Making WIC Work for Multicultural Communities - Food Research ...

Making WIC Work for 

Multicultural Communities 

Best Practices in Outreach and Nutrition Education 

FOOD RESEARCH AND ACTION CENTER 

FRAC 

1875 Connecticut Avenue, NW 

Suite 540 

Washington, DC 20009 

(202) 986-2200 

www.frac.org

About FRAC 

The Food Research and Action Center (FRAC) is the leading national organization working for more 

effective public and private policies to eradicate domestic hunger and undernutrition. 

For more information about FRAC, or to sign up for FRAC’s Weekly News Digest, visit www.frac.org. 

For information about the Special Supplemental Nutrition Program for Women, Infants and 

Children, go to www.frac.org/WIC/index.htm. 

Acknowledgements 

This guide was prepared by Madina Agenor, Kate Pettitt Callahan and Geraldine Henchy. 

The Food Research and Action Center gratefully acknowledges support of the A.L. Mailman Foundation 

and the General Mills Foundation. 

FRAC also appreciates the assistance of the WIC community in preparing this guide: Kristen Sasseen, 

Washington Department of Health, Nenebah Jalloh, Mary’s Center for Maternal and Child Health, Jayasri 

Janakiram, Children National Medical Center, Sabrina Lewis, District of Columbia Department of Health, 

WIC Agency, Anna Kanianthra, Fairfax County Health Department, Betsy Clark, Minnesota Department of 

Health, Monique Stovall, California Department of Public Health, WIC Program, Rachel Colchamiro, 

Massachusetts Department of Public Health, Nutrition Division, Karan DiMartino, Massachusetts 

Department of Public Health, Nutrition Division, Judith Anderson, Michigan Department of Community 

Health, Ann Barone, Rhode Island Department of Health, Evalyn Carbrey, District of Columbia 

Department of Health, WIC Agency and the National Association of WIC Directors’ Cecelia Richardson. 

The assistance of United States Department of Agriculture, Food and Nutrition Service experts, Debra 

Whitford and Patty Davis, has been invaluable. Megan Elsener’s work on the cultural competency 

components summary is also appreciated. 

2009

Making WIC Work for Multicultural Communities 

Best Practices in Outreach and Nutrition Education 

Table of Contents 

Introduction ...............................................................................................................................1 

Best Practices in Outreach to Families of Diverse Cultures ......................................................3 

District of Columbia WIC....................................................................................................... 4 

Mary’s Center for Maternal and Child Care Outreach.................................................... 4 

Children’s National Medical Center ............................................................................. 6 

Families Growing Healthy with WIC (California) ...................................................................... 7 

Navajo Nation Outreach...................................................................................................... 11 

Reaching Out to Immigrant Families (Minnesota) .................................................................. 13 

Responding to Demographic Changes (Fairfax County, Virginia) ............................................. 14 

Social Marketing Campaign (Massachusetts) ......................................................................... 16 

Washington WIC ................................................................................................................ 19 

Outreach Project .................................................................................................... 19 

African American Outreach Project........................................................................... 21 

Best Practices Nutrition Education for Families of Diverse Cultures ......................................24 

California Fit WIC ............................................................................................................... 25 

Incorporating Traditional Foods and Recipes into Nutrition Education (Navajo Nation).............. 28 

Motivational Interviewing (District of Columbia) .................................................................... 30 

Texas WIC ...................................................................................................................................... 33 

African American Breastfeeding Initiative.................................................................. 33 

Nutrition Education Partnerships .............................................................................. 35 

From the Food Guide Pyramid to Cooking Practices in Your Kitchen ............................ 36 

Veggin’ Out (Rhode Island) ................................................................................................. 37 

Weigh of Life…Taking Action Together (Massachusetts)......................................................... 39 

Wichealth.org (Michigan) .................................................................................................... 42 

National WIC Survey................................................................................................................45 

National WIC Survey .......................................................................................................... 46 

Outreach ........................................................................................................................... 46 

Nutrition Education............................................................................................................. 47 

Resources.................................................................................................................................49 

Outreach ........................................................................................................................... 50 

Nutrition Education............................................................................................................. 50 

WIC ................................................................................................................................. 51 

USDA WIC Nutrition Services Standards: Cultural Competency Components ............................ 52 

USDA WIC Value Enhanced Nutrition Assessment: Cultural Competency Components .............. 53

Introduction

Introduction 

This guide highlights successful outreach strategies and nutrition education methods for making WIC 

work in multicultural communities. These include effective best practices for targeting hard-to-reach 

communities, addressing language barriers and emphasizing quality services and participant access. 

In addition, FRAC’s national WIC survey results provide an overview of WIC outreach and nutrition 

education efforts to WIC participants of all cultural backgrounds. 

The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is a very important 

source of nutritious foods and nutrition education for many pregnant women, new mothers, infants and 

children up to age five in multicultural communities. The program provides a monthly package of WIC 

checks that can be used in the grocery store to buy specific healthy foods. WIC’s new food package, 

which expands cultural food options by offering fruits and vegetables, whole grains, and the option of 

soymilk and tofu, is an important marketing and nutrition education tool. 

WIC is a federally funded public health and nutrition program administered by the United States 

Department of Agriculture, Food and Nutrition Service through WIC State Agencies and Indian Tribal 

Organizations (ITOs). At the local level, services are provided by local agencies and clinics. 

In 2009, over 9 million women, infants, and children were enrolled in the WIC program. While many 

potential participants in multicultural communities are enrolled in WIC, others face significant barriers to 

accessing and fully utilizing WIC services. The guide can be used as a tool and resource for developing 

innovative outreach and nutrition education efforts focused on families from these communities. 

Outreach 

Targeted outreach is essential to increasing access to WIC services in underserved diverse communities. 

State, local, and ITO agencies throughout the United States have found that comprehensive multicultural 

and multilingual outreach and social marketing campaigns increase participation among these 

underserved populations. This guide focuses on the following nine successful outreach campaigns: 

• District of Columbia WIC 

Children’s National Medical Center Outreach 

Mary’s Center for Maternal and Child Care Outreach 

• Families Growing Healthy with WIC (California) 

• Navajo Nation Outreach 

• Reaching Out to Immigrant Families (Minnesota) 

• Responding to Demographic Changes (Fairfax County Virginia) 

• Social Marketing Campaign (Massachusetts) 

• Washington WIC 

Outreach Project 

African American Outreach Project 

At the state level, some of the most successful outreach strategies for reaching diverse underserved 

communities include: producing outreach materials in a range of languages and for various 

cultural/ethnic groups; collaborating with other statewide agencies and organizations serving WIC eligible 

families; working with the media; branding WIC to increase recognition; direct mailings to potential 

participants; working with employers; working with WIC vendors; establishing an automated WIC hotline; 

promoting income eligibility guidelines; and collaborating with health, foster, and child care providers. 

At the local level, successful outreach strategies include: attending conferences and local community 

events; distributing outreach materials to local community groups and organizations; conducting door-todoor 

outreach; and staffing a mobile unit. 

Making WIC Work for Multicultural Communities: Best Practices Outreach and Nutrition Education 1

Nutrition Education 

WIC has undergone a process of “Revitalizing Quality Nutrition Services”. Central to the success of this 

initiative are USDA’s guidelines for Value Enhanced Nutrition Assessment and Nutrition Services 

Standards which focus on a participant-centered approach to nutrition education including cultural 

competency. This guide provides case studies highlighting best practices integrating this approach to 

providing quality nutrition services. These model programs take into account the WIC participants’ 

cultural preferences, eating patterns and traditions consistent with the cultural competency requirements. 

WIC nutritionists integrate an understanding of how socio-cultural issues (race, ethnicity, religion, group 

affiliation, socioeconomic status, and world view) affect nutrition and nutrition-related health problems. 

The resource section of this guide contains a summary of the guidelines for Value Enhanced Nutrition 

Assessment and Nutrition Services Standards related to cultural competency. 

Obesity is an increasingly serious and widespread health problem in the United States, and, very 

significantly, is becoming increasingly common among young children. The Centers for Disease Control 

reported that in 2008, 14.6 percent of American children between two and five years old were obese, 

which is almost triple the rate in 1971. In light of the obesity epidemic in the United States, WIC has 

expanded nutrition education to promote physical activity and good exercise habits. It is important that 

these initiatives address the needs of families from diverse cultural and ethnic backgrounds. Indeed, 

according to the Food and Nutrition Service, Latino and Native American children have the highest 

overweight prevalence (16.4% and 18.6% respectively) compared to all other WIC children. 

This guide highlights seven State and ITO agencies whose nutrition education has successfully addressed 

the needs of multicultural communities: 

• California Fit WIC 

• Motivational Interviewing (District of Columbia) 

• Weigh of Life…Taking Action Together (Massachusetts) 

• Wichealth.org (Michigan) 

• Incorporating Traditional Foods and Recipes into Nutrition Education (Navajo Nation) 

• Veggin’ Out (Rhode Island) 

• Texas WIC 

African American Breastfeeding Initiative 

From the Food Guide Pyramid to Cooking Practices in Your Kitchen 

Nutrition Education Partnerships 

Effective strategies included producing multilingual flyers, DVD’s, and shopping guides, using multicultural 

images in their outreach and nutrition education materials, developing new logos and taglines to increase 

recognition, working with WIC vendors and collaborating with community partners. Many states have 

utilized their most successful multicultural outreach and nutrition education strategies to market the new 

healthier WIC food package to diverse families. A separate FRAC publication, Time for a Change, 

includes additional information on these efforts. 

WIC Nutrition Services funding is essential to the successful implementation of such innovative outreach 

and nutrition education initiatives. Other sources of funding include WIC Special Project Grants and 

Operational Adjustment Grants from the Food and Nutrition Service regional offices. 

National WIC Survey 

Findings from the FRAC’s WIC Directors’ Survey provide important insight into ongoing efforts to increase 

access to services by conducting outreach, and providing nutrition education and referrals to WIC 

participants of all cultural backgrounds. 

Making WIC Work for Multicultural Communities: Best Practices Outreach and Nutrition Education 2

Best Practices in Outreach to Families of 

Diverse Cultural Backgrounds 

Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education

District of Columbia WIC 

Of the 22 WIC clinics in DC, two are particularly successful 

at reaching out to families of diverse cultural and linguistic 

backgrounds: Mary’s Center for Maternal and Child Care 

and Children’s National Medical Center. 

Agency Name 

Mary’s Center for Maternal and Child Care 

Project Description 

The District of Columbia WIC State Agency has a comprehensive 

multicultural and multilingual outreach campaign that targets a range 

of populations in the District, including the African American, Latino, 

White, Ethiopian, West African, Chinese, and Vietnamese communities. 

In partnership with Houston Association, Inc., DC WIC developed 

outreach materials in a number of languages as part of their WIC: 

Working in Communities campaign. 

The materials developed included: 

• flyers in English, French, Spanish, Mandarin, Amharic, and 

Vietnamese; 

• posters in English, Spanish, and Vietnamese; 

• brochures in both English and Spanish; and 

• a postcard and factsheet in English. 

All of these materials are available on the WIC Works Sharing Center 

website. 

Door to Door Outreach 

At Mary’s Center, 20 percent of the staff are fluent in Chinese and 30 percent are fluent in Spanish. In 

addition to State outreach initiatives (attending health fairs and staffing the DC WIC mobile unit) Mary’s 

Center increases awareness of WIC by conducting door to door outreach in the community. Clinic staff 

distribute the promotional flyers and brochures provided by the State Agency based on language needs. 

While all of the staff is involved in outreach, if the goal is to target a specific group of people (e.g. 

Latinos), staff members who speak that language (e.g. Spanish) will conduct the outreach. 

The Mama and Baby Bus 

The clinic also relies on the Mama and Baby Bus, a 

mobile unit that does outreach for all Mary’s 

Centers programs, to provide eligible families with 

information about WIC. Outreach through the 

Mama and Baby Bus is done in English, Spanish, 

and Vietnamese. 

Outreach in the Community 

Mary’s Center conducts outreach for WIC in 

churches, schools, community centers, day care 

centers, grocery stores, laundromats, and all other 

sites where women, infants, and children are likely 

to be found. In addition to disseminating 

information about the program, the WIC staff 

“We basically go anywhere a 

pregnant woman, mom, or dad 

with young children may be.” 

-Anne Spaulding 

Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education 4

screens potential participants for eligibility and enrolls those who meet the program guidelines. When 

staff members are on the Mama and Baby Bus, they are able to enroll families on the spot; if they are 

conducting outreach on foot, they take eligible families back to the clinic or schedule an appointment. 

Resources 

Mary’s Center’s WIC outreach efforts are funded through Nutrition Services funds from the United States 

Department of Agriculture, Food and Nutrition Service. 

Languages Used 

English, Spanish, French, and Mandarin 

Populations Served 

Latino, Black/African American, and Chinese 

Website 

www.maryscenter.org 

Contact Information 

Nenebah Jalloh 

Director of WIC 

Mary’s Center for Maternal and 

Child Health 

2333 Ontario Rd., NW 


(T) 202-420-7156 

(F) 202-420-7156 

njalloh@maryscenter.org 

Sabrina Lewis 

Community Health 

Administration 

District of Columbia 

Department of Health 

WIC State Agency 

2100 MLK, Jr. Avenue, SE, 

Suite 409 


(T) 202-645-0505 

(F) 202-645-0516 

sabrina.lewis@dc.gov 


Agency Name 

Children’s National Medical Center 


The WIC program at 

Children’s has found that 

one of the best ways to 

reach eligible families is to 

target other agencies and 

“Word of mouth is 

essential to outreach.” 

- Jayasri Janakiram 

organizations serving low-income communities. These 

include the Medicaid program, free meals sites, free 

primary care clinics, and prenatal and pediatric care 

clinics for low-income families, among others. WIC 

staff distributes State Agency flyers and brochures; 

enrolls eligible families on site; provides in-services 

and workshops on WIC for the staff; and sends direct 

mailings with information about WIC. Children’s WIC 

also sits on a Community Board, which includes free 

health care clinics, child care, schools, and Head Start, 

among other groups serving WIC eligible families. 

In addition, Children’s conducts outreach at local health fairs (Expo Time, Wise to Humanize etc.), where 

WIC nutritionists and paraprofessionals staff a table and distribute State Agency flyers to potential 

participants. Yet another effective outreach strategy is intra-agency cross-referrals, one of the many 

benefits of being located in a hospital. The WIC clinic at Children’s orients medical students and 

residents, who in turn refer potential participants to WIC. The WIC program also frequently makes crossreferrals 

with other Children’s hospital programs, including the Generations Program (teen mother and 

child clinic), Child Health Centers, and the Family Help Desk. 

Resources 

The WIC clinic at Children’s National Medical Center funds its outreach efforts through Nutrition Services 

funds from the United States Department of Agriculture, Food and Nutrition Service. 


English and Spanish 


Black/African American, Latino, Chinese, and Vietnamese 

Website: www. cnmc.org 


Jayasri Janakiram 

WIC Coordinator 

Children’s National Medical Center 

111 Michigan Ave., NW 


(T) 202-476-5594 

(F) 202-476-4126 

jayaj@cnmc.org 

Wherever low-income families are being served, an 

opportunity for outreach exists. 

- Jayasri Janakiram 


Families Growing Healthy with WIC (California) 

The California WIC program has a comprehensive outreach 

strategy that reaches out to the Latino, White, African American, 

and Asian communities throughout the state. Latinos currently 

comprise the majority of WIC participants in California (78%). 

The State Agency is increasing its efforts to target underserved 

communities, specifically the African American, Caucasian, 

Chinese, Vietnamese, and Hmong populations. 

California’s outreach goal is to expand and enhance collaboration 

between the WIC program and other statewide agencies and 

organizations serving WIC eligible families in order to promote 

local WIC referrals. An Outreach Committee advises the California 

WIC program on state and local outreach efforts, including: 

• distributing outreach materials, 

• having an automated WIC hotline, 

• attending conferences and community events, 

• working with the media, and 

• branding the WIC program to increase recognition. 

Agency Name 

California Department of Health Services, WIC Supplemental Nutrition Branch 


Outreach Committee 

The state’s outreach committee consists of approximately ten local agency members representing WIC 

directors, nutritionists, and outreach coordinators. The group meets quarterly to advise the California 

WIC State Agency in designing statewide outreach materials and shaping outreach efforts. Their mission 

includes helping all local agencies reach WIC eligible persons, particularly the underserved, working poor, 

and hard to reach populations, as well as improve retention of current participants. 

Outreach Materials 

The California WIC program developed a wide range of outreach materials in a number of languages. 

Materials are available in English, Spanish, Chinese, Vietnamese, Russian, Hmong, Korean and Armenian. 

• The State Agency produced outreach pamphlets, which provide potential participants with 

detailed information about WIC services, benefits, and income eligibility guidelines in English, 

Spanish, Chinese, and Vietnamese. California WIC is also planning to translate the pamphlet into 

both Russian and Hmong in an effort to reach more of the many cultural and linguistic 

communities in California. Each version of the pamphlet is targeted to a specific area based on 

language needs. 

• The State Agency produced additional outreach and education materials in English, Spanish, 

Chinese, and Vietnamese, Russian, Hmong, Armenian, and Korean. These materials included 

information about WIC clients’ rights and responsibilities, breastfeeding, and formula feeding. 

• The California WIC program also developed a one-page envelope 

stuffer intended to be sent to eligible families along with materials 

from other agencies, including electricity bills and MediCal (Medicaid) 

application forms. The stuffers are an Agency favorite and provide 

outreach information, as well as a simple nutrition education message 

“The envelope stuffer is 

one of our most effective 

outreach tools. It’s 

quick, simple, and 

direct.” 

-Carol Chase 


on limiting juice consumption. One side is printed in English and the other in Spanish. 

• Yet another California WIC outreach material is a half-page flyer providing information about WIC 

benefits, services, and income eligibility guidelines, as well as nutrition tips about healthy snacks. 

• The WIC program also produced a limited number of English and Spanish WIC posters for 

organizations serving low-income families, as a well as materials for health care providers. The 

clinician outreach packet included a WIC fact sheet and referral guide, including a rolodex card 

with the State Agency’s number and website. 

• The California WIC program also distributes incentive items during conference exhibits and health 

fairs. 

1-888-WIC-WORKS 

All outreach materials include the number for 

the California WIC automated phone line, 1- 

888-WIC-WORKS, which is a critical 

component of the State Agency’s outreach 

campaign. The hotline provides callers with 

information about the nearest WIC clinic, WIC 

benefits, and access to other services (health 

care, schools etc.) in five languages: English, 

Spanish, Vietnamese, Hmong, and Chinese. 

Outreach Strategy 

The California WIC program reaches potential 

participants by collaborating with other social 

services agencies that serve WIC eligible 

families. For instance, the State Agency 

conducts outreach to MediCal (Medicaid) enrollees and provides outreach materials free of charge to child 

care providers, Head Start, food banks, and health care providers, among others. The State Agency also 

partners with social services agencies through efforts such as mailing outreach letters to local MediCal 

and Food Stamp Program directors. Another important outreach strategy is using geo-mapping software 

in order to identify underserved areas throughout the state. 

In addition, California WIC also attends state and local events and promotes WIC in the media: 

• Attending Conferences and Other Community Events 

At the state level, California WIC attends large conferences where they can staff an exhibit about 

the WIC program. They specifically target conferences hosted by organizations that serve the 

WIC population, including the American Academy of Pediatrics, the California Department of 

Education, the American Academy of Nurse Practitioners, and the California School Nurses 

Association. Local agency staff members help with state conference exhibits and also attend 

local health fairs in their area. 

In an effort to improve outreach to African Americans, who are an underserved population in 

California, the State Agency attends conferences and events such as the National Association for 

the Advancement of Colored People (NAACP) Annual State Conference in Los Angeles and the 

Annual Black Expo in Sacramento. 


The California State Agency carefully targets the conferences and other community events they 

attend. When deciding what events to attend, they ask themselves: 

“Who is the sponsor?” 

“Where is the event being held?” 

“Who is the sponsor targeting?” 

“Is this a state or local event?” 

“Will WIC eligible families be attending the event?” 

“Will those who serve WIC eligible families be attending?” 

“What is the average attendance?” 

“Is this event the best use of our funds?” 

“How will this event further our outreach efforts?” 

• Working with the Media 

At the request of local agencies, the California WIC State 

Agency developed a media outreach kit. Working with the 

media can be too expensive for many state agencies, so 

California WIC encourages local agencies to advertise in their 

community by providing them with the resources they need. 

The local agency media kit includes camera ready advertising 

for billboard ads, print inserts, flyers, draft press releases, and a user guide on media advocacy 

strategy. Local agencies throughout California have worked with public television stations, local 

cable stations, and local radio stations to promote WIC in the media. 

The State Agency regularly runs print advertisements in statewide publications that target WIC 

eligible families, such as the Child Support Handbook for foster parents, and writes nutrition 

articles with an outreach message for health provider newsletters. 

Branding WIC 

The State Agency has branded WIC in order to raise awareness of the 

program throughout the state. The campaign’s major goal is to enroll 

all WIC eligible families who are not participating in the program by 

increasing their knowledge of WIC and dismantling any misconceptions 

about eligibility. For example, many families are unaware of the income 

eligibility guidelines and mistakenly believe they do not qualify. Since 

this is often a deterrent for working families, California WIC promotes 

income guidelines in its promotional materials. 

The State Agency also designed a new, more recognizable logo for the 

California WIC Program. The new logo was launched on October 1, 

2006. The logo includes the tagline “Families growing healthy with 

WIC.” The new logo is used on all education materials, promotional 

items and WIC letterhead. In addition, all authorized WIC vendors are 

encouraged to display the WIC decal at their entrance to help families 

identify stores where WIC foods are available. 

The WIC branding campaign was informed by focus groups with WIC 

participants and local agency WIC staff. 

“Some media 

opportunities exist at the 

local level that don’t exist 

at the state level.” 

- Monique Stovall 

“All WIC programs should consider 

doing informal focus groups to plan 

their outreach activities. They’re an 

inexpensive way to assess what 

participants’ value about WIC and what 

is keeping others from applying. 

California could provide other states 

with focus group questions.” 

-Carol Chase 


Project Evaluation 

The California WIC State Agency has conducted a number of informal process evaluations to determine 

how to better reach and improve WIC services for underserved populations, including focus groups with 

WIC participants and local agency staff. In addition, the state monitors requests for outreach resources 

to measure the success of California’s collaboration efforts with other state programs. These evaluations 

taught the California WIC program valuable lessons about effective outreach strategies. 

Lessons Learned 

Both the surveys and focus groups revealed that the most effective strategy for increasing awareness of 

the WIC program was word of mouth. The focus groups also showed that health care providers were 

crucial to informing eligible patients of WIC services and benefits. 

These findings also led the California WIC State Agency to conclude that major statewide paid TV 

advertising campaigns were not the most effective outreach strategy in California. 

Resources 

The California WIC program uses Nutrition Services funding from the United States Department of 

Agriculture, Food and Nutrition Service for all of its outreach efforts. 


English, Spanish, Chinese, Vietnamese, Russian, Hmong, Armenian, and Korean 


Latino, White, African American, Chinese, Vietnamese, Hmong, Korean, Russian, and Armenian 

State WIC Participation by Race/Ethnicity: 

78 percent Latino, 8 percent White, 5.5 percent Black/African American, 5 percent Asian/Pacific Islander, 

and 0.87 percent American Indian/ Alaska Native 

Website 

www.wicworks.ca.gov 


Monique Stovall 

Chief, Nutrition Education, Marketing and Outreach Section 

California Department of Public Health-WIC Program 

P.O. Box 997375 

West Sacramento, CA 95899-7375 

(T) 916 928-8604 

Monique.Stovall@cdph.ca.gov 


Navajo Nation Outreach 

All WIC clinics in the Navajo Nation in Arizona 

are required to draft a bi-annual outreach plan. 

Each plan is shaped by the specific needs of 

community members and varies based on 

locality. Outreach is the responsibility of all 

WIC staff members and everyone is involved in 

the process regardless of their role in the clinic. 

Outreach is conducted in English and Navajo. 

Some materials are also available in Spanish, 

which increases access to the program for 

Latino participants. 

Outreach efforts are conducted on a monthly 

basis, usually after a staff in-service or 

workshop when WIC clinics are closed. The 

Navajo Nation WIC program’s goal is to set high 

standards for outreach and to empower WIC 

clinic staff to reach them. Their outreach 

strategy involves attending community events and working with other agencies serving WIC eligible 

families in the Navajo Nation. 

Agency Name 

Navajo Division of Health, Navajo Nation WIC Program 


Working in the Community 

Navajo Nation WIC attends as many local events as possible in order to increase awareness of the 

program in the community. For example, when appropriate, clinics attend tribal fairs, traditional 

ceremonies, and health fairs. WIC staff distributes flyers, which include information about WIC services 

and benefits, clinic locations, income eligibility guidelines, and the toll free number for the central office 

(1-800-307-4231). The Navajo Nation WIC program also prints ads in the reservation’s three biggest 

newspapers: the Navajo Times, the Gallup Independent, and the Farmington Daily Times. In order to 

reach families in rural areas, they produce monthly Public Service Announcements (PSAs) on the radio in 

both English and Navajo. Outreach in more isolated rural areas is only conducted in Navajo. The Navajo 

Nation WIC program also has some outreach materials in Spanish to distribute to the Latino population. 

Working with Partners 

A key component of the Navajo Nation’s outreach strategy is partnering with other groups and agencies 

on the reservation. For example, Navajo Nation WIC collaborates with area food banks and other food 

distribution sites, the Navajo Special Diabetes Project, and the local Breastfeeding Task Force. They also 

make referrals to Medicaid and the Food Stamp Program. In addition, they partner with dietitians at the 

Indian Health Service to provide the same messages on nutrition and physical activity and disseminate 

community resource guides in which WIC is listed to health care providers. The goal is to educate others 

working with low-income families about WIC so that they can refer them to the program. 

“Strong partnerships are a key component 

of our successful outreach strategy.” 

-Adele King 

Each clinic’s outreach plan 

needs to be tailored to 

the needs of the community.” 

-Doris McGuire 



All WIC clinics on the reservation keep a record of their outreach activities. The records are evaluated by 

the state’s Quality Assurance Review (QAR) team. Every clinic nutritionist also conducts an in-house 

evaluation of outreach efforts for self-regulation. 

Resources 

The Navajo Nation WIC program uses Nutrition Services funding from the United States Department of 

Agriculture, Food and Nutrition Service to produce outreach materials and conduct outreach efforts. 


Navajo, English, and Spanish 


Navajo, Latino, and White 


Adele King 

WIC Program Manager 

Navajo Division of Health-Navajo Nation WIC Program 

P.O. Box 1390 

Window Rock, AZ 86515 

(T) 928-871-6698 

(F) 928-871-6255 

aking@navajowic.org 

“If it wasn’t for the WIC program, 

I wouldn’t have made it. You know 

with the milk and stuff how expensive 

it is these days. Thank goodness that 

you guys are here because it’s just me 

and my baby.” 

-WIC Participant 


Reaching Out to Immigrant Families 

Minnesota has become home to many immigrant groups from all over the world, including Hmong immigrants 

from Southeast Asia, Africans from Somalia and Ethiopia, Karen people from Burma, and many Spanishspeaking 

immigrants from Mexico and various other regions of Latin America. Minnesota WIC has developed 

outreach strategies to reach out to and better serve these populations. The State Agency has developed 

culturally appropriate outreach materials in four languages, hired 

multilingual and multicultural staff and has a clinic located in the 

Hmong American Center in St. Paul. 

Agency Name 

Minnesota Department of Health, WIC Program 


Minnesota WIC has developed and disseminated outreach flyers in English, Spanish, Hmong, and Somali. The 

outreach flyers, WIC’s food list brochure, and WIC’s direct mail postcards all feature pictures of culturally 

diverse women, infants, and children. WIC has just recently developed New WIC food package brochures in 

seven languages including English, Spanish, Hmong, Somali, Chinese, Russian, and Vietnamese. The brochure 

can also be translated into Arabic, Bosnian, Burmese, French, Hindi, Korean, Polish, and Urdu at the request of 

local agencies. 

In addition to the print materials the WIC state website has participant information pages in English, Spanish, 

and Somali. To enhance their ability to serve the state’s diverse population Minnesota WIC has also hired 

Hmong, Somali, Mexican, and Karen staff to ensure effective communication and cultural understanding 

amongst WIC staff and Minnesota’s immigrant populations. 

To further reach the Hmong immigrant population Minnesota WIC opened a clinic in the Hmong American 

Partnership (HAP) Center in St. Paul. In the early 1980s many Hmong fleeing Southeast Asia after America’s 

withdrawal after the Vietnam War immigrated to Ramsey County, Minnesota and there is now a large Hmong 

population in St. Paul. When WIC was searching for a larger space for their St. Paul Clinic they took the 

opportunity to partner with the Hmong American Partnership Center. The center had a large space available in 

their building that was perfect for WIC’s clinic. Having the clinic located in the HAP center has allowed Ramsey 

County WIC to successfully serve the Hmong population. Not only can HAP staff easily refer their clients to the 

WIC clinic but WIC staff can refer participants to the many services that HAP offers, including job counseling, 

English classes, job fairs, and teen youth groups. Ramsey County WIC considers their partnership with HAP a 

“win-win relationship.” 


The primary way Minnesota evaluates their outreach efforts is by tracking participation. They track 

participation trends over time and participation by race and ethnicity. 

Resources 

Minnesota’s WIC allocates a portion of their budget to outreach efforts. 


English, Spanish, Hmong, and Somali 


White, Black/African American, Latino, Southeast Asian, and 

East African 

Website: http://www.health.state.mn.us/divs/fh/wic 


Betsy Clark 

WIC Director 

Minnesota Department of Health 

P.O. Box 64975 

St. Paul, MN 55164-0975 

(T) 651-201-4403 

Betsy.Clarke@state.mn.us 


Responding to Demographic Changes 

Agency Name 

Fairfax County Health Department, WIC Program 


The population of Fairfax Country has become 

increasingly diverse over the last several years. 

Fairfax County WIC has developed a 

comprehensive multicultural outreach campaign 

to respond to these demographic changes to 

ensure they are serving the diverse families that 

are now residing within the county. The 

campaign includes both external partnerships 

with area organizations and internal integration 

efforts with other county programs. The 

outreach efforts of Fairfax county staff 

contributed to a 5 percent growth in WIC 

participation from October 2008 to April 2009. 

External Outreach 

Fairfax County WIC currently partners with 21 local organizations to reach potential WIC participants. 

These community partners included resources centers, schools, religious organizations, and other 

community programs. Some of the partnerships include: 

• Bryant Adult Alternative High School: WIC partners with Bryant, an alternative school for 

pregnant teens, to educate students about the WIC program and work with school nurses to 

refer eligible students to WIC. 

• Catholic Charities: Fairfax County WIC partners with Catholic Charities in Springfield to reach out 

to the families with adopted children. Adopted children are eligible for Medicaid and therefore are 

automatically eligible for WIC services but adoptive families are often uncomfortable or unwilling 

to visit a WIC clinic. Fairfax County WIC requires that a child’s adoptive parents bring the child in 

for just his or her first visit for a nutrition assessment. After the initial visit a Catholic Charities 

social worker picks up the WIC food vouchers for the family of the adopted child. WIC staff also 

provides the social workers nutrition education that they then pass along to adoptive families. 

• Dar Al Hijrah Islamic Center: WIC staff will plan to hold clinics at the Islamic Center following 

Saturday services to disseminate information about the programs, screen potential participants 

for eligibility and enroll those who meet the program guidelines. This initiative will start in 

August 2009. 

• Grace Ministries: WIC staff works with the Grace ministries of Herndon Methodist Church to reach 

out to Hispanic families. On the first Saturday of every month Grace Ministries opens their doors 

to roughly 200 families in need, offering them food pantry bags, clothing, and other necessities. 

On each of these Saturdays WIC staff is present to educate families about WIC and schedule 

eligible families for an appointment at the local WIC clinic. 


Internal Outreach 

WIC partners with other County programs to reach additional WIC participants. WIC staff educates 

providers about WIC benefits and eligibility guidelines to ensure they are able to appropriately refer 

potentials participants to WIC. Fairfax County WIC coordinates outreach efforts with the Department of 

Family Services Special Nutrition Assistance Program (formerly the Food Stamp program), dental clinics, 

the Public Health Nurses Fairfax Hospital Liaison, Medicaid workers, and the Health Department clinic 

staff. 


Fairfax county WIC measures the effectiveness of their outreach efforts by tracking WIC enrollment. In 

April 2009, the Fairfax County WIC program assisted 18,513 participants, a 5 percent growth since 

October 2008. 


Fairfax county WIC identified health care providers’ and potential participants’ lack of knowledge of the 

WIC benefits and eligibility guidelines as a barrier to participation. Fairfax County WIC outreach efforts 

have helped increase knowledge of the WIC program and helped reach out to underserved populations 

which Fairfax county WIC has learned is the key to serving potential WIC clients. 


English, Spanish, Korean, Chinese, Vietnamese, and Russian 


White, Black/African American, Latino, Chinese, East 

African, South East Asians, Indians, and Pakistanis 

Website 

http://www.fairfaxcounty.gov/hd/wic/ 


Anna Kanianthra 

WIC Nutrition Coordinator 

Fairfax Country Health Department 

(T) 703-246-8657 

(F) 520-871-6255 

Anna.Kanianthra@fairfaxcounty.gov 



“Focus groups are how 

you come up with the 

best ideas.” 

-Karan DiMartino 

Social Marketing Campaign 

The Massachusetts WIC program developed a comprehensive, 

statewide outreach campaign with the goal of increasing awareness 

of WIC among eligible families of all racial, ethnic, cultural, and 

linguistic backgrounds. Massachusetts’ outreach plan is based on 

the success of a three-year multicultural social marketing campaign 

launched in 2001. Their outreach efforts include: 

• partnering with employers to reach working families, 

• working with the media, 

• partnering with child care, health and foster care providers, 

• partnering with WIC vendors, 

• direct mail campaigns to potential participants, and 

• targeting local organizations and events. 

Agency Name 

Massachusetts Department of Public Health, WIC Nutrition Program 

Social Marketing Campaign 

The Massachusetts WIC program had a three-year statewide, multicultural social marketing campaign to 

increase enrollment and the retention of current WIC participants. In partnership with Policy Studies, 

Inc., the State Agency branded WIC as a “health and nutrition program for all types of families.” Based 

on focus groups with both current and potential participants, they designed a new WIC logo, changed the 

WIC tag line to “Good Food and a Whole Lot More,” and produced a wide variety of both written and 

audiovisual outreach materials. 

Many of the Massachusetts WIC outreach materials were 

developed in nine languages: Chinese, English, French, Khmer, 

Portuguese (Brazil), Portuguese (Portugal), Russian, Spanish, and 

Vietnamese. All others are available in both English and Spanish. 

This allows the Massachusetts State Agency to reach a range of 

populations throughout the state, including the Latino, Brazilian, 

Vietnamese, Cambodian, Portuguese, Russian, White, African American, East and West African, Chinese, 

and Haitian communities. The materials range from brochures, poster, flyers, toolkits, transit and TV 

advertisements, and radio spots to direct mail postcards. All of the written outreach materials include the 

number for the WIC phone line (1-800-WIC1007), which provides Massachusetts residents with 

information about the program. 

Target audiences for the social marketing campaign include employers (human resources offices), local 

WIC agencies, WIC vendors, health care providers, foster and child care providers, WIC participants, and 

eligible families not enrolled in the program. The materials developed are permanent components of the 

State Agency’s outreach efforts. They can be found on the WIC Works Sharing Center website. 

Partnering with Employers to Reach Working Families 

An essential outreach tool developed during the social marketing campaign was the human resources 

package. After identifying companies that hire low-income employees (e.g. hotels, restaurants), 

Massachusetts WIC conducted focus groups with employers in order to identify how the WIC program 

could work for them. The goal was to market WIC as an employee benefit and enlist employers to 

educate employees about WIC income eligibility guidelines since many working families mistakenly 

believe they are ineligible for the program. 


The State Agency sent information about WIC to human resources offices in over 40,000 companies 

throughout Massachusetts. The information packets included an “Information for Employers” folder; a 

“WIC is for Working Families” poster; a “WIC Fast Facts for Employers” factsheet; a letter to employers; a 

sample email for employees; and a general WIC brochure. 

Working with the Media 

During the social marketing campaign, Massachusetts WIC developed TV, radio, and transit 

advertisements. The TV and radio ads were designed to provide all listeners with nutrition information, 

while dismantling any stigma of WIC being a “welfare program”. They were produced in both English 

and Spanish. The radio spot features a variety of speakers who discuss child eating habits, 

breastfeeding, and WIC services, including health and social services referrals. The TV ad features happy 

children from diverse backgrounds eating healthy WIC foods. The State Agency also developed transit 

ads to put throughout the Massachusetts Bay Transportation Authority bus and train system. 

The Massachusetts WIC program’s media outreach strategy emphasized radio spots since they are 

significantly less expensive than TV ads and allow for more repetition. Since 2002, the State Agency has 

partnered with the radio station Magic 106.7 FM to conduct a weekly nutrition minute. The goal is to 

give listeners healthy eating tips and brand WIC as a nutrition program. Massachusetts WIC has also 

partnered with other local radio stations to conduct outreach at free summer concerts and events, give 

information about WIC on air, and post their hyperlink on the stations’ website. 

Partnering with Health, Foster, and Child Care Providers 

Massachusetts WIC developed a clinician brochure, which provides health care providers with information 

about WIC services and how to refer patients to the program. They also developed brochures for foster 

care and child care providers. These materials are available in English and Spanish and outline WIC 

benefits, eligibility requirements, and referral and enrollment procedures. 

Partnering with Vendors 

The vendor materials package provides vendors with 

information about the WIC program and highlights their role 

in WIC transactions. The package includes a picture guide 

of WIC-approved foods; factsheets for cashiers (available in 

English and Spanish) and bookkeepers; a brochure 

explaining WIC transactions; and a poster thanking cashiers 

for making WIC work for families. 

Reaching Out to Eligible Families 

In addition to the strategies outlined above, the 

Massachusetts WIC program reaches out to eligible families 

through direct mailings and community coordinators. 

In order to reach potential WIC participants, two postcards 

were developed and distributed via mail. The first was sent 

out to all residents enrolled in the MassHealth program (Medicaid). The second postcard was sent to all 

families earning under $40,000 per year with at least one child under the age of five. The WIC State 

Agency purchased this mailing list from a local company that sends value pack offers to low-income 

families in Massachusetts. 

At the local level, community coordinators are a crucial part of outreach to eligible families. A total of 36 

coordinators (one per local agency) distribute posters, flyers, and brochures containing information about 

the WIC program to various sites throughout the state. 


Target sites include welfare offices, libraries, preschools, utility companies, doctor’s offices, pharmacies, 

local health fairs, and other community events. These coordinators have a limited budget and usually 

attend community events free of charge. 


After the outreach materials were developed in partnership with Policy Studies, Inc., the Massachusetts 

WIC program conducted focus groups to evaluate their effectiveness. They found that more families 

were aware of WIC as a result of the social marketing campaign. 

“You need to step 

outside the box 

and see what’s 

going on in the 

community.” 

-Karan DiMartino 


Some of the campaign’s challenges included tackling the misconception that 

WIC is a “welfare program” and reaching dads. In response to this last 

challenge, the Massachusetts State Agency created outreach materials 

specifically targeting fathers and used words like “families” instead of “moms” 

and “women” in all outreach materials. 

Massachusetts WIC also learned that investing time and money in focus groups was essential to 

developing a successful outreach campaign. They found that focus groups were the only way to know 

what the community’s needs and wants were. They also learned that focus groups were crucial to 

determining which populations to target during an outreach campaign. Massachusetts WIC noted that in 

order to be most useful, focus groups should be conducted with both participants and eligible families not 

enrolled in the program. They recommend that State Agencies that cannot conduct focus groups before 

launching an outreach campaign conduct phone interviews instead. 

A creative and forward-thinking State Director with a “big picture” vision of WIC was also crucial to the 

success of the social marketing campaign in Massachusetts. Indeed, the Massachusetts WIC staff 

insisted that without Mary Kelligrew Kassler’s leadership, these outreach initiatives would not have been 

possible. 

Resources 

The Massachusetts State Agency receives 85 percent of its funding from the Federal government and 15 

percent from the State in Supplemental WIC funds. Outreach initiatives are funded through Nutrition 

Services funding from the United States Department of Agriculture, Food and Nutrition Service. 


Chinese, English, French, Khmer, Portuguese (Brazil), Portuguese (Portugal), Russian, Spanish, and 

Vietnamese 


White, Latino, African American, Haitian, Chinese, West African and East African, Portuguese, Brazilian, 

Russian, Vietnamese, and Cambodian 

Websites 

www.nal.usda.gov/wicworks/Sharing_Center/statedev_soc_market_ma.htm 


Karan DiMartino 

Marketing and Media Coordinator 

Nutrition Division-WIC Nutrition Program 

Massachusetts Department of Public Health 

(T) 617-624-6121 

Karan.dimartino@state.ma.us 


Washington WIC 

The Washington State WIC agency has a comprehensive 

multicultural and multilingual outreach strategy designed to 

reach diverse families across the state. Through multilingual 

outreach materials and activities, the Nutrition Program 

Outreach Project has welcomed many new families to the 

Washington State WIC program. The WIC African American 

Outreach Project, focused on positive messages disseminated 

through media and other channels in the community, has been 

successful in increasing the participation of African American 

families. This work is done through a public/private 

partnership with WithinReach, a nonprofit organization working 

to improve maternal, child and family health in Washington 

State. 

Agency Name 

• Washington Department of Health, WIC Nutrition Program 

for Women, Infants and Children (WIC) 

Project Name 

Washington State WIC Nutrition Program Outreach Project 


Washington developed numerous culturally appropriate outreach materials and resources to increase 

eligible families’ access to WIC services. The project includes outreach materials in 11 languages, a 

statewide family health hotline with bi-lingual operators, an online WIC clinic search tool and an 

interactive website where families apply for state-sponsored health and nutrition services. 

Outreach Materials 

Messaging: Outreach materials are worded to overcome barriers and encourage people to apply. Most of 

the materials include the following information: 

• WIC income guidelines because many people do not realize they are eligible. 

• WIC services and the value of the WIC foods as an incentive for applying. 

• The message “It’s easy to apply. It just takes a phone call. WIC even takes care of the 

paperwork.” This is based on information from focus groups on what would encourage 

people to apply and overcome perceived barriers. 

• The statement “Getting WIC does not affect your immigration status.” so immigrants are not 

afraid to apply. 

• The address and phone numbers of local WIC clinics for the county. These are printed on 

the back of the flyers. 

• The toll free, statewide WithinReach Family Health Hotline number 

Materials: The Washington State WIC Nutrition Program and WithinReach developed and disseminated 

the following multilingual outreach materials: 

• WIC outreach flyers in 11 languages including English, Spanish, Chinese, Somali, Amharic, 

Tigrinya, Vietnamese, Korean, Ukrainian, Russian, and Arabic. 

• A four-language outreach flyer in English, Spanish, Russian, and Vietnamese. 

• Counter cards in both English and Spanish that encourage WIC clients to tell their friends and 

families about the WIC program. 


• Including an 8-language Medicaid insert in mailings to all pregnant women and households 

with children under 5. The insert messages are in English, Spanish, Russian, Vietnamese, 

Somali, Chinese, Korean, and Cambodian. Income guidelines are not included because all 

Medicaid clients are income eligible for WIC. 

• New food package flyers in English, Arabic, Chinese, Korean, Russian, Somali, Spanish, 

Vietnamese that include a New Food Choices 2009 logo. 

WIC outreach materials can be ordered from The Washington State WIC Nutrition Program and 

WithinReach. 

On-line WIC Clinic Search Tool in English and Spanish 

The search toll is maintained by WithinReach on their 

website. There is a link to this from the WIC website, 

the Basic Food Website, and the Parent Help 123 site. 

The search tool allows families find the address, phone 

number and hours of operation of a WIC clinic close to 

where they live. The tool includes a system for 

locating a WIC approved grocery store. The clinic 

search tool site gets over 45,000 hits per year. 

Family Health Hot Line 

Through a multi-program contract with the Washington 

State Department of Health, WithinReach operates a 

toll Family Health Hotline. This creates a one-stopshopping 

opportunity because all callers are screened 

and referred as needed to a number of programs 

including WIC, Medicaid, Basic Food, Immunizations, 

and Family Planning. All the participating programs 

benefit from each others’ outreach efforts since all 

callers get referred to an array of services. This is a 

very cost effective way to operate and fund a statewide 

toll free line. 

Parenthelp123.org 

Patenthelp123.org is an interactive website to help 

families find and apply for local services available to them including WIC. The website is available in 

English and Spanish. www.ParentHelp123.org includes a “benefit finder” that guides families as they 

enter specific information so the system can determine if they are eligible for free and low-cost health 

insurance and a number of food programs. The website also has a resource finder, a new search tool 

that allows families to search by zip code for services including low-cost medical clinics, immunizations, 

child care referral agencies and food assistance programs. The website has an easy online interview tool 

that can be used to complete the applications for programs for which families are eligible. Families can 

choose to print and send the applications in by mail or submit them online. 


Washington WIC and WithinReach track the family health hotline calls by race and language and collect 

information about how callers learned about the hotline number. In 2006, Washington WIC conducted a 

call back survey of hotline callers to gather information about the usefulness of the hotline. They also 

tracked caller’s responses to the various outreach methods and materials and make changes based on 

this. Over 60 percent of callers to the toll free line report getting the WIC number from the phone book. 


The “how learned” hotline information revealed that the two most effective ways to publicize the hotline 

number are in the phone book and through print materials. Provider referrals are also an important 


source for callers. The on-line WIC clinic search tool in English and Spanish has been well received and 

gets over 45,000 hits per year. The number of hits continues to increase each quarter. The most 

effective way to reach non-English speaking clients was the eight language Medicaid insert. Medicaid is 

changing their system and will be using “debit type cards” instead of mailing out Medical coupons. WIC 

will be looking for other ways to reach this population in the future. 

All of the clients responding to the call back survey indicated that they found the hotline helpful and 99% 

of them were successful in enrolling in WIC. Washington WIC plans to repeat this survey in 2011. 

Resources 

WithinReach and all the partnering programs and organizations contribute funding to operate the Family 

Health Hotline. WIC also funds WithinReach to: 

• Conduct outreach activities publicizing the line. 

• Maintain up to date addresses etc. on the on-line WIC clinic search tool. 

• Support the development of the Spanish version of ParentHelp123. WithinReach obtained 

most of the funding by writing grant requests. 


• Washington WIC Outreach Materials are available in these languages: English, Spanish, 

Chinese, Cambodian, Somali, Amharic, Tigrinya, Vietnamese, Korean, Ukrainian, Russian, and 

Arabic. 

• WIC tracks the languages that WIC clients read in their data system. They review this data 

regularly and create materials in new languages based on this information. 

• WithinReach and the local WIC agencies use a “language line contract” so they can meet the 

needs of callers in over 50 languages. 


Native American, African American, Hispanic, and Asian 

Websites 

Washington State WIC Program: http://www.doh.wa.gov/cfh/WIC/default.htm 

Washington State WIC Clinic Search Tool: http://www.withinreachwa.org/wicsearch 

WithinReach – Essential Resources for Family Health: http://www.withinreachwa.org/ 

Parent Help 123: http://www.parenthelp123.org/ 

Project Name 

Washington State WIC African American Outreach Project 


Key Informant Meeting 

In February 2005, Washington WIC convened an African American key informant brainstorming session 

to explore barriers to African American participation in WIC, and to gather information on effective 

messages and outreach activities to reach eligible pregnant African American women and parents of 

African American children under age 5. The key informants included health and social service providers 

who work with African American families. 

Through active idea generation the attendees identified and prioritized recommendations for key 

messages and images: 

• Include images of healthy African American children of various ages and African American 

pregnant women 


• Tell them it is easy to access and then make sure it is. Develop and highlight “drop in days” or 

“new enrollment days.” 

• Highlight the benefits of the program (i.e. saves money, provides healthy foods, and supplements 

their diets). 

• Stress presence of ethnically diverse and bilingual providers. 

The groups’ prioritized list of “best outreach methods” for African Americans included: 

• Putting materials in places where people visit: barber shops, beauty supply and grocery stores, 

churches, hair salons, clinics, schools, libraries, metro buses, and public markets. 

• Partnering with other groups for outreach: Basic Food outreach workers, food banks, meal sites, 

senior centers to reach grandparents who have taken in their grandchildren, and locations in 

ethnic neighborhoods. 

• Airing radio PSAs on stations popular with African American families 

• Putting ads in community newsletters such as: In Time Production, FACTS, and Color Magazine 

Outreach to African Americans 

Based on the findings above, the Washington WIC Nutrition Program partnered with WithinReach to 

develop materials and activities for an African American Outreach Project. 

Outreach Material Revisions 

WIC revised many of their English outreach materials to feature additional pictures of African American 

women, infants and children. They hired a photographer to take professional photographs for the 

materials. The revised materials included the WA WIC general outreach flyer, a “Tell your Friends” 

appointment folder insert, and the 8-language Medicaid Flyer. 

New Outreach Materials 

WIC and WithinReach also developed and disseminated new direct mail post cards and Valpak coupons 

book inserts with images of African American women, infants, and children. WIC sent the post cards and 

ValPak inserts to African American and low-income families across the state. One of the Valpak stuffers 

featured a picture of an African American WIC provider on the phone that urged women to “call me to 

get on WIC as soon as you know you are pregnant!” 

Working with the Media 

As recommended by the key informants, Washington developed radio, newspaper and transit 

advertisements. They partnered with Kent Stevenson, a successful African American producer and Debbie 

Cavitt, an African American gospel singer and director of Leschi Children’s Choir to produce a public 

service announcement. The PSA aired on local radio stations African Americans listen to. Debbie Cavitt 


and the Leschi choir were featured on the PSA. Two newspaper advertisements, featuring an African 

American mother and child and a pregnant African American woman, were developed and placed in local 

African American Newspapers. Bus signs were also developed and posted in 126 buses in Pierce County 

and 126 buses in King County on routes in African American communities. One bus sign featured a 

picture of a pregnant African American woman and the other a preschool aged African American child. 

The signs included the ParentHelp123.org web address and the Family Health Hotline number. 

Outreach in the Community 

The WIC outreach team established and maintained relationships with local African American churches by 

making one-on-one phone calls and personal visits. They educated church leaders about WIC services 

and eligibility and encourage them to post WIC outreach materials on church bulletin boards. The 

churches also put WIC outreach flyers in with their church bulletins. Free materials were provided. 

WIC information was also provided at African American health fairs. Small teddy bears and lip gloss with 

outreach messages were given out to attract families to the booth. 


WithinReach provides Washington WIC with a yearly report about the reach of their outreach efforts. WA 

WIC has seen a steady increase in African American enrollment since they began their outreach efforts in 

2006. From February 2006 to February 2007 there was a 3.5 percent increase in the percent of African 

Americans served. During the outreach project, February 2008 to February 2009, African American WIC 

participation increased by 9 percent. 


The brainstorming sessions revealed that when trying to reach African American populations it is 

important to develop relationships within the African American community and develop materials and 

outreach activities that include targeted messages and culturally appropriate images. It is also imperative 

that the outreach efforts are ongoing and involve members of the community, especially African 

American churches. 

Resources 

Washington WIC received a Operational Adjustment Grant for $75,000 from the Western Region United 

States Department of Agriculture, Food and Nutrition Service to fund their African American Outreach 

Project. In addition, Washington WIC allocated $20,000 for this project. 


English 


African American 

Websites 

Washington State WIC Program: http://www.doh.wa.gov/cfh/WIC/default.htm 


Kristin Sasseen 

Washington State WIC Outreach Coordinator 

Washington State Department of Health 

PO Box 47886 

Olympia, Washington, 98504-7886 

(T) 360-236-3633 

Kristin.Sasseen@DOH.WA.GOV 


Best Practices Nutrition Education for 

Families of Diverse Cultural Backgrounds 

Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education

California Fit WIC 

This case study specifically focuses on the California Fit WIC project because of its efforts to make 

nutrition and physical activity accessible to WIC families of diverse cultural backgrounds. California’s 

program takes a holistic, community-centered approach to healthy eating and exercise, with a particular 

focus on Latino communities. This case study also highlights the Fit Families Novela series, a set of 

bilingual video and fotonovelas promoting nutrition and physical activity. 

Project Name 


Agency Name 

California Department of Health Services, WIC Branch 



The Fit WIC program in California seeks to increase WIC’s role in preventing childhood 

obesity/overweight in the community as a whole. The California team implemented intervention 

strategies that not only targeted WIC staff and participants, but also members of the entire community. 

California developed resources for the project in both English and Spanish. 

Targeting WIC Participants 

One of the main goals was to 

integrate physical activity into 

nutrition education for WIC 

participants. For instance, California 

Fit WIC developed a training manual 

entitled “FitWIC: Active Play for 

Families,” which encouraged families 

to be more active by doing easy and 

fun physical activities. California Fit 

WIC also produced parent handouts 

in both English and Spanish 

discussing active child play (“Playing 

With Your Baby, Playing With Your 

Toddler, Playing With Your 3 to 5 

Year Old”) and healthy eating habits 

for children (“Healthy Choices for 

Kids”). They also promoted child 

education resources, such as 

children’s books, music, and videos 

addressing healthy eating and 

physical activity in both English and 

Spanish. In addition, the lesson 

plans used during nutrition 

education sessions covered topics 

such as gardening (“Grow Your Own 

Garden”), healthy snacks (“Making 

Snacks Count”), and fast food 

(“Super-Sized!”), and TV watching 

(“What’s On TV?”). 


Targeting WIC staff 

Yet another California Fit WIC program goal was to increase staff awareness of childhood 

overweight/obesity and help them improve their own health behaviors, as outlined in the staff training 

manual “Fit WIC: Supporting WIC Families and Staff.” For instance, the project included special trainings 

and workshops to assist staff in discussing weight, healthy eating, and physical activity with WIC 

participants. The project also encouraged all local WIC agencies to develop staff wellness programs. 

California WIC believes WIC staff are the best role models for WIC families so it is important to support 

staff to make health lifestyle choices. 

Targeting Other Community Members 

In the community, California Fit WIC developed gardens, implemented task forces on physical activity 

and nutrition, and drafted physical activity resource guides. For example, the program produced a 

training kit for communities to address overweight/obesity among children entitled “Children and Weight: 

What Communities Can Do.” The Fit WIC program also promoted farmers’ markets near WIC clinics and 

established a partnership with local restaurants to increase community members’ fruit and vegetable 

consumption. 

The Fit Families Novela Series 

In an effort to make Fit WIC accessible to families of diverse cultural 

and racial/ethnic backgrounds, the Center for Weight and Health at the 

University of California, Berkeley created the Fit Families Novela Series, 

a set of three videonovelas and three fotonovelas addressing Fit WIC 

topics in both English and Spanish. This allows Fit WIC to reach the 

three largest WIC populations in California, the Latino, White, and 

African American communities. 

These bilingual materials depict realistic characters striving to create 

healthy snacks, limit their TV watching, and increase their physical 

activity. The California WIC State Agency distributed the video and 

fotonovelas to all of their local agencies (over 600 sites). The intent 

was to incorporate them into nutrition education classes for WIC 

participants throughout the state. 

National Fit WIC 

In 1999, the Food and Nutrition Service (FNS) at the United States Department of Agriculture launched 

Fit WIC, a three-year research and evaluation project, in five WIC Agencies: California, Kentucky, 

Vermont, Virginia, and the Intertribal Council of Arizona (ITCA). According to FNS, Fit WIC is “a collection 

of social-environmental strategies to promote healthy weight [and prevent obesity/overweight] among 

children enrolled in WIC.” The Fit WIC implementation manual contains more information about all of 

these initiatives, as well as lessons learned and recommendations. 


The California Fit WIC program administered a survey to all staff in order to assess “staff knowledge, 

practices, intervention ideas, and perceived barriers to implementation of programs to prevent 

overweight among WIC children.” The survey instrument was developed by the WIC State Agency, the 

University of California, Berkeley, and Samuels and Associates consulting group. 

The State Agency and Berkeley also administered a similar survey to WIC participants in order to assess 

the effectiveness of the Fit WIC project on WIC families. They compared survey findings from three Fit 

WIC intervention sites (Pico Rivera, Santa Paula, and Grand Avenue) and three control sites (Flower 

Street, Ventura, and County Main). The surveys were distributed in both English and Spanish. 


Survey results showed that the Fit WIC program was very effective in improving the nutrition and 

increasing the physical activity level of participants. Findings from both the staff and participant surveys 

are available on the California Fit WIC website. 

http://www.cdph.ca.gov/PROGRAMS/WICWORKS/Pages/WICNEFITWIC.aspx 

Resources 

The Fit WIC projects in all five Agencies were funded by $1.8 million in Federal funds from the United 

States Department of Agriculture, Food and Nutrition Service, under WIC Special Projects Grants. 

In addition, California Fit WIC received a $300,000 operational adjustment grant from the United States 

Department of Agriculture, Food and Nutrition Service Western Regional Office to develop a community 

garden. 




Latino, White, and Black/African American 

State WIC Participation by Race/Ethnicity 

78 percent Latino, 8 percent White, 5.5 percent Black/African American, 5 percent Asian/Pacific Islander, 

and 0.87 percent American Indian/ Alaska Native 

Websites 


www.wicworks.ca.gov/education/nutrition/FitWIC/FitWICIndex.htm 

The Fit Families Novela Series 

http://anrcatalog.ucdavis.edu/InOrder/Shop/ItemDetails.asp?ItemNo=3496 

New WIC Food Package Campaign 

Building on their Fit WIC project and other work, the California WIC agency created a comprehensive 

nutrition education campaign marketing the new WIC food package nutrition messages. 

http://ww2.cdph.ca.gov/programs/wicworks/Pages/WICNewFoodPackages.aspx 

Maximizing the New WIC Food Package 

The California WIC Association launched a strategic campaign to maximize the new WIC food package 

including a variety of materials that can be used in California and other states. 

http://www.calwic.org/ 


Monique Stovall 

Chief Nutrition Education, Marketing and Outreach Section 

California Department of Public Health-WIC Program 

P.O. Box 997375 

West Sacramento, CA 95899-7375 

(T) 916 928-8604 

Monique.Stovall@cdph.ca.gov 


Incorporating Traditional Foods and Recipes 

into Nutrition Education 

Navajo Nation WIC has a comprehensive nutrition education program in both Navajo and English. 

Although the program is open to all WIC participants, it is specifically geared towards the Navajo. In 

turn, nutritionists incorporate information about traditional foods and recipes into nutrition education 

classes. They also provide nutrition education to children because, as in many other areas in the United 

States, child obesity is a major concern on the reservation. 

Agency Name 

Navajo Division of Health, Navajo Nation WIC Program 


Incorporating Traditional Foods 

You have to really 

involve the client and get 

them to identify their 

own goals. You can’t 

just lecture.” 

-Doris McGuire 

When appropriate to the geographic location and 

topic, the Navajo Nation WIC Program incorporates 

traditional foods into nutrition education lesson 

plans. For instance, during the session on anemia, 

nutritionists discuss the recipe for making the 

traditional food blue corn mush, which is very high 

in iron. Similarly, during Five-A-Day month in 

September, Navajo Nation WIC distributes a 

handout on traditional fruits and vegetables, such as 

lychee, sumac berries, and yucca fruit. In addition, 

traditional recipes for Navajo cake, shape blue corn 

bread, and chiilchin berry pudding, among others, 

are made available in the clinic waiting room. 

Recipes using WIC foods to make snacks for kids 

are also available in an effort to encourage 

participants to use all of their WIC foods. 

Nutrition Education for Children 

In addition to nutrition education for adults, the Navajo Nation WIC Program also conducts nutrition 

education sessions for children on a monthly basis. They specifically target kids between the ages of 

three and five years old, many of whom are at risk for overweight (11%). This initiative is based on 

classes developed by the Fit WIC Inter Tribal Council of Arizona (ITCA) project, which involved children in 

reading stories about nutrition, preparing healthy snacks, and engaging in physical activities. In addition, 

Navajo Nation WIC uses SPARK (Sports, Play, and Active Recreation for Kids) activities to engage children 

in nutrition education and physical activity. 

Addressing Language Barriers 

Nutrition education sessions are usually conducted in English. However, in more isolated areas where 

English is not spoken by all participants, Navajo is used. 


The Navajo Nation WIC Program administers annual surveys assessing participant satisfaction with 

nutrition education, as well as customer service, the food package, their grocery store experience, 

parking, and clinic wait time, among other issues. 


Some of the challenges in nutrition education include lack of participant involvement, lack of participant 

access to transportation (which often results in missed appointments), and nutritionists not having 

enough time to conduct sessions. 


Some of the solutions adopted to address the lack of participant involvement in nutrition education 

include requiring participants to establish one nutrition goal with a paraprofessional before seeing the 

nutritionist; asking participants questions during classes; empowering participants to express their needs; 

and encouraging WIC staff to listen to them. 

Resources 

Navajo Nation WIC uses Nutrition Services funds from the United States Department of Agriculture, Food 

and Nutrition Service to support these initiatives. 


Navajo and English 


Navajo, Latino, and White 


Adele King 

WIC Program Manager 

Navajo Division of Health 

Navajo Nation WIC Program 

P.O. Box 1390 

Window Rock, AZ 86515 

(T) 928-871-6698 

aking@navajowic.org 

“For my son, I just want to find 

out all the information that I 

need for him to grow up healthy 

without ever getting into junk 

food and stuff.” 



Motivational Interviewing Counseling Techniques 


The District of Columbia WIC (DC WIC) State Agency is 

implementing a comprehensive multicultural nutrition education 

strategy with the goal of changing the health and nutrition 

behaviors of African American and Latino children between the 

ages of two and five. 

The strategy has two phases: a pilot phase during which 

motivational interviewing nutrition education techniques will be 

pilot-tested in selected WIC clinics and an implementation phase 

during which the pilot’s successful components will be 

implemented in all DC WIC clinics. 

Project Name 

Impact of Motivational Interviewing Counseling Techniques on 

Health and Nutrition Behaviors in Urban Multi-Ethnic WIC 

Participants 

Agency Name 

DC Department of Health, WIC State Agency 

Motivational Interviewing 

Motivational interviewing is a participant-centered counseling 

tool that aims to elicit behavior change. By using motivational 

interviewing in nutrition education, DC WIC seeks to change the 

nutritional habits of African American and Latino children 

between the ages of two and five. The project targets 

children’s moms, guardians, and other primary caretakers and 

provides them with nutrition education on five child nutrition 

topics: (1) increasing consumption of fruits and vegetables; (2) 

decreasing consumption of fast foods; (3) decreasing 

consumption of sugary beverages; (4) increasing physical 

activity; and (5) decreasing TV watching. 

Phase One: Pilot-Testing 

DC WIC launched a three-year motivational interviewing pilot involving seven clinics. Two clinics replaced 

their traditional nutrition education with motivational interviewing (Mary’s Center for Maternal and Child 

Care and DC General Hospital). Two others (Upper Cardozo Clinic and Children’s Health Center at Good 

Hope Road) adopted “motivational interviewing plus.” The “motivational interviewing plus” format 

consists of motivational interviewing nutrition education combined with a traditional nutrition education 

activity, such as a group session or mailing. The pilot also included three control sites using current 

nutrition education methods (Marie Reed Clinic, Adams Morgan Clinic, 

“The states that have 

already done motivational 

interviewing pilots have 

been very open about 

sharing their resources.” 

-Evalyn Carbrey 

and Howard University Hospital). 

“DC WIC held focus groups with 

WIC nutritionists before launching 

the study. They spoke about how 

they wanted more client input and 

participation, and how helping 

clients find the desire to change 

from within would lead to 

healthier behaviors.” 

-Evalyn Carbrey 

Training for the nutritionists in the four clinics implementing 

motivational interviewing nutrition education techniques began with a 

two-day workshop led by motivational interviewing expert Ken 

Resnicow, Professor of Health Behavior and Health Education at the 

University of Michigan, School of Public Health. 


Targeting African American and Latino 

Children 

The pilot specifically targets Latino and African 

American WIC participants, the two largest WIC 

populations in DC. One motivational interviewing 

and one “motivational interviewing plus” pilot clinic 

(Mary’s Center and Upper Cardozo) are 

predominately Latino, while the two others (DC 

General Hospital and Good Hope Road) are 

predominately African American. The goal of the 

pilot is to see if motivational interviewing is more 

effective in one group over the other. 

Phase Two: Implementation 

If the pilot is successful, the nutritionists trained 

during the pilot will help train all other WIC 

nutritionists in DC. In addition, the State Agency will develop a motivational interviewing training manual 

and tool kit for nutritionists in other states to use. Similar motivational interviewing pilots have been 

conducted in North Dakota and Nebraska. 


A piloted evaluation questionnaire will be given to all moms, guardians, and primary caretakers who wish 

to participate in the study. Participants will be recruited from all seven sites. In addition, the State 

Agency will conduct a cost-benefit analysis of motivational interviewing and “motivational interviewing 

plus.” 


Although they are still in the early stages of the project, the DC WIC State Agency has already learned 

several valuable lessons while conducting the motivational interviewing pilot. First, they learned that in 

order for motivational interviewing to be successful, it is necessary that the nutritionists implementing the 

technique speak the same language as participants. If not, a translator would be useful in decreasing 

language barriers. In addition, although the grant targets children between the ages of two and five, 

staff still needs to meet the needs of the other children who come into the pilot clinics, which is often a 

challenge. 

Resources 

In FY 2005, the DC WIC State Agency received a three-year Special Project Grant ($130,000) from the 

United States Department of Agriculture (USDA), Food and Nutrition Service (FNS) to pilot motivational 

interviewing in DC. The initiative is also supported by a $10,000 General Mills grant, which funds the 

additional nutrition activities used in the “motivational interviewing plus” pilot clinics. States interested in 

this initiative could also use training funds from their regular WIC budget (Nutrition Services and 

Administration funding) to train nutritionists in motivational interviewing. 




Black/African American, and Latino 


Motivational Interviewing Pilot Participation Data by Race/Ethnicity 

Motivational interviewing pilot clinics: 

• Mary’s Center for Maternal and Child Care 

• 75% Latino 

• 21% Black/African American 

• DC General Hospital 

• 99% black/African American 

• 1% Latino 

“Motivational interviewing plus” pilot clinics: 

• Upper Cardozo Clinic 



• Children’s Health Center 


• 1% Latino 

Control clinics: 

• Children’s Hospital Marie Reed Clinic 



• Children’s Hospital Adams Morgan Clinic 



• Howard University Hospital 


• 4% Latino 

Website 

http://app.doh.dc.gov/services/wic/index.shtm 


Evalyn Carbrey 

Project Manager, Special Project Grants 

Nutrition Programs Administration 

WIC State Agency 

DC Department of Health 

2100 Martin Luther King Jr. Avenue, SE 

Suite 409 


(T) 202-645-5663 

(F) 202-645-0516 


Texas WIC 

In an effort to make nutrition education services accessible to families of all cultural and linguistic 

backgrounds, the Texas WIC program has adopted a comprehensive, multicultural approach to tackling 

language barriers and low literacy levels among WIC participants. 

For instance, all written and audiovisual nutrition education materials are available in both English and 

Spanish and up to 20% are also available in Vietnamese. In addition, nutrition education materials, such 

as fact sheets, pamphlets, and brochures, are all written at a 5 th to 6 th grade literacy level. 

The Texas WIC State Agency oversees a range of projects targeting diverse populations throughout the 

state. This case study highlights three models that successfully address the specific needs of various 

racial, ethnic, cultural, and linguistic communities in Texas. They include: 

• the African American Breastfeeding Initiative, 

• nutrition education partnerships with other groups and agencies, and 

• a local agency obesity prevention project for Latino children: “From the Food Guide Pyramid to 

Cooking Practices in Your Kitchen”. 

Project Name 

African American Breastfeeding Initiative 

Agency Name 

Texas Department of State Health Services, WIC Nutrition Services 


In 2003, the Texas WIC program developed an African American 

Breastfeeding Initiative based on national and Texas WIC research 

regarding infant feeding attitudes and beliefs among African 

American families. The goal of the project was to raise awareness 

about breastfeeding and increase the breastfeeding rates among 

African American WIC participants in Texas. 

By working with an advertising agency, Texas WIC produced a 

range of social marketing materials that promote breastfeeding, 

including brochures, posters, radio spots, a TV commercial, outdoor 

spots, and newspaper columns. These materials targeted pregnant 

women, moms, dads, partners, grandparents, health care 

providers, and the general public. 

The Texas WIC program also developed a logo for the campaign, which later became the statewide 

breastfeeding brand. The project was piloted from January to September 2004 in South East Texas and 

implemented statewide in 2005. The campaign’s media component has run for three consecutive years 

and is scheduled to end in August 2006. All other components of the campaign are permanent. 


The Texas WIC program contracted with SUMA/Orchard Social Marketing, Inc. to evaluate the project’s 

effectiveness. They found that the initiative was very popular with all participants and that radio spots 

were especially successful in reaching young moms. They also identified that outreach to churches was 

particularly useful for getting older community members involved in the initiative. 

In addition, post-campaign interviews revealed an increased awareness of the benefits of breastfeeding 

among African American women involved in the project. Similarly, many health care providers and WIC 

staff reported fielding more questions about breastfeeding from African American participants. Many 


noted that the most significant change in attitude came from teen moms who had previously shown little 

interest in breastfeeding. Furthermore, breastfeeding rates in two local agencies increased and a hospital 

lactation support program was implemented as a result of this initiative. 

The Texas WIC program is very willing to help other WIC Agencies interested in implementing an African 

American breastfeeding campaign in their state. All print and audiovisual materials are available online for 

duplication free of charge. 

Resources 

In order to fund the African American Breastfeeding Initiative, the Texas State Agency requested an 

operational adjustment grant from the United States Department of Agriculture, Food and Nutrition 

Service Southwest Regional Office. They submitted a brief description of their project, as well as midyear 

and end-of-year reports. 


Materials for the African American Breastfeeding Initiative were 

produced in English. All other breastfeeding materials are also 

available in Spanish and a few are printed in Vietnamese. 


Black/African American 

Website 

www.dshs.state.tx.us/wichd/bf/african_americanbf.shtm 


Tracy Erickson 

Breastfeeding Coordinator 

WIC Nutrition Services 

Texas Department of State 

Health Services 

1100 West 49th Street 

Austin, TX 78756-3199 

(T) 512-458-7444 

tracy.erickson@dshs.state.tx.us 


Project Name 

Nutrition Education Partnerships 

Agency Name 

Texas Department of State Health Services, WIC Nutrition Services 


The Texas WIC program has partnered with various groups and agencies to develop high-quality nutrition 

education materials, including a video on dental care with the Oral Health Program at the Texas 

Department of State Health Services and the Zowzoo fitness video for kids with the University of Texas at 

Austin. This bilingual video presents information in both English and Spanish, allowing the WIC program 

to reach the three largest WIC populations in Texas, notably Latinos, Whites, and African Americans. 

Participants take the Zowzoo video home to use with their children and fill out a survey and evaluation 

for WIC. A classroom version of the video is also available for use during nutrition education group 

sessions. In addition, Texas WIC made a cooking video, which features recipes and chefs from the 

Sustainable Food Center in Austin. 

In preparation for implementing the new food package Texas WIC mailed health care providers and other 

WIC partners across the state selected materials related to the new food package including a 16 page 

brochure, Your Guide to WIC Foods. Health Care providers also received an educational DVD with details 

about the new WIC food package. 

Among other initiatives to increase access to services for working women, the Texas WIC program has 

developed a series of home-based nutrition education and fitness activities. A highlight is the internetbased 

nutrition education on TexasWIC.org. The website includes lessons on pregnancy, food safety, 

physical activity, smart snacking, and breastfeeding. New lessons have just recently been added to 

educate WIC participant about the new WIC food packages. These lessons include Moove to Low-Fat 

Milk, Cooking with Fruits and Vegetables, New Food Package and the Importance of Exclusively 

Breastfeeding in the First Month, and Whole Grains. All lessons are available in both English and Spanish. 


All Texas WIC nutrition education lessons and classes have oral or written evaluations completed by WIC 

participants. For other special projects, the WIC program contracts with various agencies to conduct 

both qualitative and quantitative evaluations. 

Resources 

In order to provide nutrition education, the Texas WIC program uses nutrition education funding from the 

Nutrition Services funds administered by the United States Department of Agriculture, Food and Nutrition 

Service. 


English, Spanish, and Vietnamese 

Populations Served Website 

Latino, White, Black/African American, and Vietnamese www.dshs.state.tx.us/wichd/nut/nut1.shtm 


Project Name 

From the Food Guide Pyramid to Cooking Practices in Your Kitchen 

Agency Name 

Cameron County Department of Health and Human Services, 

WIC Program 


In June 2006, the Texas WIC State Agency administered obesity 

mini-grants to 19 of the 22 local agencies that applied. The 

grants provide $1,000 to $15,000 from June 2006 to September 

2006, with the possibility of being extended or renewed. 

A notable mini-grant project is being implemented by the 

Cameron County Department of Health and Human Services 

Brownsville area WIC clinics. Their “Desde la Guia de la 

Piramide Hasta Su Cocina” (“From the Food Guide 

Pyramid to Cooking Practices in Your Kitchen”) initiative 

targets overweight Latino children and their families. A series of 

twelve classes, all taught in Spanish, address issues related to 

obesity prevention and healthy food preparation. Topics include 

the Food Pyramid; the importance of physical activity and 

inexpensive ways to exercise; understanding food labels; making 

the most of a limited food budget; and maintaining a healthy life 

balance. The classes use a combination of previously developed WIC and ENP materials. They are held 

twice a week and in the evenings in order to accommodate working parents. 


All grantees are expected to conduct a formal evaluation of the project and present their findings in a 

poster at the Nutrition and Breastfeeding Annual Conference. 

Resources 

In order to fund the obesity mini-grants, the Texas State 

Agency requested an operational adjustment grant ($200,000 

in FY06) from the United States Department of Agriculture, 

Food and Nutrition Service Southwest Regional Office. 


Spanish 


Latino children 

Website 

www.co.cameron.tx.us/health/wic.htm 

“All of the grant project ideas 

came from local agencies. But we 

also talked to leaders in the 

community to understand what 

the needs were.” 

-Amanda Hovis 


Amanda Hovis 

Nutrition Education Consultant 

WIC Nutrition Services 

Texas Department of State Health Services 

1100 West 49th Street 

Austin, TX 78756-3199 

(T) 512-458-7111 x3411 

Amanda.hovis@dshs.state.tx.us 


Veggin’ Out 

Since 1998, chefs from Johnson and Wales University (JWU) have worked with the Rhode Island 

Department of Health and the Rhode Island Department of Environmental Management to put on 

bilingual cooking demonstrations at ten WIC Farmers’ Market Nutrition Program (FMNP) sites throughout 

Rhode Island in July and August. During each two-hour cooking demonstration, JWU chefs showcase 

four creative yet simple recipes, all made with fresh vegetables from the markets. A translator, provided 

by WIC, ensures that the sessions are conducted in both English and Spanish and accessible to both the 

English-speaking and Spanish-speaking communities in Rhode Island. 


Nutritionist from both JWU and WIC are always present to highlight the nutritional content of each recipe 

and answer any nutrition questions from the audience. Nutrition education is fully integrated into the 

demonstrations and seeks to promote participant involvement. The nutritionists cover the benefits of 

local produce, including freshness and supporting local farmers. 

“We look for interactive 

ways to add nutrition 

education into our cooking 

demonstrations. We may 

ask people “Why are beans 

good for you?” or ask kids 

to volunteer to help. 

-Linda Kane 


At the end of each farmers’ market season, JWU and WIC meet to 

discuss any problems and brainstorm solutions for the following 

year. In addition, WIC follows up with program participants for 

feedback. Some of the challenges include strict Health Department 

standards regarding the proper handling of food in an outdoor 

venue. Yet another challenge arises when participants want to 

follow-up with chefs about the cooking demonstrations, but only 

one translator is on-hand. One solution would be having multiple 

translators or bilingual chefs. 

All audience members receive a Veggin’ Out Cook Book, printed in 

English and Spanish. The Cook Book includes 20 simple recipes, all 

made with fresh fruits and vegetables, as well as nutrition 

information for each recipe. In addition, WIC and JWU raffle off gift 

bags filled with kitchen utensils, two $5 farmers’ market gift 

certificates, storybooks entitled “Vegetable Friends,” and a Veggin’ 

Out T-shirt. 

The Feinstein Community Service Center at JWU and the Rhode 

Island WIC program have graciously offered to provide assistance to 

those interested in replicating this project in their state. Veggin’ Out 

cook books are available free of charge upon request. 

Language can be a 

barrier. But we strive to 

make people feel 

comfortable enough to 

ask questions, regardless 

of what language they 

speak.” 

-Linda Kane 

Resources 

JWU and WIC meet every April to discuss the Veggin’ Out budget. WIC pays for the printing and 

translation of the cook books, the gift bags, and the translator. These services are funded through WIC 

Farmers’ Market Nutrition Program (FMNP) money (if available) or the nutrition education budget. 

Chefs from JWU use money from the University’s United Way DownCity fund to buy vegetables from the 

farmers ($30 per market; $500 for the entire season). Other necessities, such as cooking staples and 

utensils, are also included in that budget. JWU suggests that those interested in replicating the project in 

their state could ask farmers to donate produce at first; however, they recommend eventually 

establishing a permanent food budget. 





White, Latino, Black/African American, Asian/Pacific 

Islander, Portuguese, and Cape Verdean 

WIC Participation by Race/Ethnicity 

White: 44.1% 

Latino: 37.2% 

Black/African American: 14.4% 

Asian/Pacific Islander: 3.8% 

American Indian/Alaskan Native: .4% 

Website 

www.health.ri.gov/family/wic/veggin.php 


Linda Kane 

Community Service Chef 

Feinstein Community Service Center 

Johnson and Wales University 

8 Abbott Park Place 

Providence, RI 02903 

(T) 401-598-1323 

(F) 401-598-1277 

Linda.kane@jwu.edu 

Ann Barone 

WIC Client Services Manager 

WIC Program 

Rhode Island Department of Health 

3 Capitol Hill Room 302 

Providence, RI 02908 

(T) 401-222-4623 

(F) 401-222-6548 

Ann.barone@health.ri.gov 


Weigh of Life…Taking Action Together 

In 2001, the Massachusetts WIC Nutrition Program was 

awarded a USDA Special Project Grant entitled, “Cultural 

Perspectives on Childhood Overweight Among Hispanic 

WIC Participants in Massachusetts.” The grant was used to 

fund a project with the overall goal to strengthen the 

ability of Massachusetts WIC program staff to provide 

culturally sensitive services that promote healthy eating 

behaviors, particularly for Dominican and Puerto Rican 

children, among whom the problem of overweight is 

particularly acute. 

Project Name 

Weigh of Life...Taking Action Together 

Agency Name 

Massachusetts Department of Public Health, WIC Nutrition 

Program 


The project began with the collection of anthropometric 

and body composition measurements of approximately 

400 Hispanic children and the facilitation of 24 focus 

groups with WIC mothers to identify the cultural beliefs that affect what mothers believe constitutes 

healthy body weight and influence the dietary behavior of children. The results of the focus groups were 

used to identify culturally sensitive key themes related to health. The themes were used to develop 

educational messages and materials for WIC staff and healthcare providers to enhance their efforts to 

prevent childhood overweight. 

The culmination of the project was the development of the Weigh of Life...Taking Action Together 

initiative. The initiative included the development of emotion-based educational messages, a program 

implementation manual for WIC nutrition counselors, and a provider toolkit. 

Key Messages 

The initiative focused on six emotion-based messages for Hispanic families based on the focus group 

findings that addressed the cultural beliefs and assumptions of Hispanic families surrounding weight and 

dietary practices. Emotion-based messages focus on universal health points that trigger behavior change. 

These messages were: 

• A slender looking child is a healthy child. 

• Developing good eating habits makes a lifelong difference. 

• Eat together as a family. 

• Offer your child a variety of foods instead of a steady diet of milk and juice. 

• Mom knows what is best for her child. 

• Mothers will be surprised that children enjoy eating healthy foods- this will make mothers happy. 

Both wall-sized and miniature posters were developed in English and Spanish to convey each of the six 

key messages. The wall posters were produced for display in health care providers’ offices and the miniposters 

were produced for use by WIC nutritionists during counseling sessions. In addition, a child-sized 

placemat was developed to communicate a seventh targeted message that child-sized servings provide all 

the nutrients necessary for growth. 


Project Implementation Manual 

A project implementation manual was developed as a resource and training tool for WIC staff. The 

manual included: 

• Key findings from the WIC participant focus groups. 

• Strategies to successfully coordinate and collaborate with health care providers to provide 

consistent messages about dietary habits and healthy body weight to Hispanic families. 

• Introduction on a new culturally sensitive nine-step approach to discussing a child’s weight with 

families. 

• Nutrition education materials. 

Physician Tool Kit 

A provider took kit was developed to foster successful partnerships with health care provider to deliver 

consistent positive messages about weight and dietary practices to Hispanic families. The tool kit was 

distributed by WIC nutritionists on personal visits to physicians and other health care personnel. The tool 

kit includes the following materials: 

• Steps to Healthy Weight in Children: a guide to providing standardized, age-appropriate nutrition 

messages to Hispanic families and children. 

• A CD containing electronic versions of the nutrition education materials for health care providers 

to use. 

• A mock prescription pad, “Prescription for Your Healthy Child”, allowing physicians to “prescribe” 

diet and physical activity changes and refer parents to the nearest WIC office. 


All local WIC agencies were responsible for delivering the physician’s tool kits to health care providers in 

their area. After the tool kits were delivered the state agency made follow-up calls to the providers. The 

call revealed that of the physicians that utilized the toolkit materials about 60% displayed the wall posters 

in their offices and about 20% were using the tool kits to help facilitate discussions about body weight 

with families. 

The focus groups revealed two important issues that the initiative addressed. The first was that WIC’s 

health messages, based mostly on logic and facts, were not resonating with WIC mothers. WIC found 

behavior change is more likely to happen when WIC counselors speak to people’s feelings and highlight 

the emotional benefits of taking action in addition to providing facts. The focus groups also revealed that 

WIC and the medical community were not delivering consistent messages to Hispanic families which led 

Massachusetts WIC to realize the importance of collaborating with health care providers. 


The focus group results made it apparent that is was important for Massachusetts WIC to improve their 

delivery of health messages. Based on the finding of the focus group WIC developed an untraditional 

approach to nutrition education that focused on emotions rather than logic and fact alone. WIC’s 

emotion-based approach to counseling uses messages and materials that highlighted the emotion-based 

benefits of making health eating and activity changes in addition to the logical, rational benefits of taking 

action. Through the implementation of the Weigh of Life…Taking Action Together Initiative it became 

apparent that the emotion-based messaging could be applied to all WIC clients and in 2003 they began 

the Touching Hearts….Touching Minds project. Massachusetts WIC was awarded a second USDA grant, 

and conducted additional focus groups to identify what emotions drove mothers behaviors and integrated 

these emotional “pulse points” into 30 nutrition education messages. Massachusetts WIC now uses 

emotion-based materials and counseling to touch people’s hearts first and then provide factual 

information to act on. 


Resources 

The Weigh of Life…Taking Action Together Initiative was funded by a USDA Special Project Grant 

entitled, “Cultural Perspectives on Childhood Overweight Among Hispanic WIC Participants in 

Massachusetts.” 




Dominican and Puerto Rican 

Website 

www.mass.gov/wic 

The nutrition education materials are available 

on the Touching Hearts Touching Minds website 

http://www.touchingheartstouchingminds.com/index.php. 


Rachel Colchamiro 

Acting Director, Nutrition Services and 

WIC Breastfeeding Coordinator 

MA Department of Public Health 

250 Washington Street 

Boston, MA 02108 

(P) 617-624-6153 

Rachel.Colchamiro@state.ma.us 


WIChealth.org 

Agency Name 

Michigan Department of Community Health, WIC Division 


The WIChealth.org website project delivers high quality 

web-based education on nutrition and physical activity 

to WIC participants. It is a partnership between the 

Michigan WIC State Agency, WIC State Agencies in 

several other states (Delaware, Illinois, Indiana, 

Minnesota, Ohio, North Carolina Utah, Washington, and 

Wisconsin), and Western Michigan University. The 

website provides interactive, learner-centered nutrition 

education to WIC participants in all of the partner states. 

Project Name 

Nutrition Education for the Internet Project 

“This is a great example 

of a partnership between 

WIC and a university.” 

-Judith Anderson 


In an effort to be accessible to families of diverse linguistic 

backgrounds, the website is available in English and Spanish and will possibly be translated into Arabic 

and Chinese as well. The wording is kept simple in order to be accessible to participants of all literacy 

levels. 

Increasing Access for Working Families 

In addition, the website increases access to nutrition education for working families. It allows 

participants who cannot attend nutrition education classes because of work, school, or lack of 

transportation to get nutrition education at home or during breaks at work. In addition, many WIC 

participants lack child care and are often forced to bring their children to nutrition education classes. This 

can be distracting for all participants in attendance and the website allows participants to complete their 

nutrition education requirement in their own time and without worrying about their children. 

Nutrition Education Modules 

The project’s steering committee, which is comprised of representatives from all seven WIC State 

Agencies, develops online nutrition education modules based on participant needs and interests. The site 

currently includes ten modules, each covering a different child nutrition topic, including: 

• child feeding (“Create Good Eating Habits in Your Child”), 

• breastfeeding (“Support for Breastfeeding Moms”), and 

• physical activity (“Happy, Healthy, Active Children”). 

Fruit and vegetable modules have just recently been added to the website to educate WIC participants 

about the changes to the WIC food package. 

The modules are based on the stages of change theory developed by Dr. Robert Bensley at Western 

Michigan University (www.cdc.gov/PCD/issues/2004/oct/pdf/04_0070.pdf). Participants choose a module 

and answer a set of questions that places them in one of the five stages of change: (1) precontemplation; 

(2) contemplation; (3) preparation; (4) action; and (5) maintenance. Based on their 

stage of change, participants are provided with stage-specific nutrition education addressing their chosen 

topic. They are given easy and practical action steps to help them reach their behavior change goals. 


“Happy, Healthy, Active Children” 

For example, in the physical activity module “Happy, Healthy, Active Children,” participants are 

asked if their child undertakes planned and/or unplanned physical activities, such as walking, bike riding, 

dancing, and active games. Participants who answer “no” are reassured that they are not alone. 

Respondents are then asked if they have an interest in someday changing their child’s lack of physical 

activity. Those who answer “yes” are then asked if they are willing to do so in the next few days. 

Possible responses include “yes” and “I’m not sure.” Participants who answer the latter are asked what 

barriers stand in their way. A few of their options include TV watching, lack of time, and lack of ideas 

about active games for their child. If participants select “TV watching,” they are provided with a simple 

factsheet about how to turn off the TV and increase physical activity. 


The steering committee has quarterly, mid-year, and yearly 

evaluation results assessing the website’s effectiveness from 

2002 to 2008. The yearly 2008-2009 evaluation results are 

forthcoming. The website includes a feedback page, and 95 

percent of all participant responses to date have been 

positive. The 2008-2009 six month evaluation provides 

important information about the project’s challenges as well 

as ways in which the web education can be improved. 


In addition to a high level of user satisfaction, the evaluation results show 65.6 percent of Wichealth.org 

user were in the maintenance stage of behavior change. These results are not consistent with previous 

knowledge of the population. This inconsistency may be the result of response bias associated with the 

yes/no staging questions used to categorize user into stages of change and WIChealth.org has begun 

replacing yes/no staging questions with multiple choice questions to ensure accuracy in stage 

assignment. Accurate staging will improve the likeness of users showing behavior change progression. 

The inconsistency may also be the results of low website usage among clients in the pre-contemplation, 

contemplation, and action phases. It may be necessary to implement strategies to attract WIC clients in 

earlier stages of change to access the website and 

“Thank you for the 

opportunity to take this 

class in my own time 

without interference from 

my children.” 


“One of the main challenges 

is getting local WIC agencies 

to promote the Internet. 

When they don’t think 

participants have access, we 

do a survey to see if they 

do.” 

-Judith Anderson 

The evaluation results shows that among users in the precontemplative 

stage 45.4 percent advanced to the action phase by 

the end of their session and that 92 percent of users who began in 

the action or maintenance phase indicated they could make changes 

using what they learned. These results demonstrate that 

Wichealth.org is effective in promoting health behavior and 

continued use and further expansion to other states is 

recommended. 

While Wichealth.org is effective in promoting behavior change amongst most users some still report 

resistance to change. Most users reporting unwillingness to make changes based on what they learned 

report that the information covered was not applicable to them at that time. These results suggest that it 

may be necessary to use screening questions to recommend appropriate modules for users based on 

their current needs. 

Spanish language module users did not rate the usability of WIChealth.org as highly as English language 

users. While 78 percent of English language module users indicated that WIChealth.org was their favorite 

way to receive nutrition education fewer of the Spanish language module users felt the same way. Sixty 

three percent Spanish language module users indicated they prefer class or group session nutrition 

education at a WIC clinic. These results indicate that it may beneficial to develop interactive tool on 

WIChealth.org to promote a sense of community and facilitate social networking. 


Resources 

The website’s initial start-up costs were supported by an 

operational adjustment grant requested from the United States 

Department of Agriculture, Food and Nutrition Service Midwest 

Regional Office. Six of the Midwest States (Illinois, Indiana, 

Minnesota, Ohio, Michigan, and Wisconsin) collaborated in the 

development and pilot-testing of the project, with the WIC 

Division of the Michigan Department of Community Health 

serving as the lead agency. 

Currently, all ten states contribute money to keep the website up 

to date and make translations as needed. The project received a 

special project grant from USDA to add the new fruit and 

vegetable modules. The website is maintained and updated by 

Dr. Bensley’s staff at Western Michigan University. 


English and Spanish; Possibility Arabic and Chinese in the future 


White, Black/African American, and Latino 

WIC Participation by Race/Ethnicity 

White: 57.7% 

Black/African American: 28.5% 

Latino: 11.6% 

Asian/Pacific Islander: 1.5% 

American Indian/Alaskan Native: 0.7% 

Website 

www.wichealth.org 

“I love being able to do this 

online, it saves me time, and if 

my son is sick, I don’t need to 

worry about him making other 

people sick. Also, I don’t need 

to worry about a need for a 

sitter, as well as him getting 

bored or if he is crabby.” 



Judith Anderson 

Manager, Nutrition Services Unit and 

WIC Nutrition Coordinator 

Nutrition Program and Evaluation 

WIC Division 

MI Department of Community Health 

320 South Walnut 

Lansing, MI 48913 

(T) 517-335-8957 

(F) 517-335-8835 

andersonjv@michigan.gov 


National WIC Survey

National WIC Survey 

Findings from the Food Research and Action Center’s WIC Directors’ Survey provide important insight into 

ongoing efforts to increase access to services by conducting outreach, and providing nutrition education 

and referrals to WIC participants of all cultural backgrounds. The survey had a very good response rate: 

a total of 68 completed surveys were received, including 47 surveys from states and territories and 21 

surveys from Indian Tribal Organizations (ITOs). 

Outreach 

Outreach is an important tool for decreasing access barriers and promoting participation in the WIC 

program by eligible families. The large majority of WIC State Agencies and ITOs (85%) undertook 

outreach efforts to raise awareness about WIC and increase participation in the program. More 

specifically, 82 percent of State Agencies conducted outreach in their state and 75 percent of ITOs lead 

outreach initiatives in their area. 

Targeting Hard to Reach Populations 

80 

60 

40 

20 

0 

Certain populations are harder to reach than others, and therefore harder to enroll in the program. Many 

WIC State Agencies and ITOs (55%) tackled this problem by conducting outreach targeting hard to reach 

populations in their state, including working women (69%) and women, infants, and children who speak 

a language other than English (69%). Other populations targeted by State Agency and ITO outreach 

campaigns included women, infants, and children of underserved racial and ethnic groups (50%), 

women, infants, and children in migrant families (41%), and immigrant families (38%). State Agency 

and ITO directors also mentioned reaching out to grandmothers and persons experiencing homelessness 

as part of their outreach efforts. 

Hard to Reach Populations Targeted by Outreach (%) 

Working 

Families 

Immigrant 

Families 


In order to reach families of diverse cultural 

and ethnic backgrounds, many WIC State 

Agencies design outreach initiatives that 

address the specific language and cultural 

needs of the different communities in their 

state. Of those with language initiatives, 

Spanish was the most frequently used 

language for outreach by State Agencies 

(100%), followed by Vietnamese (26%), 

Chinese (20%), Somali (17%), and Arabic 

Specific 

Racial/Ethnic 

Groups 

100 

90 

80 

70 

60 

50 

40 

30 

20 

10 

0 

Spanish 

Speak a 

Language 

Other than 

English 

Migrant 

Families 

Other 

Languages Other Than English Used for Outreach by State 

Agencies (%) 

Russian 

Haitian Creole 

Vietnamese 

Cambodian 

Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education 46 

Hmong 

Laotian 

Thai 

French 

Panjabi 

Portuguese 

Somali 

Chinese 

Arabic

(11%). Other less frequently used languages included Russian, Haitian Creole, Cambodian, Hmong, 

Laotian, Thai, and Portuguese (9%). ITOs reported conducting outreach in English, Spanish (63%), and 

Native American languages (38%). 

Outreach Strategies 

State Agencies and ITOs use various strategies to conduct outreach and many adopt comprehensive 

plans that combine a number of methods. For both State Agencies and ITOS, distributing brochures and 

pamphlets was the most frequently used outreach strategy (95%). Partnering with the State Medicaid 

office was also a popular outreach method (65%), followed by partnering with the Supplemental Nutrition 

Assistance Program (formerly known as the Food Stamp program) (63%), advertisements (54%), Public 

Service Announcements (PSAs) (49%), partnering with the TANF office (49%), and working with food 

banks (42%) and anti-hunger organizations (40%). Other strategies to reach WIC eligible families 

included press releases (47%), the National WIC Association’s Ad Campaign (37%), and partnering with 

religious congregations or groups (30%). Other effective outreach methods mentioned by State Agency 

and ITO directors included partnering with the local Head Start program, collaborating with private 

physicians, and launching a direct mail campaign targeting potential WIC participants. 

State Agencies and ITOs indicated that the four most effective outreach strategies were: 

• word of mouth, 

• the media, 

• partnering with other government agencies and/or local groups, and 

• working with health care providers. 



In an effort to make nutrition services accessible to families of diverse cultural backgrounds, WIC 

programs throughout the United States offer nutrition education in a range of languages. Other than 

English, Spanish was the most popular language for nutrition education, with 96 percent of WIC State 

Agencies indicating its use. The next most often used language by State Agencies was Vietnamese 

(28%), followed by Cambodian (20%), Chinese (17%), Russian (17%), Laotian (15%), Somali (15%), 

and Arabic (15%). Other less frequently used languages included Hmong (11%), Thai (9%), Haitian 

Creole (7%), French (7%), Panjabi (7%), and Portuguese (7%). ITOs reported using English, Spanish 

(75%), and Native American languages such as Zuni and Lakota in their nutrition education sessions. 

100 

90 

80 

70 

60 

50 

40 

30 

20 

10 

0 

Spanish 

Russian 

Languages Other Than English Used for Nutrition 

Education by State Agency (%) 

Haitian Creole 

Vietnamese 

Cambodian 

Hmong 

Laotian 

Thai 

French 

Panjabi 

Portuguese 

Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education 47 

Somali 

Chinese 

Arabic 

Other

Nutrition Education Topics 

All WIC State Agencies and Indian Tribal Organizations (ITOs) covered fruit and vegetable consumption 

in their nutrition education sessions. This will be particularly useful in light of the new WIC food 

packages, which promote fruits and vegetables for women, infants, and children. 

In addition, all WIC State Agencies also covered physical activity and overweight/obesity. These sessions 

are particularly noteworthy since many communities are struggling with overweight and obesity, 

especially Latinos and Native Americans. Other topics often offered by State Agencies included 

breastfeeding education (100%), maternal and child health (96%), increasing calcium rich foods (94%), 

and understanding dietary guidelines and the Food Pyramid (91%). 

All ITOs addressed fruit and vegetable consumption and breastfeeding education, with maternal and child 

health (95%), increasing whole grain consumption (90%), and understanding dietary guidelines and the 

Food Pyramid (90%) being other popular topics. In addition, 85% of ITOs reported addressing physical 

activity in their nutrition education sessions. 

Nutrition Education Formats 

For both WIC State Agencies and ITOs, the most frequently used nutrition education format was printed 

materials, such as brochures, pamphlets, fact sheets, calendars, day planners, and food/activity diaries 

(99%). Other popular formats included one-on-one nutrition education counseling sessions (97%), as 

well as bulletin boards and other educational displays in the waiting room (89%). In addition, 82 percent 

of WIC State Agencies and ITOs reported showing nutrition education videos in clinic waiting rooms. 

More states are using web-based systems as a tool for WIC nutrition education: 26 percent have webbased 

interactive nutrition education, 26 percent have web-based nutrition materials, and 15 percent 

having web-based nutrition education in the waiting room. 

Access to Health Care and Social Services 

One of the WIC program’s essential functions is referring participants to other health care and social 

services. Survey results show that 97 percent of WIC State Agencies and ITOs required clinics to make 

specific health care referrals, including immunizations (94%); Medicaid (88%); prenatal, maternal, and 

pediatric care (82%); and dental care (48%).Similarly, 91 percent of State Agencies and ITOs required 

WIC clinics to make social services referrals, including Child Abuse and Neglect services (86%); the 

Supplemental Nutrition Assistance Program (formerly known as the Food Stamp program) (79%); TANF 

(68%); domestic violence programs (62%); and emergency food providers such as food pantries, food 

banks, churches, and other faith-based organizations (55%). 


Resources 


Outreach 

The Sustainable Outreach Toolkit, developed by the Oregon WIC State Agency, presents 

outreach strategies for local agencies to use. 

www.nal.usda.gov/wicworks/Sharing_Center/Sustainable_Outreach_Tool_Kit_OR.pdf. 

The North Carolina WIC program developed the “WIC Outreach: Guidelines for Building 

Media Relations” guide to help local agencies seize media opportunities. 

www.nal.usda.gov/wicworks/Sharing_Center/NCmediaguidelines.pdf. 

“Outreach Campaign: Checklist for Local WIC Agencies,” also developed by North 

Carolina WIC, provides local agencies with outreach strategies, including information on reaching 

various racial, ethnic, and cultural communities. 

www.nal.usda.gov/wicworks/Sharing_Center/NCoutreachandreferralchecklist.pdf. 

The Office of Minority Health at the United States Department of Health and Human Services 

has a factsheet that helps outreach workers connect communities of color to health services. 

www.omhrc.gov/assets/pdf/checked/Linking%20Minorities%20to%20Health%20Services- 

Successful%20Strategies%20for%20Outreach%20Workers.pdf. 

The WIC Works Resource System provides information about WIC and service tools for 

nutrition professionals. www.nal.usda.gov/wicworks. 

The Institute for Social Research identified strategies for the California WIC program on how 

to reach underserved populations, including diverse racial/ethnic communities. Their findings are 

presented in “Reaching the Underserved and Improving WIC Services,” 2001. 

www.wicworks.ca.gov/research/ExecutiveSummary2001.pdf. 


The Food and Nutrition Information Center at the National Agriculture Library developed a 

“cultural and ethnic food and nutrition education materials” resource list for educators. 

www.nal.usda.gov/fnic/pubs/bibs/gen/ethnic.html. 

The National Heart, Lung, and Blood Institute at the National Institutes of Health 

provides healthy recipes for African Americans and Latinos. 

“Heart-Healthy Home Cooking, African American Style” 

http://rover.nhlbi.nih.gov/health/public/heart/other/chdblack/cooking.pdf 

“Delicious Heart Healthy Latino Recipes” (English and Spanish) 

http://www.nhlbi.nih.gov/health/public/heart/other/sp_recip.pdf 

The Center for Weight and Health at the University of California, Berkeley produced two 

brochures providing information about healthy Korean and Vietnamese food options. 

“Vietnamese Foods, Healthy Food Options: What to Eat More of and What to Eat Less of.” 

(English and Vietnamese) 

http://nature.berkeley.edu/cwh/PDFs/CWH_English_vietfood.pdf 

“Korean Foods, Healthy Food Options: What to Eat More of and What to Eat Less of.” 

(English and Korean) 

http://nature.berkeley.edu/cwh/PDFs/CWH_English_koreanfood.pdf 


The Office of Minority Health at the United States Department of Health and Human Services 

developed a guide to help health organizations decrease language barriers and improve access to 

services for persons of limited-English-proficiency. www.omhrc.gov/Assets/pdf/Checked/HC- 

LSIG.pdf. 

More Than Words Toolkit Series, a resource developed by Hablamos Juntos with support 

from the Robert Wood Johnson Foundation, clarifies the translation process and provides a 

roadmap to help health care organizations improve the quality of their translated materials in 

order to get better results. http://www.rwjf.org/pr/product.jsp?id=39591 

U.S. Department of Health and Human Services Guide to Health Literacy offers helpful 

information on cultural competency for service providers. 

http://www.health.gov/communication/literacy/quickguide/Quickguide.pdf 

The WIC Program 

The Food Research and Action Center has WIC advocacy and program information, as well 

as WIC contact lists. www.frac.org. 

The United States Department of Agriculture, Food and Nutrition Service provides detailed 

information on WIC. www.fns.usda.gov. 

The National WIC Association offers WIC information, a calendar of WIC events, and services 

for members throughout the United States. www.nwica.org. 


USDA WIC Nutrition Services Standards: Cultural Competency Components 

Nutrition Assessment 

• State agency ensures that standardized dietary assessment procedures are used 

consistently statewide by all local agencies. These procedures include an assessment of 

participant diet and feeding practices at time of certification and other requirements. 

• State agency ensures that medical/health/economic/social information is collected and 

assessed at the time of certification ensuring participants’ privacy and confidentiality. 


• Content of nutrition education considers participants’: 

Nutritional needs/interests, household situation, and cultural preferences 

Language spoken and literacy level 

Religious values 

• Local agency provides nutrition education that is: 

Family-centered 

Responsive to participant needs 

Evaluation 

• State and local agencies use written criteria to evaluate nutrition education and 

breastfeeding promotion and support materials. The criteria for evaluating these 

materials should address: 

Language to ensure its appropriateness for the participant population 

Literacy level to ensure its appropriateness for the participant population 

Content to ensure its accuracy and its relevance to participants 

Graphic design that reflects the participant population (i.e. ethnic/cultural 

background, developmental stages, etc.) 

• Appropriate methods to deliver nutrition education should be evaluated considering 

participants’: 

Ages 

Nutritional needs 

Preferences 

Culture 

Lifestyle 

Breastfeeding Promotion and Support 

• State agency develops guidelines for ongoing training that includes all clinic staff and 

includes culturally appropriate breastfeeding promotion strategies 

WIC Supplemental Foods and Food Packages 

• State agency uses appropriate criteria for selecting and authorizing WIC foods, including 

cultural or religious considerations whenever possible. 

Program Outreach and Marketing 

• State and local agencies should use marketing strategies to promote participation in WIC 

using materials designed and outreach conducted with consideration for language and 

cultural needs of participants. 

FRAC Summary 

Source: USDA’s Nutrition Services Standards www.fns.usda.gov/wic/benefitsandservices/rqns.htm 


USDA WIC Value Enhanced Nutrition Assessment: Cultural Competency Components 

Key Steps in the Process of WIC Value Enhanced Nutrition Assessment 

• Collecting the Relevant Information: When selecting methods to collect relevant 

information, the WIC state agency should consider such factors as: 

What are the issues/needs of the participant? 

What method should be used to obtain the information – oral, written, other, 

and/or some combination of these methods? 

• Clarify and Synthesize the Information that has been Collected: Critical thinking 

necessitates the collection of all information prior to deciding upon the best course of 

action, including social/cultural information. 

• Identify the Pertinent and Appropriate Risks and Other Related Issues (such as cultural 

preferences, environmental factors, etc.): This is crucial when planning personalized 

nutrition interventions that will improve the health status and influence behavior. 

Dietary Assessment is Essential to a WIC Nutrition Assessment 

• WIC personnel may ask about appetite, favorite foods, and cultural food preferences, 

rather than quantify ounces or servings. 

• Other cultural/personal information that may be collected includes: frequency, amount, 

and type of feedings offered; food preferences or aversions. 

• Variables, such as knowledge, attitudes, beliefs, and family and community environment, 

affect food consumption and should be addressed. 

• Environmental and family factors to consider include: 

Migrant status – food preparation and storage equipment 

Food security – availability of safe and nutritious food 

Feelings on breastfeeding/breastfeeding support 

Usual meal pattern 

Activity level/feelings about the need for physical activity 

Essential Staff Competencies for WIC Nutrition Assessment 

• Multicultural awareness is an important component of WIC nutrition assessment: WIC 

staff are required to understand how sociocultural issues (race, ethnicity, religion, group 

affiliation, SES, and world view) affect nutrition and health practices and nutrition-related 

health problems. Factors to consider include: 

• Cultural groups in the target population including their families and communities, 

values and beliefs, characteristics, and resources: 

Respects different belief systems about issues such as blood-work, 

immunizations, dietary supplements, alternative medicine, and traditional 

healers 

Evaluates cultural practices for their potential to harm the client’s health 

or nutritional status 

• Cultural eating patterns and family traditions such as core foods, traditional 

celebrations, and fasting: 

Assesses eating patterns 

Evaluates food selection and preparation within a cultural context 

• Differences in communication styles between groups and how these differences 

may impact the assessment process: 

Uses translation services appropriately 

Uses culturally appropriate strategies to assess breastfeeding practices 

and beliefs 

FRAC Summary 

Source: Value Enhanced Nutrition Assessment (VENA) in WIC www.nal.usda.gov/wicworks

Making WIC Work for Multicultural Communities - Food Research ...

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?