Development and validation protocol for an instrument to measure household water insecurity across cultures and ecologies: the Household Water InSecurity Experiences (HWISE) Scale

Abstract

IntroductionA wide range of water-related problems contribute to the global burden of disease. Despite the many plausible consequences for health and well-being, there is no validated tool to measure individual- or household-level water insecurity equivalently across varying cultural and ecological settings. Accordingly, we are developing the Household Water Insecurity Experiences (HWISE) Scale to measure household-level water insecurity in multiple contexts.Methods and analysisAfter domain specification and item development, items were assessed for both content and face validity. Retained items are being asked in surveys in 28 sites globally in which water-related problems have been reported (eg, shortages, excess water and issues with quality), with a target of at least 250 participants from each site. Scale development will draw on analytic methods from both classical test and item response theories and include item reduction and factor structure identification. Scale evaluation will entail assessments of reliability, and predictive, convergent, and discriminant validity, as well as the assessment of differentiation between known groups.Ethics and disseminationStudy activities received necessary ethical approvals from institutional review bodies relevant to each site. We anticipate that the final HWISE Scale will be completed by late 2018 and made available through open-access publication. Associated findings will be disseminated to public health professionals, scientists, practitioners and policymakers through peer-reviewed journals, scientific presentations and meetings with various stakeholders. Measures to quantify household food insecurity have transformed policy, research and humanitarian aid efforts globally, and we expect that an analogous measure for household water insecurity will be similarly impactful.

Household water insecurity is strongly associated with food insecurity: Evidence from 27 sites in low‐ and middle‐income countries

“…Data obtained from the Household Water Insecurity Experiences (HWISE) study conducted between March 2017 and July 2018 consisted of households from 27 sites in 21 low‐ and middle‐income countries (Figure ) (Young et al, ). The HWISE study sites were selected in order to capture a wide array of ecologies in which water insecurity occurs, from urban settings where insecurity is based on market failures or weak infrastructure, to highly arid seasonal subsistence communities primarily dependent on surface water.…”

“…For 816 of the 7507 households, one or more of the key variables or covariates were missing, thus providing a final analytic sample of 6691. The exact method for selection of surveyed households varied by site, as did the seasons of data collection (Table , see also Young et al, ). The sample sizes varied somewhat across sites, but were collected with the target of 250 households in each.…”

“…We operationalized household water insecurity in several ways. We began by selecting 14 water‐related survey items from the longer HWISE study surveys presented in Young et al () relevant to four subdomains of theoretical interest. These were (a) insufficient water quantity (based on 7 items related to the impacts of water shortages), (b) low water quality (2 items), (c) time/labor costs of water insecurity (3 items), and (d) the reported impact of water insecurity on changing what was eaten (1 item) (see Table ).…”

“…We begin by reviewing the prior literature that has considered empirically the proximate theorized connections between household water and food insecurity. We then integrate and model cross‐sectional data collected from households within 27 highly ecologically diverse urban and rural community sites in Africa, Asia, the Middle East, and the Americas, all with known problems with water (Young et al, ). A significant advantage of the data set used herein is the application of consistent measures of both food and water insecurity at a single scale (the household) across multiple sites.…”

Water insecurity: An agenda for research and call to action for human biology

“…Our network works on a range of questions around water insecurity (Jepson et al, ). An early outcome of the collaboration is the development of the first cross‐cultural scale for measuring water insecurity (Young et al, ). The HWISE Network, with human biology as an emerging strength, also provides a space for interdisciplinary conversations and a community of practice that aims to benefit a broad range of researchers.…”