Objective: Food insecurity is a salient health issue comprised of four dimensions – food access, availability, utilization and stability over time. The aim of the present study was to conduct a systematic literature review to identify all multi-item tools that measure food insecurity and explore which of the dimensions they assess.Design: Five databases were searched (CENTRAL, CINAHL plus, EMBASE, MEDLINE, TRIP) for studies published in English since 1999. Inclusion criteria included human studies using multi-item tools to measure food security and studies conducted in developed countries. Manuscripts describing the US Department of Agriculture Food Security Survey Module, that measures ‘food access’, were excluded due to wide acceptance of the validity and reliability of this instrument. Two authors extracted data and assessed the quality of the included studies. Data were summarized against the dimensions of food insecurity.Setting: A systematic review of the literature.Subjects: The majority of tools were developed in the USA and had been used in different age groups and cultures.Results: Eight multi-item tools were identified. All of the tools assessed the ‘food access’ dimension and two partially assessed the dimensions ‘food utilization’ and ‘stability over time’, respectively. ‘Food availability’ was not assessed by existing tools.Conclusions: Current tools available for measuring food insecurity are subjective, limited in scope, with a majority assessing only one dimension of food insecurity (access). To more accurately assess the true burden of food insecurity, tools should be adapted or developed to assess all four dimensions of food insecurity.

Objectives: To compare prevalence estimates of food insecurity using a single‐item measure, with three adaptations of the United States Department of Agriculture Food Security Survey Module (USDA‐FSSM). Methods: Data were collected by postal survey, from individuals aged ≥18 years from disadvantaged suburbs of Brisbane, Australia (n= 505, 53% response). Food security status was ascertained by the Australian single‐item measure, and the 6‐, 10‐ and 18‐item versions of the USDA‐FSSM. Prevalence estimates of food insecurity and different levels of severity of food insecurity estimated by each tool were determined. Data were analysed using McNemar's test, polychoric correlation and Rasch analyses. Results: The prevalence of food insecurity was 19.5% using the single‐item measure; significantly less than the 24.4%, 22.8% and 21.1% identified using the 18‐item, 10‐item and 6‐item versions of the USDA‐FSSM, respectively. Rasch analyses revealed that overall the USDA‐FSSM may be a valid tool for the measurement of food insecurity within the current sample. Conclusion: The measure of food insecurity employed in national surveys in Australia may underestimate its prevalence and public health significance. Implications for public health: Future monitoring and surveillance efforts should seek to employ a more accurate measure as the first step in recognising the right to food for all Australians.

Research has historically focussed on participants who are relatively easy to access; those who have resources (time and literacy) to respond to surveys, who can travel, and are socially connected. Failure to meaningfully engage with intended participants and achieve representativeness in participation risks diminishing the applicability and impact of research findings to local contexts. Motivated by goals of social justice and health equity, this scoping review sought to identify strategies to effectively engage and integrate the “authentic voice” of populations that are described as vulnerable or precarious and therefore perceived as “hard-to-reach.” A system tic search strategy identified 34 eligible papers. Articles underwent (i) a title and abstract screening by two reviewers, followed by (ii) a full text review of eligible articles by one author. Free-form research problem mind-mapping was applied to facilitate analysis and generate creative associations between ideas. Thematic and content analysis was then applied to generate themes and subthemes. Four high-level themes emerged: key players, trust and rapport, navigating structural precarity, and moving beyond “participation.” We identified that substantial shifts in researcher mindsets are required to reframe perceptions of vulnerability and move towards strengths-based approaches. Efforts need to be directed towards establishing deep trust and rapport through early engagement and social reciprocity. Systemic barriers to research participation and partnership must be addressed to overcome issues of structural precarity. We urge researchers and practitioners to embrace “scholar activism” and to actively dismantle the precarity that limits active “participation” and to build deliberate strategies to create forums where the “authentic” voice can be amplified.

Objective: To investigate the psychometric properties, validity and reliability of a newly developed measure of food insecurity, the Household Food and Nutrition Security Survey (HFNSS), among an Australian population.Design: Cross-sectional study.Setting: Metropolitan areas of Melbourne, Australia, identified as very high, high or medium vulnerability in the 2008 Vulnerability Assessment for Mortgage, Petrol and Inflation Risks and Expenditure index.Subjects: A convenience sample of 134 adults (117 females and fifteen males, aged over 18 years).Results: Rasch modelling and factor analysis identified four items for exclusion. The remaining items yielded excellent reliability among the current sample and assessed three underlying components: the adult experience of food insecurity (component one), initial/periodic changes to children’s food intakes (component two) and progressive/persistent decreases in children’s food intakes (component three). Compared with the widely used US Department of Agriculture Food Security Survey Module, the HFNSS identified a significantly higher proportion of food insecurity; this is likely due to the HFNSS’s identification of food insecurity due to reasons other than (and including) limited financial access.Conclusions: The HFNSS may be a valid and reliable tool for the assessment of food insecurity among the Australian population and provides a means of assessing multiple barriers to food security beyond poor financial access (which has been identified as a limitation of other existing tools). Future research should explore the validity and reliability of the tool among a more representative sample, as well as specifically among vulnerable population subgroups.

Objective: To develop a measure of food and nutrition security for use among an Australian population that measures all pillars of food security and to establish its content validity.Design: The study consisted of two phases. Phase 1 involved focus groups with experts working in the area of food security. Data were assessed using content analysis and results informed the development of a draft tool. Phase 2 consisted of a series of three online surveys using the Delphi technique. Findings from each survey were used to establish content validity and progressively modify the tool until consensus was reached for all items.Setting: Australia.Subjects: Phase 1 focus groups involved twenty-five experts working in the field of food security, who were attending the Dietitians Association of Australia National Conference, 2013. Phase 2 included twenty-five experts working in food security, who were recruited via email.Results: Findings from Phase 1 supported the need for an Australian-specific tool and highlighted the failure of current tools to measure across all pillars of food security. Participants encouraged the inclusion of items to measure barriers to food acquisition and the previous single item to enable comparisons with previous data. Phase 2 findings informed the selection and modification of items for inclusion in the final tool.Conclusions: The results led to the development of a draft tool to measure food and nutrition security, and supported its content validity. Further research is needed to validate the tool among the Australian population and to establish inter- and intra-rater reliability.