Table 2.

Themes & Subthemes Identified Through Focus Groups About WIC^a Participants Experiences in Rural Appalachian North Carolina

Themes and Subthemes	Representative Quotes
1. Most Valued Aspects of WIC Participation
Theme 1A. Financial Benefits	“I mean just probably $100 a month worth of savings if not more…then when you, if you supplement or whatever, the formula is also very helpful.”
	“They gave me the pump which was ecstatic because, those are expensive and I definitely couldn't afford one.”
Theme 1B. Support/Resource Benefits	“…So WIC was very instrumental in ….putting us in …connection with health related dietitians, and speech pathologist and, just other… people in our community that I had no idea where to turn to.”
	“[The nutritionist] has really helped me, with the breastfeeding, an' she's answered every question if she didn't know the answer to my question she would find out and she'll call me back.”
2. Experiences During WIC Appointments
Positive Aspects: Theme 2A. Efficiency of Clinic Visits	“I do love how they get you in and get you out [so] quick.”
Theme 2B: Caring and Nurturing Approach	“We love to go to the WIC office…they spoil us, they take care of us, they're very kind… they're good with questions or concerns we have.”
Negative Aspects Theme 2C: Discrepancy in Nutrition Recommendations from WIC staff and Pediatricians	“[My baby] had a sore butt for like a week… And so the doctor was like, ‘Well try cutting out dairy.’ And so I did and her butt cleared up. I told [the nutritionist] that, and she was like, ‘Oh, the doctors always blame it on the dairy first and you shouldn't listen to what the doctor says.’”
Theme 2D: High-Pressure Approach	“When you're parenting, you kinda take from like, a little bit from everybody and see what works with your child it seems like, right?.…But it just seems like the way that, that sometimes [the nutritionist] approaches [feeding recommendations], it's like, "No! This is like, this is just one way.”
Theme 2E: High-Pressure Approach	“With all three of my children, I have been made to publicly, breastfeed, in front of someone in the WIC office…I felt like I had to prove that I was breastfeeding.”
3. Barriers Related to Redeeming Benefits
Theme 3A. Poor Labeling in Stores	“[The grocery store] does not label things very well at all. Apparently, I just found out this like last week, they have, sometimes they don't have the big blue label that says WIC, but you can look somewhere in the corner, there is one little W which means it is WIC approved.”
Theme 3B. Problems Redeeming WIC Approved Items	“Like, like with brands and stuff like that, like [Store 1] will say one thing, [Store 2] will say another. Um, and I don't know if you can get Reese’s peanut butter at [Store 2], but you can at [Store 1].”
Theme 3C. Lack of Variety of WIC Approved Foods Locally Available	“…locally the store only stocks one of these five or six breads, so I don't even bother looking at the others.”
Theme 3D. Limited Number of Grocery Stores	“You have 2 options in this entire town to shop for WIC at [Store 1] or at [Store 2] an' at [Store 2] at only one register.”
	“I recently went to [a grocery store in a larger county], and I was just amazed at how large their produce and vegetable section was, ours is like an eighth of the size. Like it was just amazing, to walk through. I think that's a big disadvantage just overall is we don't have as big a selection.”
Theme 3E. Delays at Checkout	“Even goin' to the checkout, like [Speaker 302] said, it's just like, you almost dread it because it was like you do take a long time.”
Theme 3F. Social Stigma	“Just their body language, lets you know that they're communicating their judgment, towards you. And they don't even have to say a word.”
	“Even goin' to the checkout, … it's just like, you almost DREAD it because it was like you do take a long time and people get behind you, you're like "Oh man!" And then like, even the cashiers, like, you know, they just kind of like judge you … sometimes it was just embarrassing, and like I even had like some cashiers like visually say like, ‘Oh my God!’"
4. Suggestions for Improving WIC Program and Services
Theme 4A. Available Food Packages	“We get allotted too much [juice], um, you know, we're encouraged not to give our children, those sort of products, but, at the same time, that's what we're approved for.”
	“If they could add maybe some of the store brands of the whole wheat pasta. That would be wonderful because then I could, could use that.”
Theme 4B. Enhanced Nutrition Education Services	“I would like to have more information on postpartum weight loss.”
	“Maybe um, explaining what your options are. So I've never been, no one ever explained to me, from, the office, that I could switch yogurt for milk or cheese for milk or, stuff like that, or, what you were getting.”
	“You offer [a] nutrition program and you're not educated really on the best way to use it.”
Theme 4C. Expanded Community Outreach, Knowledge, and Awareness of WIC Program	“My sister lives… [in] a bigger place, an' she told me about [WIC]. I felt like I'm, like I haven't heard about [WIC] around here like nobody really talks about it around here.”
	“I wasn't even aware of [WIC] as a, um, member of the community an' even as a foster parent until my children came to me as foster children and immediately DSS made me aware of it.”
	“I started [using WIC] toward the end of my first pregnancy because I didn't know that you could be pregnant and get WIC.”

^aWIC = Supplemental Nutrition Program for Women, Infants, and Children’s Program

WIC Program Experiences and Barriers in Rural Appalachian North Carolina