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Original research
Toward a more systematic understanding of water insecurity coping strategies: insights from 11 global sites
  1. Shalean M Collins1,
  2. Nancy Mock1,
  3. M Pia Chaparro2,
  4. Donald Rose3,
  5. Benjamin Watkins1,
  6. Amber Wutich4,
  7. Sera L Young5
  8. HWISE Research Coordination Network
    1. 1Department of International Health and Sustainable Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
    2. 2Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Washington, USA
    3. 3Tulane Nutrition, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
    4. 4School of Human Evolution and Social Change, Arizona State University, Tempe, Arizona, USA
    5. 5Anthropology, Northwestern University, Evanston, Illinois, USA
    6. 1Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
    7. 2Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
    8. 3Anthropology, The Islamia University of Bahawalpur, Punjab, Pakistan
    9. 4University of Westminster, London, UK
    10. 5Anthropology, The University of North Carolina at Greensboro, Greensboro, North Carolina, USA
    11. 6Nutrition, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
    12. 7Geography, University of Miami, Coral Gables, Florida, USA
    1. Correspondence to Dr Shalean M Collins; scollin4{at}tulane.edu

    Abstract

    Introduction Water insecurity–the inability to access and benefit from affordable, reliable and safe water for basic needs–is a considerable global health threat. With the urgent need to target interventions to the most vulnerable, accurate and meaningful measurement is a priority. Households use diverse strategies to cope with water insecurity; however, these have not been systematically characterised nor measured. The Food Insecurity Coping Strategies Index has been insightful for targeting nutrition interventions to the most vulnerable. As a first step towards creating an analogous scale for water, this study characterises the largest empirical data set on water insecurity coping strategies and proposes guidance on measuring it using a novel toolkit.

    Methods Open-ended responses on water insecurity coping (n=2301) were collected across 11 sites in 10 low- and middle-income countries in the Household Water InSecurity Experiences (HWISE) Scale validation study. Responses were characterised and compared with behaviours identified in the literature to construct an instrument to systematically assess coping.

    Results We identified 19 distinct strategies that households used when experiencing water insecurity. These findings, paired with prior literature, were used to develop a Water Insecurity Coping Strategies Assessment Toolkit with guidance on its piloting to assess coping prevalence, frequency and severity.

    Conclusions The widespread occurrence of water insecurity coping strategies underscores the importance of understanding their prevalence and severity. The Water Insecurity Coping Strategies Assessment Toolkit offers a comprehensive approach to evaluate these strategies and inform the design and monitoring of interventions targeting those most vulnerable to water insecurity.

    • Public Health
    • Cross-sectional survey

    Data availability statement

    Data are available upon reasonable request. Data are available upon request from the HWISE Research Coordination Network.

    https://creativecommons.org/licenses/by/4.0/

    This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

    https://doi.org/10.1136/bmjgh-2023-013754

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      Data availability statement

      Data are available upon reasonable request. Data are available upon request from the HWISE Research Coordination Network.

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      Footnotes

      • Handling editor Seema Biswas

      • X @ShaleanCollins, @profserayoung

      • Collaborators HWISE Research Coordination Network:Zeina Jamaluddine (London School of Hygiene and Tropical Medicine, London, UK); Hala Ghattas (Arnold School of Public Health, University of South Carolina, Columbia, South Carolina); Farooq Ahmed, (Department of Anthropology, Quaid-I-Azam University, Islamabad, Pakistan); Stroma Cole (University of Westminster, London, UK); Cassandra Workman (Department of Anthropology, University of North Carolina Greensboro, Greensboro, North Carolina); Joshua Miller (Department of Nutrition, The University of North Carolina, Department of Nutrition, Chapel Hill, NC); Justin Stoler (Department of Geography and Sustainable Development, University of Miami, Coral Gables, FL, USA).

      • Contributors SMC conceptualised the study, analysed the data, prepared the manuscript, and is the guarantor of the article who accepts full responsibility for the work and conduct of the study, has access to the data, and controlled the decision to publish. NM provided critical review of all manuscript drafts, revising it for intellectual content, feedback and statistical support. MPC provided critical review of all manuscript drafts, revising it for intellectual content and feedback. DR provided critical review of all manuscript drafts revising it for intellectual content, feedback, and statistical support. BW provided critical review, feedback, and statistical support. AW provided critical review, feedback and guidance on conceptualisation. SLY assisted with study conceptualisation, provided critical review of all manuscript drafts, revising it for intellectual content, feedback and guidance. HWISE consortium authors provided data from respective study sites, reviewed the manuscript drafts, provided feedback on study sites' context and revised drafts for intellectual content. All listed authors approved the final version to be published.

      • Funding This work was funded by the Innovative Methods and Metrics for Agriculture and Nutrition Action (IMMANA) program, led by the London School of Hygiene & Tropical Medicine (LSHTM). IMMANA was co-funded by UK Foreign Commonwealth and Development Office (FCDO), grant number 300654 and by the Bill & Melinda Gates Foundation INV-002962/OPP1211308. Under the grant conditions of the Foundation, a Creative Commons Attribution 4.0 Generic License has already been assigned to the Author Accepted Manuscript version that might arise from this submission. This project was also supported by the Buffett Institute for Global Studies and the Center for Water Research at Northwestern University (N/A); Arizona State University’s Center for Global Health at the School of Human Evolution and Social Change and Decision Center for a Desert City (National Science Foundation SES-1462086); the Office of the Vice Provost for Research of the University of Miami (N/A). We also acknowledge the National Science Foundation's HWISE Research Coordination Network (BCS-1759972) for support of the collaboration. Sera L. Young was supported by the National Institutes of Health (NIMH R21 MH108444; NIMH K01 MH098902). Funders of the study had no role in study design, data collection, data analysis, data interpretation or writing of the report. Authors had full access to all study data and had final responsibility for the decision to submit for publication.

      • Competing interests None declared.

      • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

      • Provenance and peer review Not commissioned; externally peer-reviewed.

      • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.