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

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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 Project Description 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. Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education 39
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. Project Evaluation 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. Lessons Learned 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. Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education 40
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Page 6 and 7: Introduction This guide highlights
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