A protocol for the development of a validated scale of household water insecurity in the United States: HWISE-USA

Background New metrics of household water insecurity have been validated for low- to middle-income countries, but it is unclear how these measurements apply to the experiences of people living in high-income countries. This project aims to develop and validate a novel metric for household water insecurity experiences in the United States (HWISE-USA) using a cross-sectional design and data from the Southwest, Midwest, and Western regions. Methods We outline the protocol for the development and validation of a novel household water insecurity scale for the United States to address this scientific need, including the following key steps: (1) item development through literature and theory; (2) pre-testing of items and expert review; (3) scale development and item reduction; and (4) scale validation. To assess the performance of the HWISE-USA scale, we will follow the same scale development analytics on a separate, quasi-nationally-representative U.S. sample. The scale will be generated from household survey data collected from communities at risk of water insecurity throughout the United States. Discussion We explain how a novel metric of water insecurity experiences for households in the United States has important implications for resource allocation, structural interventions, public health and infrastructure planning, and reductions in inequalities.