Objective: To compare the Household Food Insecurity Access Scale (HFIAS), the US Food Security Survey Module (US FSSM) and a modified version of the US FSSM in which references to buying food were changed to references to getting food, in terms of their classification of food security levels among homeless individuals, and to determine which of these instruments was most preferred by homeless individuals. Design: A cross-sectional survey. Setting: Recruitment of participants took place at seven shelters and from three drop-in programmes that serve homeless individuals in Toronto, Canada. Subjects: Fifty individuals who were $18 years of age, able to communicate in English and currently homeless. Results: The modified US FSSM assigned 20 % of participants to a lower ordinal food security category compared with the US FSSM, and only 8 % to a higher food security category. The HFIAS assigned 30 % of participants to a lower food security category compared with either the US FSSM or the modified US FSSM, and only 10-16 % of participants to a higher food security category. When asked to compare all three instruments, the majority of respondents (62 %) selected the HFIAS as the best instrument for people who are homeless. Conclusions: A majority of homeless individuals selected the HFIAS as the best food security instrument for people who are homeless. Our findings suggest that the HFIAS is a more appropriate instrument than the US FSSM for measuring food security in the homeless population.

In this study, cognitive interviewing methods were used to test targeted questionnaire items from a battery of quantitative instruments selected for a large multisite trial of supported housing interventions for homeless individuals with mental disorders. Most of the instruments had no published psychometrics in this population. Participants were 30 homeless adults with mental disorders (including substance use disorders) recruited from service agencies in Vancouver, Winnipeg, and Toronto, Canada. Six interviewers, trained in cognitive interviewing methods and using standard interview schedules, conducted the interviews. Questions and, in some cases, instructions, for testing were selected from existing instruments according to a priori criteria. Items on physical and mental health status, housing quality and living situation, substance use, health and justice system service use, and community integration were tested. The focus of testing was on relevance, comprehension, and recall, and on sensitivity/acceptability for this population. Findings were collated across items by site and conclusions validated by interviewers. There was both variation and similarity of responses for identified topics of interest. With respect to relevance, many items on the questionnaires were not applicable to homeless people. Comprehension varied considerably; thus, both checks on understanding and methods to assist In addition, there are five site coordinators (one for each city where the study is carried out) and numerous lead service and housing providers. CEA is lead for quantitative measurement and data collection at the national level; MLP and KSM are site research coordinators; SWH is lead investigator for the Toronto site; ACH was an undergraduate medical research student for the summer of 2009; and PNG is the national research lead. 36comprehension and recall are recommended, particularly for participants with acute symptoms of mental illness and those with cognitive impairment. The acceptability of items ranged widely across the sample, but findings were consistent with previous literature, which indicates that "how you ask" is as important as "what you ask." Cognitive interviewing methods worked well and elicited information crucial to effective measurement in this unique population. Pretesting study instruments, including standard instruments, for use in special populations such as homeless individuals with mental disorders is important for training interviewers and improving measurement, as well as interpreting findings.

No abstract