Program

Sep 13, 2004

OVERVIEW

The WIC Nutrition Education Demonstration supplied information on proper prenatal nutrition through the WIC service program to pregnant, at-nutrition-risk mothers. WIC has traditionally supplied mothers with nutrition advice and supplemental foods or food vouchers to mothers in need. One new strategy for increasing nutrition knowledge was an interactive touch-screen video program which mothers accessed individually. The other was a “facilitated” group instruction that focused on behavior change rather than knowledge acquisition. The initial study found no difference in nutrition knowledge between this new strategy, the traditional strategy, and those who did not receive a treatment.

DESCRIPTION OF PROGRAM

Target population: Pregnant mothers eligible for WIC services based on residence, income level, pregnancy status, and “nutrition risk” level

The prenatal nutrition intervention program was composed of two different types of interventions, both designed to increase low-income mothers’ knowledge of proper prenatal and post-partum nutrition. One form of the intervention was an interactive touch-screen video program that presented a five-module curriculum called What to Eat When You’re Pregnant, which mothers accessed individually. The other was a group-implemented intervention called Eating for Two, which was a “facilitated” group instruction that focused on behavior change rather than knowledge acquisition. Both interventions, as well as the traditional WIC nutrition education, contained the following core concepts:

  • A Food Guide Pyramid — describing necessary intake of the different food groups
  • Diet for Pregnancy — addressing specific nutritional needs of expecting mothers
  • Food choices: Everyday Versus Sometimes Foods — explaining which foods have nutritional value and which are empty calories.
  • Nutrients for Healthy Mother and Baby — describing what the key vitamins and nutrients are for pregnant women and their babies
  • Nutrients in WIC Foods – outlining the nutritional information of the foods distributed to the mothers through the WIC program.

Both interventions were intended to increase mothers’ knowledge of their own dietary needs and the dietary needs of their children, as well as to encourage positive nutritional choices and behaviors.

EVALUATION(S) OF PROGRAM

Evaluated population: 1,926 pregnant mothers who were eligible for WIC benefits and were judged to have a low-risk pregnancy participated in a random assignment study to asses various approaches for delivering nutritional education.

Approach: Mothers were recruited to participate in this study when they came to apply for WIC benefits at one of 6 WIC locations. Prior to receiving any WIC services, they were randomly assigned to one of three groups: Group 1 received the traditional WIC nutrition education (which varied by site), group 2 received the “innovative” nutrition education, and group 3 was a control (who received the education after the completion of the study). The control group consisted of 800 women; 566 women were in the innovative group; and the traditional group consisted of 560 women. Three of the sites administered the group intervention and three sites gave the individual video-based intervention (the specific intervention was chosen for each site based on whether their traditional intervention was administered individually or in a group).Following group assignment, mothers took a pretest of their prenatal nutrition knowledge (this test was split into 2 measures in order to avoid any memory effect so those women who took pre-test A then took post-test B and vice-versa). All three groups received an initial WIC counseling session at the time of their first visit. Then, after 4 to 8 weeks following their initial assessment, the traditional group and the 2 experimental groups returned for follow-up education sessions for whichever group they had been assigned. All three groups took the post-test after the follow-up intervention (the control group took the post-test 8 weeks after their original WIC assessment and then received nutrition education). It should be noted that to lower the attrition rate for the intervention group, several sites decided to use various incentives (some financial) to encourage participants to take the post-test. Sites did not have similar problems getting control-group participants to take the post-test as they were allowed to complete the test over the phone.

Results: Researchers found neither the traditional nor the innovative group showed increased knowledge of nutrition. The only significant finding was that women in innovative implementation groups had an average post-test score that was 2 percentage points higher than women in the control group. Though significant, researchers note that this only translates into approximately one additional correct test item.Researchers state that the content of the test may not have corresponded directly to the topics addressed in the interventions because both the traditional and group counseling programs were less knowledge based and more focused on changing behavior. Additionally, though the instrument was pilot tested and psychometrically evaluated prior to implementation, it turned out that one of the tests (test A) was more difficult when given to the actual participants.

SOURCES FOR MORE INFORMATION

References:

Randall, B., Sprague, K., Connell, D. B., & Golay, J. (2001). WIC Nutrition Education Demonstration Study: Prenatal Intervention (CN-01-WICNEPI). Alexandria, VA: Office of Analysis, Nutrition and Evaluation, USDA.

Program categorized in this guide according to the following:

Evaluated participant ages: Prenatal (Pregnant Mothers) Program age ranges in the Guide: Prenatal

Program components: clinic/provider-based, parent or family component

Measured outcomes: Physical Health, Education/Cognitive Skills

KEYWORDS:
Pregnant Mothers, High-Risk, Young Adulthood (18-24), Gender-Specific (Female Only), Clinic-Based, Provider-Based, Parent or Family Component, Education, Group, Urban, Rural, Physical Health, Education, Cognitive Development, Nutrition, White or Caucasian, Black or African American, Hispanic or Latino, American Indian or Alaska Native, Asian, Native Hawaiian or other Pacific Islander.

Program information last updated 9/13/04.