Development of a Survey to Assess the Effects of the New WIC Food Package on Participant Dietary and Child Feeding Habits

The Special Supplemental Nutrition Program for Women, Infants, and Children (The WIC Program), began in 1974, and has not seen any major changes to its food packages since then. In 2009, the WIC Program began implementing changes that mandated the inclusion of whole grains, fruits and vegetables, and low-fat dairy, among other changes. These changes aim to better align the food package benefits of the WIC Program with the Dietary Guidelines for Americans, 2005, and the American Academy of Pediatrics Child Feeding Recommendations. The objective of this research was to develop a culturally appropriate original questionnaire for The Texas WIC Program, which aimed to assess the dietary/feeding behaviors of Texas WIC participants both before and after the new WIC food package was implemented. The present study aims to present the methodology of how said survey was developed including pilot study and literature review. A mixed methods, biphasic approach was used to draft, edit and finalize the survey. The first phase consisted of item development, which involved literature review, and expert panel (n= 14) review to refine the instrument prior to piloting. Phase 2 of this research included recruitment of participants, a timed classroom administration of the survey, data collection, analysis and substantive reasoning based on the results of items to be included in the final survey. Quantitative data from survey piloting at two WIC local agency offices was used. Participants (n=54) completed two survey versions during piloting. The final questionnaire included measures of behaviors, attitudes and self-efficacy. Results from piloting showed that the "bubble" survey format had fewer errors and was more easily understood by participants. Incorporating relevant and recent scientific literature as related to survey design within a diverse population with social behavioral theory and mixed methods study design yielded a psychometrically sound instrument that has been used on a large scale and provided relevant data.