An Evaluation of Nutrition Services Delivered to WIC High-Risk Prenatal Women by Three Nutrition Provider Types in a Regional Rural Health Department

Objective: To determine if differences existed in pregnancy outcomes and quality of nutrition care delivered to WIC high-risk prenatal women by three nutrition provider types.

Design: A seven month retrospective medical record audit

Subjects/Setting: WIC high-risk prenatal women who met the following criteria, underweight for height, enrolled in WIC ≤ 32 weeks gestation, no other primary certification codes, and could have iron deficiency anemia, were sampled from a 23 county regional rural health department (n=146). The women were divided into three groups based on the provider type classification during their prenatal WIC enrollment.

Main outcome measures: An audit tool was developed by the researchers to gather data from the medical record. This information was utilized to assess the overall quality of nutrition care based on four intervention process variables, accuracy, completeness, quality of nutrition education, and quality of charting note. The information was also used to describe the population. The outcome variables, total weight gain and birth weight, were gathered from WIC's regional computer data system.

Statistical analyses: Mulitivariant analysis and Tukey's test were used to analysis quality of nutrition care and analysis of variance was used for the outcome variables (p<0.05). Means and Chi-square analysis were used to further describe the population.

Results: The women were relatively homogenous. Significant differences were not noted for the outcome variables by provider type. For the process variables significant differences were noted for quality of nutrition education and quality of charting note.

Applications: Outcome variables continues to support prenatal WIC services. Process variables revealed the need for appropriate staff, adequate staffing ratios and training of staff for WIC nutrition services.