A multilevel, multidimensional scale for measuring housing insecurity in slums and informal settlements

Housing insecurity is a pervasive challenge in the cities and urban areas of low-and middle-income countries, particularly in the informal settlements where a disproportionately high number of urban residents live. Despite this persistent challenge and its impact on health and well-being, there are scarce comprehensive, standardized, and validated instruments for measuring housing insecurity in these regions. Therefore, our objectives were to develop and validate a housing insecurity scale for slums and informal settlements in the global South. Using a complementary set of qualitative and quantitative techniques, we developed the scale from data collected from three slums in Ghana (N = 1036) on housing deprivations and characteristics, slum severity, resource insecurity, health outcomes, and socio-demography. Following item generation, domain identification, and content validation, we identified a set of 28 items, which were tested for tetrachoric and Biserial correlations. We then extracted an optimal number of factors and tested for dimensionality using confirmatory factor analysis and second-order confirmatory factor analysis. This was followed by tests of reliability, external validity, unidimensionality of sub-scales, local independence, invariant item ordering, and monotonicity. The resultant scale is a multilevel, multidimensional scale comprising 17 items that subdivide into three sub-scales: lack of essential utility (alpha = 0.63), built environment deficiency (alpha = 0.80), and tenancy challenges (alpha = 0.82). The composite scale is reliable, with a coefficient alpha of 0.83. Criterion concurrent and predictive validity, convergent and discriminant validity, and known group comparisons supported the validity of the scale. Assumptions of subscale unidimensionality, local independence, invariant item ordering, and monotonicity were verified. This is one of the few comprehensively validated scales developed to measure housing insecurity in slums and informal settlements in the global South. It can be used to test different hypotheses on the impact of housing insecurity on several environmental and health outcomes; assess and plan clinical, programmatic and policy interventions; and aid in tracking progress made on the Sustainable Development Goal 11.