Reaching Families Where They Are to Increase WIC Benefit Redemption: A Cluster-Randomized Study of a Text Message Intervention

Background and Purpose: Most households enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) do not fully redeem their monthly food benefits, leaving substantial nutritional support unused during a critical period for health and development. Structural and logistical barriers, limited program navigation information, and caregiver burden contribute to this gap. Digital tools such as the WICShopper app have potential for increasing benefit access, yet evidence on how agencies can actively promote their use and effectively engage participants remains limited. This study examines whether a co-designed, low-cost informational text message promoting the WICShopper app increases WIC food benefit redemption rates among Missouri households and how effects vary by household size and rurality.

Methods: The study utilized a community-engaged, multi-phase design. Phase 1 qualitative and survey data informed the development of a WICShopper app FAQ video series addressing participant-identified needs, including checking benefit balances and locating WIC-approved foods. In Phase 2, a cluster-randomized design assigned 57 of 116 Missouri WIC agencies, to an intervention condition, representing 122 participant-serving clinics. In November 2024, Missouri WIC sent a single text message promoting the video series and encouraging benefit checking to participants enrolled through the randomly selected agencies. Intervention agencies also posted informational flyers at local WIC clinics with a QR code to the video series. Pre- and post-text message redemption data were analyzed for 71,297 unique households spanning six months (347,631 household-months). A mixed-effects linear regression estimated intervention effects on monthly redemption rates, with random effects for agency and month and fixed effects for household size, rurality, race and ethnicity, education, and marital status of the household representative.

Results: Overall, single-participant households showed higher rates of redemption than larger ones, and no redemption differences were found between rural and urban households. After the intervention, redemption rates were approximately 1% higher (β = 0.98; 95% CI: 0.62, 1.34) for households served by agencies that sent the text message among 71,297 unique households analyzed. No significant interaction effects between the text message and other household demographics were found. Across intervention agencies, 5,731 WICShopper app video engagements were recorded via unique agency QR codes.

Conclusions and Implications: A single, co-designed text message sent to participants connected to 57 randomly selected Missouri WIC agencies demonstrated a statistically significant increase in their WIC food benefit redemption, offering actionable evidence for government agencies and community organizations seeking scalable, low-cost strategies to improve benefit uptake. Grounding the intervention in participant experience data illustrates how community-engaged design can strengthen even minimal-touch digital outreach. The consistent effects across demographic groups and rurality support broad applicability, and suggests that similar strategies tailored to relatively lower-redeeming groups, for example, larger households or those with lower levels of education attainment, could help increase redemptions overall and merit further examination. Future efforts should examine multi-message campaigns, multi-channel approaches, and targeted interventions to further close the gap between benefits issued and benefits redeemed.