Development of a food security assessment tool for prenatal care in pregnant women: a mixed-method study

Women have more complex nutritional needs due to menstrual cycles, pregnancy, and breastfeeding. They are the most vulnerable group in terms of household food insecurity. Until now, public tools used to assess the food security of pregnant women. This study aims to develop and validate a food security assessment tool specifically for pregnant women to integrate into antenatal care in the health system. A sequential-exploratory mixed-method design was implemented. In the qualitative phase, 23 in-depth semi-structured interviews with 17 pregnant women and 6 food security experts were analysed using conventional content analysis to define the concept and dimensions of food security during pregnancy. Based on these findings and a structured instrument-development framework, an initial item pool was generated and evaluated through face validity, content validity, item analysis, and construct validity assessments. Exploratory factor analysis (EFA) was conducted with a sample of 300 pregnant women, followed by confirmatory factor analysis (CFA) in an independent sample of 150 women. Reliability (Cronbach’s alpha, ICC), responsiveness, feasibility, and known-group validity were also examined. EFA supported a two-factor structure explaining 63.9% of the variance. CFA demonstrated acceptable model fit (χ².df = 1.71, CFI = 0.953, IFI = 0.953, RMSEA = 0.069). The final 20-item Pregnancy Food Security Questionnaire (Pregnancy-FSQ) exhibited excellent internal consistency (α = 0.965) and test–retest reliability (ICC = 0.999). Known-group validity was confirmed through significant score differences across maternal education, household income, occupation, and place of residence (p < 0.001). The tool showed minimal nonresponse, required approximately 15 min to complete, and demonstrated adequate responsiveness to socio-demographic disparities associated with food insecurity. The Pregnancy-FSQ is a valid, reliable, and feasible instrument specifically designed to assess food security among pregnant women. Its integration into routine antenatal care can support early identification of food-insecure pregnant women and indirectly highlight food-insecure households, facilitating timely interventions.