A Systems Approach to Identify Factors Influencing Participation in Two Tribally-Administered WIC Programs

Michelle Estradé, Samantha Grace Alarcon Basurto, Abbegayle McCarter, Joel Gittelsohn, Takeru Igusa, Siyao Zhu, Lisa Poirier, Susan Gross, Marla Pardilla, Martha Rojo, Kevin Lombard, Henry Haskie, Veronica Clark, Jacqueline Swartz, Yeeli Mui

Research output: Contribution to journalArticlepeer-review


Native American populations experience highly disproportionate rates of poor maternal-child health outcomes. The WIC program aims to safeguard health by providing greater access to nutritious foods, but for reasons not well understood, participation in many tribally-administered WIC programs has declined to a greater extent compared to the national average decline in participation over the last decade. This study aims to examine influences on WIC participation from a systems perspective in two tribally-administered WIC programs. In-depth interviews were conducted with WIC-eligible individuals, WIC staff, tribal administrators, and store owners. Interview transcripts underwent qualitative coding, followed by identifying causal relationships between codes and iterative refining of relationships using Kumu. Two community-specific causal loop diagrams (CLDs) were developed and compared. Findings from interviews in the Midwest yielded a total of 22 factors connected through 5 feedback loops, and in the Southwest a total of 26 factors connected through 7 feedback loops, resulting in three overlapping themes: Reservation and Food Store Infrastructure, WIC Staff Interactions and Integration with the Community, and State-level Administration and Bureaucracy. This study demonstrates the value of a systems approach to explore interconnected barriers and facilitators that can inform future strategies and mitigate declines in WIC participation.

Original languageEnglish (US)
Article number1210
Issue number5
StatePublished - Mar 2023


  • Native American
  • WIC
  • causal loop diagram
  • health equity
  • nutrition
  • system dynamics

ASJC Scopus subject areas

  • Food Science
  • Nutrition and Dietetics


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