Abstract
Background:
Household Food Insecurity is a “limited or uncertain availability of nutritionally adequate and safe foods, or limited ability to acquire personally acceptable foods that meet cultural needs in a socially acceptable way.” In New Zealand, Household Food Insecurity is measured face-to-face, however, there is growing interest in administering the survey online. Research is lacking about whether online administration of the Household Food Security Survey (HHFSS) online is feasible. Since former refugees were not considered when the survey was developed, it is also important to determine whether the survey is suitable for them. Furthermore, research is needed on how the experience of Household Food Insecurity in the former refugee population differs from the general population and from how Household Food Insecurity is conveyed in the survey.
Objective:
The two primary aims are to consider the feasibility of administrating the HHFSS online in terms of both accessibility and comprehension (Part 1) and to explore, through stakeholder perspective, how former refugees experience Household Food Insecurity in New Zealand (Part 2).
Methods:
For part one, ten participants were recruited using posters, flyers, Facebook and a literacy support agency. The participants completed cognitive interviews, as they responded to the eight-item HHFSS administered online using Qualtrics. Following this they completed a questionnaire regarding the practicality of the online modality.
For part two, individuals and organisations who worked with former refugees were identified from conversations with mutual contacts and research. Eleven were recruited. A focus group was conducted for seven stakeholders from one organisation, and four in depth interviews were completed for four stakeholders from three other organisations. The semi-structured interview guide was developed after reviewing literature. Most interviews from both sections were audio recorded, they were transcribed by LM and the rest using the app Otter. The transcriptions were coded in NVivo 12 and thematic analysis was used to analyse the data.
Results:
In part one, 90% of the participants reported they had a computer and internet. The participants reported they would prefer using computers for surveys; only one stated having difficulties using a computer. The cognitive interviews revealed that the responses to the eight items reflected their experiences. This research found that a small number of statements were misinterpreted; especially statement five about relying on others for food. This was sometimes interpreted as relying on food banks or food grants for foods, essentially question six of the questionnaires.
A stakeholder who works with former refugees attending English classes emphasised that the level of English was far too complex for them to complete the HHFSS.
For part two, stakeholder interviews and focus groups revealed that language barriers influenced many challenges faced by former refugees (e.g food identification). Therefore, accessing foods that were suited to cultural tastes and preferences was challenging. While availability of those foods has improved, some former refugees still struggle to find their preferred food. The former refugee community was integral in helping former refugees access preferred and traditional foods and increasing the availability of those. Financially, some former refugees struggled because the Government benefits were not enough. Finding suitable employment was an issue, even with education or a New Zealand qualification.
Conclusion: This research shows that it is feasible to administer the HHFSS online. However, future research is needed to determine methods to overcome the potential issues raised such as the misinterpretation of the statements, not having the space to reflect or change answers, and distractions. This research showed that former refugees in New Zealand face issues related to Household Food Insecurity that are not represented in the current survey. Thus, further research should explore broadening the survey to include those domains, mainly food access and language.