Towards measuring food insecurity stigma: Development and validation of the Food Insecurity Self- Stigma Scale and the Food Support Experiences Scale

Abstract

Abstract Background Within high income countries such as the UK, individuals experiencing food insecurity have become increasingly reliant on food support to satisfy household food needs. However, experiencing food insecurity and accessing food support are highly stigmatised, negatively impacting psychological and emotional wellbeing. Being able to quantify this stigma may contribute towards reducing these impacts. This study aimed to develop and validate two novel scales enabling the quantification of stigma concepts within the food insecurity and food support context: (1) the Food Insecurity Self-Stigma Scale (FISS), which measures the level of self-stigma that individuals experiencing food insecurity feel regarding their food insecure status; and (2) the Food Support Experiences Scale (FSES), which measures the psycho-social experiences (including the experience of self-stigma) when individuals access a food support service. Methods English speaking participants who identified as experiencing food insecurity completed the new FISS (N=211) and FSES (N=123) measures, alongside other validation measures. Exploratory (EFA) and confirmatory factor analysis (CFA) were carried out for both scales. Regressions using latent variables derived from the CFA were used to test convergent and divergent validity. McDonald’s Omega was used to assess internal reliability and intra-class correlations between initial and retest FISS and FSES scores of a small number of participants (FISS: N=14; FSES: N=8) were used to assess test-retest reliability. Results EFA indicated that a three-factor structure best accounted for the data in both the FISS and FSES. CFA revealed a good fit of the model for the FISS, comprising of 15 items across the three factors (righteous anger, non-disclosure, and stereotype endorsement). Meanwhile, an acceptable-to-poor fit of the model was revealed for the FSES, comprising of 23 items across the three factors (self-approval and disclosure, dietary and interpersonal satisfaction, and perceived effectiveness and impact). Both scales demonstrated good internal reliability and test-retest reliability. Conclusions The FISS and FSES provide valid tools for quantifying aspects of stigma relating to the experience of food insecurity and accessing food support respectively. These two scales may provide an important step towards developing interventions which reduce this psychological burden and work to promote psychological wellbeing within populations experiencing food insecurity.