Development and Validation of an Experience-Based Measure Of Urban Household Food Insecurity in Northern India

Introduction: Use of experience-based measures of household food insecurity (HFI) remains largely unexplored in India.

Objective: We assessed the reliability and validity of an experience-based measure of HFI and the extent and predictors of HFI in Meerut slums in Uttar Pradesh, India.

Design/Methods: The 6-item HFI measure developed in the United States was adapted and administered through household interviews to 40,016 adults across 75 slums. Adaptations included omitting ‘eat less’ item and merging ‘cut meal’ and ‘skip meal’ items. Internal reliability of the measure was assessed using psychometric statistics based on Rasch measurement model as well as classical test theory. Households reporting 2 or more indicators of food insecurity were classified as food insecure. Bivariate associations of HFI with household economic and socio-demographic characteristics were analyzed, and independent predictors were identified through binary logistic regression.

Results: Affirmative responses to food security scale items ranged from 84% for “couldn’t afford nutritious meals” to 21% for “hungry but didn’t eat.” Corresponding Rasch-model severity parameters ranged across 7.1 logistic units, and item-infit statistics indicated an adequate fit to the measurement model. Classification reliability assessed at food-insecure threshold (2+) indicated sensitivity of 0.94 and specificity of0.83.  We found 74.2% of households were food insecure at sometime during the year preceding the survey. Poor households were five-times more likely to experience HFI (OR 5.1 CI 4.8-5.5).

Potential Value of Study: HFI in the studied population was alarming and strongly linked to poverty. The adapted scale had a moderate validity. For better validity, following is suggested -retain ‘eat less’ item and split ‘cut meal’ and ‘skip meal items’ and their ‘how often’ options.