A qualitative analysis of formative research used to develop a pilot digital intervention for improving diet quality and increasing redemption of WIC-approved foods

Background: The prevalence of childhood obesity in the US is high; this includes young children living in low-income households. Many of these children are served by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Digital interventions that target caregivers enrolled in WIC show potential for childhood obesity prevention. This study aims to describe 1) the formative research for developing a pilot digital intervention focused on improving diet quality and increasing redemption of WIC-approved foods, and 2) the challenges faced in developing the intervention due to the COVID-19 pandemic. Methods: In-depth interviews were conducted with 13 WIC caregivers. Interviews were recorded and transcribed. Transcripts were coded using structural themes, and analyzed using NVivo 12. A data reduction table was created afterwards and inter-coder reliability was achieved. Results: Fourteen themes clustered into four domains. The first domain centered on how caregivers perceived healthy eating. Definitions for healthy and unhealthy eating depended on the source of nutrition information and contributed to practices of healthy eating. The second domain described the caregiver’s purchasing of WIC-approved foods. Fruits, vegetables, milk, cheese, and eggs were the most purchased foods, while yogurt and peanut butter were the least purchased foods. The biggest facilitator to purchasing WIC-approved foods was taste preferences, and the biggest barrier was picky eating. The third domain described WIC’s helpfulness in healthy eating promotion; caregivers believed in the latter and provided suggestions for WIC to help them further. The last domain described the text messaging preferences. It showed that WIC caregivers believed that a text messaging program would help them eat healthier. They preferred receiving text messages weekly, in the morning, and receiving recipes and tips. The COVID-19 pandemic affected implementation of the intervention through disrupting contact with stakeholders, the recruitment process, and the completion of surveys used for intervention feasibility analysis. Conclusions: Future studies should consider utilizing and documenting formative research to guide intervention development. Comprehensive protocols for contacting stakeholders, recruitment, and follow up are important proactive tools during implementation.