Predictors of Redemption among Low-Income, Pregnant Women, Infants, and Children Participants: A Secondary Analysis of a Multicomponent eHealth Behavioral Intervention Study

BACKGROUND: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides essential nutrition support to low-income pregnant individuals in the United States, yet food package redemption remains suboptimal. Digital interventions to support lifestyle behavior change may improve benefit utilization during pregnancy. OBJECTIVES: This study aimed to evaluate whether participation in a multicomponent eHealth behavioral intervention influenced WIC food package redemption, the factors associated with redemption, and to explore the relationship between redemption and dietary intake. METHODS: This prespecified secondary analysis used data from a 2-arm randomized controlled trial in which n = 351 pregnant individuals enrolled in WIC were randomly assigned to either a multicomponent eHealth behavioral intervention promoting healthy gestational weight gain plus standard WIC services (n = 179) or standard WIC services alone (n = 172). Food package redemption rates across the intervention period were calculated from electronic benefit transfer data. Aim 1 assessed differences in redemption between study arms and potential effect modifiers. Aim 2 examined individual (e.g., education and race/ethnicity) and environmental (e.g., geospatial food access and neighborhood disadvantage) correlates of redemption regardless of intervention group. Aim 3 explored associations between food redemption and dietary intake assessed via dietary recalls. RESULTS: Redemption rates were low (∼50%) and did not differ between study arms. However, within the intervention group, adherence to daily self-weighing predicted higher redemption. Higher redemption was also observed in those of older age, having some college education, with obesity, and in non-Hispanic White participants. Environmental indices, including neighborhood deprivation and geospatial food access, did not significantly moderate redemption behaviors. Higher benefit redemption was associated with improved dietary quality. CONCLUSIONS: Although the multicomponent behavioral intervention did not increase redemption rates overall, individual characteristics, including intervention engagement, age, education, BMI, and race/ethnicity, were predictive of redemption behavior. More targeted interventions that address structural disparities may be needed to enhance WIC benefit utilization during pregnancy.