Integrating Co-Creation Principles in a Delphi Process to Address “Fit” for WIC Online Shopping in a Rural Indian Tribal Organization

Implementing Women, Infants, and Children (WIC) online shopping in an equitable manner across all 88 State, Indian Tribal Organization (ITO), and territory WIC agencies has the potential to improve access to nutritious foods and enhance nutrition security for WIC-eligible families nationwide. This project explored the feasibility of WIC online shopping in rural areas serving Indigenous populations in partnership with the Pleasant Point WIC ITO which serves the Passamaquoddy Tribe in Maine. Co-creation principles were embedded within a mixed methods modified Delphi process to understand contextual factors and tailor an existing WIC online shopping implementation Blueprint to the needs of the Pleasant Point WIC staff, partners and participants (n = 21). Process data from listening sessions and transcripts from recorded interviews were double-coded and analyzed using a rapid qualitative analysis approach. Pleasant Point WIC participants were eager to have WIC online shopping as an option to address transportation and child care barriers to onsite shopping. Potential implementation partners' listening sessions revealed positive views of WIC online shopping because it could increase accessibility to WIC foods for participants by decreasing transportation barriers and verifying WIC-approved foods are in stock before going to the store. Potential implementation partners also suggested that a WIC online shopping solution would be most successful if it were characterized by low implementation burden, was affordable for vendors, and used familiar technology for participants. The iterative co-creation process helped us develop an achievable, tailored blueprint aligned with the specific needs and contexts of the community.