(Reuters Health) - Parents who receive supplemental food vouchers for grocery shopping need a better retail experience to make the most of the benefits, U.S. researchers say.

When shoppers have a difficult time identifying allowable items under the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program, and then feel stigma during checkout, they’re more likely to feel frustrated and uncomfortable and not use the benefits, the study authors write in the Journal of the Academy of Nutrition and Dietetics.

“The grocery store can be an overwhelming place for everyone with all of the choices available, and with WIC, you have to figure out what you can and can’t purchase with the benefits,” said lead study author Christina Chauvenet of the University of North Carolina in Chapel Hill.

The WIC program, run by the Food and Nutrition Service of the U.S. Department of Agriculture, differs from the broader Supplemental Nutrition Assistance Program (SNAP), sometimes known as “food stamps.” WIC has promoted parental and child health and combated food insecurity since 1975, the study authors note. The program benefits include food vouchers, healthcare referrals and breastfeeding support for low-income women and children under age 5.

However, participation declined between 2009, when there were 9 million people, representing 63 percent of eligible recipients, and 2015, when 8 million people or 53 percent of eligible recipients used the program, the authors point out.

“If people are not able to use their maximum benefits, they’re either not getting the full potential of the program or aren’t going to participate,” Chauvenet said in a phone interview. “It’s important to find ways to make sure people stay enrolled and use their benefits.”

The study team conducted focus groups and individual interviews with a total of 55 WIC participants in Texas, North Carolina, Oregon and Illinois. Researchers chose these states for their differences in allowable items, brand restrictions, signage requirements and stage of transition from benefits in the form of a paper check to an electronic bank card. All states must transition to the EBT card by the end of 2020.

The research team asked questions such as, “How long does it take to figure out what foods you can buy with your WIC vouchers?” and “Are you ever confused or do you ever make mistakes about what you can buy with WIC? Then what happens?”

Five themes emerged. First, most WIC participants expressed frustration with the signage (or lack of signage) in many stores, which deterred them from shopping there.

Second, a majority reported feeling stigmatized by store employees and other customers, typically during checkout, due to the need to separate WIC items and ring up the voucher separately. This was particularly true in states that still use the paper voucher. To further reduce stigma, participants also recommended allowing self-checkout for WIC items, having a register specifically for WIC customers and putting WIC and SNAP benefits on the same card to streamline payments.

Third, participants agreed that WIC helped them buy healthier foods, especially fruits and vegetables, but they struggled to use their full benefits in this category because they have a cash value, rather than being based on quantity. In some states, the benefit must be spent all at once, too. If the fruit and vegetable allowance is $10, for instance, participants often spend time calculating the pricing of their items to make sure they’ve spent the full amount.

Fourth, WIC-only stores and sections seemed to increase customer satisfaction. Those from Illinois and Texas had experiences in WIC-only stores and appreciated the ease of finding items and decreasing decision fatigue. In North Carolina, stores with WIC-focused sections helped shoppers identify products quickly. Finally, participants said they understand WIC restrictions but did express a desire for different items or brands.

“We need to acknowledge the barriers in the purchasing process, which for so long weren’t even considered by officials as a possibility,” said Larry Powell of the University of Alabama at Birmingham, who wasn’t involved in the study.

“Stigma is now a problem that’s known, but officials don’t know what to do about it,” Powell told Reuters Health by email. “It’s important to make the process as simple and easy as possible.”

SOURCE: bit.ly/2E2g1B4 Journal of the Academy of Nutrition and Dietetics, online November 27, 2018.