Sprint 1: Starting Our Journey
First, let us introduce ourselves…
We are Team WICked Nutrition, a group of Master’s students in the Human-Computer Interaction program at Carnegie Mellon University. We have teamed up with Pennsylvania Special Supplemental Nutrition Program for Women, Infants and Children (WIC), a federal nutrition program under the United States Department of Agriculture (USDA) that provides nutrition services, breastfeeding support, health care and social service referrals, and healthy foods to families in Pennsylvania.
Our goals for this project:
- Analyze the total service experience with PA WIC for the caregiver/guardian, parents, children and staff from WIC clinics and stores, and identify opportunities to improve experience and increase participation and retention
- Design a solution that implements safety measure (during COVID and post COVID) and is economically feasible for users in the WIC enterprise
- Generate evidence with validation and testing that increases the capability to implement the design statewide
- Develop a plan that describes deployment within the resource constraints of the program
A little bit about us:
Connor Shannon (LinkedIn)
“I graduated from University of Delaware with a degree in Biomedical Engineering then went on to work in new medical device development at Air Liquide healthcare for two years. I’m interested in using technology and user centered design to positively impact the lives of those in my community.”
Jane Lee (LinkedIn)
“I graduated from UC Santa Barbara with a B.A. in Psychology. I worked with children with autism spectrum disorder as a behavior interventionist for around four years before coming to CMU. My career goal is to use UX research as a tool to benefit underserved communities.”
Kristy Zhang (LinkedIn)
“I am in the CMU Accelerated Master of Human-Computer Interaction (HCI) program. My undergraduate majors are business administration and HCI. My professional goal is to use UX research and design thinking to further humanize product development processes and customer experiences. Some of my passions include applying psychology to technology, playing Mahjong, and spending time with my family! I look forward to working with my team on this journey to impact individuals involved with PA WIC!”
Onyekachi Nwabueze (LinkedIn)
“My background is rooted in Cognitive Science from Occidental College, CA. Since then, I have worked in Education with children who have cognitive differences, behavioral challenges, and who come from low-income/socio-economic backgrounds, and/or traumatic experiences. Fun fact: my mother used WIC (in San Francisco, CA) for her three children (me included!) when she first came to the United States and has great memories from it. So, I am excited to have this full-circle experience.”
Yunmin Oh (LinkedIn)
“I studied Cognitive Science and Psychology at Rice University. I was primarily involved in the research lab working with stroke patients to explore their language and neural recovery process. I am interested in developing methods to best utilize technology to augment and improve human lives.”
Client Kick-Off Meetings
Background Research
Due to the current Covid-19 pandemic, we held our initial meetings through video call over the course of three days (how else could we get an awesome group photo??). To prepare for these meetings, our team conducted background research on PA WIC. We conducted the following insights:
- WIC creates and pays for customized nutrition plans and offers nutrition education and counseling as well as healthier foods for healthier lifestyles, yet only about 50% of eligible participants were using them in past years.
- Participation dropped 21% over the last five years.
- There is a fairly steep drop-off in participation as the child gets older. Around age 1, the drop-off was related to a variety of reasons, including losing eligibility, no longer needing benefits, inconvenience, and travel issues.
- Long waiting times and delays can cause frustration for both clients and staff. One academic research paper reported that waiting too long was the most frequently cited barrier (48%), and many reported that there is “nothing for kids to do” during the wait time, which makes it difficult for parents to bring their children and revisit the clinic. In addition, the clinic space gets overcrowded with participants and causes a high staff turnover as they feel pressured to complete appointments quickly.
- Incorporating technology into the PA WIC journey has seemed to improve the experience for participants. In 2019, the eWIC card was introduced in PA. Participants’ benefits are loaded onto this card, which they use to purchase WIC-approved foods at stores. The WICShopper App allows families to check which foods are WIC-eligible in stores and find helpful shopping information.
- The WIC Shopper App overall has great reviews (4.5 stars out of 5), with customers enjoying the efficiency of the eWIC card and app because it saves them time and draws less attention to them when shopping, in comparison to needing to use paper brochures and vouchers in the past.
- We have also seen customers talk about their WIC experiences on social media posts such as Reddit. They mentioned that their shopping experiences greatly improved with the introduction of eWIC cards, as it reduced the concern of being judged in stores. Many of these posts had a common theme of worrying about the perceived stigma surrounding WIC when in public.
Going into the Kick-Off meetings, we wanted to answer the following questions:
- Why has coverage gone down recently? Was it mainly due to Covid?
- What has WIC done in the past to address coverage and participation decline?
- Some states have a coverage rate of over 60% while some had less than 40%; what is each state doing differently?
What did we learn from the Kick-Off Meetings?
After presenting the above information to the PA WIC representatives, we were able to discuss and clarify some gaps in our data. We found that the major reasons for the steep drop-offs after age 1 were that nutrition loses value for parents when babies turn 1, in addition to baby formula no longer being available to most families through WIC (there are cases, based on medical need, where formula is offered beyond age 1). And although the pandemic has brought opportunities to use virtual touchpoints, the ultimate goals for PA WIC is to get people back into the clinic and build strong relationships with their participants. Families should see WIC as a safe space.
In addition to getting those insights, we were able to delve a little deeper into the “why’s” of our research with two activities: Empathy Mapping and Speed Car.
Empathy Mapping Activity
For this activity, we asked PA WIC to fill out what mothers/caregivers and children think, feel, see, say, do, and hear in the waiting room. Here are the common themes we observed as a result of this activity:
- It is difficult to pinpoint one problem with the waiting room, as there is a wide variance of WIC clinics in terms of size, operation, and service, each with their unique set of struggles.
- If someone shows up late, it backlogs other appointments, causing the waiting time to increase. In addition, appointment times are only 15–30 minutes long, regardless of whether the family has one child or three children.
- The check-in process can be anxiety-inducing. Many mothers fear losing benefits upon entering the clinic due to their income or other situation, and most clinics do not have receptionists to guide, direct, or put mothers at ease.
Speed Car Activity
The speed car activity is also another one that we all enjoyed, and it sparked very productive discussions. The parachute on the car refers to things that have been slowing PA WIC down. The engine refers to things that have been pushing them forward and making them move fast. We categorize the parachute and engine as “Looking Back.” For the right side of the bridge (“Looking Forward”), we asked them to tell us what they hope for PA WIC one, five, and twenty years from now. The bridge indicates us, Team WICked Nutrition, as we help PA WIC bridge the gap between where they are now and where they want to be. From this activity, we noted the following important points:
- The shopping experience is a touchpoint that has had many difficulties.
- Pediatricians are not referring patients to PA WIC.
- Most mothers are not willing to pull their children from daycare to go to WIC clinic, leading to appointment scheduling issues.
- PA WIC is currently working on telehealth and WIC Smart (mobile health education).
- Sponsors hope that Head Start, SNAP, and WIC can work together with a shared application, and hope for remote reload benefits (Head Start and SNAP are other programs focused on children’s nutritional and educational growth in low-income families).
- WIC clinics can reach more eligible families if they are in locations where potential participants already go for other services or that are part of their normal routine. This can be accomplished by permanently co-locating a WIC clinic in a community health center or a hospital. Another approach is to enroll people offsite in other locations such as a Head Start center, a food bank, or a military base.
Next Steps
Based off our initial research, insights, and current data, we’d like to investigate the following questions:
- What prevents people from going to a WIC clinic? What are the challenges that they face?
- What motivates people to go to a WIC clinic? What do they expect/hope to gain when they go?
- How do people feel about WIC? What emotions arise?
- How do the different touch-points in the WIC journey affect the service as a whole? What of these aspects are within the scope of the project?
- How has Covid changed people’s perspective of and interaction with WIC Services? How has it affected their relationship and overall experience?
Primary Research
To answer these research questions, we will start off by conducting surveys and semi-structured interviews with PA WIC participants in order to begin to learn more about the customer side of the PA WIC journey. We are hoping to recruit around ten of each participants from the following categories: former WIC participant, eligible but not participating, and current participants.
Secondary Research
For our secondary research, we will be compiling and analyzing data from the National WIC Association site. The main things we will be looking for are anomalies in the data, such as big shifts in coverage or unique trends. We would also like to investigate state policy changes and see if there is a connection with the anomalies. Social media research has also proven to be insightful. Finally, we’d like to do “ecosystem” research on connected organizations, create stakeholder maps, and look into how people heard about and got involved with WIC.
See you in the next sprint!
Resources
Citations:
Woelfel, Mary Lou, et al. “Barriers to the use of WIC services.” Journal of the American Dietetic Association 104.5 (2004): 736–743.
Boe, Debra Thingstad, William Riley, and Helen Parsons. “Improving service delivery in a county health department WIC clinic: an application of statistical process control techniques.” American journal of public health 99.9 (2009): 1619–1625.
Harwood, K. Public Health Quality Improvement Exchange. Improving WIC Client and WIC Staff Experience by Decreasing Wait Times. Wed, 07/15/2015–10:16. Available at http://www.phqix.org/content/improving-wic-client-and-wic-staff-experience-decreasing-wait-times. Accessed February 7, 2021
