Appendix G.2
Survey of WIC Participants
(English)
OMB
Number: 0584-XXXX
Expiration
Date: XX/XX/XXXX
Introduction
NOTE: WORDS AND PHRASES IN ALL CAPITAL LETTERS ARE INSTRUCTIONS TO THE INTERVIEWERS AND WILL NOT BE READ TO RESPONDENTS.
May I speak with (WIC WOMAN OR MOTHER/GUARDIAN OF WIC INFANT/CHILD)?
WHEN CONNECTED:
Hello, my name is . I’m working with Mathematica Policy Research, a firm located in Princeton, New Jersey. My company is doing a study for the United States Department of Agriculture, Food and Nutrition Service. We want to talk to WIC participants about your experiences when shopping for WIC foods.
You have been selected for this study. The interview takes about 30 minutes and you will receive a $30 prepaid Visa gift card after completing the interview.
Taking part in this study is completely voluntary. We are required by law to use your information for statistical research only and to keep it private. The law prohibits us from giving anyone any information that may identify you or members of your household. You do not have to answer any questions that make you feel uncomfortable. There are no risks for participating. Your answers will not be shared with WIC staff and will not affect the benefits or services that you receive from WIC or any other government agency. Answers to this survey will be used by researchers to help them understand WIC participants’ satisfaction with WIC foods.
Do you have any questions before we begin? (ANSWER R’s QUESTIONS, IF ANY.) We really appreciate your time and help with this study.
According to the Paperwork
Reduction Act of 1995, an agency may not conduct or sponsor, and a
person is not required to respond to, a collection of information
unless it displays a valid OMB control number. The valid OMB
control number for this information collection is 0584-XXXX. The
time required to complete this information collection is estimated
to average 30 minutes per response, including the time for
reviewing instructions, searching existing data sources, gathering
and maintaining the data needed, and completing and reviewing the
collection of information.
EXIT: Thank you for your time.
S1. First, are you 18 years of age or older?
YES CONTINUE
NO GO TO EXIT 1
S2. CODE WITHOUT ASKING IF KNOWN, OTHERWISE, ASK: Are you male or female?
MALE
FEMALE
VERIFY WIC PARTICIPATION
1a. Were you receiving WIC benefits in (2 MONTHS AGO)?
YES GO TO 1b
NO GO TO EXIT 1
1b. According to our records,
IF FAMSIZE = 1 AND WOMAN = 1: You are the only member of your household receiving WIC benefits.
IF FAMSIZE > 1 AND WOMAN = 1: You and/or NAME(s) are currently receiving WIC benefits.
IF WOMAN = 0: NAME(s) (IS/ARE) currently receiving WIC benefits.
Is that correct?
YES GO TO A1
NO ASK 2
SKIP A2A IF R IS MALE
2. Are you currently receiving WIC foods as a pregnant, postpartum, or breastfeeding woman?
YES
NO
IF FAMSIZE = 1 AND (WOMAN = 1 OR Q2 = YES), SKIP TO A1.
2a. Please tell me the ages of your children who currently receive WIC foods. (IF AGE < 1 YEAR, ENTER 0 FOR AGE AND ASK FOR MONTHS.)
AGE |
IF AGE = 0, ENTER # MONTHS |
|
|
|
|
|
|
NO CHILDREN CURRENTLY RECEIVING WIC
[PROGRAMMER: HOUSEHOLD HAS PRECODED FLAGS FOR TYPES OF WIC PARTICIPANTS. IF Q1 = NO THEN UPDATE FLAGS:
IF Q2 = 1 THEN WOMAN = 1.
IF ANY AGE IN Q2a = 0 AND MONTHS=0-5, THEN INFANT = 1.
IF ANY AGE IN Q2a = 0 AND MONTHS=6-12, THEN INFANT = 2.
IF ANY AGE IN Q2a = 1–4 THEN CHILD=1
PROGRAMMER CHECK: IF 2 = NO AND ONLY ONE AGE IS ENTERED IN 2a AND AGE = 0 & MONTHS < 6, THEN STOP INTERVIEW WITH QUESTION 3.
3. According to what you have told me, the only person in your household who receives WIC foods is your infant. Is that correct?
NO GO BACK TO 2
YES GO TO EXIT 2
Exit 1
Those are all the questions I have. Thank you for your time.
Exit 2
This study is collecting information about WIC foods other than formula, so we do not need to continue with the survey. Thank you for your time.
A. WIC Food Items
My next questions are about the last calendar month; that is, the month of (MONTH).
A1. I’d like to know the types of foods that you could buy with (your/your family’s) [STATE NAME FOR WIC EBT CARD] card. For each type of food, tell me if you could buy it with your [STATE NAME FOR WIC EBT CARD] in (MONTH). Say yes if you could buy it, even if you did not buy it.
In (MONTH), could you buy [FOOD CATEGORY] with [STATE NAME FOR WIC EBT CARD]?
REPEAT FOR EACH FOOD CATEGORY. READ ENTIRE QUESTION FOR FIRST TWO CATEGORIES THEN, JUST READ “…could you buy [FOOD CATEGORY]?
PROGRAMMER: IF SUM (WOMAN, CHILDREN) > 0 THEN WC = 1, ELSE WC = 0.
|
FOOD CATEGORY |
YES (1) |
NO (0) |
Not applicable |
DON’T KNOW |
REFUSED |
A1a |
Milk (IF WC = 1) |
|
|
|
|
|
A1b |
Eggs (IF WC = 1) |
|
|
|
|
|
A1c |
Soy milk or soy beverage (IF WC = 1) |
|
|
|
|
|
A1d |
Cheese (IF WC = 1) |
|
|
|
|
|
A1e |
Breakfast cereal (IF WC = 1) |
|
|
|
|
|
A1f |
Juice (IF WC = 1) |
|
|
|
|
|
A1g |
Tofu (IF STATE = x AND WC = 1) |
|
|
|
|
|
A1h |
Yogurt (IF STATE = X AND WC = 1) |
|
|
|
|
|
A1i |
Peanut butter (IF WC = 1) |
|
|
|
|
|
A1j |
Dry beans (IF WC = 1) |
|
|
|
|
|
A1k |
Canned beans (IF WC = 1) |
|
|
|
|
|
A1l |
Whole-grain bread (IF WC = 1) |
|
|
|
|
|
A1m |
Tortillas (IF WC = 1) |
|
|
|
|
|
A1n |
Whole-wheat pasta (IF STATE = X & WC = 1) |
|
|
|
|
|
A1o |
Brown rice (IF STATE = X AND WC = 1) |
|
|
|
|
|
A1p |
Oats (IF STATE = X AND WC = 1) |
|
|
|
|
|
A1q |
Infant cereal (IF INFANT = 2) |
|
|
|
|
|
A1r |
Jars of baby food fruits and vegetables (IF INFANT = 2) |
|
|
|
|
|
IF SUM (A1a, A1c) > 0
A1_1. Which of the following did you buy with WIC last month? Milk, lactose-free or lactose-reduced milk, or soy milk or beverage? (SELECT ALL THAT APPLY)
PROBE: You can name more than one food if you bought it last month.
MILK 1
LACTOSE-FREE OR LACTOSE-REDUCED MILK 2
SOY MILK OR BEVERAGE 3
NONE/DID NOT BUY ANY MILK BEVERAGE LAST MONTH 0
IF SUM (A1l, A1m, A1n, A1o, A1p) > 1 ASK A1_2:
A1_2. Which of the following did you buy with WIC last month? Bread, tortillas, pasta, brown rice, or oats? (SELECT ALL THAT APPLY)
PROBE: You can name more than one food if you bought it last month.
BREAD 1
TORTILLAS 2
PASTA 3
BROWN RICE 4
OATS 5
NONE/DID NOT BUY ANY BREAD/GRAINS LAST MONTH 0
IF SUM (A1i, A1j, A1k) > 1
A1_3. Which of the following did you buy with WIC last month? Dry beans, canned beans, or peanut butter? (SELECT ALL THAT APPLY)
PROBE: You can name more than one food if you bought it last month.
DRY BEANS 1
CANNED BEANS 2
PEANUT BUTTER…………………………………………………..3
NONE/DID NOT BUY ANY BEANS OR PB LAST MONTH 0
A1_4 In general, how satisfied are you with the foods you purchase through WIC? Are you very satisfied, satisfied, dissatisfied, or very dissatisfied?
VERY SATISFIED
SATISFIED
DISSATISFIED
VERY DISSATISFIED
A2. WIC provides particular brands of foods. For example, Cheerios, Chex, and Wheaties are national brand cereals. Great Value is the Walmart store brand.
REPEAT QUESTION FOR EACH FOOD CATEGORY WITH A1a, b, d, e, f, i, l, m, n, o, p, q =YES
Are you very satisfied, satisfied, dissatisfied, or very dissatisfied with the brands of [FOOD CATEGORY] that you can buy with WIC?
VERY SATISFIED
SATISFIED
DISSATISFIED
VERY DISSATISFIED
A3. Now, please think only about package sizes. WIC provides particular package sizes for some foods. For example, you might have to buy milk in gallon sizes or juice in 48-ounce bottles.
REPEAT QUESTION FOR EACH FOOD CATEGORY WITH A1a, d, e, f, h=YES;
Are you very satisfied, satisfied, dissatisfied, or very dissatisfied with the package sizes of [FOOD CATEGORY] that you can buy with WIC?
VERY SATISFIED
SATISFIED
DISSATISFIED
VERY DISSATISFIED
A4. How easy or difficult is it for you to shop for WIC foods? Is it …
Very easy, SKIP TO A6
Easy, SKIP TO A6
Neither easy nor difficult, ASK A5
Difficult, or ASK A5
Very difficult ASK A5
SOMETIMES EASY AND SOMETIMES DIFFICULT ASK A5
A5. I’m going to read a list of things that could make it difficult to shop for WIC foods. For each, tell me if it makes shopping for WIC foods difficult for you.
|
YES |
NO |
DON’T KNOW |
REFUSED |
Knowing the remaining balance on your card |
|
|
|
|
Finding foods when you are in the store |
|
|
|
|
Finding the allowed brand |
|
|
|
|
Finding package sizes you can buy |
|
|
|
|
Finding the allowed type or flavor of food |
|
|
|
|
Remembering your PIN |
|
|
|
|
Some other issue? (SPECIFY) |
|
|
|
|
A6. When shopping for WIC foods, have you ever selected the wrong item and been sent back to get a different item once you got to the checkout lane?
YES
NO
A7. When shopping for WIC foods, how often have you wanted a WIC item that was out of stock or not available in the correct size? Was it …
Never,
At least one time, or
Five or more times,
DON’T KNOW………………………………………………………
A8. Have you ever felt embarrassed when purchasing WIC foods because of confusion about what foods are allowed?
YES
NO
B. Benefit Use
IF A1_1, A1_2, or A1_3 > 0 THEN SKIP TO C1
B1. Did you purchase any WIC foods in (MONTH)?
YES GO TO SECTION C
NO SET NOFOOD = 1 AND ASK B2
B2. Why didn’t you purchase any WIC foods in (MONTH)? Was it because …
You didn’t want or need the food, ASK B2B
Or it’s too much trouble to shop for WIC foods GO TO B2C
BOTH ASK B2b & B2c
OTHER (SPECIFY) _______________________________ GO TO D1
B2b. Why you didn’t want or need the food? Was it because … (CHECK ONE)
INTERVIEWER: PROBE FOR MOST IMPORTANT REASON.
(You/child) don’t/doesn’t usually eat the WIC foods
(You/child) don’t/doesn’t like the brands of WIC foods
It’s hard to find the WIC foods in the store
Other people need WIC more than you do
Have WIC foods at home from prior months
Or
something else (SPECIFY) ______________________________
GO TO SECTION C
B2c. Why is it too much trouble to shop for WIC foods? Is it because (CHECK ONE)
INTERVIEWER: PROBE FOR MOST IMPORTANT REASON.
Your grocery store does not take WIC
Stores that take WIC are too far away
The WIC shopping list is confusing
It’s hard to find the WIC foods in the store
It’s hard to pay using WIC
It takes too long to pay using WIC, or
Something else (SPECIFY) ___________________________
SKIP TO D1
C. Item Purchase and Consumption
ASK C1 FOR EACH FOOD CATEGORY WITH A1 = YES (SKIP APPROPRIATE CATEGORIES IF A1_1, A1_2, OR A1_3=0). THEN GO TO C2
C1. WIC allows you to buy a specific amount of each food. For example, you may be able to buy 36 ounces of breakfast cereal with [STATE NAME OF WIC EBT CARD].
During (MONTH), did you buy all, some, or none of the amount of [FOOD CATEGORY] WIC provides?
ALL
SOME
NONE
ASK C2 FOR EACH FOOD CATEGORY WITH C1 = SOME OR NONE, THEN GO TO C3
C2. Why didn’t you buy (all/any) of the WIC [FOOD CATEGORY]?1 (OPEN-END RESPONSE WITH PRESPECIFIED CODES FOR ANSWERS. CHECK ALL THAT APPLY.)
NO REASON GIVEN
COULD NOT BUY BECAUSE CHOSE ALTERNATIVE ITEM
TOO MUCH—CAN’T USE IT ALL/GOES BAD BEFORE I CAN
USE IT
CAN’T FIND LEAST EXPENSIVE BRANDS
CONFUSION ABOUT WHICH BRANDS OR WHAT FOODS
ARE ALLOWED
DON’T LIKE IT
DON’T NORMALLY EAT/DRINK IT
DON’T LIKE THE BRANDS WIC ALLOWS
DON’T
LIKE THE TYPE/FLAVOR (E.G., CHEDDAR CHEESE,
APPLE JUICE)
DON’T
LIKE THE FORM (E.G., STRING CHEESE, SLICED
CHEESE, FROZEN
JUICE)
DON’T LIKE THE PACKAGE SIZE (E.G., GALLONS OF MILK)
CAN’T FIND THE RIGHT PACKAGE SIZE
PACKAGE SIZES DON’T ADD UP
[IF YOGURT] BOUGHT 1 QUART OF MILK INSTEAD
PREFER ORGANIC FOODS
CAN’T FIND IT IN STORE
BODY CAN’T TOLERATE THE FOOD
DON’T HAVE ROOM IN REFRIGERATOR
DON’T HAVE A REFRIGERATOR
NO TIME TO SHOP
TRANSPORTATION PROBLEMS
STORE DIDN’T HAVE IT
FOOD ISN’T CONSISTENT WITH SPECIAL DIET
OTHER (SPECIFY) ______________________________________
C2a. IF C2=NO REASON OR DON’T KNOW: Was it because….(READ LIST AND CODE ONE)
You could not buy it because you chose an alternative item, 1
You couldn’t find it, 2
You don’t like it, or 3
It’s too much food? 4
C2a_1. IF C2a=2: Were you unable to find it because….(READ LIST AND CODE ONE)
You couldn’t find the brand 1
You couldn’t find the right package size, or 2
The store didn’t have it 3
C2a_2. IF C2a_2=3: Why don’t you like it?….( OPEN-END RESPONSE WITH PRESPECIFIED CODES FOR ANSWERS. CHECK ALL THAT APPLY)
DON’T NORMALLY EAT/DRINK IT 1
DON’T LIKE THE BRANDS WIC ALLOWS 2
DON’T LIKE THE TYPE/FLAVOR (E.G., CHEDDAR CHEESE,
APPLE JUICE) 3
DON’T LIKE THE FORM (E.G., STRING CHEESE, SLICED
CHEESE, FROZEN JUICE)……………………………………..4
PREFER ORGANIC FOODS 5
CAN’T FIND IT IN STORE 6
MY BODY CAN’T TOLERATE THE FOOD 7
FOOD ISN’T CONSISTENT WITH SPECIAL DIET………………..8
OTHER (SPECIFY) ______________________________________9
C2a_3. IF C2a=4: Is it too much food because….(READ LIST AND CODE ONE)
You can’t use it all 1
It goes bad before you can use it, or 2
You don’t have room in the refrigerator 3
Earlier you told me that (you/you and X children/your X child(ren)) (are/is) (a) WIC participant(s).
[PROGRAMMER: USE FLAG FOR WOMAN AND X = INFANT + CHILDREN FROM QUESTION 2a]
ASK C3 FOR EACH FOOD CATEGORY WITH C1 = SOME OR ALL, THEN GO TO C4.
C3. Did [you/the WIC participant(s) in your family] (eat/drink) some, all, or none of the WIC [FOOD CATEGORY] that you bought? Don’t be afraid to say some or none. Your answers will not affect your participation in WIC or the types of food you get from WIC.
ALL
SOME
NONE
ASK C4 FOR EACH FOOD CATEGORY WITH C3 = SOME OR NONE AND C2 = COULD NOT BUY BECAUSE CHOSE ALTERNATIVE ITEM, THEN GO TO C5.
C4. Why didn’t [you/the WIC participant(s)] (eat/drink) (all/any) of the WIC [FOOD CATEGORY]? (OPEN-END RESPONSE WITH PRESPECIFIED CODES FOR ANSWERS CHECK ALL THAT APPLY.)
NO REASON
DON’T NORMALLY EAT/DRINK IT
DIDN’T LIKE IT
DON’T LIKE THE TYPE/FLAVOR
FOOD WENT BAD
DON’T HAVE REFRIGERATOR
OTHER (NON-WIC) FAMILY MEMBERS ATE/DRANK IT
CAN’T EAT/DRINK THAT MUCH
OTHER (SPECIFY) ______________________________________
C4A. IF C4=NO REASON OR DON’T KNOW: Was it because….(READ LIST AND CODE ALL THAT APPLY)
Don’t normally eat/drink it
Didn’t like it
Don’t like the type/flavor
Food went bad
Don’t have refrigerator
Other (non-WIC) family members ate/drank it, or
Can’t eat/drink that much
OTHER (SPECIFY) ______________________________________
C5a. IF A1_1 = 1 OR 2, AND IF C2/C2a ≠ DON’T LIKE IT: When you shop for WIC milk, which of the following is most important to you? (CHECK ONE)
The brand of milk,
[IF STATE = X] Being able to buy half-gallons or quarts,
Being able to find WIC milk quickly in the store,
Or something else (SPECIFY)? ______________________________________
C5a1. Are there any specific types or brands of milk that you would like to buy with WIC but can’t?
MILK1 ____________________
a. Anything else?
FILL MILK2 AND REPEAT “Anything else?” FOR MILK3-MILK10 OR UNTIL RESPONDENT SAYS NO
MILK2 ____________________
MILK3 ____________________
MILK4 ____________________
MILK5 ____________________
MILK6 ____________________
MILK7 ____________________
MILK8 ____________________
MILK9 ____________________
MILK10 ____________________
C5d. IF A1d = 1, AND C2/C2a ≠ DON’T LIKE IT: When you shop for WIC cheese, which of the following is most important to you? (CHECK ONE)
The brand of cheese,
The type or flavor of cheese,
[IF STATE = X] whether the cheese is a block or sliced,
Being able to find WIC cheese quickly in the store,
Or something else? (SPECIFY) ______________________________________
C5d1. Are there any specific types or brands of cheeses that you would like to buy with WIC but can’t?
CHEESE1 ____________________
a. Anything else?
FILL CHEESE2 AND REPEAT “Anything else?” FOR CHEESE3-CHEESE10 UNTIL RESPONDENT
SAYS NO.
CHEESE2 ____________________
CHEESE3 ____________________
CHEESE4 ____________________
CHEESE5 ____________________
CHEESE6 ____________________
CHEESE7 ____________________
CHEESE8 ____________________
CHEESE9 ____________________
CHEESE10 ____________________
C5e. IF A1e = 1 AND C1 ≠ NONE: In (MONTH), did you buy hot or cold breakfast cereals with [STATE NAME OF WIC EBT CARD]?
HOT 1 ASK C5e2
COLD 2
BOTH 3
C5e1. IF C5e = 2 or 3: When you are shopping for cold breakfast cereal with [STATE NAME OF WIC EBT CARD], which of the following is most important to you?
(CHECK ONE)
The brand of breakfast cereal
The type of breakfast cereal such as wheat, corn, rice, or oats
The size of the cereal box
Being able to find WIC breakfast cereal quickly in the store
Or something else? (SPECIFY)
C5e2. IF C5e=1 or 3: When you are shopping for hot breakfast cereal with [STATE NAME OF WIC EBT CARD], which of the following is most important to you? (READ AND CIRCLE ONE.)
The brand of breakfast cereal
The type of breakfast cereal such as wheat, corn, rice, or oats.
The size of the cereal box.
Being able to buy individual packets for hot cereal
Being able to find WIC breakfast cereal quickly in the store
Or something else? (SPECIFY) ______________________________________
C5e3. Are there any specific types or brands of hot or cold breakfast cereals that you would like to buy with WIC but can’t?
CEREAL1 ____________________
a. Anything else?
FILL CEREAL2 AND REPEAT “Anything else?” FOR CEREAL3-CEREAL10 OR UNTIL RESPONDENT SAYS NO
CEREAL2 ____________________
CEREAL3 ____________________
CEREAL4 ____________________
CEREAL5 ____________________
CEREAL6 ____________________
CEREAL7 ____________________
CEREAL8 ____________________
CEREAL9 ____________________
CEREAL10 ____________________
C5f. IF A1f = 1, AND C2/C2a ≠ DON’T LIKE IT: When you shop for WIC juice, which of the following is most important to you? (CHECK ONE)
The brand of juice
The flavor of juice
Whether juice is frozen, refrigerated, canned, or bottled
Being able to find WIC juice quickly in the store
Or something else? (SPECIFY) ______________________________________
C5f1. Are there any specific types or brands of juices that you would like to buy with WIC but can’t?
JUICE1 ____________________
a. Anything else?
FILL JUICE2 AND REPEAT “Anything else?” FOR JUICE3-JUICE 10 OR UNTIL RESPONDENT SAYS NO
JUICE2 ____________________
JUICE3 ____________________
JUICE4 ____________________
JUICE5 ____________________
JUICE6 ____________________
JUICE7 ____________________
JUICE8 ____________________
JUICE9 ____________________
JUICE10 ____________________
C5i. IF A1_3 = PB, AND C2/C2a ≠ DON’T LIKE IT: When you shop for WIC peanut butter, which of the following is most important to you? (CHECK ONE)
The brand of peanut butter
Whether peanut butter is creamy or crunchy
Being able to find WIC peanut butter quickly in the store
Or something else? (SPECIFY) ______________________________________
C5i1. Are there any specific types or brands of peanut butters that you would like to buy with WIC but can’t?
PEANUT BUTTER1 ____________________
a. Anything else?
FILL PEANUT BUTTER2 AND REPEAT “Anything else?” FOR PEANUT BUTTER3-PEANUT BUTTER10 OR UNTIL RESPONDENT SAYS NO
PEANUT BUTTER2 ____________________
PEANUT BUTTER3 ____________________
PEANUT BUTTER4 ____________________
PEANUT BUTTER5 ____________________
PEANUT BUTTER6 ____________________
PEANUT BUTTER7 ____________________
PEANUT BUTTER8 ____________________
PEANUT BUTTER9 ____________________
PEANUT BUTTER10 ____________________
C6l. IF SUM (A1l,A1m,A1n,A1o,A1p) > 0, AND C2/C2a ≠ DON’T LIKE IT: Are there any specific types or brands of [whole-grain bread/tortillas/brown rice/whole-wheat pasta/oats] that you would like to buy with WIC but can’t?
WHOLE GRAIN1 ______________
a. Anything else?
FILL WHOLE GRAIN2 AND REPEAT “Anything else?” FOR WHOLE GRAIN3-10 OR UNTIL RESPONDENT SAYS NO
WHOLE GRAIN2 ____________________
WHOLE GRAIN3 ____________________
WHOLE GRAIN4 ____________________
WHOLE GRAIN5 ____________________
WHOLE GRAIN6 ____________________
WHOLE GRAIN7 ____________________
WHOLE GRAIN8 ____________________
WHOLE GRAIN9 ____________________
WHOLE GRAIN10 ___________________
D. Mobile Shopping App
The next questions are about where you shop and using mobile apps while you shop for WIC foods.
D1. First, is the store where you shop for WIC foods the same store where buy most of your other foods?
YES
NO
D2. Do you use a shopping app on a mobile phone when you are shopping for WIC foods?
YES
NO ASK D4
D3. What is the name of the shopping app you use when you are shopping for WIC foods?
_______________________________________________________
GO TO D5
D4. Have you ever tried a shopping app to help you shop for WIC foods?
YES ASK D5
NO GO TO SECTION E
D5. Please tell me yes or no if you have done any of the following with your WIC mobile app.
|
YES |
NO |
Viewed the WIC food list on your phone |
|
|
Checked your WIC EBT balance |
|
|
Searched for a WIC store |
|
|
Scanned a UPC code in a store to see if you could buy it with WIC |
|
|
Searched for recipes that use WIC foods |
|
|
D6. Overall, how helpful is the app when you shop for WIC foods? Would you say….
Very helpful
Somewhat helpful
Not very helpful, Or
Not at all helpful?
E. Participation
IF C1 = SOME OR NONE FOR ANY FOOD CATEGORY, GO TO E3. [NOTE: THIS IS A FOLLOW-UP ABOUT “EVER” NOT REDEEMING BENEFITS FOR THOSE WHO SAID THEY BOUGHT ALL FOOD IN EVERY FOOD CATEGORY LAST MONTH.]
E1. While (you have/your family has) been in the WIC program, have you ever decided not to buy a WIC item or not to buy the full amount of a WIC item?
YES ASK E2
NO SKIP TO E4
DON’T KNOW
REFUSED
E2. Which of the following statements best describes why you did not buy the WIC item or the full amount of the WIC item? Was it because …
(READ LIST AND CHECK ALL THAT APPLY)
Store doesn’t usually have item
Store ran out of item
Couldn’t find the item
Had plenty of item left over from last month
Had to carry groceries and item is too big or too heavy
Store doesn’t carry a convenient size of that item, or
Some other reason? (SPECIFY) ______________________________________
E3. Would you apply to WIC again when (your/SAMPLE CHILD’s) current eligibility ends?
PROBE: IF R SAYS CHILD IS NO LONGER ELIGIBLE SAY: If your child were still eligible, would you apply again?
YES SKIP TO SECTION F
NO ASK E4
NOT SURE YET ASK E4
E4. What are the reasons why you would not apply to WIC again? (OPEN-END RESPONSE WITH PRESPECIFIED CODES FOR ANSWERS. CHECK ALL THAT APPLY.)
INCOME OR OTHER RESOURCES WILL BE TOO HIGH
(YOU/SAMPLE CHILD) WILL NOT MEET THE HEALTH OR NUTRITIONAL REQUIREMENTS
WIC APPOINTMENTS TAKE TOO LONG
IT’S HARD TO GET WIC APPOINTMENTS
OTHER PEOPLE NEED IT MORE
YOUR CHILD GOES TO DAY CARE AND EATS THERE
YOU CAN BUY THE FOOD WIC GIVES WITH SNAP (FOOD STAMPS)
THE WIC CLINIC IS TOO FAR AWAY
WIC STORES ARE TOO FAR AWAY
YOU HAVE TO MAKE EXTRA SHOPPING TRIPS TO BUY WIC FOODS
YOU DON’T LIKE TO SHOP IN WIC STORES
IT’S TOO DIFFICULT TO FIND WIC FOODS
THE STORE RUNS OUT OF WIC FOODS
(YOU DON’T/YOUR FAMILY DOESN’T) LIKE WIC FOODS
(YOU DON’T/YOUR FAMILY DOESN’T) NEED WIC FOODS
OTHER (SPECIFY) ______________________________________
F. Special Diets or Food Allergies
Now I have some questions about special diets or food allergies that (you/you or your child/your child) may have. These questions will help us understand the types of foods required by WIC participants.
F1. Has a doctor ever told you that (you have/you or your child have/your child has) . . .?
|
YES |
NO |
DK |
REF |
Diabetes |
|
|
|
|
High blood pressure |
|
|
|
|
Heart disease |
|
|
|
|
High blood cholesterol |
|
|
|
|
Asthma |
|
|
|
|
A food allergy |
|
|
|
|
Celiac disease or sprue |
|
|
|
|
Lactose intolerance or milk intolerance |
|
|
|
|
Sulfite sensitivity |
|
|
|
|
IF “YES” TO “food allergy,” ASK F2. OTHERWISE, SKIP TO F3.
F2. What food(s) are (you/you or your child/your child) allergic to? (OPEN-END RESPONSE WITH PRESPECIFIED CODES FOR ANSWERS. DO NOT READ LIST TO RESPONDENT. CHECK ALL THAT APPLY.)
COW’S MILK
EGGS
WHEAT
PEANUTS .
SOY
CORN
OTHER NUTS, INCLUDING ALMONDS, WALNUTS,
PECANS
FISH
SHELLFISH .
OTHER (SPECIFY) _________________________________________
DON’T KNOW
F3. Within an hour after eating something, have (you/you or your child/your child) ever had a severe reaction, such as itching all over, trouble breathing, flushing, hives, or swelling of the face or hands or feet?
YES
NO
IF F1> 0 OR F3 = YES, ASK F4; OTHERWISE, SKIP TO F5.
F4. Do you modify (your/your or your child’s/your child’s) diet due to an allergy or health condition?
YES
NO
F5. Some people are on special diets for religious reasons or because they are vegetarian. I’m going to read a list of diets. Please tell me yes or no if they describe (your/you or your child’s/your child’s) diet.
PROBE: IF RESPONDENT ASKS WHAT A KOSHER DIET IS, SAY: A kosher diet is one that people of Jewish faith maintain.
PROBE: IF RESPONDENT ASKS WHAT A HALAL DIET IS, SAY: A halal diet is one that people of Muslim faith maintain.
PROBE: IF RESPONDENT ASKS WHAT A SEVENTH - DAY ADVENTIST DIET IS, SAY: A Seventh-day Adventist diet is one that people who belong to the Seventh-day Adventist church maintain.
PROBE: IF RESPONDENT ASKS WHAT A VEGETARIAN OR VEGAN DIET IS, SAY: A vegetarian diet is one where a person does not eat meat. A vegan diet is one where a person does not eat any food that comes from animals, including cow’s milk, eggs, and honey.
|
YES |
NO |
DK |
REF |
Kosher, Halal, or Seventh-Day Adventist diet |
|
|
|
|
Vegetarian or vegan diet |
|
|
|
|
Other (SPECIFY)_________________ |
|
|
|
|
F6. IF F4 OR F5 (ANY DIET) = YES, ASK: Do you have problems finding appropriate WIC foods because of your special diet?
PROBE: Your “special diet” refers to a special diet for any of the reasons stated, including: (a health condition or allergy: IF F4= YES), (a religious reason: IF F5= YES FOR KOSHER/HALAL/SEVENTH-DAY = YES), or (being vegetarian or vegan: IF F5 = YES FOR VEGETARIAN OR VEGAN = YES).
YES ASK F7
NO GO TO G1
F7. In what way(s)? (OPEN-END RESPONSE WITH PRESPECIFIED CODES FOR ANSWERS. DO NOT READ LIST TO RESPONDENT. CHECK ALL THAT APPLY.)
I DON’T KNOW WHETHER ALLOWED BRANDS ARE SAFE FOR (ME/MY CHILD) TO EAT
I DON’T KNOW HOW TO FIND OUT ABOUT INGREDIENTS IN STORE BRAND FOOD ITEMS
I CANNOT FIND CEREALS HIGH ENOUGH IN IRON OR FOLIC ACID/FOLATE
I CANNOT BUY CALCIUM-FORTIFIED JUICE
I CANNOT FIND LACTOSE-FREE OR LACTOSE-REDUCED MILK
I CANNOT FIND THE SPECIAL KOSHER OR HALAL FOODS I AM REQUIRED TO EAT
VEGETARIAN/VEGAN OPTIONS ARE NOT AVAILABLE
OTHER (SPECIFY) ______________________________________
G. Demographics
We are almost done. The final questions are for statistical purposes to ensure all groups are represented in the study.
Household Composition
G1. Not counting yourself, how many adults aged 18 or older currently live in your household? By household, I mean the people who live and share food with you.
NUMBER OF ADULTS __________
G2. Earlier you told me the ages of the (NUMBER OF CHILDREN IN 2A) (child/children) in your household receiving WIC. What are the ages of the children in your household who do not receive WIC? Start with the youngest. IF AGE = < 1 YEAR, RECORD ZERO. IF PREGNANT, DO NOT INCLUDE UNBORN CHILD.
AGE (YRS) |
|
|
|
|
NO CHILDREN IN HOUSEHOLD NOT RECEIVING WIC
G3 So, the total number of people in your household is (1 + ANSWER TO 2A PLUS ANSWER TO G1 PLUS ANSWER TO G2). Is that correct? (By household, I mean the people who live and share food with you.)
YES
NO
IF NOT CORRECT, RESOLVE BY RE-ASKING QUESTIONS G1 AND G2
IF (NUMBER OF ADULTS IN G1 = 0), SKIP TO G5.
G4. Not counting yourself, are there any women in your household receiving WIC?
YES
NO .
Education
G5. What is the last grade of school or college that you completed? (OPEN-END RESPONSE WITH PRESPECIFIED CODES FOR ANSWERS. CHECK ONE. PROBE TO DETERMINE THE HIGHEST LEVEL ATTAINED.)
NO FORMAL SCHOOLING
LESS THAN 8TH GRADE
COMPLETED 8TH GRADE
SOME HIGH SCHOOL
COMPLETED HIGH SCHOOL OR GED
SOME COLLEGE OR SCHOOL AFTER HIGH SCHOOL
COMPLETED ASSOCIATE DEGREE, JUNIOR COLLEGE, OR VOCATIONAL/TECHNICAL PROGRAM
COMPLETED BACHELOR’S DEGREE ADVANCED DEGREE
(M.A., M.B.A., J.D., PH.D., M.D.)
OTHER (SPECIFY) ______________________________________
Employment Status
The next questions are about employment and we will use this for statistical purposes only. Your answers will not be shared with the WIC agency.
G6. What is your employment status right now—are you currently employed full time, part time, or not employed? (CHECK ONE.)
EMPLOYED FULL TIME
EMPLOYED PART TIME
NOT EMPLOYED
IF G1 = 1, SKIP TO G7.
G6b. Are any other adults in your household employed full time or part time? (CHECK ALL THAT APPLY)
EMPLOYED FULL TIME
EMPLOYED PART TIME
NOT EMPLOYED
Race/Ethnicity
G7. Are you of Hispanic or Latino origin? (CHECK ONE)
HISPANIC OR LATINO
NOT HISPANIC OR LATINO
G8. What is your race? I am going to read you a list of five race categories. Please choose one or more races. Are you: White; Black or African American; American Indian or Alaska Native; Asian; or Native Hawaiian or Other Pacific Islander? (CHECK ALL THAT APPLY)
WHITE
BLACK OR AFRICAN AMERICAN
AMERICAN INDIAN OR ALASKA NATIVE
ASIAN
NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER
Automobile Ownership
G9. Do you or does anyone in your household own or lease a car, van, or truck? Do not include motorcycles or recreational vehicles.
YES
NO .
SNAP Participation
G10. Do you or does anyone in your household receive benefits from the [FILL FOR STATE SNAP PROGRAM] program? This program used to be called food stamps. It puts money on an [NAME OF STATE SNAP EBT CARD] card that you can use to buy food.
YES
NO
CLOSING
Those are all the questions I have. We want to thank you for participating in this interview.
Please provide the address where we should send the $30 VISA gift card.
NAME:__________________________________________________________
ADDRESS:_______________________________________________________
APT/BLDG/UNIT NUMBER________________________________________________
CITY:___________________ STATE:_____________
You have been a big help in our study. Thank you very much. Goodbye.
RECORD WHETHER INTERVIEW WAS CONDUCTED IN ENGLISH OR SPANISH:
ENGLISH
SPANISH
1 All occurrences of (all/any) are filled based on response to prior question. If prior response is SOME, fill ALL; if prior response is NONE, fill ANY.
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Carole Trippe |
File Modified | 0000-00-00 |
File Created | 2021-01-23 |