JMIR Publications

ABSTRACT

Background:

Following the third week of March 2020, states and agencies of the Women, Infants and Children (WIC) program were granted temporary waivers to secondary contact requirements for clients seeking to receive or recertify WIC benefits given the emerging COVID-19 global pandemic. By April 1, 2020, four COVID-19 specific educational resources were launched on the dashboard page where users land after logging onto Wichealth, an online nutrition education behavior change program. This investigation compared users who accessed these resources to users with no access to any COVID-19 resources during April 1, 2020 through October, 31, 2021. User engagement with emergency response embedded in an online health education system has not previously been investigated due to a paucity of opportunities and a lack of the ability to evaluate relevant users at scale.

Objective:

This investigation sought to understand differences between Wichealth users who accessed at least one COVID-19 specific response resource and Wichealth users who recorded no use during the entire the period the resources were active.

Methods:

A comparative cross-sectional study was completed evaluating differences between Wichealth lesson completion and performance statistics between 29,979 unique WIC clients who accessed COVID-19 resources and 555,861 unique users who did not access the resources over the same period. Odds ratios and binomial 95% confidence intervals using normal approximation were calculated for both groups across all measures stratified by available socio-demographic characteristics.

Results:

Overall, Wichealth COVID-19 resources were utilized by 6.5% of system users with access to them, much lower than expected given historical Wichealth resource usage rates. A significantly greater level of COVID-19 resource access was observed for Latino users (P<.05; OR=1.15, 95% CI 1.13,1.18) and Spanish language version users (P<.05; OR=1.73, 95% CI 1.61,1.86), compared to overall Wichealth system usage for these groups. Further, compared to Wichealth system users with no COVID-19 resource utilization, individuals who accessed these resources were more likely to engage with Wichealth lesson resources during lesson completion (P<.05, OR=1.3; 95% CI 1.25,1.35). However, users who accessed COVID-19 resources were slightly less likely to recommend Wichealth lesson resources to others and believe in their ability to make healthy changes using information they learned from completing the lesson, but these differences were not statistically significant overall or by any socio-demographic strata.

Conclusions:

Wichealth COVID-19 response resource use was limited among system users and associated with those most likely to engage with other Wichealth resources. The relatively low access and lack of reach across all user socio-demographic characteristics suggests that separate, COVID-19 specific resources may not be the most effective way of addressing user concerns of an existing online educational system. Rather, integration of COVID-19 messaging within existing resources may be more effective at reaching more users.