ObjectiveProgress towards equitable and sufficient water has primarily been measured by population-level data on water availability. However, higher-resolution measures of water accessibility, adequacy, reliability and safety (ie, water insecurity) are needed to understand how problems with water impact health and well-being. Therefore, we developed the Household Water InSecurity Experiences (HWISE) Scale to measure household water insecurity in an equivalent way across disparate cultural and ecological settings.MethodsCross-sectional surveys were implemented in 8127 households across 28 sites in 23 low-income and middle-income countries. Data collected included 34 items on water insecurity in the prior month; socio-demographics; water acquisition, use and storage; household food insecurity and perceived stress. We retained water insecurity items that were salient and applicable across all sites. We used classical test and item response theories to assess dimensionality, reliability and equivalence. Construct validity was assessed for both individual and pooled sites using random coefficient models.FindingsTwelve items about experiences of household water insecurity were retained. Items showed unidimensionality in factor analyses and were reliable (Cronbach’s alpha 0.84 to 0.93). The average non-invariance rate was 0.03% (threshold <25%), indicating equivalence of measurement and meaning across sites. Predictive, convergent and discriminant validity were also established.ConclusionsThe HWISE Scale measures universal experiences of household water insecurity across low-income and middle-income countries. Its development ushers in the ability to quantify the prevalence, causes and consequences of household water insecurity, and can contribute an evidence base for clinical, public health and policy recommendations regarding water.

Despite the central importance of water for human wellbeing and development, researchers and practitioners have few tools to quantitatively measure, assess, and compare the scope and scale of household and individual water insecurity across cultural and climatic variations. There are multiple definitions of water insecurity, and the analytical tools for measuring household-level water insecurity are in their infancy. This paper provides an overview and systematic evaluation of current household and individual water in security metrics for human development. We seek to advance micro-level metrics-attending to the considerations of dimensionality, temporality, unit of analysis, and comparabilitybecause they will provide the research community with necessary tools to untangle the complex determinants and outcomes of water insecurity. Moreover, such metrics will support the translation of research outcomes into meaningful and useful products and results for stakeholders, communities, and decision-makers.

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