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Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education

Authors:
  • Brown University School of Public Health

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FOOD RESEARCH AND ACTION CENTER
Making WIC Work for
Multicultural Communities
Best Practices in Outreach and Nutrition Education
FRAC
1875 Connecticut Avenue, NW
Suite 540
Washington, DC 20009
(202) 986-2200
www.frac.or
g
About FRAC
The Food Research and Action Center (FRAC) is the leading national organization working for more
effective public and private policies to eradicate domestic hunger and undernutrition.
For more information about FRAC, or to si
g
n up for FRAC’s Weekly News Di
g
est, visit www.frac.or
g
.
For information about the Special Supplemental Nutrition Program for Women, Infants and
Children, go to www.frac.org/WIC/index.htm.
Acknowledgements
This guide was prepared by Madina Agenor, Kate Pettitt Callahan and Geraldine Henchy.
The Food Research and Action Center gratefully acknowledges support of the A.L. Mailman Foundation
and the General Mills Foundation.
FRAC also appreciates the assistance of the WIC community in preparing this guide: Kristen Sasseen,
Washington Department of Health, Nenebah Jalloh, Mary’s Center for Maternal and Child Health, Jayasri
Janakiram, Children National Medical Center, Sabrina Lewis, District of Columbia Department of Health,
WIC Agency, Anna Kanianthra, Fairfax County Health Department, Betsy Clark, Minnesota Department of
Health, Monique Stovall, California Department of Public Health, WIC Program, Rachel Colchamiro,
Massachusetts Department of Public Health, Nutrition Division, Karan DiMartino, Massachusetts
Department of Public Health, Nutrition Division, Judith Anderson, Michigan Department of Community
Health, Ann Barone, Rhode Island Department of Health, Evalyn Carbrey, District of Columbia
Department of Health, WIC Agency and the National Association of WIC Directors’ Cecelia Richardson.
The assistance of United States Department of Agriculture, Food and Nutrition Service experts, Debra
Whitford and Patty Davis, has been invaluable. Megan Elsener’s work on the cultural competency
components summary is also appreciated. 2009
Making WIC Work for Multicultural Communities
Best Practices in Outreach and Nutrition Education
Table of Contents
Introduction...............................................................................................................................1
Best Practices in Outreach to Families of Diverse Cultures ......................................................3
District of Columbia WIC.......................................................................................................4
Mary’s Center for Maternal and Child Care Outreach....................................................4
Children’s National Medical Center .............................................................................6
Families Growing Healthy with WIC (California) ......................................................................7
Navajo Nation Outreach...................................................................................................... 11
Reaching Out to Immigrant Families (Minnesota).................................................................. 13
Responding to Demographic Changes (Fairfax County, Virginia)............................................. 14
Social Marketing Campaign (Massachusetts)......................................................................... 16
Washington WIC................................................................................................................ 19
Outreach Project.................................................................................................... 19
African American Outreach Project...........................................................................21
Best Practices Nutrition Education for Families of Diverse Cultures ......................................24
California Fit WIC............................................................................................................... 25
Incorporating Traditional Foods and Recipes into Nutrition Education (Navajo Nation).............. 28
Motivational Interviewing (District of Columbia).................................................................... 30
Texas WIC......................................................................................................................................33
African American Breastfeeding Initiative.................................................................. 33
Nutrition Education Partnerships.............................................................................. 35
From the Food Guide Pyramid to Cooking Practices in Your Kitchen............................ 36
Veggin’ Out (Rhode Island)................................................................................................. 37
Weigh of Life…Taking Action Together (Massachusetts)......................................................... 39
Wichealth.org (Michigan).................................................................................................... 42
National WIC Survey................................................................................................................45
National WIC Survey .......................................................................................................... 46
Outreach........................................................................................................................... 46
Nutrition Education............................................................................................................. 47
Resources.................................................................................................................................49
Outreach........................................................................................................................... 50
Nutrition Education............................................................................................................. 50
WIC ................................................................................................................................. 51
USDA WIC Nutrition Services Standards: Cultural Competency Components............................ 52
USDA WIC Value Enhanced Nutrition Assessment: Cultural Competency Components .............. 53
Introduction
Making WIC Work for Multicultural Communities: Best Practices Outreach and Nutrition Education 1
Introduction
This guide highlights successful outreach strategies and nutrition education methods for making WIC
work in multicultural communities. These include effective best practices for targeting hard-to-reach
communities, addressing language barriers and emphasizing quality services and participant access.
In addition, FRAC’s national WIC survey results provide an overview of WIC outreach and nutrition
education efforts to WIC participants of all cultural backgrounds.
The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is a very important
source of nutritious foods and nutrition education for many pregnant women, new mothers, infants and
children up to age five in multicultural communities. The program provides a monthly package of WIC
checks that can be used in the grocery store to buy specific healthy foods. WIC’s new food package,
which expands cultural food options by offering fruits and vegetables, whole grains, and the option of
soymilk and tofu, is an important marketing and nutrition education tool.
WIC is a federally funded public health and nutrition program administered by the United States
Department of Agriculture, Food and Nutrition Service through WIC State Agencies and Indian Tribal
Organizations (ITOs). At the local level, services are provided by local agencies and clinics.
In 2009, over 9 million women, infants, and children were enrolled in the WIC program. While many
potential participants in multicultural communities are enrolled in WIC, others face significant barriers to
accessing and fully utilizing WIC services. The guide can be used as a tool and resource for developing
innovative outreach and nutrition education efforts focused on families from these communities.
Outreach
Targeted outreach is essential to increasing access to WIC services in underserved diverse communities.
State, local, and ITO agencies throughout the United States have found that comprehensive multicultural
and multilingual outreach and social marketing campaigns increase participation among these
underserved populations. This guide focuses on the following nine successful outreach campaigns:
District of Columbia WIC
Children’s National Medical Center Outreach
Mary’s Center for Maternal and Child Care Outreach
Families Growing Healthy with WIC (California)
Navajo Nation Outreach
Reaching Out to Immigrant Families (Minnesota)
Responding to Demographic Changes (Fairfax County Virginia)
Social Marketing Campaign (Massachusetts)
Washington WIC
Outreach Project
African American Outreach Project
At the state level, some of the most successful outreach strategies for reaching diverse underserved
communities include: producing outreach materials in a range of languages and for various
cultural/ethnic groups; collaborating with other statewide agencies and organizations serving WIC eligible
families; working with the media; branding WIC to increase recognition; direct mailings to potential
participants; working with employers; working with WIC vendors; establishing an automated WIC hotline;
promoting income eligibility guidelines; and collaborating with health, foster, and child care providers.
At the local level, successful outreach strategies include: attending conferences and local community
events; distributing outreach materials to local community groups and organizations; conducting door-to-
door outreach; and staffing a mobile unit.
Making WIC Work for Multicultural Communities: Best Practices Outreach and Nutrition Education 2
Nutrition Education
WIC has undergone a process of “Revitalizing Quality Nutrition Services”. Central to the success of this
initiative are USDA’s guidelines for Value Enhanced Nutrition Assessment and Nutrition Services
Standards which focus on a participant-centered approach to nutrition education including cultural
competency. This guide provides case studies highlighting best practices integrating this approach to
providing quality nutrition services. These model programs take into account the WIC participants’
cultural preferences, eating patterns and traditions consistent with the cultural competency requirements.
WIC nutritionists integrate an understanding of how socio-cultural issues (race, ethnicity, religion, group
affiliation, socioeconomic status, and world view) affect nutrition and nutrition-related health problems.
The resource section of this guide contains a summary of the guidelines for Value Enhanced Nutrition
Assessment and Nutrition Services Standards related to cultural competency.
Obesity is an increasingly serious and widespread health problem in the United States, and, very
significantly, is becoming increasingly common among young children. The Centers for Disease Control
reported that in 2008, 14.6 percent of American children between two and five years old were obese,
which is almost triple the rate in 1971. In light of the obesity epidemic in the United States, WIC has
expanded nutrition education to promote physical activity and good exercise habits. It is important that
these initiatives address the needs of families from diverse cultural and ethnic backgrounds. Indeed,
according to the Food and Nutrition Service, Latino and Native American children have the highest
overweight prevalence (16.4% and 18.6% respectively) compared to all other WIC children.
This guide highlights seven State and ITO agencies whose nutrition education has successfully addressed
the needs of multicultural communities:
California Fit WIC
Motivational Interviewing (District of Columbia)
Weigh of Life…Taking Action Together (Massachusetts)
Wichealth.org (Michigan)
Incorporating Traditional Foods and Recipes into Nutrition Education (Navajo Nation)
Veggin’ Out (Rhode Island)
Texas WIC
African American Breastfeeding Initiative
From the Food Guide Pyramid to Cooking Practices in Your Kitchen
Nutrition Education Partnerships
Effective strategies included producing multilingual flyers, DVD’s, and shopping guides, using multicultural
images in their outreach and nutrition education materials, developing new logos and taglines to increase
recognition, working with WIC vendors and collaborating with community partners. Many states have
utilized their most successful multicultural outreach and nutrition education strategies to market the new
healthier WIC food package to diverse families. A separate FRAC publication, Time for a Change,
includes additional information on these efforts.
WIC Nutrition Services funding is essential to the successful implementation of such innovative outreach
and nutrition education initiatives. Other sources of funding include WIC Special Project Grants and
Operational Adjustment Grants from the Food and Nutrition Service regional offices.
National WIC Survey
Findings from the FRAC’s WIC Directors’ Survey provide important insight into ongoing efforts to increase
access to services by conducting outreach, and providing nutrition education and referrals to WIC
participants of all cultural backgrounds.
Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education
Best Practices in Outreach to Families of
Diverse Cultural Back
g
rounds
Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education 4
District of Columbia WIC
The District of Columbia WIC State Agency has a comprehensive
multicultural and multilingual outreach campaign that targets a range
of populations in the District, including the African American, Latino,
White, Ethiopian, West African, Chinese, and Vietnamese communities.
In partnership with Houston Association, Inc., DC WIC developed
outreach materials in a number of languages as part of their WIC:
Working in Communities campaign.
The materials developed included:
flyers in English, French, Spanish, Mandarin, Amharic, and
Vietnamese;
posters in English, Spanish, and Vietnamese;
brochures in both English and Spanish; and
a postcard and factsheet in English.
All of these materials are available on the WIC Works Sharing Center
website.
Of the 22 WIC clinics in DC, two are particularly successful
at reaching out to families of diverse cultural and linguistic
backgrounds: Mary’s Center for Maternal and Child Care
and Children’s National Medical Center.
Agency Name
Mary’s Center for Maternal and Child Care
Project Description
Door to Door Outreach
At Mary’s Center, 20 percent of the staff are fluent in Chinese and 30 percent are fluent in Spanish. In
addition to State outreach initiatives (attending health fairs and staffing the DC WIC mobile unit) Mary’s
Center increases awareness of WIC by conducting door to door outreach in the community. Clinic staff
distribute the promotional flyers and brochures provided by the State Agency based on language needs.
While all of the staff is involved in outreach, if the goal is to target a specific group of people (e.g.
Latinos), staff members who speak that language (e.g. Spanish) will conduct the outreach.
The Mama and Baby Bus
The clinic also relies on the Mama and Baby Bus, a
mobile unit that does outreach for all Mary’s
Centers programs, to provide eligible families with
information about WIC. Outreach through the
Mama and Baby Bus is done in English, Spanish,
and Vietnamese.
Outreach in the Community
Mary’s Center conducts outreach for WIC in
churches, schools, community centers, day care
centers, grocery stores, laundromats, and all other
sites where women, infants, and children are likely
to be found. In addition to disseminating
information about the program, the WIC staff
“We basically go anywhere a
pregnant woman, mom, or dad
with young children may be.”
-Anne Spaulding
Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education 5
screens potential participants for eligibility and enrolls those who meet the program guidelines. When
staff members are on the Mama and Baby Bus, they are able to enroll families on the spot; if they are
conducting outreach on foot, they take eligible families back to the clinic or schedule an appointment.
Resources
Mary’s Center’s WIC outreach efforts are funded through Nutrition Services funds from the United States
Department of Agriculture, Food and Nutrition Service.
Languages Used
English, Spanish, French, and Mandarin
Populations Served
Latino, Black/African American, and Chinese
Website
www.maryscenter.org
Contact Information
Nenebah Jalloh
Director of WIC
Mary’s Center for Maternal and
Child Health
2333 Ontario Rd., NW
Washington, DC 20009
(T) 202-420-7156
(F) 202-420-7156
njalloh@maryscenter.org
Sabrina Lewis
Community Health
Administration
District of Columbia
Department of Health
WIC State Agency
2100 MLK, Jr. Avenue, SE,
Suite 409
Washington, DC 20020
(T) 202-645-0505
(F) 202-645-0516
sabrina.lewis@dc.gov
Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education 6
“Word of mouth is
essential to outreach.”
- Jayasri Janakiram
Contact Information
Jayasri Janakiram
WIC Coordinator
Children’s National Medical Center
111 Michigan Ave., NW
Washington, DC 20010
(T) 202-476-5594
(F) 202-476-4126
jayaj@cnmc.org
Agency Name
Children’s National Medical Center
Project Description
The WIC program at
Children’s has found that
one of the best ways to
reach eligible families is to
target other agencies and
organizations serving low-income communities. These
include the Medicaid program, free meals sites, free
primary care clinics, and prenatal and pediatric care
clinics for low-income families, among others. WIC
staff distributes State Agency flyers and brochures;
enrolls eligible families on site; provides in-services
and workshops on WIC for the staff; and sends direct
mailings with information about WIC. Children’s WIC
also sits on a Community Board, which includes free
health care clinics, child care, schools, and Head Start,
among other groups serving WIC eligible families.
In addition, Children’s conducts outreach at local health fairs (Expo Time, Wise to Humanize etc.), where
WIC nutritionists and paraprofessionals staff a table and distribute State Agency flyers to potential
participants. Yet another effective outreach strategy is intra-agency cross-referrals, one of the many
benefits of being located in a hospital. The WIC clinic at Children’s orients medical students and
residents, who in turn refer potential participants to WIC. The WIC program also frequently makes cross-
referrals with other Children’s hospital programs, including the Generations Program (teen mother and
child clinic), Child Health Centers, and the Family Help Desk.
Resources
The WIC clinic at Children’s National Medical Center funds its outreach efforts through Nutrition Services
funds from the United States Department of Agriculture, Food and Nutrition Service.
Languages Used
English and Spanish
Populations Served
Black/African American, Latino, Chinese, and Vietnamese
Website: www. cnmc.org
Wherever low-income families are being served, an
opportunity for outreach exists.
- Jayasri Janakiram
Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education 7
Families Growing Healthy with WIC (California)
The California WIC program has a comprehensive outreach
strategy that reaches out to the Latino, White, African American,
and Asian communities throughout the state. Latinos currently
comprise the majority of WIC participants in California (78%).
The State Agency is increasing its efforts to target underserved
communities, specifically the African American, Caucasian,
Chinese, Vietnamese, and Hmong populations.
California’s outreach goal is to expand and enhance collaboration
between the WIC program and other statewide agencies and
organizations serving WIC eligible families in order to promote
local WIC referrals. An Outreach Committee advises the California
WIC program on state and local outreach efforts, including:
distributing outreach materials,
having an automated WIC hotline,
attending conferences and community events,
working with the media, and
branding the WIC program to increase recognition.
Agency Name
California Department of Health Services, WIC Supplemental Nutrition Branch
Project Description
Outreach Committee
The state’s outreach committee consists of approximately ten local agency members representing WIC
directors, nutritionists, and outreach coordinators. The group meets quarterly to advise the California
WIC State Agency in designing statewide outreach materials and shaping outreach efforts. Their mission
includes helping all local agencies reach WIC eligible persons, particularly the underserved, working poor,
and hard to reach populations, as well as improve retention of current participants.
Outreach Materials
The California WIC program developed a wide range of outreach materials in a number of languages.
Materials are available in English, Spanish, Chinese, Vietnamese, Russian, Hmong, Korean and Armenian.
The State Agency produced outreach pamphlets, which provide potential participants with
detailed information about WIC services, benefits, and income eligibility guidelines in English,
Spanish, Chinese, and Vietnamese. California WIC is also planning to translate the pamphlet into
both Russian and Hmong in an effort to reach more of the many cultural and linguistic
communities in California. Each version of the pamphlet is targeted to a specific area based on
language needs.
The State Agency produced additional outreach and education materials in English, Spanish,
Chinese, and Vietnamese, Russian, Hmong, Armenian, and Korean. These materials included
information about WIC clients’ rights and responsibilities, breastfeeding, and formula feeding.
The California WIC program also developed a one-page envelope
stuffer intended to be sent to eligible families along with materials
from other agencies, including electricity bills and MediCal (Medicaid)
application forms. The stuffers are an Agency favorite and provide
outreach information, as well as a simple nutrition education message
“The envelope stuffer is
one of our most effective
outreach tools. It’s
quick, simple, and
direct.” -Carol Chase
Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education 8
on limiting juice consumption. One side is printed in English and the other in Spanish.
Yet another California WIC outreach material is a half-page flyer providing information about WIC
benefits, services, and income eligibility guidelines, as well as nutrition tips about healthy snacks.
The WIC program also produced a limited number of English and Spanish WIC posters for
organizations serving low-income families, as a well as materials for health care providers. The
clinician outreach packet included a WIC fact sheet and referral guide, including a rolodex card
with the State Agency’s number and website.
The California WIC program also distributes incentive items during conference exhibits and health
fairs.
1-888-WIC-WORKS
All outreach materials include the number for
the California WIC automated phone line, 1-
888-WIC-WORKS, which is a critical
component of the State Agency’s outreach
campaign. The hotline provides callers with
information about the nearest WIC clinic, WIC
benefits, and access to other services (health
care, schools etc.) in five languages: English,
Spanish, Vietnamese, Hmong, and Chinese.
Outreach Strategy
The California WIC program reaches potential
participants by collaborating with other social
services agencies that serve WIC eligible
families. For instance, the State Agency
conducts outreach to MediCal (Medicaid) enrollees and provides outreach materials free of charge to child
care providers, Head Start, food banks, and health care providers, among others. The State Agency also
partners with social services agencies through efforts such as mailing outreach letters to local MediCal
and Food Stamp Program directors. Another important outreach strategy is using geo-mapping software
in order to identify underserved areas throughout the state.
In addition, California WIC also attends state and local events and promotes WIC in the media:
Attending Conferences and Other Community Events
At the state level, California WIC attends large conferences where they can staff an exhibit about
the WIC program. They specifically target conferences hosted by organizations that serve the
WIC population, including the American Academy of Pediatrics, the California Department of
Education, the American Academy of Nurse Practitioners, and the California School Nurses
Association. Local agency staff members help with state conference exhibits and also attend
local health fairs in their area.
In an effort to improve outreach to African Americans, who are an underserved population in
California, the State Agency attends conferences and events such as the National Association for
the Advancement of Colored People (NAACP) Annual State Conference in Los Angeles and the
Annual Black Expo in Sacramento.
Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education 9
The California State Agency carefully targets the conferences and other community events they
attend. When deciding what events to attend, they ask themselves:
“Who is the sponsor?”
“Where is the event being held?”
“Who is the sponsor targeting?”
“Is this a state or local event?”
“Will WIC eligible families be attending the event?”
“Will those who serve WIC eligible families be attending?”
“What is the average attendance?”
“Is this event the best use of our funds?”
“How will this event further our outreach efforts?”
Working with the Media
At the request of local agencies, the California WIC State
Agency developed a media outreach kit. Working with the
media can be too expensive for many state agencies, so
California WIC encourages local agencies to advertise in their
community by providing them with the resources they need.
The local agency media kit includes camera ready advertising
for billboard ads, print inserts, flyers, draft press releases, and a user guide on media advocacy
strategy. Local agencies throughout California have worked with public television stations, local
cable stations, and local radio stations to promote WIC in the media.
The State Agency regularly runs print advertisements in statewide publications that target WIC
eligible families, such as the Child Support Handbook for foster parents, and writes nutrition
articles with an outreach message for health provider newsletters.
Branding WIC
The State Agency has branded WIC in order to raise awareness of the
program throughout the state. The campaign’s major goal is to enroll
all WIC eligible families who are not participating in the program by
increasing their knowledge of WIC and dismantling any misconceptions
about eligibility. For example, many families are unaware of the income
eligibility guidelines and mistakenly believe they do not qualify. Since
this is often a deterrent for working families, California WIC promotes
income guidelines in its promotional materials.
The State Agency also designed a new, more recognizable logo for the
California WIC Program. The new logo was launched on October 1,
2006. The logo includes the tagline “Families growing healthy with
WIC.” The new logo is used on all education materials, promotional
items and WIC letterhead. In addition, all authorized WIC vendors are
encouraged to display the WIC decal at their entrance to help families
identify stores where WIC foods are available.
The WIC branding campaign was informed by focus groups with WIC
participants and local agency WIC staff.
“Some media
opportunities exist at the
local level that don’t exist
at the state level.”
- Monique Stovall
All WIC programs should consider
doing informal focus groups to plan
their outreach activities. They’re an
inexpensive way to assess what
participants’ value about WIC and what
is keeping others from applying.
California could provide other states
with focus group questions.”
-Carol Chase
Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education 10
Project Evaluation
The California WIC State Agency has conducted a number of informal process evaluations to determine
how to better reach and improve WIC services for underserved populations, including focus groups with
WIC participants and local agency staff. In addition, the state monitors requests for outreach resources
to measure the success of California’s collaboration efforts with other state programs. These evaluations
taught the California WIC program valuable lessons about effective outreach strategies.
Lessons Learned
Both the surveys and focus groups revealed that the most effective strategy for increasing awareness of
the WIC program was word of mouth. The focus groups also showed that health care providers were
crucial to informing eligible patients of WIC services and benefits.
These findings also led the California WIC State Agency to conclude that major statewide paid TV
advertising campaigns were not the most effective outreach strategy in California.
Resources
The California WIC program uses Nutrition Services funding from the United States Department of
Agriculture, Food and Nutrition Service for all of its outreach efforts.
Languages Used
English, Spanish, Chinese, Vietnamese, Russian, Hmong, Armenian, and Korean
Populations Served
Latino, White, African American, Chinese, Vietnamese, Hmong, Korean, Russian, and Armenian
State WIC Participation by Race/Ethnicity:
78 percent Latino, 8 percent White, 5.5 percent Black/African American, 5 percent Asian/Pacific Islander,
and 0.87 percent American Indian/ Alaska Native
Website
www.wicworks.ca.gov
Contact Information
Monique Stovall
Chief, Nutrition Education, Marketing and Outreach Section
California Department of Public Health-WIC Program
P.O. Box 997375
West Sacramento, CA 95899-7375
(T) 916 928-8604
Monique.Stovall@cdph.ca.gov
Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education 11
Navajo Nation Outreach
All WIC clinics in the Navajo Nation in Arizona
are required to draft a bi-annual outreach plan.
Each plan is shaped by the specific needs of
community members and varies based on
locality. Outreach is the responsibility of all
WIC staff members and everyone is involved in
the process regardless of their role in the clinic.
Outreach is conducted in English and Navajo.
Some materials are also available in Spanish,
which increases access to the program for
Latino participants.
Outreach efforts are conducted on a monthly
basis, usually after a staff in-service or
workshop when WIC clinics are closed. The
Navajo Nation WIC program’s goal is to set high
standards for outreach and to empower WIC
clinic staff to reach them. Their outreach
strategy involves attending community events and working with other agencies serving WIC eligible
families in the Navajo Nation.
Agency Name
Navajo Division of Health, Navajo Nation WIC Program
Project Description
Working in the Community
Navajo Nation WIC attends as many local events as possible in order to increase awareness of the
program in the community. For example, when appropriate, clinics attend tribal fairs, traditional
ceremonies, and health fairs. WIC staff distributes flyers, which include information about WIC services
and benefits, clinic locations, income eligibility guidelines, and the toll free number for the central office
(1-800-307-4231). The Navajo Nation WIC program also prints ads in the reservation’s three biggest
newspapers: the Navajo Times, the Gallup Independent, and the Farmington Daily Times. In order to
reach families in rural areas, they produce monthly Public Service Announcements (PSAs) on the radio in
both English and Navajo. Outreach in more isolated rural areas is only conducted in Navajo. The Navajo
Nation WIC program also has some outreach materials in Spanish to distribute to the Latino population.
Working with Partners
A key component of the Navajo Nation’s outreach strategy is partnering with other groups and agencies
on the reservation. For example, Navajo Nation WIC collaborates with area food banks and other food
distribution sites, the Navajo Special Diabetes Project, and the local Breastfeeding Task Force. They also
make referrals to Medicaid and the Food Stamp Program. In addition, they partner with dietitians at the
Indian Health Service to provide the same messages on nutrition and physical activity and disseminate
community resource guides in which WIC is listed to health care providers. The goal is to educate others
working with low-income families about WIC so that they can refer them to the program.
Each clinic’s outreach plan
needs to be tailored to
the needs of the community.”
-Doris McGuire
“Strong partnerships are a key component
of our successful outreach strategy.”
-Adele King
Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education 12
Project Evaluation
All WIC clinics on the reservation keep a record of their outreach activities. The records are evaluated by
the state’s Quality Assurance Review (QAR) team. Every clinic nutritionist also conducts an in-house
evaluation of outreach efforts for self-regulation.
Resources
The Navajo Nation WIC program uses Nutrition Services funding from the United States Department of
Agriculture, Food and Nutrition Service to produce outreach materials and conduct outreach efforts.
Languages Used
Navajo, English, and Spanish
Populations Served
Navajo, Latino, and White
Contact Information
Adele King
WIC Program Manager
Navajo Division of Health-Navajo Nation WIC Program
P.O. Box 1390
Window Rock, AZ 86515
(T) 928-871-6698
(F) 928-871-6255
aking@navajowic.org
“If it wasn’t for the WIC program,
I wouldn’t have made it. You know
with the milk and stuff how expensive
it is these days. Thank goodness that
you guys are here because it’s just me
and my baby.”
-WIC Participant
Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education 13
Reaching Out to Immigrant Families
Minnesota has become home to many immigrant groups from all over the world, including Hmong immigrants
from Southeast Asia, Africans from Somalia and Ethiopia, Karen people from Burma, and many Spanish-
speaking immigrants from Mexico and various other regions of Latin America. Minnesota WIC has developed
outreach strategies to reach out to and better serve these populations. The State Agency has developed
culturally appropriate outreach materials in four languages, hired
multilingual and multicultural staff and has a clinic located in the
Hmong American Center in St. Paul.
Agency Name
Minnesota Department of Health, WIC Program
Project Description
Minnesota WIC has developed and disseminated outreach flyers in English, Spanish, Hmong, and Somali. The
outreach flyers, WIC’s food list brochure, and WIC’s direct mail postcards all feature pictures of culturally
diverse women, infants, and children. WIC has just recently developed New WIC food package brochures in
seven languages including English, Spanish, Hmong, Somali, Chinese, Russian, and Vietnamese. The brochure
can also be translated into Arabic, Bosnian, Burmese, French, Hindi, Korean, Polish, and Urdu at the request of
local agencies.
In addition to the print materials the WIC state website has participant information pages in English, Spanish,
and Somali. To enhance their ability to serve the state’s diverse population Minnesota WIC has also hired
Hmong, Somali, Mexican, and Karen staff to ensure effective communication and cultural understanding
amongst WIC staff and Minnesota’s immigrant populations.
To further reach the Hmong immigrant population Minnesota WIC opened a clinic in the Hmong American
Partnership (HAP) Center in St. Paul. In the early 1980s many Hmong fleeing Southeast Asia after America’s
withdrawal after the Vietnam War immigrated to Ramsey County, Minnesota and there is now a large Hmong
population in St. Paul. When WIC was searching for a larger space for their St. Paul Clinic they took the
opportunity to partner with the Hmong American Partnership Center. The center had a large space available in
their building that was perfect for WIC’s clinic. Having the clinic located in the HAP center has allowed Ramsey
County WIC to successfully serve the Hmong population. Not only can HAP staff easily refer their clients to the
WIC clinic but WIC staff can refer participants to the many services that HAP offers, including job counseling,
English classes, job fairs, and teen youth groups. Ramsey County WIC considers their partnership with HAP a
“win-win relationship.”
Project Evaluation
The primary way Minnesota evaluates their outreach efforts is by tracking participation. They track
participation trends over time and participation by race and ethnicity.
Resources
Minnesota’s WIC allocates a portion of their budget to outreach efforts.
Languages Used
English, Spanish, Hmong, and Somali
Populations Served
White, Black/African American, Latino, Southeast Asian, and
East African
Website: http://www.health.state.mn.us/divs/fh/wic
Contact Information
Betsy Clark
WIC Director
Minnesota Department of Health
P.O. Box 64975
St. Paul, MN 55164-0975
(T) 651-201-4403
Betsy.Clarke@state.mn.us
Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education 14
Responding to Demographic Changes
The population of Fairfax Country has become
increasingly diverse over the last several years.
Fairfax County WIC has developed a
comprehensive multicultural outreach campaign
to respond to these demographic changes to
ensure they are serving the diverse families that
are now residing within the county. The
campaign includes both external partnerships
with area organizations and internal integration
efforts with other county programs. The
outreach efforts of Fairfax county staff
contributed to a 5 percent growth in WIC
participation from October 2008 to April 2009.
Agency Name
Fairfax County Health Department, WIC Program
Project Description
External Outreach
Fairfax County WIC currently partners with 21 local organizations to reach potential WIC participants.
These community partners included resources centers, schools, religious organizations, and other
community programs. Some of the partnerships include:
Bryant Adult Alternative High School:
WIC partners with Bryant, an alternative school for
pregnant teens, to educate students about the WIC program and work with school nurses to
refer eligible students to WIC.
Catholic Charities
: Fairfax County WIC partners with Catholic Charities in Springfield to reach out
to the families with adopted children. Adopted children are eligible for Medicaid and therefore are
automatically eligible for WIC services but adoptive families are often uncomfortable or unwilling
to visit a WIC clinic. Fairfax County WIC requires that a child’s adoptive parents bring the child in
for just his or her first visit for a nutrition assessment. After the initial visit a Catholic Charities
social worker picks up the WIC food vouchers for the family of the adopted child. WIC staff also
provides the social workers nutrition education that they then pass along to adoptive families.
Dar Al Hijrah Islamic Center
: WIC staff will plan to hold clinics at the Islamic Center following
Saturday services to disseminate information about the programs, screen potential participants
for eligibility and enroll those who meet the program guidelines. This initiative will start in
August 2009.
Grace Ministries:
WIC staff works with the Grace ministries of Herndon Methodist Church to reach
out to Hispanic families. On the first Saturday of every month Grace Ministries opens their doors
to roughly 200 families in need, offering them food pantry bags, clothing, and other necessities.
On each of these Saturdays WIC staff is present to educate families about WIC and schedule
eligible families for an appointment at the local WIC clinic.
Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education 15
Internal Outreach
WIC partners with other County programs to reach additional WIC participants. WIC staff educates
providers about WIC benefits and eligibility guidelines to ensure they are able to appropriately refer
potentials participants to WIC. Fairfax County WIC coordinates outreach efforts with the Department of
Family Services Special Nutrition Assistance Program (formerly the Food Stamp program), dental clinics,
the Public Health Nurses Fairfax Hospital Liaison, Medicaid workers, and the Health Department clinic
staff.
Project Evaluation
Fairfax county WIC measures the effectiveness of their outreach efforts by tracking WIC enrollment. In
April 2009, the Fairfax County WIC program assisted 18,513 participants, a 5 percent growth since
October 2008.
Lessons Learned
Fairfax county WIC identified health care providers’ and potential participants’ lack of knowledge of the
WIC benefits and eligibility guidelines as a barrier to participation. Fairfax County WIC outreach efforts
have helped increase knowledge of the WIC program and helped reach out to underserved populations
which Fairfax county WIC has learned is the key to serving potential WIC clients.
Languages Used
English, Spanish, Korean, Chinese, Vietnamese, and Russian
Populations Served
White, Black/African American, Latino, Chinese, East
African, South East Asians, Indians, and Pakistanis
Website
http://www.fairfaxcounty.gov/hd/wic/
Contact Information
Anna Kanianthra
WIC Nutrition Coordinator
Fairfax Country Health Department
(T) 703-246-8657
(F) 520-871-6255
Anna.Kanianthra@fairfaxcounty.gov
Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education 16
“Focus groups are how
you come up with the
best ideas.”
-
Karan DiMartino
Social Marketing Campaign
The Massachusetts WIC program developed a comprehensive,
statewide outreach campaign with the goal of increasing awareness
of WIC among eligible families of all racial, ethnic, cultural, and
linguistic backgrounds. Massachusetts’ outreach plan is based on
the success of a three-year multicultural social marketing campaign
launched in 2001. Their outreach efforts include:
partnering with employers to reach working families,
working with the media,
partnering with child care, health and foster care providers,
partnering with WIC vendors,
direct mail campaigns to potential participants, and
targeting local organizations and events.
Agency Name
Massachusetts Department of Public Health, WIC Nutrition Program
Project Description
Social Marketing Campaign
The Massachusetts WIC program had a three-year statewide, multicultural social marketing campaign to
increase enrollment and the retention of current WIC participants. In partnership with Policy Studies,
Inc., the State Agency branded WIC as a “health and nutrition program for all types of families.” Based
on focus groups with both current and potential participants, they designed a new WIC logo, changed the
WIC tag line to “Good Food and a Whole Lot More,” and produced a wide variety of both written and
audiovisual outreach materials. Many of the Massachusetts WIC outreach materials were
developed in nine languages: Chinese, English, French, Khmer,
Portuguese (Brazil), Portuguese (Portugal), Russian, Spanish, and
Vietnamese. All others are available in both English and Spanish.
This allows the Massachusetts State Agency to reach a range of
populations throughout the state, including the Latino, Brazilian,
Vietnamese, Cambodian, Portuguese, Russian, White, African American, East and West African, Chinese,
and Haitian communities. The materials range from brochures, poster, flyers, toolkits, transit and TV
advertisements, and radio spots to direct mail postcards. All of the written outreach materials include the
number for the WIC phone line (1-800-WIC1007), which provides Massachusetts residents with
information about the pro
g
ram.
Target audiences for the social marketing campaign include employers (human resources offices), local
WIC agencies, WIC vendors, health care providers, foster and child care providers, WIC participants, and
eligible families not enrolled in the program. The materials developed are permanent components of the
State Agency’s outreach efforts. They can be found on the WIC Works Sharing Center website.
Partnering with Employers to Reach Working Families
An essential outreach tool developed during the social marketing campaign was the human resources
package. After identifying companies that hire low-income employees (e.g. hotels, restaurants),
Massachusetts WIC conducted focus groups with employers in order to identify how the WIC program
could work for them. The goal was to market WIC as an employee benefit and enlist employers to
educate employees about WIC income eligibility guidelines since many working families mistakenly
believe they are ineligible for the program.
Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education 17
The State Agency sent information about WIC to human resources offices in over 40,000 companies
throughout Massachusetts. The information packets included an “Information for Employers” folder; a
“WIC is for Working Families” poster; a “WIC Fast Facts for Employers” factsheet; a letter to employers; a
sample email for employees; and a general WIC brochure.
Working with the Media
During the social marketing campaign, Massachusetts WIC developed TV, radio, and transit
advertisements. The TV and radio ads were designed to provide all listeners with nutrition information,
while dismantling any stigma of WIC being a “welfare program”. They were produced in both English
and Spanish. The radio spot features a variety of speakers who discuss child eating habits,
breastfeeding, and WIC services, including health and social services referrals. The TV ad features happy
children from diverse backgrounds eating healthy WIC foods. The State Agency also developed transit
ads to put throughout the Massachusetts Bay Transportation Authority bus and train system.
The Massachusetts WIC program’s media outreach strategy emphasized radio spots since they are
significantly less expensive than TV ads and allow for more repetition. Since 2002, the State Agency has
partnered with the radio station Magic 106.7 FM to conduct a weekly nutrition minute. The goal is to
give listeners healthy eating tips and brand WIC as a nutrition program. Massachusetts WIC has also
partnered with other local radio stations to conduct outreach at free summer concerts and events, give
information about WIC on air, and post their hyperlink on the stations’ website.
Partnering with Health, Foster, and Child Care Providers
Massachusetts WIC developed a clinician brochure, which provides health care providers with information
about WIC services and how to refer patients to the program. They also developed brochures for foster
care and child care providers. These materials are available in English and Spanish and outline WIC
benefits, eligibility requirements, and referral and enrollment procedures.
Partnering with Vendors
The vendor materials package provides vendors with
information about the WIC program and highlights their role
in WIC transactions. The package includes a picture guide
of WIC-approved foods; factsheets for cashiers (available in
English and Spanish) and bookkeepers; a brochure
explaining WIC transactions; and a poster thanking cashiers
for making WIC work for families.
Reaching Out to Eligible Families
In addition to the strategies outlined above, the
Massachusetts WIC program reaches out to eligible families
through direct mailings and community coordinators.
In order to reach potential WIC participants, two postcards
were developed and distributed via mail. The first was sent
out to all residents enrolled in the MassHealth program (Medicaid). The second postcard was sent to all
families earning under $40,000 per year with at least one child under the age of five. The WIC State
Agency purchased this mailing list from a local company that sends value pack offers to low-income
families in Massachusetts.
At the local level, community coordinators are a crucial part of outreach to eligible families. A total of 36
coordinators (one per local agency) distribute posters, flyers, and brochures containing information about
the WIC program to various sites throughout the state.
Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education 18
Target sites include welfare offices, libraries, preschools, utility companies, doctor’s offices, pharmacies,
local health fairs, and other community events. These coordinators have a limited budget and usually
attend community events free of charge.
Project Evaluation
After the outreach materials were developed in partnership with Policy Studies, Inc., the Massachusetts
WIC program conducted focus groups to evaluate their effectiveness. They found that more families
were aware of WIC as a result of the social marketing campaign.
Lessons Learned
Some of the campaign’s challenges included tackling the misconception that
WIC is a “welfare program” and reaching dads. In response to this last
challenge, the Massachusetts State Agency created outreach materials
specifically targeting fathers and used words like “families” instead of “moms”
and “women” in all outreach materials.
Massachusetts WIC also learned that investing time and money in focus groups was essential to
developing a successful outreach campaign. They found that focus groups were the only way to know
what the community’s needs and wants were. They also learned that focus groups were crucial to
determining which populations to target during an outreach campaign. Massachusetts WIC noted that in
order to be most useful, focus groups should be conducted with both participants and eligible families not
enrolled in the program. They recommend that State Agencies that cannot conduct focus groups before
launching an outreach campaign conduct phone interviews instead.
A creative and forward-thinking State Director with a “big picture” vision of WIC was also crucial to the
success of the social marketing campaign in Massachusetts. Indeed, the Massachusetts WIC staff
insisted that without Mary Kelligrew Kassler’s leadership, these outreach initiatives would not have been
possible.
Resources
The Massachusetts State Agency receives 85 percent of its funding from the Federal government and 15
percent from the State in Supplemental WIC funds. Outreach initiatives are funded through Nutrition
Services funding from the United States Department of Agriculture, Food and Nutrition Service.
Languages Used
Chinese, English, French, Khmer, Portuguese (Brazil), Portuguese (Portugal), Russian, Spanish, and
Vietnamese
Populations Served
White, Latino, African American, Haitian, Chinese, West African and East African, Portuguese, Brazilian,
Russian, Vietnamese, and Cambodian
Websites
www.nal.usda.gov/wicworks/Sharing_Center/statedev_soc_market_ma.htm
Contact Information
Karan DiMartino
Marketing and Media Coordinator
Nutrition Division-WIC Nutrition Program
Massachusetts Department of Public Health
(T) 617-624-6121
Karan.dimartino@state.ma.us
“You need to step
outside the box
and see what’s
going on in the
community.”
-Karan DiMartino
Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education 19
Washington WIC
The Washington State WIC agency has a comprehensive
multicultural and multilingual outreach strategy designed to
reach diverse families across the state. Through multilingual
outreach materials and activities, the Nutrition Program
Outreach Project has welcomed many new families to the
Washington State WIC program. The WIC African American
Outreach Project, focused on positive messages disseminated
through media and other channels in the community, has been
successful in increasing the participation of African American
families. This work is done through a public/private
partnership with WithinReach, a nonprofit organization working
to improve maternal, child and family health in Washington
State.
Agency Name
Washington Department of Health, WIC Nutrition Program
for Women, Infants and Children (WIC)
Project Name
Washington State WIC Nutrition Program Outreach Project
Project Description
Washington developed numerous culturally appropriate outreach materials and resources to increase
eligible families’ access to WIC services. The project includes outreach materials in 11 languages, a
statewide family health hotline with bi-lingual operators, an online WIC clinic search tool and an
interactive website where families apply for state-sponsored health and nutrition services.
Outreach Materials
Messaging: Outreach materials are worded to overcome barriers and encourage people to apply. Most of
the materials include the following information:
WIC income guidelines because many people do not realize they are eligible.
WIC services and the value of the WIC foods as an incentive for applying.
The message “
It’s easy to apply. It just takes a phone call. WIC even takes care of the
paperwork
.” This is based on information from focus groups on what would encourage
people to apply and overcome perceived barriers.
The statement “Getting WIC does not affect your immigration status.” so immigrants are not
afraid to apply.
The address and phone numbers of local WIC clinics for the county. These are printed on
the back of the flyers.
The toll free, statewide WithinReach Family Health Hotline number
Materials: The Washington State WIC Nutrition Program and WithinReach developed and disseminated
the following multilingual outreach materials:
WIC outreach flyers in 11 languages including English, Spanish, Chinese, Somali, Amharic,
Tigrinya, Vietnamese, Korean, Ukrainian, Russian, and Arabic.
A four-language outreach flyer in English, Spanish, Russian, and Vietnamese.
Counter cards in both English and Spanish that encourage WIC clients to tell their friends and
families about the WIC program.
Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education 20
Including an 8-language Medicaid insert in mailings to all pregnant women and households
with children under 5. The insert messages are in English, Spanish, Russian, Vietnamese,
Somali, Chinese, Korean, and Cambodian. Income guidelines are not included because all
Medicaid clients are income eligible for WIC.
New food package flyers in English, Arabic, Chinese, Korean, Russian, Somali, Spanish,
Vietnamese that include a New Food Choices 2009 logo.
WIC outreach materials can be ordered from The Washington State WIC Nutrition Program and
WithinReach.
On-line WIC Clinic Search Tool in English and Spanish
The search toll is maintained by WithinReach on their
website. There is a link to this from the WIC website,
the Basic Food Website, and the Parent Help 123 site.
The search tool allows families find the address, phone
number and hours of operation of a WIC clinic close to
where they live. The tool includes a system for
locating a WIC approved grocery store. The clinic
search tool site gets over 45,000 hits per year.
Family Health Hot Line
Through a multi-program contract with the Washington
State Department of Health, WithinReach operates a
toll Family Health Hotline. This creates a one-stop-
shopping opportunity because all callers are screened
and referred as needed to a number of programs
including WIC, Medicaid, Basic Food, Immunizations,
and Family Planning. All the participating programs
benefit from each others’ outreach efforts since all
callers get referred to an array of services. This is a
very cost effective way to operate and fund a statewide
toll free line.
Parenthelp123.org
Patenthelp123.org is an interactive website to help
families find and apply for local services available to them including WIC. The website is available in
English and Spanish. www.ParentHelp123.org includes a “benefit finder” that guides families as they
enter specific information so the system can determine if they are eligible for free and low-cost health
insurance and a number of food programs. The website also has a resource finder, a new search tool
that allows families to search by zip code for services including low-cost medical clinics, immunizations,
child care referral agencies and food assistance programs. The website has an easy online interview tool
that can be used to complete the applications for programs for which families are eligible. Families can
choose to print and send the applications in by mail or submit them online.
Project Evaluation
Washington WIC and WithinReach track the family health hotline calls by race and language and collect
information about how callers learned about the hotline number. In 2006, Washington WIC conducted a
call back survey of hotline callers to gather information about the usefulness of the hotline. They also
tracked caller’s responses to the various outreach methods and materials and make changes based on
this. Over 60 percent of callers to the toll free line report getting the WIC number from the phone book.
Lessons Learned
The “how learned” hotline information revealed that the two most effective ways to publicize the hotline
number are in the phone book and through print materials. Provider referrals are also an important
Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education 21
source for callers. The on-line WIC clinic search tool in English and Spanish has been well received and
gets over 45,000 hits per year. The number of hits continues to increase each quarter. The most
effective way to reach non-English speaking clients was the eight language Medicaid insert. Medicaid is
changing their system and will be using “debit type cards” instead of mailing out Medical coupons. WIC
will be looking for other ways to reach this population in the future.
All of the clients responding to the call back survey indicated that they found the hotline helpful and 99%
of them were successful in enrolling in WIC. Washington WIC plans to repeat this survey in 2011.
Resources
WithinReach and all the partnering programs and organizations contribute funding to operate the Family
Health Hotline. WIC also funds WithinReach to:
Conduct outreach activities publicizing the line.
Maintain up to date addresses etc. on the on-line WIC clinic search tool.
Support the development of the Spanish version of ParentHelp123. WithinReach obtained
most of the funding by writing grant requests.
Languages Used
Washington WIC Outreach Materials are available in these languages: English, Spanish,
Chinese, Cambodian, Somali, Amharic, Tigrinya, Vietnamese, Korean, Ukrainian, Russian, and
Arabic.
WIC tracks the languages that WIC clients read in their data system. They review this data
regularly and create materials in new languages based on this information.
WithinReach and the local WIC agencies use a “language line contract” so they can meet the
needs of callers in over 50 languages.
Populations Served
Native American, African American, Hispanic, and Asian
Websites
Washington State WIC Program: http://www.doh.wa.gov/cfh/WIC/default.htm
Washington State WIC Clinic Search Tool: http://www.withinreachwa.org/wicsearch
WithinReach – Essential Resources for Family Health: http://www.withinreachwa.org/
Parent Help 123: http://www.parenthelp123.org/
Project Name
Washington State WIC African American Outreach Project
Project Description
Key Informant Meeting
In February 2005, Washington WIC convened an African American key informant brainstorming session
to explore barriers to African American participation in WIC, and to gather information on effective
messages and outreach activities to reach eligible pregnant African American women and parents of
African American children under age 5. The key informants included health and social service providers
who work with African American families.
Through active idea generation the attendees identified and prioritized recommendations for key
messages and images:
Include images of healthy African American children of various ages and African American
pregnant women
Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education 22
Tell them it is easy to access and then make sure it is. Develop and highlight “drop in days” or
“new enrollment days.”
Highlight the benefits of the program (i.e. saves money, provides healthy foods, and supplements
their diets).
Stress presence of ethnically diverse and bilingual providers.
The groups’ prioritized list of “best outreach methods” for African Americans included:
Putting materials in places where people visit: barber shops, beauty supply and grocery stores,
churches, hair salons, clinics, schools, libraries, metro buses, and public markets.
Partnering with other groups for outreach: Basic Food outreach workers, food banks, meal sites,
senior centers to reach grandparents who have taken in their grandchildren, and locations in
ethnic neighborhoods.
Airing radio PSAs on stations popular with African American families
Putting ads in community newsletters such as: In Time Production, FACTS, and Color Magazine
Outreach to African Americans
Based on the findings above, the Washington WIC Nutrition Program partnered with WithinReach to
develop materials and activities for an African American Outreach Project.
Outreach Material Revisions
WIC revised many of their English outreach materials to feature additional pictures of African American
women, infants and children. They hired a photographer to take professional photographs for the
materials. The revised materials included the WA WIC general outreach flyer, a “Tell your Friends”
appointment folder insert, and the 8-language Medicaid Flyer.
New Outreach Materials
WIC and WithinReach also developed and disseminated new direct mail post cards and Valpak coupons
book inserts with images of African American women, infants, and children. WIC sent the post cards and
ValPak inserts to African American and low-income families across the state. One of the Valpak stuffers
featured a picture of an African American WIC provider on the phone that urged women to “call me to
get on WIC as soon as you know you are pregnant!”
Working with the Media
As recommended by the key informants, Washington developed radio, newspaper and transit
advertisements. They partnered with Kent Stevenson, a successful African American producer and Debbie
Cavitt, an African American gospel singer and director of Leschi Children’s Choir to produce a public
service announcement. The PSA aired on local radio stations African Americans listen to. Debbie Cavitt
Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education 23
and the Leschi choir were featured on the PSA. Two newspaper advertisements, featuring an African
American mother and child and a pregnant African American woman, were developed and placed in local
African American Newspapers. Bus signs were also developed and posted in 126 buses in Pierce County
and 126 buses in King County on routes in African American communities. One bus sign featured a
picture of a pregnant African American woman and the other a preschool aged African American child.
The signs included the ParentHelp123.org web address and the Family Health Hotline number.
Outreach in the Community
The WIC outreach team established and maintained relationships with local African American churches by
making one-on-one phone calls and personal visits. They educated church leaders about WIC services
and eligibility and encourage them to post WIC outreach materials on church bulletin boards. The
churches also put WIC outreach flyers in with their church bulletins. Free materials were provided.
WIC information was also provided at African American health fairs. Small teddy bears and lip gloss with
outreach messages were given out to attract families to the booth.
Project Evaluation
WithinReach provides Washington WIC with a yearly report about the reach of their outreach efforts. WA
WIC has seen a steady increase in African American enrollment since they began their outreach efforts in
2006. From February 2006 to February 2007 there was a 3.5 percent increase in the percent of African
Americans served. During the outreach project, February 2008 to February 2009, African American WIC
participation increased by 9 percent.
Lessons Learned
The brainstorming sessions revealed that when trying to reach African American populations it is
important to develop relationships within the African American community and develop materials and
outreach activities that include targeted messages and culturally appropriate images. It is also imperative
that the outreach efforts are ongoing and involve members of the community, especially African
American churches.
Resources
Washington WIC received a Operational Adjustment Grant for $75,000 from the Western Region United
States Department of Agriculture, Food and Nutrition Service to fund their African American Outreach
Project. In addition, Washington WIC allocated $20,000 for this project.
Languages Used
English
Populations Served
African American
Websites
Washington State WIC Program: http://www.doh.wa.gov/cfh/WIC/default.htm
Contact Information
Kristin Sasseen
Washington State WIC Outreach Coordinator
Washington State Department of Health
PO Box 47886
Olympia, Washington, 98504-7886
(T) 360-236-3633
Kristin.Sasseen@DOH.WA.GOV
Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education
Best Practices Nutrition Education for
Families of Diverse Cultural Back
g
rounds
Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education 25
California Fit WIC
This case study specifically focuses on the California Fit WIC project because of its efforts to make
nutrition and physical activity accessible to WIC families of diverse cultural backgrounds. California’s
program takes a holistic, community-centered approach to healthy eating and exercise, with a particular
focus on Latino communities. This case study also highlights the Fit Families Novela series, a set of
bilingual video and fotonovelas promoting nutrition and physical activity.
Project Name
California Fit WIC
Agency Name
California Department of Health Services, WIC Branch
Project Description
California Fit WIC
The Fit WIC program in California seeks to increase WIC’s role in preventing childhood
obesity/overweight in the community as a whole. The California team implemented intervention
strategies that not only targeted WIC staff and participants, but also members of the entire community.
California developed resources for the project in both English and Spanish.
Targeting WIC Participants
One of the main goals was to
integrate physical activity into
nutrition education for WIC
participants. For instance, California
Fit WIC developed a training manual
entitled “FitWIC: Active Play for
Families,” which encouraged families
to be more active by doing easy and
fun physical activities. California Fit
WIC also produced parent handouts
in both English and Spanish
discussing active child play (“Playing
With Your Baby, Playing With Your
Toddler, Playing With Your 3 to 5
Year Old”) and healthy eating habits
for children (“Healthy Choices for
Kids”). They also promoted child
education resources, such as
children’s books, music, and videos
addressing healthy eating and
physical activity in both English and
Spanish. In addition, the lesson
plans used during nutrition
education sessions covered topics
such as gardening (“Grow Your Own
Garden”), healthy snacks (“Making
Snacks Count”), and fast food
(“Super-Sized!”), and TV watching
(“What’s On TV?”).
Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education 26
Targeting WIC staff
Yet another California Fit WIC program goal was to increase staff awareness of childhood
overweight/obesity and help them improve their own health behaviors, as outlined in the staff training
manual “Fit WIC: Supporting WIC Families and Staff.” For instance, the project included special trainings
and workshops to assist staff in discussing weight, healthy eating, and physical activity with WIC
participants. The project also encouraged all local WIC agencies to develop staff wellness programs.
California WIC believes WIC staff are the best role models for WIC families so it is important to support
staff to make health lifestyle choices.
Targeting Other Community Members
In the community, California Fit WIC developed gardens, implemented task forces on physical activity
and nutrition, and drafted physical activity resource guides. For example, the program produced a
training kit for communities to address overweight/obesity among children entitled “Children and Weight:
What Communities Can Do.” The Fit WIC program also promoted farmers’ markets near WIC clinics and
established a partnership with local restaurants to increase community members’ fruit and vegetable
consumption.
The Fit Families Novela Series
In an effort to make Fit WIC accessible to families of diverse cultural
and racial/ethnic backgrounds, the Center for Weight and Health at the
University of California, Berkeley created the Fit Families Novela Series,
a set of three videonovelas and three fotonovelas addressing Fit WIC
topics in both English and Spanish. This allows Fit WIC to reach the
three largest WIC populations in California, the Latino, White, and
African American communities.
These bilingual materials depict realistic characters striving to create
healthy snacks, limit their TV watching, and increase their physical
activity. The California WIC State Agency distributed the video and
fotonovelas to all of their local agencies (over 600 sites). The intent
was to incorporate them into nutrition education classes for WIC
participants throughout the state.
National Fit WIC
In 1999, the Food and Nutrition Service (FNS) at the United States Department of Agriculture launched
Fit WIC, a three-year research and evaluation project, in five WIC Agencies: California, Kentucky,
Vermont, Virginia, and the Intertribal Council of Arizona (ITCA). According to FNS, Fit WIC is “a collection
of social-environmental strategies to promote healthy weight [and prevent obesity/overweight] among
children enrolled in WIC.” The Fit WIC implementation manual contains more information about all of
these initiatives, as well as lessons learned and recommendations.
Project Evaluation
The California Fit WIC program administered a survey to all staff in order to assess “staff knowledge,
practices, intervention ideas, and perceived barriers to implementation of programs to prevent
overweight among WIC children.” The survey instrument was developed by the WIC State Agency, the
University of California, Berkeley, and Samuels and Associates consulting group.
The State Agency and Berkeley also administered a similar survey to WIC participants in order to assess
the effectiveness of the Fit WIC project on WIC families. They compared survey findings from three Fit
WIC intervention sites (Pico Rivera, Santa Paula, and Grand Avenue) and three control sites (Flower
Street, Ventura, and County Main). The surveys were distributed in both English and Spanish.
Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education 27
Survey results showed that the Fit WIC program was very effective in improving the nutrition and
increasing the physical activity level of participants. Findings from both the staff and participant surveys
are available on the California Fit WIC website.
http://www.cdph.ca.gov/PROGRAMS/WICWORKS/Pages/WICNEFITWIC.aspx
Resources
The Fit WIC projects in all five Agencies were funded by $1.8 million in Federal funds from the United
States Department of Agriculture, Food and Nutrition Service, under WIC Special Projects Grants.
In addition, California Fit WIC received a $300,000 operational adjustment grant from the United States
Department of Agriculture, Food and Nutrition Service Western Regional Office to develop a community
garden.
Languages Used
English and Spanish
Populations Served
Latino, White, and Black/African American
State WIC Participation by Race/Ethnicity
78 percent Latino, 8 percent White, 5.5 percent Black/African American, 5 percent Asian/Pacific Islander,
and 0.87 percent American Indian/ Alaska Native
Websites
California Fit WIC
www.wicworks.ca.gov/education/nutrition/FitWIC/FitWICIndex.htm
The Fit Families Novela Series
http://anrcatalog.ucdavis.edu/InOrder/Shop/ItemDetails.asp?ItemNo=3496
New WIC Food Package Campaign
Building on their Fit WIC project and other work, the California WIC agency created a comprehensive
nutrition education campaign marketing the new WIC food package nutrition messages.
http://ww2.cdph.ca.gov/programs/wicworks/Pages/WICNewFoodPackages.aspx
Maximizing the New WIC Food Package
The California WIC Association launched a strategic campaign to maximize the new WIC food package
including a variety of materials that can be used in California and other states.
http://www.calwic.org/
Contact Information
Monique Stovall
Chief Nutrition Education, Marketing and Outreach Section
California Department of Public Health-WIC Program
P.O. Box 997375
West Sacramento, CA 95899-7375
(T) 916 928-8604
Monique.Stovall@cdph.ca.gov
Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education 28
Incorporating Traditional Foods and Recipes
into Nutrition Education
Navajo Nation WIC has a comprehensive nutrition education program in both Navajo and English.
Although the program is open to all WIC participants, it is specifically geared towards the Navajo. In
turn, nutritionists incorporate information about traditional foods and recipes into nutrition education
classes. They also provide nutrition education to children because, as in many other areas in the United
States, child obesity is a major concern on the reservation.
Agency Name
Navajo Division of Health, Navajo Nation WIC Program
Project Description
Incorporating Traditional Foods
When appropriate to the geographic location and
topic, the Navajo Nation WIC Program incorporates
traditional foods into nutrition education lesson
plans. For instance, during the session on anemia,
nutritionists discuss the recipe for making the
traditional food blue corn mush, which is very high
in iron. Similarly, during Five-A-Day month in
September, Navajo Nation WIC distributes a
handout on traditional fruits and vegetables, such as
lychee, sumac berries, and yucca fruit. In addition,
traditional recipes for Navajo cake, shape blue corn
bread, and chiilchin berry pudding, among others,
are made available in the clinic waiting room.
Recipes using WIC foods to make snacks for kids
are also available in an effort to encourage
participants to use all of their WIC foods.
Nutrition Education for Children
In addition to nutrition education for adults, the Navajo Nation WIC Program also conducts nutrition
education sessions for children on a monthly basis. They specifically target kids between the ages of
three and five years old, many of whom are at risk for overweight (11%). This initiative is based on
classes developed by the Fit WIC Inter Tribal Council of Arizona (ITCA) project, which involved children in
reading stories about nutrition, preparing healthy snacks, and engaging in physical activities. In addition,
Navajo Nation WIC uses SPARK (Sports, Play, and Active Recreation for Kids) activities to engage children
in nutrition education and physical activity.
Addressing Language Barriers
Nutrition education sessions are usually conducted in English. However, in more isolated areas where
English is not spoken by all participants, Navajo is used.
Project Evaluation
The Navajo Nation WIC Program administers annual surveys assessing participant satisfaction with
nutrition education, as well as customer service, the food package, their grocery store experience,
parking, and clinic wait time, among other issues.
You have to really
involve the client and get
them to identify their
own goals. You can’t
just lecture.”
-Doris McGuire
Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education 29
Some of the challenges in nutrition education include lack of participant involvement, lack of participant
access to transportation (which often results in missed appointments), and nutritionists not having
enough time to conduct sessions.
Lessons Learned
Some of the solutions adopted to address the lack of participant involvement in nutrition education
include requiring participants to establish one nutrition goal with a paraprofessional before seeing the
nutritionist; asking participants questions during classes; empowering participants to express their needs;
and encouraging WIC staff to listen to them.
Resources
Navajo Nation WIC uses Nutrition Services funds from the United States Department of Agriculture, Food
and Nutrition Service to support these initiatives.
Languages Used
Navajo and English
Populations Served
Navajo, Latino, and White
Contact Information
Adele King
WIC Program Manager
Navajo Division of Health
Navajo Nation WIC Program
P.O. Box 1390
Window Rock, AZ 86515
(T) 928-871-6698
aking@navajowic.org
“For my son, I just want to find
out all the information that I
need for him to grow up healthy
without ever getting into junk
food and stuff.”
-WIC Participant
Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education 30
Motivational Interviewing Counseling Techniques
The District of Columbia WIC (DC WIC) State Agency is
implementing a comprehensive multicultural nutrition education
strategy with the goal of changing the health and nutrition
behaviors of African American and Latino children between the
ages of two and five.
The strategy has two phases: a pilot phase during which
motivational interviewing nutrition education techniques will be
pilot-tested in selected WIC clinics and an implementation phase
during which the pilot’s successful components will be
implemented in all DC WIC clinics.
Project Name
Impact of Motivational Interviewing Counseling Techniques on
Health and Nutrition Behaviors in Urban Multi-Ethnic WIC
Participants
Agency Name
DC Department of Health, WIC State Agency
Project Description
Motivational Interviewing
Motivational interviewing is a participant-centered counseling
tool that aims to elicit behavior change. By using motivational
interviewing in nutrition education, DC WIC seeks to change the
nutritional habits of African American and Latino children
between the ages of two and five. The project targets
children’s moms, guardians, and other primary caretakers and
provides them with nutrition education on five child nutrition
topics: (1) increasing consumption of fruits and vegetables; (2)
decreasing consumption of fast foods; (3) decreasing
consumption of sugary beverages; (4) increasing physical
activity; and (5) decreasing TV watching.
Phase One: Pilot-Testing
DC WIC launched a three-year motivational interviewing pilot involving seven clinics. Two clinics replaced
their traditional nutrition education with motivational interviewing (Mary’s Center for Maternal and Child
Care and DC General Hospital). Two others (Upper Cardozo Clinic and Children’s Health Center at Good
Hope Road) adopted “motivational interviewing plus.” The “motivational interviewing plus” format
consists of motivational interviewing nutrition education combined with a traditional nutrition education
activity, such as a group session or mailing. The pilot also included three control sites using current
nutrition education methods (Marie Reed Clinic, Adams Morgan Clinic,
and Howard University Hospital).
Training for the nutritionists in the four clinics implementing
motivational interviewing nutrition education techniques began with a
two-day workshop led by motivational interviewing expert Ken
Resnicow, Professor of Health Behavior and Health Education at the
University of Michigan, School of Public Health.
“DC WIC held focus groups with
WIC nutritionists before launching
the study. They spoke about how
they wanted more client input and
participation, and how helping
clients find the desire to change
from within would lead to
healthier behaviors.”
-Evalyn Carbrey
“The states that have
already done motivational
interviewing pilots have
been very open about
sharing their resources.”
-Evalyn Carbrey
Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education 31
Targeting African American and Latino
Children
The pilot specifically targets Latino and African
American WIC participants, the two largest WIC
populations in DC. One motivational interviewing
and one “motivational interviewing plus” pilot clinic
(Mary’s Center and Upper Cardozo) are
predominately Latino, while the two others (DC
General Hospital and Good Hope Road) are
predominately African American. The goal of the
pilot is to see if motivational interviewing is more
effective in one group over the other.
Phase Two: Implementation
If the pilot is successful, the nutritionists trained
during the pilot will help train all other WIC
nutritionists in DC. In addition, the State Agency will develop a motivational interviewing training manual
and tool kit for nutritionists in other states to use. Similar motivational interviewing pilots have been
conducted in North Dakota and Nebraska.
Project Evaluation
A piloted evaluation questionnaire will be given to all moms, guardians, and primary caretakers who wish
to participate in the study. Participants will be recruited from all seven sites. In addition, the State
Agency will conduct a cost-benefit analysis of motivational interviewing and “motivational interviewing
plus.”
Lessons Learned
Although they are still in the early stages of the project, the DC WIC State Agency has already learned
several valuable lessons while conducting the motivational interviewing pilot. First, they learned that in
order for motivational interviewing to be successful, it is necessary that the nutritionists implementing the
technique speak the same language as participants. If not, a translator would be useful in decreasing
language barriers. In addition, although the grant targets children between the ages of two and five,
staff still needs to meet the needs of the other children who come into the pilot clinics, which is often a
challenge.
Resources
In FY 2005, the DC WIC State Agency received a three-year Special Project Grant ($130,000) from the
United States Department of Agriculture (USDA), Food and Nutrition Service (FNS) to pilot motivational
interviewing in DC. The initiative is also supported by a $10,000 General Mills grant, which funds the
additional nutrition activities used in the “motivational interviewing plus” pilot clinics. States interested in
this initiative could also use training funds from their regular WIC budget (Nutrition Services and
Administration funding) to train nutritionists in motivational interviewing.
Languages Used
English and Spanish
Populations Served
Black/African American, and Latino
Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education 32
Motivational Interviewing Pilot Participation Data by Race/Ethnicity
Motivational interviewing pilot clinics:
Mary’s Center for Maternal and Child Care
75% Latino
21% Black/African American
DC General Hospital
99% black/African American
1% Latino
“Motivational interviewing plus” pilot clinics:
Upper Cardozo Clinic
67% Latino
29% Black/African American
Children’s Health Center
99% Black/African American
1% Latino
Control clinics:
Children’s Hospital Marie Reed Clinic
61% Latino
25% Black/African American
Children’s Hospital Adams Morgan Clinic
64% Latino
24% Black/African American
Howard University Hospital
91% Black/African American
4% Latino
Website
http://app.doh.dc.gov/services/wic/index.shtm
Contact Information
Evalyn Carbrey
Project Manager, Special Project Grants
Nutrition Programs Administration
WIC State Agency
DC Department of Health
2100 Martin Luther King Jr. Avenue, SE
Suite 409
Washington, DC 20020
(T) 202-645-5663
(F) 202-645-0516
Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education 33
Texas WIC
In an effort to make nutrition education services accessible to families of all cultural and linguistic
backgrounds, the Texas WIC program has adopted a comprehensive, multicultural approach to tackling
language barriers and low literacy levels among WIC participants.
For instance, all written and audiovisual nutrition education materials are available in both English and
Spanish and up to 20% are also available in Vietnamese. In addition, nutrition education materials, such
as fact sheets, pamphlets, and brochures, are all written at a 5th to 6th grade literacy level.
The Texas WIC State Agency oversees a range of projects targeting diverse populations throughout the
state. This case study highlights three models that successfully address the specific needs of various
racial, ethnic, cultural, and linguistic communities in Texas. They include:
the African American Breastfeeding Initiative,
nutrition education partnerships with other groups and agencies, and
a local agency obesity prevention project for Latino children: “From the Food Guide Pyramid to
Cooking Practices in Your Kitchen”.
Project Name
African American Breastfeeding Initiative
Agency Name
Texas Department of State Health Services, WIC Nutrition Services
Project Description
In 2003, the Texas WIC program developed an African American
Breastfeeding Initiative based on national and Texas WIC research
regarding infant feeding attitudes and beliefs among African
American families. The goal of the project was to raise awareness
about breastfeeding and increase the breastfeeding rates among
African American WIC participants in Texas.
By working with an advertising agency, Texas WIC produced a
range of social marketing materials that promote breastfeeding,
including brochures, posters, radio spots, a TV commercial, outdoor
spots, and newspaper columns. These materials targeted pregnant
women, moms, dads, partners, grandparents, health care
providers, and the general public.
The Texas WIC program also developed a logo for the campaign, which later became the statewide
breastfeeding brand. The project was piloted from January to September 2004 in South East Texas and
implemented statewide in 2005. The campaign’s media component has run for three consecutive years
and is scheduled to end in August 2006. All other components of the campaign are permanent.
Project Evaluation
The Texas WIC program contracted with SUMA/Orchard Social Marketing, Inc. to evaluate the project’s
effectiveness. They found that the initiative was very popular with all participants and that radio spots
were especially successful in reaching young moms. They also identified that outreach to churches was
particularly useful for getting older community members involved in the initiative.
In addition, post-campaign interviews revealed an increased awareness of the benefits of breastfeeding
among African American women involved in the project. Similarly, many health care providers and WIC
staff reported fielding more questions about breastfeeding from African American participants. Many
Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education 34
noted that the most significant change in attitude came from teen moms who had previously shown little
interest in breastfeeding. Furthermore, breastfeeding rates in two local agencies increased and a hospital
lactation support program was implemented as a result of this initiative.
The Texas WIC program is very willing to help other WIC Agencies interested in implementing an African
American breastfeeding campaign in their state. All print and audiovisual materials are available online for
duplication free of charge.
Resources
In order to fund the African American Breastfeeding Initiative, the Texas State Agency requested an
operational adjustment grant from the United States Department of Agriculture, Food and Nutrition
Service Southwest Regional Office. They submitted a brief description of their project, as well as mid-
year and end-of-year reports.
Languages Used
Materials for the African American Breastfeeding Initiative were
produced in English. All other breastfeeding materials are also
available in Spanish and a few are printed in Vietnamese.
Populations Served
Black/African American
Website
www.dshs.state.tx.us/wichd/bf/african_americanbf.shtm
Contact Information
Tracy Erickson
Breastfeeding Coordinator
WIC Nutrition Services
Texas Department of State
Health Services
1100 West 49th Street
Austin, TX 78756-3199
(T) 512-458-7444
tracy.erickson@dshs.state.tx.us
Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education 35
Project Name
Nutrition Education Partnerships
Agency Name
Texas Department of State Health Services, WIC Nutrition Services
Project Description
The Texas WIC program has partnered with various groups and agencies to develop high-quality nutrition
education materials, including a video on dental care with the Oral Health Program at the Texas
Department of State Health Services and the Zowzoo fitness video for kids with the University of Texas at
Austin. This bilingual video presents information in both English and Spanish, allowing the WIC program
to reach the three largest WIC populations in Texas, notably Latinos, Whites, and African Americans.
Participants take the Zowzoo video home to use with their children and fill out a survey and evaluation
for WIC. A classroom version of the video is also available for use during nutrition education group
sessions. In addition, Texas WIC made a cooking video, which features recipes and chefs from the
Sustainable Food Center in Austin.
In preparation for implementing the new food package Texas WIC mailed health care providers and other
WIC partners across the state selected materials related to the new food package including a 16 page
brochure, Your Guide to WIC Foods. Health Care providers also received an educational DVD with details
about the new WIC food package.
Among other initiatives to increase access to services for working women, the Texas WIC program has
developed a series of home-based nutrition education and fitness activities. A highlight is the internet-
based nutrition education on TexasWIC.org. The website includes lessons on pregnancy, food safety,
physical activity, smart snacking, and breastfeeding. New lessons have just recently been added to
educate WIC participant about the new WIC food packages. These lessons include Moove to Low-Fat
Milk, Cooking with Fruits and Vegetables, New Food Package and the Importance of Exclusively
Breastfeeding in the First Month, and Whole Grains. All lessons are available in both English and Spanish.
Project Evaluation
All Texas WIC nutrition education lessons and classes have oral or written evaluations completed by WIC
participants. For other special projects, the WIC program contracts with various agencies to conduct
both qualitative and quantitative evaluations.
Resources
In order to provide nutrition education, the Texas WIC program uses nutrition education funding from the
Nutrition Services funds administered by the United States Department of Agriculture, Food and Nutrition
Service.
Languages Used
English, Spanish, and Vietnamese
Populations Served Website
Latino, White, Black/African American, and Vietnamese www.dshs.state.tx.us/wichd/nut/nut1.shtm
Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education 36
Project Name
From the Food Guide Pyramid to Cooking Practices in Your Kitchen
Agency Name
Cameron County Department of Health and Human Services,
WIC Program
Project Description
In June 2006, the Texas WIC State Agency administered obesity
mini-grants to 19 of the 22 local agencies that applied. The
grants provide $1,000 to $15,000 from June 2006 to September
2006, with the possibility of being extended or renewed.
A notable mini-grant project is being implemented by the
Cameron County Department of Health and Human Services
Brownsville area WIC clinics. Their
“Desde la Guia de la
Piramide Hasta Su Cocina” (“From the Food Guide
Pyramid to Cooking Practices in Your Kitchen”)
initiative
targets overweight Latino children and their families. A series of
twelve classes, all taught in Spanish, address issues related to
obesity prevention and healthy food preparation. Topics include
the Food Pyramid; the importance of physical activity and
inexpensive ways to exercise; understanding food labels; making
the most of a limited food budget; and maintaining a healthy life
balance. The classes use a combination of previously developed WIC and ENP materials. They are held
twice a week and in the evenings in order to accommodate working parents.
Project Evaluation
All grantees are expected to conduct a formal evaluation of the project and present their findings in a
poster at the Nutrition and Breastfeeding Annual Conference.
Resources
In order to fund the obesity mini-grants, the Texas State
Agency requested an operational adjustment grant ($200,000
in FY06) from the United States Department of Agriculture,
Food and Nutrition Service Southwest Regional Office.
Languages Used
Spanish
Populations Served
Latino children
Website
www.co.cameron.tx.us/health/wic.htm
Contact Information
Amanda Hovis
Nutrition Education Consultant
WIC Nutrition Services
Texas Department of State Health Services
1100 West 49th Street
Austin, TX 78756-3199
(T) 512-458-7111 x3411
Amanda.hovis@dshs.state.tx.us
All of the grant project ideas
came from local agencies. But we
also talked to leaders in the
community to understand what
the needs were.” -Amanda Hovis
Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education 37
Veggin’ Out
Since 1998, chefs from Johnson and Wales University (JWU) have worked with the Rhode Island
Department of Health and the Rhode Island Department of Environmental Management to put on
bilingual cooking demonstrations at ten WIC Farmers’ Market Nutrition Program (FMNP) sites throughout
Rhode Island in July and August. During each two-hour cooking demonstration, JWU chefs showcase
four creative yet simple recipes, all made with fresh vegetables from the markets. A translator, provided
by WIC, ensures that the sessions are conducted in both English and Spanish and accessible to both the
English-speaking and Spanish-speaking communities in Rhode Island.
Project Description
Nutritionist from both JWU and WIC are always present to highlight the nutritional content of each recipe
and answer any nutrition questions from the audience. Nutrition education is fully integrated into the
demonstrations and seeks to promote participant involvement. The nutritionists cover the benefits of
local produce, including freshness and supporting local farmers.
All audience members receive a Veggin’ Out Cook Book, printed in
English and Spanish. The Cook Book includes 20 simple recipes, all
made with fresh fruits and vegetables, as well as nutrition
information for each recipe. In addition, WIC and JWU raffle off gift
bags filled with kitchen utensils, two $5 farmers’ market gift
certificates, storybooks entitled “Vegetable Friends,” and a Veggin’
Out T-shirt.
The Feinstein Community Service Center at JWU and the Rhode
Island WIC program have graciously offered to provide assistance to
those interested in replicating this project in their state. Veggin’ Out
cook books are available free of charge upon request.
Project Evaluation
At the end of each farmers’ market season, JWU and WIC meet to
discuss any problems and brainstorm solutions for the following
year. In addition, WIC follows up with program participants for
feedback. Some of the challenges include strict Health Department
standards regarding the proper handling of food in an outdoor
venue. Yet another challenge arises when participants want to
follow-up with chefs about the cooking demonstrations, but only
one translator is on-hand. One solution would be having multiple
translators or bilingual chefs.
Resources
JWU and WIC meet every April to discuss the Veggin’ Out budget. WIC pays for the printing and
translation of the cook books, the gift bags, and the translator. These services are funded through WIC
Farmers’ Market Nutrition Program (FMNP) money (if available) or the nutrition education budget.
Chefs from JWU use money from the University’s United Way DownCity fund to buy vegetables from the
farmers ($30 per market; $500 for the entire season). Other necessities, such as cooking staples and
utensils, are also included in that budget. JWU suggests that those interested in replicating the project in
their state could ask farmers to donate produce at first; however, they recommend eventually
establishing a permanent food budget.
We
l
ook for interactive
ways to add nutrition
education into our cooking
demonstrations. We may
ask people “Why are beans
good for you?” or ask kids
to volunteer to help.
-Linda Kane
Language can be a
barrier. But we strive to
make people feel
comfortable enough to
ask questions, regardless
of what language they
speak.”
-Linda Kane
Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education 38
Languages Used
English and Spanish
Populations Served
White, Latino, Black/African American, Asian/Pacific
Islander, Portuguese, and Cape Verdean
WIC Participation by Race/Ethnicity
White: 44.1%
Latino: 37.2%
Black/African American: 14.4%
Asian/Pacific Islander: 3.8%
American Indian/Alaskan Native: .4%
Website
www.health.ri.gov/family/wic/veggin.php
Contact Information
Linda Kane
Community Service Chef
Feinstein Community Service Center
Johnson and Wales University
8 Abbott Park Place
Providence, RI 02903
(T) 401-598-1323
(F) 401-598-1277
Linda.kane@jwu.edu
Ann Barone
WIC Client Services Manager
WIC Program
Rhode Island Department of Health
3 Capitol Hill Room 302
Providence, RI 02908
(T) 401-222-4623
(F) 401-222-6548
Ann.barone@health.ri.
g
ov
Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education 39
Weigh of Life…Taking Action Together
In 2001, the Massachusetts WIC Nutrition Program was
awarded a USDA Special Project Grant entitled,
“Cultural
Perspectives on Childhood Overweight Among Hispanic
WIC Participants in Massachusetts.
” The grant was used to
fund a project with the overall goal to strengthen the
ability of Massachusetts WIC program staff to provide
culturally sensitive services that promote healthy eating
behaviors, particularly for Dominican and Puerto Rican
children, among whom the problem of overweight is
particularly acute.
Project Name
Weigh of Life...Taking Action Together
Agency Name
Massachusetts Department of Public Health, WIC Nutrition
Program
Project Description
The project began with the collection of anthropometric
and body composition measurements of approximately
400 Hispanic children and the facilitation of 24 focus
groups with WIC mothers to identify the cultural beliefs that affect what mothers believe constitutes
healthy body weight and influence the dietary behavior of children. The results of the focus groups were
used to identify culturally sensitive key themes related to health. The themes were used to develop
educational messages and materials for WIC staff and healthcare providers to enhance their efforts to
prevent childhood overweight.
The culmination of the project was the development of the
Weigh of Life...Taking Action Together
initiative. The initiative included the development of emotion-based educational messages, a program
implementation manual for WIC nutrition counselors, and a provider toolkit.
Key Messages
The initiative focused on six emotion-based messages for Hispanic families based on the focus group
findings that addressed the cultural beliefs and assumptions of Hispanic families surrounding weight and
dietary practices. Emotion-based messages focus on universal health points that trigger behavior change.
These messages were:
A slender looking child is a healthy child.
Developing good eating habits makes a lifelong difference.
Eat together as a family.
Offer your child a variety of foods instead of a steady diet of milk and juice.
Mom knows what is best for her child.
Mothers will be surprised that children enjoy eating healthy foods- this will make mothers happy.
Both wall-sized and miniature posters were developed in English and Spanish to convey each of the six
key messages. The wall posters were produced for display in health care providers’ offices and the mini-
posters were produced for use by WIC nutritionists during counseling sessions. In addition, a child-sized
placemat was developed to communicate a seventh targeted message that child-sized servings provide all
the nutrients necessary for growth.
Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education 40
Project Implementation Manual
A project implementation manual was developed as a resource and training tool for WIC staff. The
manual included:
Key findings from the WIC participant focus groups.
Strategies to successfully coordinate and collaborate with health care providers to provide
consistent messages about dietary habits and healthy body weight to Hispanic families.
Introduction on a new culturally sensitive nine-step approach to discussing a child’s weight with
families.
Nutrition education materials.
Physician Tool Kit
A provider took kit was developed to foster successful partnerships with health care provider to deliver
consistent positive messages about weight and dietary practices to Hispanic families. The tool kit was
distributed by WIC nutritionists on personal visits to physicians and other health care personnel. The tool
kit includes the following materials:
Steps to Healthy Weight in Children: a guide to providing standardized, age-appropriate nutrition
messages to Hispanic families and children.
A CD containing electronic versions of the nutrition education materials for health care providers
to use.
A mock prescription pad, “Prescription for Your Healthy Child”, allowing physicians to “prescribe”
diet and physical activity changes and refer parents to the nearest WIC office.
Project Evaluation
All local WIC agencies were responsible for delivering the physician’s tool kits to health care providers in
their area. After the tool kits were delivered the state agency made follow-up calls to the providers. The
call revealed that of the physicians that utilized the toolkit materials about 60% displayed the wall posters
in their offices and about 20% were using the tool kits to help facilitate discussions about body weight
with families.
The focus groups revealed two important issues that the initiative addressed. The first was that WIC’s
health messages, based mostly on logic and facts, were not resonating with WIC mothers. WIC found
behavior change is more likely to happen when WIC counselors speak to people’s feelings and highlight
the emotional benefits of taking action in addition to providing facts. The focus groups also revealed that
WIC and the medical community were not delivering consistent messages to Hispanic families which led
Massachusetts WIC to realize the importance of collaborating with health care providers.
Lessons Learned
The focus group results made it apparent that is was important for Massachusetts WIC to improve their
delivery of health messages. Based on the finding of the focus group WIC developed an untraditional
approach to nutrition education that focused on emotions rather than logic and fact alone. WIC’s
emotion-based approach to counseling uses messages and materials that highlighted the emotion-based
benefits of making health eating and activity changes in addition to the logical, rational benefits of taking
action. Through the implementation of the Weigh of Life…Taking Action Together Initiative it became
apparent that the emotion-based messaging could be applied to all WIC clients and in 2003 they began
the Touching Hearts….Touching Minds project. Massachusetts WIC was awarded a second USDA grant,
and conducted additional focus groups to identify what emotions drove mothers behaviors and integrated
these emotional “pulse points” into 30 nutrition education messages. Massachusetts WIC now uses
emotion-based materials and counseling to touch people’s hearts first and then provide factual
information to act on.
Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education 41
Resources
The Weigh of Life…Taking Action Together Initiative
was funded by a USDA Special Project Grant
entitled,
“Cultural Perspectives on Childhood Overweight Among Hispanic WIC Participants in
Massachusetts.
Languages Used
English and Spanish
Populations Served
Dominican and Puerto Rican
Website
www.mass.gov/wic
The nutrition education materials are available
on the Touching Hearts Touching Minds website
http://www.touchingheartstouchingminds.com/index.php.
Contact Information
Rachel Colchamiro
Acting Director, Nutrition Services and
WIC Breastfeeding Coordinator
MA Department of Public Health
250 Washington Street
Boston, MA 02108
(P) 617-624-6153
Rachel.Colchamiro
@
state.ma.us
Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education 42
WIChealth.org
The WIChealth.org website project delivers high quality
web-based education on nutrition and physical activity
to WIC participants. It is a partnership between the
Michigan WIC State Agency, WIC State Agencies in
several other states (Delaware, Illinois, Indiana,
Minnesota, Ohio, North Carolina Utah, Washington, and
Wisconsin), and Western Michigan University. The
website provides interactive, learner-centered nutrition
education to WIC participants in all of the partner states.
Project Name
Nutrition Education for the Internet Project
Agency Name
Michigan Department of Community Health, WIC Division
Project Description
Addressing Language Barriers
In an effort to be accessible to families of diverse linguistic
backgrounds, the website is available in English and Spanish and will possibly be translated into Arabic
and Chinese as well. The wording is kept simple in order to be accessible to participants of all literacy
levels.
Increasing Access for Working Families
In addition, the website increases access to nutrition education for working families. It allows
participants who cannot attend nutrition education classes because of work, school, or lack of
transportation to get nutrition education at home or during breaks at work. In addition, many WIC
participants lack child care and are often forced to bring their children to nutrition education classes. This
can be distracting for all participants in attendance and the website allows participants to complete their
nutrition education requirement in their own time and without worrying about their children.
Nutrition Education Modules
The project’s steering committee, which is comprised of representatives from all seven WIC State
Agencies, develops online nutrition education modules based on participant needs and interests. The site
currently includes ten modules, each covering a different child nutrition topic, including:
child feeding (“Create Good Eating Habits in Your Child”),
breastfeeding (“Support for Breastfeeding Moms”), and
physical activity (“Happy, Healthy, Active Children”).
Fruit and vegetable modules have just recently been added to the website to educate WIC participants
about the changes to the WIC food package.
The modules are based on the stages of change theory developed by Dr. Robert Bensley at Western
Michigan University (www.cdc.gov/PCD/issues/2004/oct/pdf/04_0070.pdf). Participants choose a module
and answer a set of questions that places them in one of the five stages of change: (1) pre-
contemplation; (2) contemplation; (3) preparation; (4) action; and (5) maintenance. Based on their
stage of change, participants are provided with stage-specific nutrition education addressing their chosen
topic. They are given easy and practical action steps to help them reach their behavior change goals.
“This is a great example
of a partnership between
WIC and a university.”
-Judith Anderson
Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education 43
“Happy, Healthy, Active Children”
For example, in the physical activity module “Happy, Healthy, Active Children, participants are
asked if their child undertakes planned and/or unplanned physical activities, such as walking, bike riding,
dancing, and active games. Participants who answer “no” are reassured that they are not alone.
Respondents are then asked if they have an interest in someday changing their child’s lack of physical
activity. Those who answer “yes” are then asked if they are willing to do so in the next few days.
Possible responses include “yes” and “I’m not sure.” Participants who answer the latter are asked what
barriers stand in their way. A few of their options include TV watching, lack of time, and lack of ideas
about active games for their child. If participants select “TV watching,” they are provided with a simple
factsheet about how to turn off the TV and increase physical activity.
Project Evaluation
The steering committee has quarterly, mid-year, and yearly
evaluation results assessing the website’s effectiveness from
2002 to 2008. The yearly 2008-2009 evaluation results are
forthcoming. The website includes a feedback page, and 95
percent of all participant responses to date have been
positive. The 2008-2009 six month evaluation provides
important information about the project’s challenges as well
as ways in which the web education can be improved.
Lessons Learned
In addition to a high level of user satisfaction, the evaluation results show 65.6 percent of Wichealth.org
user were in the maintenance stage of behavior change. These results are not consistent with previous
knowledge of the population. This inconsistency may be the result of response bias associated with the
yes/no staging questions used to categorize user into stages of change and WIChealth.org has begun
replacing yes/no staging questions with multiple choice questions to ensure accuracy in stage
assignment. Accurate staging will improve the likeness of users showing behavior change progression.
The inconsistency may also be the results of low website usage among clients in the pre-contemplation,
contemplation, and action phases. It may be necessary to implement strategies to attract WIC clients in
earlier stages of change to access the website and
The evaluation results shows that among users in the pre-
contemplative stage 45.4 percent advanced to the action phase by
the end of their session and that 92 percent of users who began in
the action or maintenance phase indicated they could make changes
using what they learned. These results demonstrate that
Wichealth.org is effective in promoting health behavior and
continued use and further expansion to other states is
recommended.
While Wichealth.org is effective in promoting behavior change amongst most users some still report
resistance to change. Most users reporting unwillingness to make changes based on what they learned
report that the information covered was not applicable to them at that time. These results suggest that it
may be necessary to use screening questions to recommend appropriate modules for users based on
their current needs.
Spanish language module users did not rate the usability of WIChealth.org as highly as English language
users. While 78 percent of English language module users indicated that WIChealth.org was their favorite
way to receive nutrition education fewer of the Spanish language module users felt the same way. Sixty
three percent Spanish language module users indicated they prefer class or group session nutrition
education at a WIC clinic. These results indicate that it may beneficial to develop interactive tool on
WIChealth.org to promote a sense of community and facilitate social networking.
“Thank you for the
opportunity to take this
class in my own time
without interference from
my children.”
-WIC Participant
“One of the main challenges
is getting local WIC agencies
to promote the Internet.
When they don’t think
participants have access, we
do a survey to see if they
do.” -Judith Anderson
Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education 44
Resources
The website’s initial start-up costs were supported by an
operational adjustment grant requested from the United States
Department of Agriculture, Food and Nutrition Service Midwest
Regional Office. Six of the Midwest States (Illinois, Indiana,
Minnesota, Ohio, Michigan, and Wisconsin) collaborated in the
development and pilot-testing of the project, with the WIC
Division of the Michigan Department of Community Health
serving as the lead agency.
Currently, all ten states contribute money to keep the website up
to date and make translations as needed. The project received a
special project grant from USDA to add the new fruit and
vegetable modules. The website is maintained and updated by
Dr. Bensley’s staff at Western Michigan University.
Languages Used
English and Spanish; Possibility Arabic and Chinese in the future
Populations Served
White, Black/African American, and Latino
WIC Participation by Race/Ethnicity
White: 57.7%
Black/African American: 28.5%
Latino: 11.6%
Asian/Pacific Islander: 1.5%
American Indian/Alaskan Native: 0.7%
Website
www.wichealth.org
“I love being able to do this
online, it saves me time, and if
my son is sick, I don’t need to
worry about him making other
people sick. Also, I don’t need
to worry about a need for a
sitter, as well as him getting
bored or if he is crabby.”
-WIC Participant
Contact Information
Judith Anderson
Manager, Nutrition Services Unit and
WIC Nutrition Coordinator
Nutrition Program and Evaluation
WIC Division
MI Department of Community Health
320 South Walnut
Lansing, MI 48913
(T) 517-335-8957
(F) 517-335-8835
andersonjv@michigan.gov
National WIC Survey
Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education 46
National WIC Survey
Findings from the Food Research and Action Center’s WIC Directors’ Survey provide important insight into
ongoing efforts to increase access to services by conducting outreach, and providing nutrition education
and referrals to WIC participants of all cultural backgrounds. The survey had a very good response rate:
a total of 68 completed surveys were received, including 47 surveys from states and territories and 21
surveys from Indian Tribal Organizations (ITOs).
Outreach
Outreach is an important tool for decreasing access barriers and promoting participation in the WIC
program by eligible families. The large majority of WIC State Agencies and ITOs (85%) undertook
outreach efforts to raise awareness about WIC and increase participation in the program. More
specifically, 82 percent of State Agencies conducted outreach in their state and 75 percent of ITOs lead
outreach initiatives in their area.
Targeting Hard to Reach Populations
Certain populations are harder to reach than others, and therefore harder to enroll in the program. Many
WIC State Agencies and ITOs (55%) tackled this problem by conducting outreach targeting hard to reach
populations in their state, including working women (69%) and women, infants, and children who speak
a language other than English (69%). Other populations targeted by State Agency and ITO outreach
campaigns included women, infants, and children of underserved racial and ethnic groups (50%),
women, infants, and children in migrant families (41%), and immigrant families (38%). State Agency
and ITO directors also mentioned reaching out to grandmothers and persons experiencing homelessness
as part of their outreach efforts.
Addressing Language Barriers
In order to reach families of diverse cultural
and ethnic backgrounds, many WIC State
Agencies design outreach initiatives that
address the specific language and cultural
needs of the different communities in their
state. Of those with language initiatives,
Spanish was the most frequently used
language for outreach by State Agencies
(100%), followed by Vietnamese (26%),
Chinese (20%), Somali (17%), and Arabic
Hard to Reach Populations Targeted by Outreach (%)
0
20
40
60
80
Working
Families Immigrant
Families Specific
Racial/Ethnic
Groups
Speak a
Language
Other than
English
Migrant
Families Other
Lan
g
ua
g
es Other Than En
g
lish Used for Outreach by State
Agencies (%)
0
10
20
30
40
50
60
70
80
90
100
Spanish
Russian
Haitian Creole
Vietnamese
Cambodian
Hmong
Laotian
Thai
French
Panjabi
Portuguese
Somali
Chinese
Arabic
Hard to Reach Populations Targeted by Outreach (%)
0
20
40
60
80
Working
Families Immigrant
Families Specific
Racial/Ethnic
Groups
Speak a
Language
Other than
English
Migrant
Families Other
Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education 47
Languages Other Than English Used for Nutrition
Education by State Agency (%)
0
10
20
30
40
50
60
70
80
90
100
Spanish
Russian
Haitian Creole
Vietnamese
Cambodian
Hmong
Laotian
Thai
French
Panjabi
Portuguese
Somali
Chinese
Arabic
Other
(11%). Other less frequently used languages included Russian, Haitian Creole, Cambodian, Hmong,
Laotian, Thai, and Portuguese (9%). ITOs reported conducting outreach in English, Spanish (63%), and
Native American languages (38%).
Outreach Strategies
State Agencies and ITOs use various strategies to conduct outreach and many adopt comprehensive
plans that combine a number of methods. For both State Agencies and ITOS, distributing brochures and
pamphlets was the most frequently used outreach strategy (95%). Partnering with the State Medicaid
office was also a popular outreach method (65%), followed by partnering with the Supplemental Nutrition
Assistance Program (formerly known as the Food Stamp program) (63%), advertisements (54%), Public
Service Announcements (PSAs) (49%), partnering with the TANF office (49%), and working with food
banks (42%) and anti-hunger organizations (40%). Other strategies to reach WIC eligible families
included press releases (47%), the National WIC Association’s Ad Campaign (37%), and partnering with
religious congregations or groups (30%). Other effective outreach methods mentioned by State Agency
and ITO directors included partnering with the local Head Start program, collaborating with private
physicians, and launching a direct mail campaign targeting potential WIC participants.
State Agencies and ITOs indicated that the four most effective outreach strategies were:
word of mouth,
the media,
partnering with other government agencies and/or local groups, and
working with health care providers.
Nutrition Education
Addressing Language Barriers
In an effort to make nutrition services accessible to families of diverse cultural backgrounds, WIC
programs throughout the United States offer nutrition education in a range of languages. Other than
English, Spanish was the most popular language for nutrition education, with 96 percent of WIC State
Agencies indicating its use. The next most often used language by State Agencies was Vietnamese
(28%), followed by Cambodian (20%), Chinese (17%), Russian (17%), Laotian (15%), Somali (15%),
and Arabic (15%). Other less frequently used languages included Hmong (11%), Thai (9%), Haitian
Creole (7%), French (7%), Panjabi (7%), and Portuguese (7%). ITOs reported using English, Spanish
(75%), and Native American languages such as Zuni and Lakota in their nutrition education sessions.
Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education 48
Nutrition Education Topics
All WIC State Agencies and Indian Tribal Organizations (ITOs) covered fruit and vegetable consumption
in their nutrition education sessions. This will be particularly useful in light of the new WIC food
packages, which promote fruits and vegetables for women, infants, and children.
In addition, all WIC State Agencies also covered physical activity and overweight/obesity. These sessions
are particularly noteworthy since many communities are struggling with overweight and obesity,
especially Latinos and Native Americans. Other topics often offered by State Agencies included
breastfeeding education (100%), maternal and child health (96%), increasing calcium rich foods (94%),
and understanding dietary guidelines and the Food Pyramid (91%).
All ITOs addressed fruit and vegetable consumption and breastfeeding education, with maternal and child
health (95%), increasing whole grain consumption (90%), and understanding dietary guidelines and the
Food Pyramid (90%) being other popular topics. In addition, 85% of ITOs reported addressing physical
activity in their nutrition education sessions.
Nutrition Education Formats
For both WIC State Agencies and ITOs, the most frequently used nutrition education format was printed
materials, such as brochures, pamphlets, fact sheets, calendars, day planners, and food/activity diaries
(99%). Other popular formats included one-on-one nutrition education counseling sessions (97%), as
well as bulletin boards and other educational displays in the waiting room (89%). In addition, 82 percent
of WIC State Agencies and ITOs reported showing nutrition education videos in clinic waiting rooms.
More states are using web-based systems as a tool for WIC nutrition education: 26 percent have web-
based interactive nutrition education, 26 percent have web-based nutrition materials, and 15 percent
having web-based nutrition education in the waiting room.
Access to Health Care and Social Services
One of the WIC program’s essential functions is referring participants to other health care and social
services. Survey results show that 97 percent of WIC State Agencies and ITOs required clinics to make
specific health care referrals, including immunizations (94%); Medicaid (88%); prenatal, maternal, and
pediatric care (82%); and dental care (48%).Similarly, 91 percent of State Agencies and ITOs required
WIC clinics to make social services referrals, including Child Abuse and Neglect services (86%); the
Supplemental Nutrition Assistance Program (formerly known as the Food Stamp program) (79%); TANF
(68%); domestic violence programs (62%); and emergency food providers such as food pantries, food
banks, churches, and other faith-based organizations (55%).
Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education 49
Resources
Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education 50
Outreach
The Sustainable Outreach Toolkit, developed by the Oregon WIC State Agency, presents
outreach strategies for local agencies to use.
www.nal.usda.gov/wicworks/Sharing_Center/Sustainable_Outreach_Tool_Kit_OR.pdf.
The North Carolina WIC program developed the “WIC Outreach: Guidelines for Building
Media Relations” guide to help local agencies seize media opportunities.
www.nal.usda.gov/wicworks/Sharing_Center/NCmediaguidelines.pdf.
“Outreach Campaign: Checklist for Local WIC Agencies, also developed by North
Carolina WIC, provides local agencies with outreach strategies, including information on reaching
various racial, ethnic, and cultural communities.
www.nal.usda.gov/wicworks/Sharing_Center/NCoutreachandreferralchecklist.pdf.
The Office of Minority Health at the United States Department of Health and Human Services
has a factsheet that helps outreach workers connect communities of color to health services.
www.omhrc.gov/assets/pdf/checked/Linking%20Minorities%20to%20Health%20Services-
Successful%20Strategies%20for%20Outreach%20Workers.pdf.
The WIC Works Resource System provides information about WIC and service tools for
nutrition professionals. www.nal.usda.gov/wicworks.
The Institute for Social Research identified strategies for the California WIC program on how
to reach underserved populations, including diverse racial/ethnic communities. Their findings are
presented in “Reaching the Underserved and Improving WIC Services,” 2001.
www.wicworks.ca.gov/research/ExecutiveSummary2001.pdf.
Nutrition Education
The Food and Nutrition Information Center at the National Agriculture Library developed a
“cultural and ethnic food and nutrition education materials” resource list for educators.
www.nal.usda.gov/fnic/pubs/bibs/gen/ethnic.html.
The National Heart, Lung, and Blood Institute at the National Institutes of Health
provides healthy recipes for African Americans and Latinos.
“Heart-Healthy Home Cooking, African American Style”
http://rover.nhlbi.nih.gov/health/public/heart/other/chdblack/cooking.pdf
“Delicious Heart Healthy Latino Recipes” (English and Spanish)
http://www.nhlbi.nih.gov/health/public/heart/other/sp_recip.pdf
The Center for Weight and Health at the University of California, Berkeley produced two
brochures providing information about healthy Korean and Vietnamese food options.
“Vietnamese Foods, Healthy Food Options: What to Eat More of and What to Eat Less of.”
(English and Vietnamese)
http://nature.berkeley.edu/cwh/PDFs/CWH_English_vietfood.pdf
“Korean Foods, Healthy Food Options: What to Eat More of and What to Eat Less of.”
(English and Korean)
http://nature.berkeley.edu/cwh/PDFs/CWH_English_koreanfood.pdf
Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education 51
The Office of Minority Health at the United States Department of Health and Human Services
developed a guide to help health organizations decrease language barriers and improve access to
services for persons of limited-English-proficiency. www.omhrc.gov/Assets/pdf/Checked/HC-
LSIG.pdf.
More Than Words Toolkit Series, a resource developed by
Hablamos Juntos
with support
from the Robert Wood Johnson Foundation, clarifies the translation process and provides a
roadmap to help health care organizations improve the quality of their translated materials in
order to get better results. http://www.rwjf.org/pr/product.jsp?id=39591
U.S. Department of Health and Human Services Guide to Health Literacy offers helpful
information on cultural competency for service providers.
http://www.health.gov/communication/literacy/quickguide/Quickguide.pdf
The WIC Program
The Food Research and Action Center has WIC advocacy and program information, as well
as WIC contact lists. www.frac.org.
The United States Department of Agriculture, Food and Nutrition Service provides detailed
information on WIC. www.fns.usda.gov.
The National WIC Association offers WIC information, a calendar of WIC events, and services
for members throughout the United States. www.nwica.org.
Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education 52
USDA WIC Nutrition Services Standards: Cultural Competency Components
Nutrition Assessment
State agency ensures that standardized dietary assessment procedures are used
consistently statewide by all local agencies. These procedures include an assessment of
participant diet and feeding practices at time of certification and other requirements.
State agency ensures that medical/health/economic/social information is collected and
assessed at the time of certification ensuring participants’ privacy and confidentiality.
Nutrition Education
Content of nutrition education considers participants’:
Nutritional needs/interests, household situation, and cultural preferences
Language spoken and literacy level
Religious values
Local agency provides nutrition education that is:
Family-centered
Responsive to participant needs
Evaluation
State and local agencies use written criteria to evaluate nutrition education and
breastfeeding promotion and support materials. The criteria for evaluating these
materials should address:
Language to ensure its appropriateness for the participant population
Literacy level to ensure its appropriateness for the participant population
Content to ensure its accuracy and its relevance to participants
Graphic design that reflects the participant population (i.e. ethnic/cultural
background, developmental stages, etc.)
Appropriate methods to deliver nutrition education should be evaluated considering
participants’:
Ages
Nutritional needs
Preferences
Culture
Lifestyle
Breastfeeding Promotion and Support
State agency develops guidelines for ongoing training that includes all clinic staff and
includes culturally appropriate breastfeeding promotion strategies
WIC Supplemental Foods and Food Packages
State agency uses appropriate criteria for selecting and authorizing WIC foods, including
cultural or religious considerations whenever possible.
Program Outreach and Marketing
State and local agencies should use marketing strategies to promote participation in WIC
using materials designed and outreach conducted with consideration for language and
cultural needs of participants.
FRAC Summary
Source: USDA’s Nutrition Services Standards www.fns.usda.gov/wic/benefitsandservices/rqns.htm
Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education 53
USDA WIC Value Enhanced Nutrition Assessment: Cultural Competency Components
Key Steps in the Process of WIC Value Enhanced Nutrition Assessment
Collecting the Relevant Information:
When selecting methods to collect relevant
information, the WIC state agency should consider such factors as:
What are the issues/needs of the participant?
What method should be used to obtain the information – oral, written, other,
and/or some combination of these methods?
Clarify and Synthesize the Information that has been Collected:
Critical thinking
necessitates the collection of all information prior to deciding upon the best course of
action, including social/cultural information.
Identify the Pertinent and Appropriate Risks and Other Related Issues (such as cultural
preferences, environmental factors, etc.):
This is crucial when planning personalized
nutrition interventions that will improve the health status and influence behavior.
Dietary Assessment is Essential to a WIC Nutrition Assessment
WIC personnel may ask about appetite, favorite foods, and cultural food preferences,
rather than quantify ounces or servings.
Other cultural/personal information that may be collected includes: frequency, amount,
and type of feedings offered; food preferences or aversions.
Variables, such as knowledge, attitudes, beliefs, and family and community environment,
affect food consumption and should be addressed.
Environmental and family factors to consider include:
Migrant status – food preparation and storage equipment
Food security – availability of safe and nutritious food
Feelings on breastfeeding/breastfeeding support
Usual meal pattern
Activity level/feelings about the need for physical activity
Essential Staff Competencies for WIC Nutrition Assessment
Multicultural awareness is an important component of WIC nutrition assessment: WIC
staff are required to understand how sociocultural issues (race, ethnicity, religion, group
affiliation, SES, and world view) affect nutrition and health practices and nutrition-related
health problems. Factors to consider include:
Cultural groups in the target population including their families and communities,
values and beliefs, characteristics, and resources:
Respects different belief systems about issues such as blood-work,
immunizations, dietary supplements, alternative medicine, and traditional
healers
Evaluates cultural practices for their potential to harm the client’s health
or nutritional status
Cultural eating patterns and family traditions such as core foods, traditional
celebrations, and fasting:
Assesses eating patterns
Evaluates food selection and preparation within a cultural context
Differences in communication styles between groups and how these differences
may impact the assessment process:
Uses translation services appropriately
Uses culturally appropriate strategies to assess breastfeeding practices
and beliefs
FRAC Summary
Source: Value Enhanced Nutrition Assessment (VENA) in WIC www.nal.usda.gov/wicworks
... Overweight and obesity is particularly high among certain racial ethnic minority populations, including Mexican American boys (40.5%) and non-Hispanic black girls (41.3%) (86). Although many initiatives that include racial/ethnic minority communities (42) have not been formally evaluated, they warrant further investigation because they provide an opportunity for culturally targeted approaches to reduce obesity in high-risk groups. ...
Article
Full-text available
With obesity affecting approximately 12.5 million American youth, population-level interventions are indicated to help support healthy behaviors. The purpose of this review is to provide a summary of population-level intervention strategies and specific intervention examples that illustrate ways to help prevent and control obesity in children through improving nutrition and physical activity behaviors. Information is summarized within the settings where children live, learn, and play (early care and education, school, community, health care, home). Intervention strategies are activities or changes intended to promote healthful behaviors in children. They were identified from (a) systematic reviews; (b) evidence- and expert consensus-based recommendations, guidelines, or standards from nongovernmental or federal agencies; and finally (c) peer-reviewed synthesis reviews. Intervention examples illustrate how at least one of the strategies was used in a particular setting. To identify interventions examples, we considered (a) peer-reviewed literature as well as (b) additional sources with research-tested and practice-based initiatives. Researchers and practitioners may use this review as they set priorities and promote integration across settings and to find research- and practice-tested intervention examples that can be replicated in their communities for childhood obesity prevention.
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