Cross-cultural adaptation and validation of adults` food security survey module

Abstract

Food insecurity occurs when there is uncertainty of the availability of food or the insufficiency in quantity and quality of food required for a healthy life style, or the need to use socially unacceptable ways to acquire foods. Based on several studies conducted from 2001 to 2014 in Malaysia, 58% to 86% of households were reported as having some kind of food insecurity. However, none of those studies has mentioned the prevalence of food insecurity in the university student population. Therefore, this study had sought to assess the validity and reliability of a cross-culturally adapted English version of the U.S. Adults Food Security Survey Module (AFSSM) in the measurement of food insecurity among university students. A total of n=208 Malay university students aged between 18-25 years old were selected in this cross-sectional study using convenient sampling. The students’ socio-economic status were evaluated using a self-reported questionnaire. The eleven item AFSSM was used to measure food insecurity. Content validity was assessed by an expert panel, and the questionnaire was then tested among 22 students for clarity. Internal consistency was evaluated by Cronbach’s ? and construct validity was assessed through exploratory factor analysis. Criterion validity was assessed by correlating the measure with a number of selected nutrition and inflammatory biomarkers. In all, the prevalence of food insecurity was measured at 56.3% (95% CI: 49.2%-63.1%), with 21.6% (n=45) of students having very low food security. Cronbach’s ? was observed at 0.81. Factor analysis of the AFSSM items revealed two factors: factor 1 (Insufficient food quantity) and factor 2 (Psychological). For criterion validity, only three items were significantly correlated with measured biomarkers. Item Q2 (r=0.15; p=0.044) and Q4 (r=0.18; p=0.018) were positively correlated with serum hs-CRP. On the other hand, item Q5 (-0.15; p=0.046) was found to be negatively correlated with serum folate levels. Only gender was significantly associated with food insecurity where female students were less likely to be food insecure (OR=0.32; 95% CI: 0.11-0.90; p=0.030). As for the conclusion, the cross-culturally adapted and validated English version of the AFSSM showed acceptable levels of reliability, construct validity, and criterion validity to recommend its use in assessing individual food insecurity among Malay university students.