1. Serenity Café, Edinburgh 13th December, 2016
Interim findings from systematic review of Household Food Insecurity Measures used in high income countries Giang Nguyen Flora Douglas Geraldine McNeill Lorna Aucott
Household food insecurity measurement in Scotland: Dec 2016 update and workshop
Serenity Café, Edinburgh 13th December, 2016

2. Systematic search to identify HFI measures used in high income countries
Study question: “Which HFI measurement will be applicable to use in the Scottish context?”
Study aim: Identify existing empirical studies which have measured HFI in high income countries (classified by the World Bank)
Search strategy:
3 key terms:
food insecurity;
high-income countries
measurement
Time period restriction:
Electronic databases searched : Medline, Embase, CINAHL
English Language only
One important part of my PhD is to do the systematic search to identify the HFI measurements which have been used in developed countries.
The search focused on 3 main facets: food insecurity; high-income countries (classified by the World Bank) and measurement
Electronic databases including Medline, EMBASE, CINAHL will be considered for this systematic search.
No language restriction will be imposed and the searches will be limited to between
At this time, we have done our first screen through titles and abstracts for 2,070 records identify after removing duplicated. 572 records have been gone through to further data extraction process. Due to the large amount of records obtained, information from abstract will be extracted.

3. Papers retrieved

4. Systematic search to identify HFI measures used in high income countries
572 is too many to get full text for
Most would not answer our RQ anyway (identify different HFI measures)
Instead we extracted a fair amount of information from just the abstracts
Data extraction (abstracts and papers)
Country
Study focus (gender, age, study population, income level)
Food insecurity measure? Full or short form?
Study aim
Study method… etc
If without citation or was a different HFI measures was further investigated:
If from USA or CANADA within the last 10 years were assumed to be USDA or the Canadian tool (to be verified)
Otherwise the Full text papers was obtained to id any new HFI tools for further reading and information
In order to identify the new HFI tools, we created a form to extract data from the abstracts, the data extraction form will yield information including:
Country of the conducted study; Study subject (gender, age, study population, income); Food insecurity measurement used? Full or short form?… etc
Analysis:
It is not traditional systematic review because it will only look at how HFI measurement has been used in developed/ high income countries rather than looking at any results of HFI prevalence. So, the results will take on a descriptive narrative about what measures were used, what is the target population they were used and how the results were used and is it any change in policy?

5. Household food insecurity measurement- data extraction form

6. Analysis Not a traditional systematic review Review aims to identify:
which HFI measure was used
in what context,
with which group,
for what purpose
Not concerned with prevalence
or any health or social outcomes associated with HFI
This will be more fully analysed later.
For now 7 different HFI measurement tools have been identified
In order to identify the new HFI tools, we created a form to extract data from the abstracts, the data extraction form will yield information including:
Country of the conducted study; Study subject (gender, age, study population, income); Food insecurity measurement used? Full or short form?… etc
Analysis:
It is not traditional systematic review because it will only look at how HFI measurement has been used in developed/ high income countries rather than looking at any results of HFI prevalence. So, the results will take on a descriptive narrative about what measures were used, what is the target population they were used and how the results were used and is it any change in policy?

7. Overview of 7 food insecurity measures
Radimer-Cornell
USDA
LIDNS
Brazilian
Canadian
HFIES
FIES
Year
1992
1995
2003
2004
2006
2013
Language
English, Iran, Russian etc
English, Spanish, Chinese etc
English
Portuguese
English, French
English etc
Used in 145 countries
Organization/Country
Cornell University, USA
The U.S Department of Agriculture
UK Food Standards Agency
Brazilian Institute of Geography and Statistics
Health Canada
FANTA-USAID
FAO
Unit of study
Household
Women
Children
Individual
Household with and without children
Household with and without children
Assessment timeframe
Not specified
Last 12 months
Last 3 months
In the past 4 weeks (30 days)
Screening question No
Yes
Food Security Status Categories
Hunger
Women and child level
Food secure
Low food security
Very low food security
Food insecure
Mildly food insecure
Moderately food insecure
Severely food insecure
Marginally food insecure
Mild food insecurity to severe food insecurity

8. The core domain of food insecurity

9. Food insecurity domains ( as defined in the Radimer Cornell questionnaire)
Quantitative: Insufficient food intake: not enough food to eat
Qualitative: Quality of food intake or nutrition inadequacy: not eating a complete or balanced meal
Social component: disrupted eating pattern (individual level) or food acquisition in socially unacceptable ways (household). For example: skip meal or gone without food or not eating for a whole day).
Psychological (at individual level) lack of choice and created feeling of deprivation.

10. Food insecurity domains
Radimer-Cornell
USDA
Canadian
LIDNS
HFIAS
Brazilian
FIES
Quantitative 11 9 8 6 7 4
Qualitative 3 1 2
Social
Psychological
Weight loss
Total 30 18 15

11. Comparing food insecurity items from the USDA, Canada, LIDNS and Brazilian questionnaires
Canadian
LIDNS
Brazilian
Q0. Screening question Q1
Preliminary question -
Q1. Worry about running out of food Q2
Q2. Food didn’t last Q3
Q3. Balance meals/ healthy food Q4
Q3*
(healthy and varied diet)
Q4. Cut the size or skip meals Q8
(Q4) Q7
Q5. (if yes to Q4)
Q8b Q5
Q6. Eat less
(Q9) Q6
(Q8)
Q7. Being hungry
Q10 Q9
Q8. Lose weight
(Q11)
Q9. Not eating for a whole day
Q12
(go without eating for a whole day)
Q10. (If yes to Q9)
Q12b
Q11. Eat only few kinds of low-cost food
Q4*
Q12. Feed children a balance meals
Q5*
Q13. Child not eating enough food
Q14. Cut the size of children meals
Q13
Q11
(Q12)
Q15. Child were hungry
Q15
Q14
Q16. Child skip meals
Q17. (if yes to Q16)
Q14b
Q18. Child ever not eat for a whole day
Q16
(Q15)
(go without food)
1. Q: similar; (Q): quite similar (in wording) and Q*: not very similar
2. USDA, Canadian, LIDNS questions used “… money for food” meanwhile Brazilian questions used “…money to buy food”
3. Additional question in Brazilian questionnaire: “did you run out of food before having money to buy more?”
4. 14 questions in Brazilian questionnaire (except Q10) have an affirmative response “how often did it happen?”

12. Compared table of Radimer-Cornell questionnaire with USDA, HFIAS and FIES questionnaires
Household items
Food depletions items
1. Amount of food enough to buy food -
2. Food runs out Q6
3. Food didn’t last Q2
4. No food for meal
Food anxiety items
5. Worry if food run out Q1
6. Worry if food enough
7. Don’t know how to get food
8. Worry next day’s food
Women’s items
Diet inadequacy items
9. Woman does not eat as should
10. Woman cannot afford nutritious diets
11. Woman eats properly?
12.Woman does not eat balanced meal Q3
Intake insufficiency items
13. Woman wants to eat more but no money
14. Woman goes hungry Q7 Q8
15. Woman eats less Q5
Disrupted eating pattern items
16. Woman goes without eating
17. Woman skip meals Q4
18. Woman eat once a day
19. Woman does not eat for whole day Q9

13. Compared table of Radimer-Cornell questionnaire with USDA, HFIAS and FIES questionnaires (cont)
Children’s items
Diet inadequacy items
20. Child composite index -
21. Child does not eat nutritious diet
22. Child does not eat balanced meals
Q12
23. Child can’t be fed as should
Intake insufficiency items
24. Child eat less
25. Child wants more food
26. Child doesn’t eat enough
Q13
27. Child hungry
Q15
Disrupted eating pattern items
28. Child goes without food
29. Child skips meals
Q16
30. Child does not eat for whole day
Q18

14. Acknowledgement
Dr Amudha Poobalan for her input and advice re systematic review search strategy

15. Small group discussion questions
What three things from this morning’s presentations were the most interesting and / or concerning? 
What actions would you like to see coming out of today’s workshop?