Predictors of Redemption among Low-Income, Pregnant Women, Infants, and Children Participants: A Secondary Analysis of a Multicomponent eHealth Behavioral Intervention Study.

BACKGROUND

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides essential nutrition support to low-income pregnant individuals in the United States, yet food package redemption remains suboptimal. Digital interventions to support lifestyle behavior change may improve benefit utilization during pregnancy.

OBJECTIVES

This study aimed to evaluate whether participation in a multicomponent eHealth behavioral intervention influenced WIC food package redemption, the factors associated with redemption, and to explore the relationship between redemption and dietary intake.

METHODS

This prespecified secondary analysis used data from a 2-arm randomized controlled trial in which n = 351 pregnant individuals enrolled in WIC were randomly assigned to either a multicomponent eHealth behavioral intervention promoting healthy gestational weight gain plus standard WIC services (n = 179) or standard WIC services alone (n = 172). Food package redemption rates across the intervention period were calculated from electronic benefit transfer data. Aim 1 assessed differences in redemption between study arms and potential effect modifiers. Aim 2 examined individual (e.g., education and race/ethnicity) and environmental (e.g., geospatial food access and neighborhood disadvantage) correlates of redemption regardless of intervention group. Aim 3 explored associations between food redemption and dietary intake assessed via dietary recalls.

RESULTS

Redemption rates were low (∼50%) and did not differ between study arms. However, within the intervention group, adherence to daily self-weighing predicted higher redemption. Higher redemption was also observed in those of older age, having some college education, with obesity, and in non-Hispanic White participants. Environmental indices, including neighborhood deprivation and geospatial food access, did not significantly moderate redemption behaviors. Higher benefit redemption was associated with improved dietary quality.

CONCLUSIONS

Although the multicomponent behavioral intervention did not increase redemption rates overall, individual characteristics, including intervention engagement, age, education, BMI, and race/ethnicity, were predictive of redemption behavior. More targeted interventions that address structural disparities may be needed to enhance WIC benefit utilization during pregnancy.