The same goes for measuring nutrition status based on anthropometric data, i.e. weight and height, at individual level. Given these challenges the USAID supported Food and Nutrition Technical Assistance (FANTA) project developed a number of tools, among which the Household Food Insecurity Access Scale (HFIAS).
The HFIAS is based on the idea that the experience of food insecurity causes predictable reactions and responses that can be captured and quantified through a survey and summarized in a scale. Extensive multi-disciplinary research with low-income households in the USA revealed that in case of (potential) food shortage or food insecurity households tend to react in a similar way, depending on the seriousness of the situation. This provided insights into the different successive phases, that households experience in case of decreasing food security, being:
- Feelings of uncertainty or anxiety over food (situation, resources, or supply)
- Perceptions that food is of insufficient quantity (for adults and children)
- Perceptions that food is of insufficient quality (diversity, nutritional adequacy, preference)
- Reported reductions of food intake (for adults and children)
- Reported consequences of reduced food intake (for adults and children)
- Feelings of shame for resorting to socially unacceptable means to obtain food resources.
These experiences at household or individual level have been classified in 3 domains:
- Anxiety, uncertainty and worrying about the household ability to obtain sufficient and good food
- Insufficient quality, compromising on the variety and preferred types of food
- Insufficient quantity, reducing food intake and its physical consequences.
The domains correlate to 3 categories of household food insecurity as shown below:
Figure: Adapted from Voices of the Hungry. http://www.fao.org/in-action/voices-of-the-hungry/fies/en
The FANTA project designed a set of questions to determine the different experiences at household level across different cultural contexts. The HFIAS questionnaire consists of 9 standardized questions asking respondents to identify behaviors, attitudes and psychological manifestations during the last month, that relate to the various experiences of the food insecurity. Some of the questions inquire about the respondent’s perceptions of food vulnerability or stress and others ask about the respondents’ behavioral responses to insecurity. The questions as shown below address the situation of all household members and do not distinguish adults from children or adolescents.
The response to each of the 9 questions is either registered as ‘yes’ or a ‘no’. If the response to question is affirmative, i.e. the described condition occurred at any time during the last month, a question is asked to determine whether the condition happened rarely (once or twice), sometimes (3 to 10 times) or often (more than 10 times) during the given period. The HFIAS was validated in several countries across different cultural contexts. It resulted that the information generated by the HFIAS can be used to assess the prevalence of household food insecurity (access, e.g. for geographic targeting) and to detect changes in the household food insecurity (access) situation of a population over time (e.g. for monitoring and evaluation).
HFIAS Scoring and Categorization
As can be gauged from the HFIAS questionnaire the response to each of the nine questions is registered as ‘yes’ or ‘no’. In case of ‘yes’ then the frequency-of-occurrence is asked. The following example describes how the responses are registered and coded:
The resulting scores between 0 - 3 for each of the nine questions can be summed forming a continuous indicator of food security, ranging from 0 to 27 indicating the severity of food insecurity. To facilitate reporting on household food insecurity prevalence USAID also developed a categorical indicator, categorizing households into four levels of household food insecurity: 1 = Food Secure, 2=Mildly Food Insecure, 3=Moderately Food Insecure, 4=Severely Food Insecure. The categorization is based on a standardized formula, ensuring that a household’s set of responses will place them in a single, unique category, as illustrated below.
Figure: Food security categorization based on frequency-of-occurrence questions. Source: Adapted from Coates et. al. 2007, Categories of Food Insecurity (Access)
To determine the HFIAS category for each household the following algorithm is applied: