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

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.