Status on the Scale Development to Measure Water Insecurity Experiences at the Household Level: A Narrative Review

Abstract

Adequate and safe water is critical in promoting all 3 pillars of food security. Hence, ensuring availability of water for all is one of the 2030 Sustainable Development Goals. To monitor progress of this goal and understand the role of water in addressing food insecurity, development of a household-level water insecurity scale has become very critical. As such, using the following concept of water insecurity: inconsistent access to sufficient amount of safe and clean water for active and healthy life, several scale development studies have been conducted to measure water insecurity experiences at the household level. Hence, in this review, the science literature was evaluated to 1) describe the scale development process; 2) assess the validity results by comparing scale measurements results with the established 4 United Nations (UN) water standards on water access; and 3) examine key water- and food-related dimensions covered by the scales in measuring water insecurity at the household level. Eight published studies were identified from the following scientific databases: EBSCO, PubMed, Google Scholar, and JSTOR. Five of the 8 selected studies were conducted in sub-Saharan Africa, 2 were conducted in North and South America, and 1 was conducted in South Asia. A majority of the studies were conducted with women and included preliminary qualitative/ethnographic phases to identify scale items. Of the 4 UN water standards, the amount of water used/stored was commonly used to test the scale results. However, no consistent results were found in its association with water insecurity. In a rural setting, distance to water source was positively associated with water insecurity. Psychosocial distress/anxiety and reduced water use for hygiene were key dimensions of scale in all the studies. Rigorous research is needed to establish various levels of water insecurity, its scoring scheme, and its association with daily intake of water—an essential nutrient.

Development of water insecurity scale for rural households in Cameroon- Central Africa

“…Overlapping with the quantity domain, women also identified the issue of not being able to drink water because of its taste. In some of the other reported scales, water insecurity was associated with drinking bad quality water [ 6 ]. For instance, in the scale by Tsai et al (2016) in rural Uganda, two items were included representing poor quality of drinking water, i.e.…”

“…Based on the findings from previous water access-related studies conducted in the study area [ 25 , 26 ] and existing household water insecurity scales literature [ 6 ], questions for the FGDs were designed.…”

“…Water is an essential nutrient and its sufficient daily intake is vital for the human physiology and optimal health. Hence, a robust measurement is needed to understand how water insecurity is associated to daily water use and intake at the household and individual level [ 6 ]. Water is also a key component for food production and plays a key role as a critical factor affecting food security for smallholder farmers in rural areas [ 7 , 8 ].…”

“…Several studies have been conducted to develop a household-level water insecurity scale [ 9–17 ]. However, a review examining the current status of research on water insecurity measurement indicates that the scale development and testing lacks uniformity and reveals a gap in the identification of key water insecurity domains [ 6 ]. Learning from the household-level food insecurity scale development, multiple efforts are needed involving ground-up development and testing in various settings to refine and establish a reliable water insecurity scale with high external validity.…”

A Qualitative Examination of Water Access and Related Coping Behaviors to Understand Its Link to Food Insecurity among Rural Households in the West Region in Cameroon

“…When the availability of water was limited, household members either drank less water than they felt they should, drank unclean water, or as a last resort borrowed drinking water from a neighbor. Additionally, in a review of recently developed household-level water insecurity scales, it was found that skipping drinking or reducing water intake was one of the strongest scale items of water insecurity assessment [27]. Hence, a link between limited water access and food insecurity is also occurring by reduced daily intake of water.…”