| Question | Answers | Source | Source Link | Dates Used | |
|---|---|---|---|---|---|
| 1 | Does your child currently participate in WIC? | • Yes • No, but they used to participate • No, they have never participated in WIC • I don't know | NA | 12/06/2022-12/13/2022 | |
| 2 | Please enter the birth month and year of your oldest child participating in WIC. | • Month (MM) __________________________________________________ • Year (YYYY) __________________________________________________ | NA | 12/06/2022-12/13/2022 | |
| 3 | Which of the following were reasons you enrolled your child in WIC? Please select all that apply. | • I wanted breastfeeding support for my infant. • I wanted access to formula for my infant. • I wanted the food package benefits (e.g. fruits, vegetables, bread, dairy, etc.) • I wanted access to the nutrition education WIC provides. • Not Listed, please specify: | NA | 12/06/2022-12/13/2022 | |
| 4 | To what extent do you agree or disagree with the following statements? I am able to buy more healthy foods for my child than I would be if we were not participating in WIC. | • Completely disagree • Somewhat disagree • Somewhat agree • Completely agree | NA | 12/06/2022-12/13/2022 | |
| 5 | To what extent do you agree or disagree with the following statements? I have more knowledge about how to prepare nutritious food compared to before we participated in WIC. | • Completely disagree • Somewhat disagree • Somewhat agree • Completely agree | NA | 12/06/2022-12/13/2022 | |
| 6 | To what extent do you agree or disagree with the following statements? WIC has helped me with referrals to other health and community services. | • Completely disagree • Somewhat disagree • Somewhat agree • Completely agree | NA | 12/06/2022-12/13/2022 | |
| 7 | To what extent do you agree or disagree with the following statements? My child has a healthier diet than they would if we did not participate in WIC. | • Completely disagree • Somewhat disagree • Somewhat agree • Completely agree | NA | 12/06/2022-12/13/2022 | |
| 8 | We would now like to ask you some questions about the foods you receive through WIC. To what extent do you agree with the following statements? I would like to see WIC offer seafood (e.g., canned tuna) for children. | • Completely disagree • Somewhat disagree • Somewhat agree • Completely agree | NA | 12/06/2022-12/13/2022 | |
| 9 | We would now like to ask you some questions about the foods you receive through WIC. To what extent do you agree with the following statements? I would like to see WIC offer herbs. | • Completely disagree • Somewhat disagree • Somewhat agree • Completely agree | NA | 12/06/2022-12/13/2022 | |
| 10 | We would now like to ask you some questions about the foods you receive through WIC. To what extent do you agree with the following statements? I would like to see WIC offer more non-dairy milk options. | • Completely disagree • Somewhat disagree • Somewhat agree • Completely agree | NA | 12/06/2022-12/13/2022 |