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

Background: Within high income countries, 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 (and related constructs) 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 three-factor structures best fit both scales. CFA revealed a good fit of the model for the FISS (15 items; 3 factors: righteous anger, non-disclosure, and stereotype endorsement). Meanwhile, an acceptable-to-poor fit of the model was revealed for the FSES (23 items; 3 factors: self-approval and disclosure, dietary and interpersonal satisfaction, and perceived effectiveness and impact). Importantly, convergent validity was only found for the non-disclosure subscale of the FISS and the self-approval and disclosure subscale of the FSES.

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. Development of these two scales may provide an important first step towards measuring stigma. developing interventions which reduce this psychological burden, and working to promote psychological wellbeing within populations experiencing food insecurity.