A social marketing approach to increasing enrollment in a public health program: A case study of the Texas WIC Program

Human Organization, Fall 2001 by Bryant, Carol, Lindenberger, James, Brown, Chris, Kent, Ellen, Et al

Although 20 percent is a low response rate for surveys in the general population, it is within the expected norm for the Medicaid population, where response rates typically fall below 25 percent (NCQA 1995). While additional data collection analysis might have improved generalizability to the population of eligible families who were not enrolled in WIC, doing so was not feasible. Financial constraints and Medicaid confidentiality guidelines also prohibited follow-up activities or a comparison of respondents and nonrespondents.

Frequency distributions, cross tabulations, and chi-square automatic interaction detection analyses (CHAID) of the survey data were conducted using SPSS PC . CHAID analyses (Magidson 1992) were used to compare the relationship between multiple independent variables (e.g., sociodemographic characteristics) and dependent variables (e.g., enrollment in WIC). CHAID has a tree-based interface that segments the sample into distinct, homogeneous subgroups and identifies the categories in the "tree" with the highest and lowest proportion of respondents exhibiting the dependent variable. This method of audience segmentation can identify target groups that may benefit from programmatic interventions (e.g., information about enrolling in WIC) (Forthofer and Bryant 2000; Sutton, Balch, and Lefebrve 1995).

Five focus groups (n = 38) and 81 telephone interviews were conducted with women who indicated on the survey that they would be willing to talk further with researchers about why they had never enrolled in Texas WIC. All qualitative and quantitative instruments, consent forms, and research procedures were approved by the University of South Florida's Institutional Review Board.

Focus group and in-depth interviews were transcribed and entered into a computer-based text file. Transcripts were then loaded into Text-based Alpha, a software package that allows transcripts to be numbered, coded, and sorted into different topical categories (Qualitative Research Management 1989). For each topic, two researchers identified recurring themes, the range of diversity in responses, and selected quotations to be included in the research findings.

Finally, three anthropologists (Brown, Bryant, and Schreiber) and other members of the research team systematically observed the delivery of WIC services (the waiting area, registration and check-in procedures, individual assessment, and counseling and nutrition education activities) and the process used to redeem food vouchers in grocery stores. Although participant observation was conducted during the initial research period to provide researchers with an understanding of WIC's organizational culture and factors that influence client and staff satisfaction, it was continued throughout the study to supplement information obtained by other data collection methods.

Results

In keeping with marketing's conceptual framework, research focused on nonenrollees' perceptions of program benefits and costs. This section presents qualitative and quantitative data collected from nonenrollees.