Use of a mixed-method approach to evaluate the implementation of retention promotion strategies in the New York State WIC program.

This research assessed the implementation of strategies piloted at 10 Special Supplemental Nutrition Program for Women, Infants and Children (WIC) clinics aimed at increasing retention in the program, by enhancing participants' shopping experiences. Under WIC Retention Promotion Study: Keep, Reconnect, Thrive (WIC RPS), clinics were recruited and assigned to implement one or a combination of strategies: a standardized Shopping Orientation (SO) curriculum, a Guided Shopping Tour (GST), and a Pictorial Foods Card (PFC) from November 2012 through August 2013. This paper presents results from the process evaluation of the retention strategies, using a mixed-methods comparative case study design employing WIC administrative data, interviews, and focus groups. Qualitative data were inductively coded, analyzed and mapped to the following implementation constructs: organizational capacity, fidelity, allowable adaptations, implementation challenges, and participant responsiveness, while quantitative data were analyzed using SAS to assess reach and dose. Several sites implemented the SO and PFC interventions with the necessary fidelity and dose needed to assess impact on participants' shopping experiences. Sites that were assigned the GST strategy struggled to implement this strategy. However, use of the standardized SO enabled staff to use a "consistent list of shopping tips" to educate participants about the proper use of checks, while use of the PFC increased participants' awareness of the variety of WIC-allowable foods. During follow-up telephone calls, 91 percent of participants reported the shopping tips as helpful. Future analyses will assess the impact of enhanced shopping experience on retention at intervention sites.