Validity of the Food Insecurity Experience Scale (FIES) for use in League of Arab States (LAS) and characteristics of food insecure individuals by Human Development Index (HDI)

Background:The Food Insecurity Experience Scale (FIES) is a UN FAO Voices-of–the-Hungry (FAO-VoH) experiential metric of food insecurity (FI). It was pilot tested in some countries but not in Arab speaking ones and validated using global data. Yet, its psychometric properties may vary in the League of Arab States (LAS) due to cultural and linguistic differences.Objectives:1) assess the validity of FIES for use in the LAS region, 2) determine the prevalence of FI, by gender, age group, and human development index (HDI), and 3) examine sociodemographic characteristics of severe FI individuals.Methods:To assess the psychometric properties of FIES, Rasch modeling was applied to the 2014–2015 Gallop World Poll (GWP) in the LAS. Prevalence and characteristics of severely FI individuals were assessed using the 2014–2017 GWP data of 62,261 respondents.Results:Overall, FIES met the Rasch model assumptions of equal discrimination and conditional independence. Infit statistics for FIES items, in most LAS countries, were <1.3, indicating good internal validity. In Syria and Sudan, the item “worried about not having enough food to eat” had infits >1.3. Outfit statistics >2.0, indicating erratic responses, were noted in 26% of the LAS countries. Significant correlations were found (≥0.4) between items in Algeria, Tunisia, and Lebanon. The overall prevalence of severe FI was 15.7%. At highest risk were those aged ≥50 years compared to younger adults (16.5% vs. 15.5%, respectively, P < 0.02), women compared to men (17.6% vs. 14.1%, respectively, P < 0.0001), and those in countries with low HDI compared to high HDI (24.9% vs. 8.3%, respectively, P < 0.0001).Conclusions:Overall, FIES is valid for measuring FI in the LAS. Cognitive testing of items with high outfit statistics and omission of correlated ones may improve the scale. Populations vulnerable to severe FI include older adults and women. These populations should be examined further.