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

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