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

Some nonenrollees said they felt acceptance of free food would "rob" them of their sense of self-sufficiency. In one focus group, when the moderator asked women what kept them from applying for WIC, the following discussion ensued:

25-year-old Anglo: I think pride has something to do with it.

30-year-old African American: That has a lot to do with it, I think.

28-year-old African American: It's a government program. We are supposed to be self-sufficient and take care of ourselves.

Some women were also reluctant to accept WIC benefits because they thought that benefits were in short supply and should only be accepted by those with the greatest need. These women felt strongly that government programs are designed to help only those who cannot provide for themselves. While they did not think it was shameful for people to accept help when it was truly justified, they did believe others should feel embarrassed to accept help if they could work and be self-sufficient. One 31 -year-old African American woman commented: "And if you don't feel like you need it and you're able to work, don't get it because it's out there to be gotten, just work."

A related concern was women's fears that enrollment of their own families in WIC might displace other women and children whose needs were far greater than their own. Some nonparticipants said they did not feel justified in accepting help in feeding their families. One 32-year-old Anglo American woman said: "Well, I just feel like if I'm there using it, well, I don't need it, and this person next to me might really need it, so they might as well. I look at it as a space...."

Compared to other families, significantly higher proportions of Anglo Americans (X2 = 55.77; p

Problems Enrolling in the Program

Some families did not enroll in WIC because of the inconveniences they encountered in their initial efforts to become certified. While none of the people in this sample had successfully enrolled in WIC during their recent pregnancy, 22 percent had tried, and 8 percent had actually gone to an appointment. In focus groups, women mentioned a myriad of system barriers that made it difficult to enter the WIC system. Among these barriers were difficulty finding the WIC phone number, calling a WIC number that was busy or was not answered, thinking that a WIC clinic was not nearby, and having to wait several weeks for an appointment.

Negative perceptions about participating in WIC

Some women did not enroll because of problems friends and relatives had encountered as WIC recipients. Long waits at WIC clinics to obtain food cards and listen to educational videotapes, rude treatment by WIC staff, lack of Spanishspeaking staff, and rude treatment while redeeming WIC food vouchers at the grocery store were mentioned repeatedly. Together, these inconveniences and insensitive treatment represented an unacceptable "price" or barrier to participation. Nonenrollees did not want to encounter the shame their friends and relatives felt because of being forced to wait for what seemed like unnecessarily long periods of time or being spoken to discourteously. Instead, they chose to forego the benefits of the program to avoid being treated poorly.