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Development and validation protocol for an instrument to measure household water insecurity across cultures and ecologies: the Household Water InSecurity Experiences (HWISE) Scale
  1. Sera L Young1,
  2. Shalean M Collins2,
  3. Godfred O Boateng2,
  4. Torsten B Neilands3,
  5. Zeina Jamaluddine4,
  6. Joshua D Miller2,
  7. Alexandra A Brewis5,
  8. Edward A Frongillo6,
  9. Wendy E Jepson7,
  10. Hugo Melgar-Quiñonez8,
  11. Roseanne C Schuster5,
  12. Justin B Stoler9,
  13. Amber Wutich5
  14. on behalf of the HWISE Research Coordination Network
    1. 1 Department of Anthropology, Institute for Policy Research, Northwestern University, Evanston, Illinois, USA
    2. 2 Department of Anthropology, Northwestern University, Evanston, Illinois, USA
    3. 3 Department of Medicine, University of California, San Francisco, California, USA
    4. 4 Center for Research on Population and Health, American University of Beirut, Beirut, Lebanon
    5. 5 School of Human Evolution and Social Change, Arizona State University, Tempe, Arizona, USA
    6. 6 Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina, USA
    7. 7 Department of Geography, Texas A&M University, College Station, Texas, USA
    8. 8 Institute for Global Food Security, McGill University, Montreal, Québec, USA
    9. 9 Department of Geography, University of Miami, Coral Gables, Florida, USA
    1. Correspondence to Dr Sera L Young; sera.young{at}


    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.

    • survey
    • water
    • household
    • scale development
    • water insecurity
    • protocol

    This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

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    • Contributors SLY conceptualised the study, developed HWISE items, wrote the manuscript, obtained funding and oversaw data collection and analysis. SMC helped develop HWISE items, wrote the manuscript, prepared the field manual and managed data. GOB developed the data analysis and validation plan and helped write the analytic section of the manuscript. TBN assisted with study design and supported scale analysis and validation. ZJ proposed data analysis and helped write the analytic section of the manuscript. JDM developed tools for data collection and managed data. AAB proposed analyses for item development. EAF and HM-Q proposed data analysis. WEJ conceptualized the study and developed HWISE items. RCS supported development of HWISE items and assisted with preparation of the manual. JBS proposed analyses for item development. AW conceptualized the study, developed HWISE items and proposed analyses for item development. HWISE RCN members provided substantial contributions to data acquisition and interpretation. All authors critically reviewed and approved the final draft of the manuscript.

    • Funding We gratefully acknowledge our funders: the Competitive Research Grants to Develop Innovative Methods and Metrics for Agriculture and Nutrition Actions (IMMANA). IMMANA is funded with UK Aid from the UK government. This project was also supported by the Buffett Institute for Global Studies and the Center for Water Research at Northwestern University; Arizona State University’s Center for Global Health at the School of Human Evolution and Social Change and Decision Center for a Desert City (National Science Foundation SES-1462086); the Office of the Vice Provost for Research of the University of Miami; the National Institutes of Health grant NIEHS/FIC R01ES019841 for the Kahemba Study, DRC. Texas A&M University-CONACyt Grant supported data collection in Torreon, Mexico. We also acknowledge the National Science Foundation’s HWISE Research Coordination Network (BCS-1759972) for support of the collaboration. SLY was supported by the National Institutes of Health (NIMH R21 MH108444; NIMH K01 MH098902). WEJ was supported by the National Science Foundation (BCS-1560962).

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval Northwestern University, African Medical Research Foundation (AMREF), American University at Beirut, Arizona State University, Cornell University, Delaware State University, Florida State University, Georgia State University, Ghana Water Company, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Johns Hopkins University, College of Medicine at the University of Lagos, University of Miami, McGill University, Michigan State University, Nepal Health Research Council, Oregon Health Sciences University, Oregon State University, Penn State University, Pontificia Universidad Javeriana, Sokoine University of Agriculture, Texas A&M University, T-Group Kampala and Yale University.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Data are currently being collected and are not yet available for access.

    • Collaborators HWISE Research Coordination Network: Ellis Adams; Farooq Ahmed; Mallika Alexander; Mobolanle Balogun; Michael Boivin; Genny Carrillo; Kelly Chapman; Stroma Cole; Hassan Eini-Zinab; Jorge Escobar-Vargas; Matthew C. Freeman; Hala Ghattas; Ashley Hagaman; Nicola Hawley; Kenneth Maes; Jyoti Mathad; Patrick Mbullo Owour; Javier Moran; Nasrin Omidvar; Amber Pearson; Asher Rosinger; Luisa Samayoa-Figueroa; Ernesto Sánchez-Rodriguez; Jader Santos; Marianne V. Santoso; Sonali Srivastava; Chad Staddon; Andrea Sullivan; Yihenew Tesfaye; Nathaly Triviño-León; Alex Trowell; Desire Tshala-Katumbay; Raymond Tutu; Felipe Uribe-Salas; Elizabeth Wood; and Cassandra Workman.

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