Exploring Perceived Motivators and Barriers to Equitable Access in Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Participation

Objective: To investigate the perceived motivators and barriers to Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participation in urban and rural Nebraska, to address the disparities in program reach. Design: Cross-sectional online survey. Setting: Low-income WIC-eligible households across urban and rural Nebraska. Participants: N = 1,116 households (n = 801 urban; n = 315 rural) with ≥ 1 child. Variables Measured: Perceived motivators and barriers to WIC participation. Analysis: Logistic regression with Benjamini-Hochberg correction assessed associations between rural-urban status and perceived motivators/barriers, adjusting for race/ethnicity, income, and education; significance was based on Benjamini-Hochberg adjusted P values < 0.05. Results: Rural residents were more likely to perceive access to nutritious food (P < 0.01), breastfeeding support (P < 0.01), and health care referrals (P < 0.05) as motivators for WIC participation than urban residents. Conversely, urban residents were 1.7 times more likely to perceive difficulty traveling to WIC clinics (P < 0.01) as a barrier than rural counterparts. Conclusions and Implications: Targeted strategies addressing Nebraska's diverse needs are necessary for improving WIC participation. Longitudinal and multistate data are needed to examine participation factors over time, supporting causal inferences and informing evidence-based policy.