Objective: To determine the reliability, validity and correlates of measures of food
insecurity (FI) obtained using an individually focused food insecurity access scale
(IFIAS) among pregnant women of mixed HIV status in northern Uganda.
Design: A mixed-methods study involving cognitive interviews nested within a
cross-sectional survey.
Setting: The antenatal care clinic of Gulu Regional Referral Hospital.
Subjects: Survey respondents included 403 pregnant women, recruited in a ratio of
one HIV-infected to two HIV-uninfected respondents, twenty-six (nine of them
HIV-infected) of whom were asked to participate in the cognitive interviews.
Results: Over 80 % of cognitive interview participants reported understanding the
respective meanings of six of the nine items (i.e. items 4 to 9) on the IFIAS. Two
main factors emerged from rotated exploratory factor analysis of the IFIAS: mild to
moderate FI (IFIAS items 1–6) and severe FI (items 7–9). Together, they explained
90·4 % of the FI measure’s variance. The full IFIAS and the two subscales had
moderate to high internal consistency (Cronbach’s α ranged from 0.75 to 0.87).
Dose–response associations between IFIAS scores, and measures of socioeconomic
status and women’s diet quality, were observed. Multivariate linear
regression revealed significant positive associations between IFIAS scores and HIV
infection, maternal age, number of children and a history of internal displacement.
IFIAS scores were negatively associated with women’s diet diversity score, asset
index and being employed.
Conclusions: The IFIAS showed strong reliability, validity and contextual
relevance among women attending antenatal care in northern Uganda.