Improving the measurement of food insecurity among people with HIV in South Africa: A psychometric examination
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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 (? = 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.
| Original language | English |
|---|---|
| Journal | Public Health Nutrition |
| Volume | 24 |
| Issue number | 12 |
| Pages (from-to) | 3805-3817 |
| Number of pages | 13 |
| ISSN | 1368-9800 |
| DOIs | |
| Publication status | Published - 2021 |
| Externally published | Yes |
Bibliographical note
Funding Information:
Funding for this project came from the National Institute of Mental Health R01MH103770 (Safren, O Cleirigh). Some additional support was from 1P30MH11 6867 and 9K24DA040489 (Safren) and F31MH122279 (Lee).
Funding Information:
Acknowledgements: The authors would like to thank the participants for their time, and the many study team members in Cape Town, Miami and Boston for their effort and dedication. Lastly, we would like to acknowledge the City of Cape Town Department of Health for their support and for granting us access to their clinics. The authors also thank staff, patients and Community Advisory Boards at the Town Two and Matthew Goniwe clinics for their time, effort and support. Financial support: Funding for this project came from the National Institute of Mental Health R01MH103770 (Safren, O’Cleirigh). Some additional support was from 1P30MH116867 and 9K24DA040489 (Safren) and F31MH122279 (Lee). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health or the National Institutes of Health, or any of the other funders. Conflict of interest: All authors do not have any conflicts of interest to report. Authorship: J.S.L., C.Z. and S.A.S. formulated the research questions, S.A.S., C.O. and J.A.J. designed the study, L.S.A., J.S.L., A.M.S., A.K., J.F.M., J.A.J., C.O.C. and S.A.S. carried out the study, J.S.L. and C.Z. analyzed the data and all authors contributed to the writing of the manuscript. Ethics of human subject participation: The current study was conducted according to the guidelines laid down in the Declaration of Helsinki and all procedures involving research study participants were approved by the University of Miami Institutional Research Board and University of Cape Town Human Research Ethics Committee. Written informed consent was obtained from all participants.
Publisher Copyright:
© 2021 Cambridge University Press. All rights reserved.
- Food insecurity, HIV, Measurement, South Africa, Sub-Saharan Africa
Research areas
ID: 288339080