A novel household water insecurity scale: Procedures and psychometric analysis among postpartum women in western Kenya.

Godfred O Boateng,Maricianah Onono,Patrick Mbullo,Shalean M Collins,Pauline Wekesa,Sera L Young,Torsten B Neilands,Timo Gnambs

doi:10.1371/journal.pone.0198591

Abstract

Our ability to measure household-level food insecurity has revealed its critical role in a range of physical, psychosocial, and health outcomes. Currently, there is no analogous, standardized instrument for quantifying household-level water insecurity, which prevents us from understanding both its prevalence and consequences. Therefore, our objectives were to develop and validate a household water insecurity scale appropriate for use in our cohort in western Kenya. We used a range of qualitative techniques to develop a preliminary set of 29 household water insecurity questions and administered those questions at 15 and 18 months postpartum, concurrent with a suite of other survey modules. These data were complemented by data on quantity of water used and stored, and microbiological quality. Inter-item and item-total correlations were performed to reduce scale items to 20. Exploratory factor and parallel analyses were used to determine the latent factor structure; a unidimensional scale was hypothesized and tested using confirmatory factor and bifactor analyses, along with multiple statistical fit indices. Reliability was assessed using Cronbach’s alpha and the coefficient of stability, which produced a coefficient alpha of 0.97 at 15 and 18 months postpartum and a coefficient of stability of 0.62. Predictive, convergent and discriminant validity of the final household water insecurity scale were supported based on relationships with food insecurity, perceived stress, per capita household water use, and time and money spent acquiring water. The resultant scale is a valid and reliable instrument. It can be used in this setting to test a range of hypotheses about the role of household water insecurity in numerous physical and psychosocial health outcomes, to identify the households most vulnerable to water insecurity, and to evaluate the effects of water-related interventions. To extend its applicability, we encourage efforts to develop a cross-culturally valid scale using robust qualitative and quantitative techniques.

Highlights

Water security, the ability to access and benefit from affordable, adequate, reliable, and safe water for wellbeing and a healthy life [1], is fundamental to physical and mental health [2,3,4,5]
Our analyses showed statistically significant correlations between household water insecurity (HHWI) and total time spent per week among all households to acquire water (r = 0.41, 95% CI: 0.23–0.57, p 0.001) and total amount of money spent on water in the last month (r = 0.25, 95% CI: 0.12–0.37, p 0.001) at 15 months postpartum
Our final scale is composed of items measuring different aspects of water insecurity, yet its latent structure reflects the central assumption of unidimensionality (Tables 5 & 6). This unidimensionality is consistent with the structure of household water insecurity scales developed in Ethiopia [2,40], Bolivia [36] and Uganda [3], but differs from the work in Texas [37] and Nepal [39] where the structure of HHWI is portrayed as multidimensional

Summary

Introduction

The ability to access and benefit from affordable, adequate, reliable, and safe water for wellbeing and a healthy life [1], is fundamental to physical and mental health [2,3,4,5]. In most parts of the developing world, women bear the physical responsibility and psychological burden of ensuring adequate household water [4,11,12,13]. This responsibility can be very demanding in terms of time and energy (e.g. walking long distances to water sources, carrying heavy jerry cans) and can leave women vulnerable to physical and sexual violence en route to sources [14,15]. The energy and time required to acquire water can compromise women’s ability to care for their children through activities such as breastfeeding and clinic visits. Pregnant and lactating women can have less physical ability to access water just as their needs increase, making the need for readily accessible, clean water especially vital during pregnancy and lactation [17]

Objectives

Methods

Results

Discussion

Conclusion