices in SNAP.
        Milbank Q. 2013; 91: 395-412
        • Roberto C.A.
        • Kawachi I.
        Use of psychology and behavioral economics to promote healthy eating.
        Am J Prev Med. 2014; 47: 832-837
        • Riis J.
        Opportunities and barriers for smaller portions in food service: Lessons from marketing and behavioral economics.
        Int J Obes (Lond). 2014; 38 (S19-24)
        • Rice T.
        The behavioral economics of health and health care.
        Annu Rev Public Health. 2013; 34: 431-447
        • Kahneman D.
        Maps of bounded rationality: Psychology for behavioral economics.
        Am Econ Rev. 2003; 93: 1449-1475
        • Simon H.A.
        Models of Bounded Rationality.
        MIT Press, Cambridge, MA1982
        • Powell L.
        • Amsbary J.
        • Xin H.
        Stigma as a communication barrier for participation in the federal government’s Women, Infants, and Children Program.
        Qual Res Reports Commun. 2015; 16: 75-85
      3. National WIC Association. WIC research to practice hot topic: Caseload decrease. 2015. Accessed March 7, 2018.

      4. United States Department of Education Food and Nutrition Services. WIC Program. Average cost per participant. 2017. Accessed April 18, 2018.

      5. BECR Center: About us. Accessed April 20, 2018. Accessed April 20, 2018.

      6. Ritchie LD, Whaley SE, Crocker NJ. Satisfaction of California WIC participants with food package changes. J Nutr Educ Behav. 46(3 Suppl):S71-S78.

        • Chiasson M.A.
        • Findley S.E.
        • Sekhobo J.P.
        • et al.
        Changing WIC changes what children eat.
        Obesity. 2013; 21: 1423-1429
        • Bertmann F.M.W.
        • Barroso C.
        • Ohri-Vachaspati P.
        • Hampl J.S.
        • Sell K.
        • Wharton C.M.
        Women, infants, and children cash value voucher (CVV) use in Arizona: A qualitative exploration of barriers and strategies related to fruit and vegetable purchases.
        J Nutr Educ Behav. 2014; 46: S53-S58
        • Bryant C.
        • Lindenberger J.
        • Brown C.
        • et al.
        A social marketing approach to increasing enrollment in a public health program: A case study of the Texas WIC Program.
        Hum Organ. 2001; 60: 234-246
        • Birkett D.
        • Johnson D.
        • Thompson J.R.
        • Oberg D.
        Reaching low-income families: Focus group results provide direction for a behavioral approach to WIC services.
        J Am Diet Assoc. 2004; 104: 1277-1280
        • Thorgeirsson T.
        • Kawachi I.
        Behavioral economics: merging psychology and economics for lifestyle interventions.
        Am J Prev Med. 2013; 44: 185-189
      7. US Food and Drug Administration. WIC Policy Memorandum #2017-2. State Agency Compliance with Split Tender Requirements. 2016. Accessed January 23, 2018.

      8. Tiehen L, Frazao E. Where do WIC participants redeem their food benefits? An analysis of WIC food dollar redemption patterns by store type. Economic Information Bulletin-152. US Department of Agriculture, Economic Research Service, 2016. Accessed October 30, 2018.

        • Wheeler A.L.
        • Chapman-Novakofski K.
        Farmers’ markets: costs compared with supermarkets, use among WIC clients, and relationship to fruit and vegetable intake and related psychosocial variables.
        J Nutr Educ Behav. 2014; 46: S65-S70
      9. Neuberger Z, Greenstein R. WIC-Only Stores and Competitive Pricing in the WIC Program. Center on Budget and Policy Priorities. 2004. Accessed January 16, 2017.


      C. Chauvenet is a PhD candidate, Maternal and Child Health, Royster Fellow at University of North Carolina Center for Health Promotion and Disease Prevention and University of North Carolina at Chapel Hill Gillings School of Global Public Health, Department of Maternal and Child Health, Chapel Hill.


      M. De Marco is a research assistant professor, Department of Nutrition, Gillings School of Global Public Health Research Fellow and project director, Center for Health Promotion & Disease Prevention (a CDC Prevention Research Center), University of North Carolina at Chapel Hill.


      C. Barnes is an assistant professor, Sanford School of Public Policy and assistant professor of political science, Duke University, Durham, NC.


      A. S. Ammerman is director, Center for Health Promotion and Disease Prevention, Kauffman Distinguished Professor, Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill.