Household+Food+Insecurity+(Access)+Scale

= Household Food Insecurity (Access) Scale = toc

Definition
The Household Food Insecurity (Access) Scale (or HFIAS) is a brief survey instrument developed by Food and Nutrition Technical Assistance (FANTA) to assess whether households have experienced problems with food access during the last 30 days. The instrument consists of nine occurrence questions and nine frequency questions; these questions ask about the changes households made in their diet or food consumption patterns as a result of limited resources to acquire food. This tool measures the level of food insecurity during the past 30 days as self-reported by the household. These measured results are then assigned a categorical designations (food secure or mildly, moderately, or severely food insecure) or given a numerical value (0-27), with higher numbers representing a greater level of food insecurity.

Relevant Characteristics
The HFIAS poses questions of increasing severity on food security domains, such as anxiety over food, insufficient dietary quality, and the quantity of food. While there are multiple definitions of food insecurity, it is essentially the lack of regular access to a sufficient quantity or quality of food required for a healthy life. The HFIAS was developed on the premise that households across different cultural or social contexts respond to food insecurity in universal ways. The acquisition of food through socially unacceptable means was seen as important to the concept of food insecurity; however, the difficulty of measuring this dimension cross-culturally resulted in its elimination from the survey (Coates et al. 2007).

There are three generally agreed upon domains of food security: //availability//, //access//, and //utilization//. A fourth domain, //stability over time//, is embedded within these three categories but deserves a separate mention. //Availability// examines if sufficient quantities of food are available on a consistent basis. Without availability, there cannot be access to food; //access// is defined by sufficient resources to obtain appropriate foods for a nutritious diet. However, having access to food does not guarantee utilization. //Utilization// refers to the proper biological use of food and can be affected by health status/illness management, food preparation, food safety, and sanitation. Regarding all aspects of food security, //stability over time// has important implications for physical and psychological well-being.

The HFIAS is a household-level survey; that is, it allows researchers to understand food insecurity as experienced by a household, not an individual. Data from the HFIAS can be used collectively to examine community, district or even national food insecurity; however, it cannot be used to determine if one household needs more help than another. The survey has two key uses: comparing change over time in one group (useful for monitoring food security interventions or observing the impact of events on food security) and comparing food access across populations (useful for determining which areas are most in need of assistance).

**Household Food Insecurity (Access) Scale Occurrence Questions**
 * 1) Did you worry or have anxiety that your household would not have enough food?
 * 2) Were you or any household member not able to eat the kinds of foods you preferred because of a lack of resources?
 * 3) Did you or any household member have to eat a limited variety of foods (less kinds of food on the plate) due to a lack of resources?
 * 4) Did you or any household member have to eat some foods that you really did not want to eat because of a lack of resources to obtain other types of food?
 * 5) Did you or any household member have to eat a smaller meal than you felt you needed because there was not enough food?
 * 6) Did you or any other household member have to eat fewer meals in a day?
 * 7) Was there ever no food (of any kind) to eat in your household?
 * 8) Did you or any household member go to sleep at night hungry?
 * 9) Did you or any household member go a whole day and night without having eaten anything?

“Method Made Easy”
While the survey is easy to carry out, steps must first be taken to insure that the survey is adapted to the setting. The HFIAS requires modification to adapt the survey to local contexts, and the adaptation needs to address more than mere translation of the instrument from English to the target language.

Steps to adopt the survey are:
 * 1) Review the survey with key informants (professional, academic or laypersons familiar with conditions and experiences of household food insecurity in the areas where the survey will be conducted). Some words in the survey may not directly translate and may be described differently from setting to setting. To ensure that participants understand these terms, ask key informants the questions from the survey, highlighting terms that may need clarification, such as “household” or “lack of resources”. Ideally, this happens in a group, so that consensus can be built. Based on this feedback, revise the survey.
 * 2) Once appropriate phrases are agreed upon by the group, the survey should be pilot tested with about 8-10 individuals that are similar to your target group (but are not part of the survey sample). Give these participants the survey, then review the survey with them. Ask participants to explain what they thought each question was asking, as well as if there was anything they did not understand. Based on this feedback, revise the survey. If there are significant changes to the questionnaire, consider a second round of pilot testing.
 * 3) The survey is ready for use.

Detailed instructions of process of adaptation can be found in the report, Household Food Insecurity Access Scale (HFIAS) for Measurement of Food Access: Indicator Guide Version 3

The HFIAS consists of nine occurrence and nine frequency questions. This means that a member of the household (ideally, the person responsible for food preparation) is asked if the situation described in each question has occurred in the last 30 days. If the answer is yes, they are then asked with what frequency did this event occur: rarely (1-2 times), sometimes (3 to 10 times), or often (more than 10 times) during the last 30 days. Thus, each of the nine questions has a possible score of 0-3, for a total possible score ranging from 0-27.



Advantages
The HFIAS is the only tool that directly measures the household’s experience of food insecurity, rather than using proxy measures such as food availability or anthropometry. Food availability has been measured in the past as a proxy for understanding food security; however, while the availability of food can be measured, it does not assure that individuals or households have access to it. Anthropometric measurements, such as height, weight, arm circumference, or even skinfolds, have been used as proxies for the assessment of food security, but these measurements do not take into account individual variation or illness status (which can be linked to weight loss). An additional advantage HFIAS has over these methods is its ability to be quickly and easily administered.

If the HFIAS is properly adapted to the local setting, it is easy both to administer and interpret. The survey takes only about 10 minutes to administer, whereas some anthropometric measures require training, time and equipment to collect. The survey is also not very invasive; participants do not have to disrobe as they would for anthropometry, though there may be some embarrassment discussing any food insecurity experienced by their household.

Limitations
One limitation of the HFIAS is that within population or places where food assistance is frequently distributed, respondent bias may be an issue; that is, households might over-report food insecurity with the expectation of receiving assistance. Another limitation is that the HFIAS should not be used for targeting assistance to individual households, since collected data are only meaningful when aggregated for a group or community. Therefore, even though households can be assigned a food security category, this category is meaningful only at the group level. For example, if you measure the food security levels of two groups, those that participate in a program and those who do not, you can say 25% of group 1 are severely food insecure, versus 39% of group 2. In addition,the HFIAS also cannot tell you if there are certain members of the household that are more vulnerable than others, since it reports the level of food insecurity for the whole household. The HFIAS does not tell you why households are food insecure;. It also cannot differentiate between seasonal food insecurity or global food crises.

A recent important study regarding the validity of the HFIAS determined that, despite a number of years of work to develop a cross-culturally valid measure of the experience of food insecurity, most of the questions in the scale may not be externally valid. By using seven data sets (Mozambique, Malawi, West Bank/Gaza Strip, Kenya, Zimbabwe and South Africa) and statistical modeling (Rasch measurement model), the study determined that HFIAS did not provide measurements for accurate cross-cultural analysis. Although HFIAS did provide accurate measurements within a given setting, those measurements were not comparable in different settings (or across cultures). Since this was one of the key goals of the scale, the authors recommend the development of a new scale. It is important to note that while the scale does not allow for the comparison of data across settings, it can achieve other intended goals, such as measuring change over time (in one group and one setting) or for comparing groups within the same or similar settings (such as two urban villages in the same area).

Analysis
The HFIAS yields both a continuous measure (score of 0-27) or a categorical measure. Categories are assigned based on responses to individual questions (see matrix, Table 5, Coates, J., Swindale, A. and Bilinsky, P. (2007)). These data can be reported in a descriptive way (for example, 51% of households were food secure) or can be analyzed with other variables to determine if there is an association. The continuous measure can be analyzed against other continuous measures (such as dietary diversity score) or categorical variables (such as sex of the head of household). Household-level demographic information (size, household composition, HIV/AIDS status, and other variables of interest) should also be collected to assist in the interpretation of HFIAS scores. HFIAS can be analyzed in conjunction with other information on food consumption, availability of food, or any other relevant contextual information related to food security.



Method in Context
In her doctoral dissertation, Elizabeth Eliot Cooper applied the HFIAS in two rural Malay villages in Borneo, where the local health department has documented a concentration of child malnutrition cases. After introducing some history about the HFIAS and experience-based measures of food security, she notes that biomedical criteria have begun to give way to these classification systems based on personal perceptions and experiences. Early assessments of food security relied heavily on proxy measures, but the space where food security is measured has been shifting over time. Early attempts to measure food security included country-level food availability statistics, then moved to the household and the distribution of food between its members. Moving closer to the body, anthropometry measures the possibly physical manifestations of a lack of food security, but genetic variation and illness can conflate the relationship between measures of the body and food security. As a result of this shift in focus, the use of biomedical criteria (like stunting, wasting and undernutrition--designations derived from anthropometry) have begun to give way to experience-based measures of food security (like the HFIAS).

Cooper's research acts as a bridge between these two domains: anthropometry, the generally accepted proxy measures of food security status, and HFIAS, the experience-based measures of food security. Her research was guided by an important question: What is added by an experiential measurement when physical indicators [such as anthropometry] are readily available? That is, what additional information does this scale provide in the presence of anthropometric data, and what is the utility of this food insecurity data?

Cooper collected HFIAS and anthropometric data (height and weight) then calculated several indicators and their z-scores: underweight (less than -2 standard deviations for weight-for-age), stunting less than -2 standard deviations for height-for-age), and wasting (less than -2 standard deviations for weight-for-height). Her sample consisted of 104 children, 13.7% of the children were stunted, 22.5% were underweight for their age and 9.8% were underweight for their height.

Results of the HFIAS showed that:


 * 51.5% worried that their families did not have enough food
 * 45.6% were unable to eat preferred foods
 * 25% had to eat they did not want to
 * 42.6% ate smaller meals than they considered adequate
 * 35.3% skipped meals that they thought they needed.
 * 11.8% had no food in the house and no way to access food at least once in the previous month
 * 10.3% went to sleep early to avoid hunger or went to bed hungry
 * 4.4% had been unable to eat for an entire day

Cooper noted that when considered by overarching domains of the HFIAS:


 * 51.5% of households experienced food anxiety and uncertainty
 * 55.7% consumed foods that they recognized as being of insufficient quality
 * 50% had insufficient food intake or its physical consequences
 * Only 36.8% of the households were food secure
 * 26.5% were severely food insecure

Furthermore, stunting (height-for-age) was negatively correlated with HFIAS scores (that is, lower height-for-age was associated with high food insecurity). This phenomenon was also seen with regard to underweight (weight-for-age); lower weight-for-age was associated with high food insecurity, though the relationship was weaker than with wasting. However, no significant relationship was found between HFIAS scores and wasting (weight-for-height).

Cooper's study legitimizes the HFIAS as a more sensitive measure of food security problems within households. The survey can reveal issues well before evidence of stunting, wasting or underweight appear in children. Rather than waiting for the evidence of food insecurity to manifest itself in the bodies of children, with long term detrimental effects for their health, the HFIAS can be applied to capture problems much sooner.

Online Resources

 * Food and Nutrition Technical Assistance website for the Household Food Insecurity Access Scale (HFIAS): http://www.fantaproject.org/publications/hfias.shtml
 * Coates, J., Swindale, A. and Bilinsky, P. (2007). Household Food Insecurity Access Scale (HFIAS) for Measurement of Household Food Access: Indicator Guide (v. 3). Washington, D.C.: Food and Nutrition Technical Assistance Project, Academy for Educational Development, August 2007. http://www.fantaproject.org/downloads/pdfs/HFIAS_v3_Aug07.pdf
 * Deitchler, M., Ballard, T., Swindale, A., and Coates, J. (2010). Validation of a Measure of Household Hunger for Cross-Cultural Use. Washington, DC: Food and Nutrition Technical Assistance II Project (FANTA-2), AED. http://www.aed.org/Publications/upload/HHS_Validation_Report_May2010.pdf