INCREASING UPTAKE AND IMPROVING HEALTH: EXPERIMENTAL EVIDENCE ON TAKE-UP OF THE WIC PROGRAM INCREASING UPTAKE AND IMPROVING HEALTH: EXPERIMENTAL EVIDENCE ON TAKE-UP OF THE WIC PROGRAM

Last registered on January 04, 2021

Pre-Trial

Trial Information

General Information

Title
INCREASING UPTAKE AND IMPROVING HEALTH: EXPERIMENTAL EVIDENCE ON TAKE-UP OF THE WIC PROGRAM INCREASING UPTAKE AND IMPROVING HEALTH: EXPERIMENTAL EVIDENCE ON TAKE-UP OF THE WIC PROGRAM
RCT ID
AEARCTR-0006985
Initial registration date
December 31, 2020

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published
January 04, 2021, 9:09 AM EST

First published corresponds to when the trial was first made public on the Registry after being reviewed.

Locations

Region

Primary Investigator

Affiliation
UC Davis

Other Primary Investigator(s)

PI Affiliation
University of Wisconsin, Madison

Additional Trial Information

Status
In development
Start date
2021-01-04
End date
2023-03-01
Secondary IDs
Abstract
The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is an important part of the safety net for pregnant women. WIC is a large program, covering about half of infants, and WIC participation has multiple health impacts in pregnancy. Despite this, the program is significantly under-enrolled. Only 63% of eligible pregnant women participate and participation has declined since 2010. Our research pilots a new approach to connect women to WIC. More than 90% of reproductive-age women have smartphones, and more than half use applications to track menstruation and pregnancy. Because prenatal care is underused, apps may provide a uniquely low-cost, scalable way to reach women in early pregnancy. We have partnered with the designers of an app used by several million WIC-eligible women. We pilot a randomized controlled trial that experimentally tests approaches to encourage WIC take-up. Because the app tracks pregnancy health, the experiment also (a) provides the first randomly-assigned variation in WIC with which to evaluate WIC health impacts and (b) allows us to test how well-targeted benefits to the marginal WIC participants are.
External Link(s)

Registration Citation

Citation
Bitler, Marianne and Jenna Nobles. 2021. " INCREASING UPTAKE AND IMPROVING HEALTH: EXPERIMENTAL EVIDENCE ON TAKE-UP OF THE WIC PROGRAM INCREASING UPTAKE AND IMPROVING HEALTH: EXPERIMENTAL EVIDENCE ON TAKE-UP OF THE WIC PROGRAM ." AEA RCT Registry. January 04. https://doi.org/10.1257/rct.6985-1.0
Experimental Details

Interventions

Intervention(s)
We experimentally test an approach to encourage WIC take-up for women using a pregnancy tracking app. We provide women in the treatment arm with a combined information, anti-stigma, and reduced administrative burden intervention. Women in the control arm are instead provided with information from ACOG.
Intervention Start Date
2021-01-15
Intervention End Date
2022-12-31

Primary Outcomes

Primary Outcomes (end points)
RCT:
At the time of the initial survey:
Did women in the treatment group click on the link to find out about the nearest WIC clinic? Did women click on any link?

At the time of the follow on survey, we consider:
Self-reported pregnancy outcome was a live birth or not?

Woman has heard of WIC?

Is the woman enrolled in WIC now?

Birthweight

Premature/early birth

Breastfeeding initiated?

Woman down/sad/had little pleasure

Not enough food/worried about food


For the descriptive analysis, primary outcomes:
Woman has experienced delay of medical care due to COVID

Woman has experienced loss of employment income or unemployment due to COVID

Woman did not have enough food to eat because she couldn't afford it

Women knows about WIC relative to knowledge about SNAP

Woman plans to enroll in WIC for her baby

Why women did not enroll in WIC and/or SNAP?

How the woman feels her state has done with handling COVID?

Primary Outcomes (explanation)

The woman clicked on a link about WIC. Woman clicked on link to find out about the nearest WIC clinic is set to 0 if the woman is in the control group.

Woman clicked on link for either group is set to 1 if clicked, and 0 if did not.

Secondary Outcomes

Secondary Outcomes (end points)
Does the woman know about services WIC provides and what food you can purchase?

Does the woman know about when women/infants/children can enroll in WIC?

Measures 3 to 8 are taken from the initial and follow up survey, and will also be compared to similar questions about SNAP.
Woman did not enroll because don't know about program (0 if enrolled)

Woman did not enroll because she doesn't think she's eligible

Woman did not enroll because it is too hard to sign up

Woman did not enroll because WIC isn't for people like me

Woman did not enroll for other reasons

Pregnancy complications

Was baby born in hospital?

Did baby go to NICU?

Confident will get food in next 4 weeks

On Medicaid

On SNAP

Engagement with the pregnancy app

Secondary Outcomes (explanation)
Reasons woman did not enroll are not mutually exclusive.

Experimental Design

Experimental Design
The app platform can randomize users based on a random numeric seed assigned at sign-up. The two arms of the RCT experiment include a control arm and a treatment arm. Following the report of a pregnancy, women will be recruited over email. They will be consented, complete a screener survey, and if likely eligible for WIC, be randomized into one of the two arms.
A large share of women but not all women found to be already participating in WIC will also be screened out.
Experimental Design Details
Not available
Randomization Method
The women will be randomized according to a random numeric seed assigned at sign-up for the app, based on a digit from 0-9. Half of the digits will be assigned to the treatment arm and half to control arm.
Randomization Unit
Individuals
Was the treatment clustered?
No

Experiment Characteristics

Sample size: planned number of clusters
6,000 women
Sample size: planned number of observations
6,000 women
Sample size (or number of clusters) by treatment arms
3,000 women in each arm
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
The MDE for clicking on the link is 7 percentage points (variable is 0 or 1). This is based on assigning women to the treatment and control arms with equal probabilities. The MDE for the outcomes at follow up using the offer as an IV for click through is 0.9 standard deviations. (These are 0/1 units.)
IRB

Institutional Review Boards (IRBs)

IRB Name
The University of Wisonsin-Madison, Minimal Risk IRB (Health Sciences)
IRB Approval Date
2020-09-24
IRB Approval Number
2020-1197
Analysis Plan

There is information in this trial unavailable to the public. Use the button below to request access.

Request Information