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1. Development and validation protocol for an instrument to measure household water insecurity across cultures and ecologies: the Household Water InSecurity Experiences (HWISE) Scale

   https://doi.org/10.1136/bmjopen-2018-023558  

   Young, Sera L ; Collins, Shalean M ; Boateng, Godfred O ; Neilands, Torsten B ; Jamaluddine, Zeina ; Miller, Joshua D ; Brewis, Alexandra A ; Frongillo, Edward A ; Jepson, Wendy E ; Melgar-Quiñonez, Hugo ; et al ( January 2019 , BMJ Open)

   Introduction A wide range of water-related problems contribute to the global burden of disease. Despite the many plausible consequences for health and well-being, there is no validated tool to measure individual- or household-level water insecurity equivalently across varying cultural and ecological settings. Accordingly, we are developing the Household Water Insecurity Experiences (HWISE) Scale to measure household-level water insecurity in multiple contexts. Methods and analysis After domain specification and item development, items were assessed for both content and face validity. Retained items are being asked in surveys in 28 sites globally in which water-related problems have been reported (eg, shortages, excess water and issues with quality), with a target of at least 250 participants from each site. Scale development will draw on analytic methods from both classical test and item response theories and include item reduction and factor structure identification. Scale evaluation will entail assessments of reliability, and predictive, convergent, and discriminant validity, as well as the assessment of differentiation between known groups. Ethics and dissemination Study activities received necessary ethical approvals from institutional review bodies relevant to each site. We anticipate that the final HWISE Scale will be completed by late 2018 and made available through open-access publication. Associated findings will be disseminated to public health professionals, scientists, practitioners and policymakers through peer-reviewed journals, scientific presentations and meetings with various stakeholders. Measures to quantify household food insecurity have transformed policy, research and humanitarian aid efforts globally, and we expect that an analogous measure for household water insecurity will be similarly impactful. 

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2. How Do Rural Ethiopians Rate the Severity of Water Insecurity Scale Items? Implications for Water Insecurity Measurement and Interventions

   https://doi.org/10.17730/1938-3525.79.2.95  

   Tesfaye, Yihenew ; Maes, Kenneth ; Abesha, Roza ; Young, Sera ; Snyder, Jedidiah S. ; Gebremariam, Abebe ; Freeman, Matthew C. ( June 2020 , Human Organization)

   null (Ed.)

   Recently developed scales aim to advance understanding of household water insecurity and inform interventions to address this critical global problem. The relative severity of items included in household water insecurity scales has been established as an inverse of the proportion of the population that reports experiencing the item. Here, we assess subjective perceptions of scale item severity among people who experience household water insecurity. In 2017, we surveyed 259 women in Amhara, Ethiopia, assessing both experiences of water insecurity and perceptions of item severity using a pictorial scale. The mean subjective severity of most items was at the high end of our pictorial scale. Subjective severity of items was not associated with whether or not a participant experienced the item in the last thirty days, with a participant’s summary household water insecurity score, or with rural versus peri-urban residence, but was consistently associated with community of residence. Item severity as defined by the proportion of the population experiencing the item aligned with average perceptions of item severity, with one exception: drinking water that might not be safe. We discuss these findings’ implications for water insecurity measurement, evaluation of interventions, and studies of the relationship between water insecurity and psychological distress. 

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3. The Household Water InSecurity Experiences (HWISE) Scale: development and validation of a household water insecurity measure for low-income and middle-income countries

   https://doi.org/10.1136/bmjgh-2019-001750  

   Young, Sera L ; Boateng, Godfred O ; Jamaluddine, Zeina ; Miller, Joshua D ; Frongillo, Edward A ; Neilands, Torsten B ; Collins, Shalean M ; Wutich, Amber ; Jepson, Wendy E ; Stoler, Justin ( September 2019 , BMJ Global Health)

   Objective Progress 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. Methods Cross-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. Findings Twelve 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. Conclusions The 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. 

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4. Gender identities, water insecurity, and risk: Re‐theorizing the connections for a gender‐inclusive toolkit for water insecurity research

   https://doi.org/10.1002/wat2.1685  

   Brewis, Alexandra ; DuBois, L. Zachary ; Wutich, Amber ; Adams, Ellis Adjei ; Dickin, Sarah ; Elliott, Susan J. ; Empinotti, Vanessa Lucena ; Harris, Leila M. ; Ilboudo Nébié, Elisabeth ; Korzenevica, Marina ( August 2023 , WIREs Water)

   Informed by decades of literature, water interventions increasingly deploy “gender‐sensitive” or even “gender transformative” approaches that seek to redress the disproportionate harms women face from water insecurity. These efforts recognize the role of gendered social norms and unequal power relations but often focus narrowly on the differences and dynamics between cisgender (cis) men and women. This approach renders less visible the ways that living with water insecurity can differentially affect all individuals through the dynamics of gender, sexuality, and linked intersecting identities. Here, we first share a conceptual toolkit that explains gender as fluid, negotiated, and diverse beyond the cis‐binary. Using this as a starting point, we then review what is known and can be theorized from current literature, identifying limited observations from water‐insecure communities to identify examples of contexts where gendered mechanisms (such as social norms) differentiate experiences of water insecurity, such as elevating risks of social stigma, physical harm, or psychological distress. We then apply this approach to consider expanded ways to include transgender, non‐binary, and gender and sexual diversity to deepen, nuance and expand key thematics and approaches for water insecurity research. Reconceptualizing gender in these ways widens theoretical possibilities, changes how we collect data, and imagines new possibilities for effective and just water interventions.

   This article is categorized under:

   Human Water > Value of Water

   Engineering Water > Water, Health, and Sanitation

   Human Water > Water as Imagined and Represented

   Human Water > Methods

    

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5. The co-occurrence of water insecurity and food insecurity among Daasanach pastoralists in northern Kenya

   https://doi.org/10.1017/S1368980022001689  

   Bethancourt, Hilary J ; Swanson, Zane S ; Nzunza, Rosemary ; Young, Sera L ; Lomeiku, Luke ; Douglass, Matthew J ; Braun, David R ; Ndiema, Emmanuel K ; Pontzer, Herman ; Rosinger, Asher Yoel ( March 2023 , Public Health Nutrition)

   Abstract Objective: Water plays a critical role in the production of food and preparation of nutritious meals, yet few studies have examined the relationship between water and food insecurity. The primary objective of this study, therefore, was to examine how experiences of household water insecurity (HWI) relate to experiences of household food insecurity (HFI) among a pastoralist population living in an arid, water-stressed region of northern Kenya. Design: We implemented the twelve-item Household Water Insecurity Experiences (HWISE, range 0–36) Scale and the nine-item Household Food Insecurity Access Scale (HFIAS, range 0–27) in a cross-sectional survey to measure HWI and HFI, respectively. Data on socio-demographic characteristics and intake of meat and dairy in the prior week were collected as covariates of interest. Setting: Northern Kenya, June–July 2019. Participants: Daasanach pastoralist households ( n 136) from seven communities. Results: In the prior 4 weeks, 93·4 % and 98·5 % of households had experienced moderate-to-severe HWI and HFI, respectively. Multiple linear regression analyses indicated a strong association between HWI and HFI. Each point higher HWISE score was associated with a 0·44-point (95 % CI: 0·22, 0·66, P = 0·003) higher HFIAS score adjusting for socio-economic status and other covariates. Conclusions: These findings demonstrate high prevalence and co-occurrence of HWI and HFI among Daasanach pastoralists in northern Kenya. This study highlights the need to address HWI and HFI simultaneously when developing policies and interventions to improve the nutritional well-being of populations whose subsistence is closely tied to water availability and access. 

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