A Novel Household Water Insecurity Scale: Procedures and Psychometric Analysis among Postpartum Women in Western Kenya

Abstract

Our ability to measure household-level food insecurity has revealed its critical role in a range of physical, psychosocial, and health outcomes. Currently, there is no analogous, standardized instrument for quantifying household-level water insecurity, which prevents us from understanding both its prevalence and consequences. Therefore, our objectives were to develop and validate a household water insecurity scale appropriate for use in our cohort in western Kenya. We used a range of qualitative techniques to develop a preliminary set of 29 household water insecurity questions, and administered those questions at 15 and 18 months postpartum, concurrent with a suite of other survey modules. These data were complemented by data on quantity of water used and stored, and microbiological quality. Inter-item and item-total correlations were performed to reduce scale items to 20. Exploratory factor and parallel analyses were used to determine the latent factor structure; a unidimensional scale was hypothesized and tested using confirmatory factor and bifactor analyses, along with multiple statistical fit indices. Reliability was assessed using Cronbach’s alpha and the coefficient of stability, which produced a coefficient alpha of 0.97 at 15 and 18 months postpartum and a coefficient of stability of 0.62. Predictive, convergent and discriminant validity of the final household water insecurity scale were supported, based on relationships with food insecurity, perceived stress, per capita household water use, and time and money spent acquiring water. The resultant scale is a valid and reliable instrument. It can be used in this setting to test a range of hypotheses about the role of household water insecurity in numerous physical and psychosocial health outcomes, to identify the households most vulnerable to water insecurity, and to evaluate the effects of water-related interventions. To extend its applicability, we encourage efforts to develop a cross-culturally valid scale using robust qualitative and quantitative techniques.

Development of water insecurity scale for rural households in Cameroon- Central Africa

“…Thus, drawing upon extensive and well-established argument on the importance of measuring food insecurity at the household-level [ 18 , 19 ], we undertook the development of a validated household-level experiential water insecurity scale using its pre-determined definition. We focused the scale on the concept that in developing countries, caretakers or female adults play a primary role in fetching and managing water for their households, including cooking and feeding infants and children, ensuring food availability and utilization for their families [ 8 , 15 , 20 ].…”

The toll of household water insecurity on health and human biology: Current understandings and future directions

“…To date, the majority of research examining the relationships between health and household water insecurity have demonstrated that water insecurity is associated with increases in psychosocial stress, risk of depression, anxiety, and creates a toll on mental health (Boateng et al, 2018; Boateng et al, 2020; Cooper‐Vince et al, 2017, 2018; Ennis‐McMillan, 2001; Krumdieck et al, 2016; Molden, Khanal, & Pradhan, 2018; Stevenson et al, 2012; Workman & Ureksoy, 2017; Wutich et al, 2017; Wutich & Ragsdale, 2008). This work on water and mental health is reviewed elsewhere (Wutich et al 2020).…”

“…Water contaminants can be broadly classified into pathogens and chemicals; much has been written about adverse consequences of exposure to both. The pathogens of greatest global concern are coliforms, which are a marker of exposure BOX 1 Quantifying experiences of water access and use Numerous experiential measures of household water insecurity have been developed in the past 20 years, for example, in the USA (Jepson, 2014), Bolivia (Rosinger, 2018;Wutich & Ragsdale, 2008), Ethiopia (Stevenson et al, 2012), Nepal (Aihara, Shrestha, Kazama, & Nishida, 2015), and Kenya (Boateng et al, 2018). A range of techniques have been used to develop, implement, and validate their scales (Jepson et al, 2017).…”

Seasonal variation in household water insecurity in rural Bangladesh: A longitudinal analysis

“…Additionally, this study builds on the few longitudinal studies in the HWI literature that examine effects of seasonal flooding [19][20][21]. While examining these water-related risks, we control for household-level water use and demographic characteristics as households within the same climate and region may experience HWI differently due to things such as water collection time [22][23][24], ability to pay for drinking water [25], water source access and ownership [26,27], and the ability to store water during periods of scarcity [24,28].…”