Fostering Stronger Relationships Between Nutritionists and their Patients

A balanced diet is vital for all of us — but doubly so for kids. In the U.S., the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a crucial program for promoting childhood nutrition. For more than four decades, the program has been providing pregnant women, new moms, and young children with access to food benefits, healthcare referrals, and dietary education. 

WIC is one of the most successful federal assistance programs in U.S. history. Research shows that enrolment in WIC is linked to a huge range of benefits, from reduced rates of infant mortality and illness to improved cognitive development in children. But in Dallas, Texas, uptake of the program among eligible families was sitting at just 40%. 

We worked with the design team at IDEO.org, the non-profit sister organization of leading design consultancy firm IDEO, to complement their human-centred design approach with insights from the behavioural sciences. Together, we investigated how we could improve engagement with the WIC program in Dallas. 

Why aren’t people enrolling in WIC if they’re eligible? When investigating this question, IDEO.org and the Child Poverty Action Lab (CPAL) found that the issue wasn’t a lack of information: people were perfectly aware that WIC existed. It was stigma, confusion about eligibility and repercussions, and a distrust in the medical system that kept people away. 

Nutritionists and other healthcare professionals have a big role to play in addressing these issues. In many cases, past negative experiences with the healthcare system — feeling judged, not being listened to, being discriminated against, and so on — keep families away from enrolling in WIC. On the flipside, having supportive and trusting relationships with healthcare providers can help to change people’s attitudes towards receiving aid, and encourage them to persevere through the difficult process of applying. 

TDL collaborated with IDEO.org to build a behavioral toolkit directed at nutritionists. The goal was to help these healthcare practitioners forge strong alliances with the people who walked in their doors — especially marginalized community members. We needed to make nutritionists aware of their power to either challenge or reinforce patients’ negative beliefs about WIC, and then give them a roadmap for fostering more supportive relationships. 

Our partners at IDEO.org sat down with both nutritionists and community members for a series of co-design sessions, to understand how both parties experienced their interactions and identify common pitfalls that emerged. TDL then translated these insights into an easy-to-use, evidence-based booklet directed at nutritionists. 

Our recommendations highlight common sources of bias that, while easy for practitioners to overlook, pose a major threat to client relationships. They also drew heavily from research on the therapeutic alliance, or the relationship that psychotherapists have with their clients. Our toolkit takes proven strategies for (re)building the therapeutic alliance and adapts them for the nutritionist’s office.

Sometimes, approving anti-poverty assistance legislation is just the first step. On-the-ground practitioners need to ensure that those in need are willing and comfortable to seek support. By providing accessible educational materials to those on the front lines, our partnership can help kids in Dallas get the assistance they need to thrive.