Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Aug;24(12):3805-3817.
doi: 10.1017/S1368980021001312. Epub 2021 Mar 26.

Improving the measurement of food insecurity among people with HIV in South Africa: a psychometric examination

Jasper S Lee  1 , Cengiz Zopluoglu  2 , Lena S Andersen  3 , Amelia M Stanton  4   5 , Jessica F Magidson  6 , Ashraf Kagee  7 , John A Joska  3 , Conall O'Cleirigh  4   5 , Steven A Safren  1
Affiliations

Improving the measurement of food insecurity among people with HIV in South Africa: a psychometric examination

Jasper S Lee et al. Public Health Nutr. 2021 Aug.

Abstract

Objective: Food insecurity is a structural barrier to HIV care in peri-urban areas in South Africa (SA), where approximately 80 % of households are moderately or severely food insecure. For people with HIV (PWH), food insecurity is associated with poor antiretroviral therapy adherence and survival rates. Yet, measurement of food insecurity among PWH remains a challenge.

Design: The current study examines the factor structure of the nine-item Household Food Insecurity Access Scale (HFIAS, isiXhosa-translated) among PWH in SA using a restrictive bifactor model.

Setting: Primary care clinics in Khayelitsha, a peri-urban settlement in Cape Town, SA.

Participants: Participants (n 440) were PWH who received HIV care in Khayelitsha screening for a clinical trial. Most were categorised as severely (n 250, 56·82 %) or moderately (n 107, 24·32 %) food insecure in the past 30 d.

Results: Revised parallel analysis suggested a three-factor structure, which was inadmissible. A two-factor structure was examined but did not adequately fit the data. A two-factor restrictive bifactor model was examined, such that all items loaded on a general factor (food insecurity) and all but two items loaded on one of two specific additional factors, which adequately fit the data (comparative fit index = 0·995, standardised root mean square residual = 0·019). The two specific factors identified were: anxiety/insufficient quality and no food intake. Reliability was adequate (ω = 0·82).

Conclusions: Results supported the use of a total score, and identified two specific factors of the HFIAS, which may be utilised in future research and intervention development. These findings help identify aspects of food insecurity that may drive relationships between the construct and important HIV-related variables.

Keywords: Food insecurity; HIV; Measurement; South Africa; Sub-Saharan Africa.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Scree plot of the eigenvalues
Fig. 2
Fig. 2
Factor structure of the three-factor restrictive bifactor model. Factor loadings presented here correspond with those presented in Table 3
See this image and copyright information in PMC

References

    1. Coates J, Swindale A & Bilinsky P (2007) Household Food Insecurity Access Scale (HFIAS) for Measurement of Food Access: Indicator Guide: Version 3. Washington, DC: Food and Nutrition Technical Assistance Project, Academy for Educational Development.
    1. United States Agency for International Development (USAID) (1992) Policy Determination 19, Definition of Food Security, April 13, 1992. Washington, DC: USAID.
    1. Crush J & Frayne B (2010) The invisible crisis: urban food security in Southern Africa. https://www.alnap.org/system/files/content/resource/files/main/afsun-1-p... (accessed December 2019).
    1. Crush J, Frayne B & Pendleton W (2012) The crisis of food insecurity in African cities. J Hunger Environ Nutr 7, 271–292.
    1. Battersby J (2011) Urban food insecurity in Cape Town, South Africa: an alternative approach to food access. Dev South Af 28, 545–561.

Publication types