1. Missouri WIC Customer Satisfaction Survey Fiscal Year 2008

2. Overall Purposes of the Survey To determine how Missouri WIC can improve service for non-native English speaking participants; To determine how Missouri WIC can improve service for non-native English speaking participants; To determine how service needs differ between English and non-native English speaking participants; To determine how service needs differ between English and non-native English speaking participants; To determine how service needs differ among specific groups of non-native English speaking participants. To determine how service needs differ among specific groups of non-native English speaking participants.

3. Sampling Method A language proficiency summary report was generated from the DSS DCN assignment data system which collects the language spoken by participant; A language proficiency summary report was generated from the DSS DCN assignment data system which collects the language spoken by participant; 21 local WIC providers were selected to participate in the FY 2008 WIC Customer Satisfaction Survey based on the number of participants who spoke various languages. 21 local WIC providers were selected to participate in the FY 2008 WIC Customer Satisfaction Survey based on the number of participants who spoke various languages.

4. Selected Local WIC Providers NW – St. Joseph/Buchanan, Platte, Truman, Crescent, Samuel Rodgers, and St. Lukes Samuel Rodgers, and St. Lukes NE – Saline C – Columbia-Boone and Pettis SE – Dunklin and Howell SW – Barry, Springfield-Greene, Joplin, McDonald, Newton, and Taney and Taney E - St. Charles, St. Louis HDC, Family Care, and Grace Hill Grace Hill

5. Language of Surveys Returned 20 local WIC providers returned surveys in English and Spanish; 20 local WIC providers returned surveys in English and Spanish; The following local WIC providers also returned surveys in other languages: The following local WIC providers also returned surveys in other languages: Pettis and Springfield – Russian Pettis and Springfield – Russian Truman – Somali & Arabic Truman – Somali & Arabic Crescent – Arabic Crescent – Arabic Samuel Rodgers – Somali, Vietnamese & Arabic Samuel Rodgers – Somali, Vietnamese & Arabic

6. Language of Surveys Returned (continued) St. Louis HDC – Somali, Bosnian, Vietnamese, St. Louis HDC – Somali, Bosnian, Vietnamese, Arabic, & Russian Arabic, & Russian Family Care – Somali, Bosnian, Vietnamese, & Family Care – Somali, Bosnian, Vietnamese, & Arabic Arabic Grace Hill - Vietnamese Grace Hill - Vietnamese

7. Survey Instrument The FY 2006 survey instrument was developed by consultants from Sinclair School of Nursing, University of Missouri-Columbia and the MO WIC Cultural Competency Team based on research questions provided by the Cultural Competency Team; The FY 2006 survey instrument was developed by consultants from Sinclair School of Nursing, University of Missouri-Columbia and the MO WIC Cultural Competency Team based on research questions provided by the Cultural Competency Team; The Missouri WIC Program revised the content and format to include additional education & FI redemption questions in the FY 2008 WIC Customer Satisfaction Survey. The Missouri WIC Program revised the content and format to include additional education & FI redemption questions in the FY 2008 WIC Customer Satisfaction Survey.

8. Distribution of Completed Surveys (FY 2008) Language Response Rate Response Rate Completed Surveys Completed Surveys English100.0%808 Spanish68.7%506 Somali26.7%44 Bosnian37.1%27 Vietnamese73.3%54 Arabic29.3%22 Russian75.7%53 Total81.8%1,514

9. Categories of Questions for Evaluation Application and education processes Application and education processes WIC staff and vendors WIC staff and vendors WIC checks WIC checks Favorite things and hard requirements Favorite things and hard requirements Overall satisfaction Overall satisfaction

10. How did you first find out about the WIC Program?

11. How would you describe the application process?

12. How would you describe the process of having height, weight and blood samples taken?

13. How would you describe the nutrition assessment process?

14. How would you describe the nutrition education receive at this WIC office?

15. The WIC food list with pictures is…

16. If WIC could give you information about nutrition in any of the following ways, which would you choose?

17. Do you have access to the internet?

18. The staff at this office use words that I understand

19. The staff at this WIC office are helpful

20. The cashiers at the WIC store or pharmacy are helpful

21. The store that I shop has the WIC foods I want

22. I use all the WIC checks I am given

23. If you don’t use all your WIC checks, why not? (N=183, 138 ELS participants and 45 NELS participants)

24. Which three things do you like most about the WIC program?

25. Which three of the following WIC requirements are the hardest for you?

26. How would you rate the services you receive from the WIC program?

27. Is English your first language?

28. How well do you speak English?

29. How often do you need an interpreter when you come to the WIC office?

30. Conclusions Both ELS and NELS participants in FY 2008 were very satisfied with most aspects of the WIC program. Both ELS and NELS participants in FY 2008 were very satisfied with most aspects of the WIC program. Improvements are recommended if more than 20% of participants from one or both groups chose the less positive responses. Improvements are recommended if more than 20% of participants from one or both groups chose the less positive responses.

31. Conclusions (continued) > 20% of the participants who completed Somali and Vietnamese surveys said that the application process and nutrition assessment process were “somewhat difficult” or “difficult”; > 20% of the participants who completed Somali and Vietnamese surveys said that the application process and nutrition assessment process were “somewhat difficult” or “difficult”; > 20% of the participants who completed Somali surveys said that the WIC food list with pictures was “somewhat difficult to understand” or “difficult to understand”; > 20% of the participants who completed Somali surveys said that the WIC food list with pictures was “somewhat difficult to understand” or “difficult to understand”;

32. Conclusions (continued) > 20% of the participants who completed Somali, Vietnamese and Arabic surveys said that they “sometimes” or “never” understand the words used by WIC staff. > 20% of the participants who completed Somali, Vietnamese and Arabic surveys said that they “sometimes” or “never” understand the words used by WIC staff.

33. Recommendations Vendor Survey: One specific program component should be investigated - WIC vendors. Although more than half of participants from both groups responded favorably to questions about WIC vendors, these proportions were much lower than those for other topics. Vendor Survey: One specific program component should be investigated - WIC vendors. Although more than half of participants from both groups responded favorably to questions about WIC vendors, these proportions were much lower than those for other topics.

34. Recommendations (continued) Provide brief Spanish language training on words or phrases specific to WIC. Provide refresher Cultural Competency training for local WIC providers in the metropolitan areas due to the more diverse populations being served by these agencies. Provide brief Spanish language training on words or phrases specific to WIC. Provide refresher Cultural Competency training for local WIC providers in the metropolitan areas due to the more diverse populations being served by these agencies. Provide more interpreters and translated educational materials to some of the WIC participants whose native language is not English. Provide more interpreters and translated educational materials to some of the WIC participants whose native language is not English.

35. Recommendations (continued) Local WIC providers should consider scheduling individual counseling sessions for some NELS participants, especially for the Vietnamese, Somali and Arabic populations. Local WIC providers should consider scheduling individual counseling sessions for some NELS participants, especially for the Vietnamese, Somali and Arabic populations. Encourage local WIC providers to use alternative methods to provide nutrition education in addition to individual and group nutrition sessions. Develop web-based nutrition education modules for ELS participants, and take home nutrition education modules for both ELS and NELS participants. Encourage local WIC providers to use alternative methods to provide nutrition education in addition to individual and group nutrition sessions. Develop web-based nutrition education modules for ELS participants, and take home nutrition education modules for both ELS and NELS participants.