Measurement of the dimensions of food insecurity in developed countries: a systematic literature review

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.