Development and validation of an experience-based scale to measure water insecurity at the household level

UNCG Author/Contributor (non-UNCG co-authors, if there are any, appear on document)
Carole Debora Nounkeu (Creator)
The University of North Carolina at Greensboro (UNCG )
Web Site:
Jigna Dharod

Abstract: In 2017, about half of the people (400 million) lacking basic access to safe water worldwide lived in Sub-Saharan Africa. Among them, 135 million had to walk for more than 30 minutes round trip to an improved water source, and 144 million solely relied on surface water sources. Water insecurity is defined as the inconsistent access to sufficient amount of safe and clean water for active and healthy life. To promote water security and improve health, one of the 17 Sustainable Development Goals (SDGs) is to ensure sustainable management of adequate water and sanitation for all. To monitor this goal, indicators such as water availability and distance to water source are often used. However, to understand the effect of water security on health and nutrition at the household level, development of a reliable and valid household water insecurity scale is of utmost importance. Additionally, water security and its measurement scale is vital in achieving SDGs on addressing hunger, gender equity, as well as responsible consumption and production of natural resources of the planet. Nevertheless, based on current literature on water security scales development, no real consensus exists on what constitutes key components of the scale, and how the scale relates to food security especially in improving food utilization at physiological level by reducing incidences of diarrhea, particularly among children. This study aimed to 1) develop an experience-based household level water insecurity scale, 2) test, and validate the experience-based household level water insecurity scale using concurrent and predictive measures. Approvals were obtained from Cameroon and the University of North Carolina at Greensboro ethical committees. The study was conducted from February 2019 to January 2020, in rural areas of West Cameroon, Central Africa, using a mixed-methods approach. The qualitative phases, including a formative stage consisting in three focus groups discussions and six key informant interviews, was conducted with adults involved in fetching or managing water at the household level. Pertinent themes related to water fetching and management, daily use of water with information about drinking and chores water put separately, and coping strategies reported by community members to palliate water shortages were used to generate an initial set of 81 items, representing quotes and lived experiences of water insecurity in the study area. Half of these items (40 items; HWIAS-40) were retained because reported as related to the usual lived experiences of community members and reviewed by five women from the community to ensure they were easy to understand, culturally appropriate, and relevant to the study area of rural setting. The resulting scale with 30 statements (HWIAS-30) was further evaluated by a panel of six experts for relevance to the water insecurity definition and overall clarity and language use leading to a pre-final scale (HWIAS-25) with 25 statements. Results from the formative phase with both men and women from different age groups showed that children and women held the primary responsibility for water fetching and their main efforts were directed toward securing drinking water for their family. Household chores were organized in a hierarchical order and priority in water use was given to cooking, bathing, and to some extent, washing clothes. Coping strategies included changing meal plan or not cooking practices, recycling already-used water, borrowing water from neighbors, providing compensation in exchange for water services, and partitioning water use. In the development of the final version of the scale, results of item reduction analysis i.e., low response rates, item difficulty index, item discrimination index, and exploratory factor analysis led to maintain 17 statements (HWIAS-17) out of the tested 25 statements. The coefficient of reliability (or consistency) of the HWIAS-17 was at the excellent level with Cronbach’s alpha of 0.92 indicating a very high level of response consistency across statements. In testing predictive validity, water insecurity score was significantly associated with food insecurity (p<0.001). Specifically, dose-response relationship was found i.e., mean water insecurity score was the highest for severely food insecure households and the lowest for the most food secure households (food secure (water insecurity score: 7.3 ± 9.6), mildly food insecure (water insecurity score: 8.3 ± 8.2), moderately food insecure (water insecurity score: 16.2±14.8), and severely food insecure (water insecurity score: 25.9±16.3). In assessing construct validity, it was found that HWIAS-17 water insecurity score was correlated with water access indicators of time spent to water source and amount of water use. In fact, water insecurity scores were positively correlated with total time spent to fetch water (drinking water (p=0.002) and chores water (p<0.001)). Further, the HWIAS-17 water insecurity scores were negatively correlated with per capita water use (p=0.015) and amount of water stored at the household level (p=0.023). In conclusion, not only women, but also children in the household shared a significant responsibility in fetching or securing water for the household. Use of a step-by-step approach and methodology involving in-depth investigation and quantitative survey are vital in developing highly reliable and valid household water insecurity scale. Water insecurity is significantly associated with food insecurity. Hence, measurement of household level water insecurity scale is critical not only in measuring water access issues, but it is even essential for food and nutrition security programs and interventions.

Additional Information

Language: English
Date: 2020
Coping strategies, Qualitative research, Scale development, Scale validation, Water access, Water insecurity
Water security $z Cameroon
Adjustment (Psychology)

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