A qualitative investigation into the U.S. Department of Agriculture 18‐item Household Food Security Survey Module: Variations in interpretation, understanding and report by gender

• Author: Jaime S. Foster,Robin S. Grenier,Marlene B. Schwartz,Amy R. Mobley,Michael P. Burke,Emily A. Taylor
• Published date: 01 August 2019
• Date: 01 August 2019
• DOI: http://doi.org/10.1002/pa.1861

ACADEMIC PAPER

A qualitative investigation into the U.S. Department of

Agriculture 18‐item Household Food Security Survey Module:

Variations in interpretation, understanding and report by gender

Jaime S. Foster

1,2

|Marlene B. Schwartz

3

|Robin S. Grenier

4

|Michael P. Burke

5

|

Emily A. Taylor

1

|Amy R. Mobley

1,6

1

Department of Nutritional Sciences,

University of Connecticut, Storrs, Connecticut,

USA

2

Rudd Center for Food Policy and Obesity,

University of Connecticut, Hartford,

Connecticut, USA

3

Department of Human Development and

Family Studies, and Director, Rudd Center for

Food Policy and Obesity, University of

Connecticut, Hartford, Connecticut, USA

4

Neag School of Education, University of

Connecticut, Storrs, Connecticut, USA

5

Center for Research in Nutrition and Health

Disparities, Arnold School of Public Health,

University of South Carolina, Columbia, South

Carolina

6

Department of Health Education and

Behavior, University of Florida, Gainesville,

Florida

Correspondence

Amy R. Mobley, Associate Professor,

University of Florida, Department of Health

Education and Behavior 1864 Stadium Road,

Gainesville, FL 32611.

Email: amy.mobley@ufl.edu

Funding information

University of Connecticut Scholarship Facili-

tation Fund and Summer Undergraduate

Research Fund

Food insecurity, or limited or uncertain availability of nutritionally adequate and safe

foods or limited or uncertain ability to acquire acceptable foods in socially acceptable

ways, affects more than 10% of Americans. The U.S. Department of Agriculture's 18‐

item Household Food Security Survey Module (HFSSM) is the most common measure

used in the United States to assess food insecurity. This measure is to be completed

by one adult who reports on the severity of disruptions in the quality and quantity of

the household food supply. Recent work suggests that men and women might

respond differently to some of the items in this measure. Therefore, the aim of the

current study was to further explore how men and women interpret each of the items

and specific concepts in this measure. Pairs (n= 25) of low‐income and food‐insecure

mothers and fathers of children aged 2.5–10 years participated in one‐on‐one inter-

views to answer the HFSSM questions using the think‐aloud method. The data were

analyzed using basic inductive qualitative methods, and the findings suggest that gen-

der is related to interpretation of key concepts relevant to food insecurity including

“household,”“balanced meal,”and “worry.”These findings have policy implications

for the use of this measure as a national benchmark of food insecurity such as the

potential need for an additional, complementary instrument to include several male

reference questions with different terminology.

1|INTRODUCTION

Household food insecurity is defined as “limited or uncertain availabil-

ity of nutritionally adequate and safe foods or limited or uncertain

ability to acquire acceptable foods in socially acceptable ways (Bickel,

Nord, Price, Hamilton, & Cook, 2000).”Early efforts to create a mea-

sure of food insecurity relied on in‐depth interviews with single,

low‐income mothers as key informants. Key constructs related to dis-

ruptions in the quality and quantity of the household food supply were

identified resulting in the Radimer–Cornell Index (Kendall, Olson, &

Frongillo Jr, 1995; Kendall, Olson, & Frongillo Jr., 1996; Radimer,

Olson, & Campbell, 1990). Later, in the mid‐1990s, the U.S. Depart-

ment of Agriculture (USDA) adopted a modified version of the

Radimer–Cornell Index to measure and monitor household food inse-

curity in the United States, the USDA's Household Food Security

Module (HFSSM).

The HFSSM measure is designed to assess the experiences of

food insecurity at the adult and child levels, with each item directly

relating to diet quality and quantity within the context of limited

income (Bickel et al., 2000; Carlson, Andrews, & Bickel, 1999). Fur-

thermore, some items also assess certainty, acceptability and worry

related to disruptions in food quality and quantity. This measure,

although contested (Barrett, 2010), is commonly accepted as the gold

standard. However, recent literature has suggested that food insecu-

rity may be reported differently by gender (Matheson & McIntyre,

2014). Similarly, responses to the 18‐item HFSSM varied by

Received: 20 April 2018 Accepted: 14 August 2018

DOI: 10.1002/pa.1861

J Public Affairs. 2019;19:e1861.

https://doi.org/10.1002/pa.1861

© 2018 John Wiley & Sons, Ltd.wileyonlinelibrary.com/journal/pa 1of7