Development and Validation of A Multidimensional Food Security–Nutrition Vulnerability (Fosenuvu) Instrument for Tuberculosis Patients in Disaster-Prone Areas
DOI:
https://doi.org/10.37287/ijghr.v8i6.2670Keywords:
disaster, food insecurity, FOSENUVU, nutritional vulnerability, psychometrics, tuberculosisAbstract
Tuberculosis (TB) patients living in disaster-prone areas may experience interconnected food, nutritional, socioeconomic, and healthcare vulnerabilities that can be exacerbated by disasters. However, an instrument that comprehensively assesses food and nutrition vulnerability in this population remains limited. This study aimed to develop and validate the multidimensional Food Security-Nutrition Vulnerability (FOSENUVU) instrument for assessing food and nutrition vulnerability among TB patients living in disaster-prone areas. A methodological study was conducted through sequential instrument development and psychometric validation. Initial item development involved a literature review, healthcare worker interviews, item construction, and expert assessment. Content validity was evaluated by five experts using the Content Validity Index. The resulting 30-item instrument was administered to 300 adult pulmonary TB patients living in disaster-prone areas of Sukabumi Regency, Indonesia, selected using purposive sampling. Validity analysis was carried out in stages: content validity was assessed by five experts using the Content Validity Index (CVI), followed by item validity testing using corrected item-total correlation. Furthermore, construct validity was analysed using Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA), whilst convergent validity was assessed using Average Variance Extracted (AVE) and Composite Reliability (CR). Expert assessment demonstrated 90% agreement, supporting the content validity of the instrument. The 30-item FOSENUVU showed strong internal consistency, with Cronbach’s alpha of 0.979 overall and 0.872–0.894 across six conceptual domains. EFA identified a dominant single-factor structure explaining 60.5% of the total variance, with factor loadings ranging from 0.709 to 0.825. CFA confirmed the one-factor model with excellent fit (χ²/df=1.046, CFI=0.997, TLI=0.997, RMSEA=0.012, and SRMR=0.022). Convergent validity was supported by an AVE of 0.605 and composite reliability of 0.979. All 30 items were retained. FOSENUVU demonstrated strong content validity, internal consistency, structural validity, and convergent validity. The final 30-item instrument provides a multidimensional yet integrated measure of food and nutrition vulnerability among TB patients in disaster-prone areas.
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