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Predictors of food security status among informal caregivers of older adults residing in slums in Ghana

Abstract

Background

Informal caregivers of older adults play a crucial role, positively influencing the physical, mental, and social well-being of their care recipients, while concurrently contributing to substantial cost savings in the healthcare sector. The significance of food security for these caregivers becomes paramount as it not only impacts their health but also influences the energy needed to fulfil their caregiving responsibilities. Nevertheless, there is a scant literature on the factors that predict food security status among informal caregivers of older adults residing in slum communities in Ghana. This study seeks to address this gap by examining the factors that predict food security status among informal caregivers.

Methods

A sample of 458 informal caregivers of older adults residing in slum communities in the Greater Kumasi metropolis was used for the study. The Generalized Linear Regression Model was used to estimate factors that predict food security status among informal caregivers of older adults in slum communities. Beta values and standard errors were utilised, with a significance level of 0.05 or lower.

Results

The analysis showed that 88.4% of the participants were females, 37.3% were aged 40–49 years, 72.7% were of Akan ethnicity, 81.4% were married, 45.4% had basic education, 96.3% did not receive pay for caregiving and 72.1% were enrolled in a national health insurance scheme. The study revealed that participants without formal education (β = 0.661, p <.05) and those aged 29 years or younger (β = 26.927, p <.001), 30–39 years (β = 27.453, p <.001), and 40–49 age group (β = 26.710, p <.001) statistically significantly exhibited an increased food security status compared to their counterparts. Additionally, participants identifying as Akan (β = -0.421, p <.05), Christians (β = -0.828, p <.001), married individuals (β = -0.500, p <.05), those who reported never being ill (β = -2.617, p <.001), those without chronic non-communicable diseases (NCDs) (β = -0.638, p <.001), and those not enrolled in the national health insurance scheme (β = -0.422, p <.01) statistically significantly experienced a decreased food security status compared to their counterparts.

Conclusion

Considering these findings, policymakers are urged to integrate socio-economic and health characteristics of informal caregivers into food security policies. This inclusive approach is essential for enhancing the food security status of informal caregivers responsible for older adults in slum communities.

Peer Review reports

Introduction

Informal care, characterised by mostly unpaid assistance from family, friends, or volunteers, has emerged as a prevalent and vital component in the caregiving landscape for individuals grappling with chronic illnesses or disabilities [1]. Informal caregiving has gained widespread acceptance and is increasingly recognised as an integral complement to formal healthcare systems, gaining popularity across various countries. The support caregivers provide enhances the quality of life for care recipients and presents a considerable cost-saving advantage for healthcare systems [2, 3]. Consequently, the role of informal caregivers has evolved to be multifaceted with political, sociological, and economic dimensions [4]. Recent work by Odunitan-Wayas et al. [5] emphasises the importance of considering the specific socio-economic conditions prevalent in slum environments in developing countries. This aligns with the broader understanding that contextual factors significantly impact food security outcomes in Switzerland [6]. Caregiving especially for chronically ill patients puts a lot of stress and strain on the caregiver due to continuous contact with the care recipient [7, 8]. Notwithstanding the role of caregivers, the literature reveals that caregivers experience food insecurity and has also emphasised the importance of integrating a caregiving perspective into the discourse on food security. The study by Thompson et al. [9] calls for an understanding of the interplay between caregiving responsibilities and food security, recognising that informal caregivers may face additional challenges that impact their nutritional status. This aligns with the overarching goal of the present research, which is to provide a holistic understanding of the predictors of food security status among informal caregivers in slum communities.

Food insecurity, characterised by inadequate of access to adequate, safe, and nutritious food, extends beyond a mere absence on physical grounds and encompasses social and economic dimensions as well [10]. Even though food insecurity affects the entire world, one of the region’s most susceptible to food insecurity is Africa. Approximately 53% of Africans are vulnerable to food insecurity [11]. Given the current societal and environmental vulnerability, Sub-Saharan African regions will be most severely affected by the effects of climate change [12]. Caregivers emerge prominently in the literature as a vulnerable population susceptible to food insecurity, facing unique challenges that intersect with their caregiving responsibilities. Research by Loopstra & Doireann [13] illuminates the economic strain experienced by caregivers, often compounded by limited employment opportunities due to caregiving commitments. The financial burden associated with medical costs and caregiving-related expenses contributes to a heightened risk of insufficient access to food among this demographic. Furthermore, the emotional and time demands of caregiving may impede caregivers’ ability to engage in income-generating activities, exacerbating their vulnerability to food insecurity.

In literature, the implications of food insecurity on the role of caregivers have been poignantly explored as a nuanced narrative thread that weaves through the fabric of societal struggles [14]. Authors delve into the intricate dynamics of familial relationships strained by the harsh realities of insufficient access to nourishment. Often portrayed as protagonists in these narratives, caregivers grapple with the practical challenges of putting food on the table and the profound psychological impact of their inability to provide adequately [15, 16]. Literature suggests a correlation between food insecurity and compromised health, income, and lower levels of education for caregivers. Caregivers experiencing food insecurity frequently experience low income, poor health, and lower levels of education, even when every family member makes an effort to improve their food security situation [17, 18]. Studies indicate that food insecurity is associated with adverse developmental and physical health outcomes among caregivers/informal caregivers, such as dietary inadequacies [19], growth stunting in children [20], obesity [21], developmental deficits [22], as well as disability and chronic diseases [23]. The caregiving role is one of multiple complexities, especially concerning giving medication to patients with dementia [8]. Aside from developmental and physical health outcomes, food insecurity is associated/correlates with poor mental health. The nutritional status of caregivers can either amplify or mitigate their stress levels, potentially leading to the onset of chronic diseases or physical exhaustion. Notably, the literature indicates that the prevalence of food insecurity is 56% higher among informal caregivers than among non-caregivers in Southern US States [24].

The determinants of food insecurity, as discussed in the literature, encompass a multifaceted interplay of economic, social, and environmental factors. Coleman-Jensen [25] underscores the pivotal role of income disparities and economic instability in contributing to inadequate access to food. Additionally, environmental factors, including climate change and natural disasters, have been identified as significant contributors to food insecurity [26]. Social factors such as political instability and conflict also play a substantial role, disrupting food production and distribution systems. The broader literature highlights the intricate relationship between socioeconomic factors and food security status, with studies often focusing on vulnerable populations. Factors like ethnicity [27], religion [28], chronic non-communicable diseases [29] and health insurance enrolment [30] may intersect, leading to diminishing food security. Marlow et al. [30] looked at how national health insurance enrolment status was linked to reduced food security in a study conducted in Lesotho, where associations with food insecurity were observed among formal caregivers of children in rural areas [31]. Studies have highlighted the significance of educational levels in enhancing skills, self-efficacy, and dietary habits among low-income caregivers [14, 32, 33].

However, there exists a notable gap in research specific to informal caregivers in slums, particularly in the Ghanaian context. Research by Racine et al. [34] underscores the impact of socio-economic conditions on the food security of vulnerable groups. Vulnerability in slums is commonly associated with inadequate housing, limited access to basic services, and precarious economic conditions. Research by Satterthwaite & Mitlin [35] emphasises the significance of factors such as poor sanitation, overcrowding, and insufficient infrastructure in slums, all contributing to increased vulnerability. These conditions impact residents’ daily lives and amplify challenges related to health, education, and economic opportunities [36]. The objective of this study is to address this gap by examining factors that explain food security status among informal caregivers of older adults in slums in Ghana. This study emphasises the importance of tailoring interventions to populations in resource-challenged settings [6]. The outcome of this study is critical to informing policies and programmes aimed at improving the food security status of informal caregivers in Ghana.

Methods

Data and methods

The data for this study were sourced from a comprehensive cross-sectional survey focused on assessing the health needs of informal caregivers responsible for older people aged 60 years or above in Oforikrom Municipality and the Asokore Mampong Municipality in the Ashanti region of Ghana. The survey was conducted between June 2023 and August 2023. A multi-level sampling approach was used to select participants. First, two municipalities (Oforikrom Municipality and the Asokore Mampong Municipality) in the Ashanti region were purposively selected. The choice of the two municipalities was informed by the following: (i) the population of older adults; (ii) the existence of slums or informal settlements; and (iii) the availability of population figures for the various age groups of older people within the communities in the municipalities. Second, a simple random sampling technique was employed to select eight communities (four urban and four rural). These communities represent a third of the communities in the two municipalities for which the Ghana Statistical Service has provided census [37] The rationale for choosing four urban and four rural communities was to ensure that the study sample was representative of the wider population. Third, two slum communities were selected to reflect the focus of the study. The two slum communities were Aboabo (in the Asokore Municipality) and Ayigya (in the Oforikrom Municipality). Lastly, snowball sampling technique was used to recruit informal caregivers of older adults to participate in the study. Snowball sampling was used to recruit participants due to the absence of data on the number of informal caregivers in the study area and Ghana and the difficulty of reaching informal caregivers through conventional means [38].

A total of 944 informal caregivers of older adults were estimated to participate in the comprehensive cross-sectional survey. We determined a minimum sample size of 899 using the statistical formula, n = design effect × [(Zα/2)2 ×P (1-P)]/ε2 by Lwanga and Lemeshow [39], incorporating a design effect of 1.5, a 95% confidence interval, and a 4% margin of error. As the precise number of informal caregivers in the study area and Ghana was unknown, we adopted a conservative prevalence (p) of 0.48, following Agyemang-Duah & Rosenberg [38], resulting in a minimum sample size of 899 informal caregivers of older adults. Considering a 5% non-response rate, we anticipated a final sample of 944 participants. However, 70 (7.42%) declined participation, 26 (2.75%) provided incomplete responses, and 9 (0.95%) had missing data, resulting in a response rate of 88.88% (839 participants). Of these, 458 participants resided in the two slum communities, aligning with the study’s focus.

Employing a structured questionnaire as our data collection instrument, all survey questions were digitally recorded using the KoboToolbox. The questionnaire used in this study was developed for this study (see supplementary file 1- a portion of the questionnaire related to this study). The questionnaire covered demographic, socio-economic, health characteristics, and food security status, among other aspects. A pilot study involving 20 informal caregivers from Ayeduase and Kotei communities with similar characteristics was conducted before the main survey. Feedback from the pilot study prompted modifications to the questionnaire, and consequently, pilot data were not included in the final analysis.

Data collection occurred at the participants’ homes, ensuring a setting free from third-party interference. The original English questionnaire was translated into Twi, a widely spoken local language in the study area. The questionnaire administration, including translation, took approximately 30–45Ìýmin per participant.

Ethical consideration

Ethical clearance was obtained from the Committee on Human Research, Publication, and Ethics at Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (Ref. CHRPE/AP/528/23). Ensuring transparency and respect for participants, we communicated the study’s objectives and obtained both oral and written informed consent before commencing data collection. Participants were informed about the voluntary nature of their participation, with the assurance that they could abstain from answering any sensitive or personal questions and withdraw from the study at any time without facing penalties.

Measures

The study’s dependent variable was food security status, assessed through the 9-item Household Food Insecurity Access Scale (HFIAS) [40]. Participants used a Likert scale (0 = none, 1 = rarely, 2 = sometimes, 3 = often) to respond to questions gauging the frequency of food (in)security occurrences. Because of the objective of this study, the responses were reverse-coded as (0 = often, 1 = sometimes, 2 = rarely, 3 = none). The composite score ranges from 0 to 27. A higher score indicates greater food security, and a lower score indicates higher food insecurity.

The independent variables were categorised into three primary dimensions: demographic, socio-economic, and health-related. Demographic variables included gender (0 = male, 1 = female), age (years) (0 = 29 or less, 1 = 30–39, 2 = 40–49, 3 = 50–59, 4 = 60 or above), ethnicity (0 = Akan, 1 = non-Akan), religion (0 = Christian, 1 = non-Christian), and marital status (0 = married, 1 = single) of informal caregivers. Socio-economic variables comprised education (0 = no formal education, 1 = basic education, 2 = secondary education, 3 = tertiary education), compensation for informal care (0 = no, 1 = yes), and enrolment in a national health insurance scheme (0 = no, 1 = yes) for informal caregivers. Health-related variables included the frequency of illness (0 = never, 1 = frequent) and the presence of chronic non-communicable diseases (NCDs) (0 = no, 1 = yes).

Analytical framework

Integrated into the Statistical Package for the Social Sciences (SPSS) software version 25, our data analysis employed both descriptive and inferential frameworks. Descriptive analysis, such as percentages and frequencies, were used to elucidate the sample characteristics of participants. For inferential analysis, the Generalized Linear Regression Model (GLRM) served as the framework to assess the association between the dependent variable (food security status) and independent variables (age, gender, ethnicity, religion, marital status, education, compensation for caregiving, enrolment in a national health insurance scheme, frequency of illness, and chronic non-communicable diseases). Beta values and standard errors were utilised, with a significance level of 0.05 or lower.

The use of GLRM was driven by the continuous nature of the dependent variable. Three distinct models were fitted: Model 1 comprised demographic variables, Model 2 incorporated socio-economic variables along with those in Model 1, and the final Model 3 encompassed health-related variables in addition to those in Model 2. This tiered approach allowed for a comprehensive exploration of the multifaceted factors that influence food security status among informal caregivers of older adults. All three models were subjected to the goodness of fit test.

Results

Participant demographics

Demographic characteristics of the participants are presented in TableÌý1. The analysis showed that 88.4% of the participants were females, 37.3% were aged 40–49 years, 72.7% were of Akan ethnicity, 81.4% were married, 45.4% had basic education, 96.3% did not receive pay for caregiving and 72.1% were enrolled in a national health insurance scheme. Further, regarding the health status of the participants, 20.1% indicated that they have been diagnosed with NCDs and 53.1% said they frequently get ill (see TableÌý1).

Table 1 Socio-demographic characteristics of the participants

Main regression model

The factors influencing food security status among informal caregivers of older adults in Ghanaian slums are detailed in TableÌý2. In Model 1, the findings indicated that participants aged 29 years or younger (Beta Coefficient [β] = 26.338, p <.001), those aged 30–39 years (β = 26.926, p <.001), and individuals in the 40–49 age group (β = 26.330, p <.001) exhibited a significantly higher food security status compared to those aged 60 or above. Additionally, participants identifying as Akan (β = -1.105, p <.001) and Christians (β = -0.946, p <.001) had a significantly lower food security status than their counterparts.

Expanding on Model 1, Model 2 incorporated socio-economic variables, revealing that male participants (β = 0.322, p <.05), those aged 29 years or younger (β = 26.870, p <.001), those aged 30–39 years (β = 27.321, p <.001), and those in the 40–49 age group (β = 26.524, p <.001) experienced a significantly elevated food security status compared to individuals aged 60 or above. Furthermore, those without formal education (β = 0.985, p <.05) significantly demonstrated increased food security status compared to those with tertiary education. Conversely, participants identifying as Akan (β = -0.990, p <.05), Christians (β = -0.841, p <.001), those without compensation for informal caregiving (β = -0.677, p <.01), and those not enrolled in the national health insurance scheme (β= -0.464, p <.01) experienced a significantly reduced food security status compared to their counterparts.

In the final Model (Model 3), incorporating health-related variables into Model 2, participants aged 29 years or younger (β = 26.927, p <.001), those aged 30–39 years (β = 27.453, p <.001), and individuals in the 40–49 age group (β = 26.710, p <.001) exhibited an increased food security status compared to those aged 60 or above. Additionally, those without formal education (β = 0.661, p <.05) demonstrated a significantly higher food security status than those with tertiary education. Notably, participants identifying as Akan (β = -0.421, p <.05), Christians (β = -0.828, p <.001), married individuals (β = -0.500, p <.05), those who reported never being ill (β = -2.617, p <.001), those without NCDs (β = -0.638, p <.001), and those not enrolled in the national health insurance scheme (β = -0.422, p <.01) significantly experienced a decreased food security status compared to their counterparts (refer to TableÌý2).

Table 2 Predictors of food security status among informal caregivers of older adults residing in slum areas

Discussion

To the best of our knowledge, this study represents one of the first investigation into the factors influencing food security status among informal caregivers of older adults dwelling in slum communities in Ghana. The findings of this study underscore that (1) age and educational level of caregivers are linked to heightened food security status among informal carers of older adults in slum communities, and (2) factors such as ethnicity, religion, presence of NCDs, frequency of illness, and enrolment status in the national health insurance scheme are correlated with diminished food security status within the context of caregiving for older adults in slum communities. These findings are discussed in relation to previous studies on caregiving of older adults and food security.

The analysis showed that the age of informal caregivers of older adults in slum communities who fell within specific age brackets up to forty-nine years had a positive and significant association with improved food security status compared to those aged 60 or above. This may suggest a level of resilience or adaptability among younger caregivers when addressing food security challenges. Those within specific age brackets up to forty-nine years form the majority of the active labour force where they engage in agricultural activities and trading [41]. These economic activities enhance access to food resources and income to mitigate food insecurity. This finding is consistent with a study conducted by Béné et al. [42] and Hanazaki et al. [43] who suggested that younger individuals were more flexible and resourceful in navigating difficulties, including those related to food security. This could be attributed to factors such as energy, innovation, and perhaps a closer connection to local community dynamics [44] Additionally, age can play a role in the accumulation of assets and financial well-being [45] since they may engage in other work apart from their caregiving responsibilities. It is therefore not surprising that these age groups have increased food security. This suggests that certain age groups of informal caregivers exhibit resilience against food insecurity or possess better resources or effective coping mechanisms to ensure food security.

The survey also revealed that participants who had no formal education also had a positive and significant association with improved food security among those caring for older adults in slum communities. This finding is at variance with the conventional wisdom that associates higher education with improved socioeconomic status and, consequently, better food security [46, 47]. Furthermore, increased educational attainment among informal caregivers is generally linked to enhanced employment prospects and higher income, factors that can positively impact food security [48,49,50]. People with no formal education work in the informal sector and often engage in activities such as farming, petty trading, and food-related activities [51]. Those who work in the agriculture or commerce sector (traders) are likely to have access to food which may not be calculated as part of their income. Participants with no formal education in this study may have relied on supplementary activities compared to those with formal education often known to have and depend on primary jobs. Literature on the relationship between education and food security often lacks specific insights into slum environments [52,53,54]. Studies emphasise that community support systems, social capital, and local initiatives align with the observed higher food security status among caregivers without formal education [14]. Caregivers without formal education may have employed informal approaches such as communal sharing, barter systems (through informal markets), or collective farming to access food and address food insecurity. The study’s finding resonates with this perspective, suggesting that informal caregivers without formal education may possess valuable local knowledge contributing to enhanced food security.

The study revealed that informal caregivers who are Akan and Christians experience food insecurity as compared with non-Akan and non-Christians. This suggests that specific ethnic or religious groups may encounter food insecurity due to access to resources, job opportunities, and income [55]. Ghanaians practice land tenure system, and the study setting is Akan communities where they own their lands. Thus, Akans are more likely to engage in agricultural activities or are landowners who can benefit from cropping arrangements. This should make them better off compared to other ethnic groups. However, explanations for these contrary findings are that despite land ownership, Akans residing in slums are affected by urbanisation, land fragmentation and land disputes [56], which could limit their ability to lease land for agricultural purposes or other economic activities. Moreover, lands in urban areas in Ghana are often leased, which could make it difficult for slum dwellers to afford land for agricultural and other economic activities [57]. Studies indicate that those who live in slums have low-income levels which aggravates their capital to lease land, and also slum dwellers are often migrants and urban poor who squat on private and public lands [57, 58].

The significant relationship for Christian caregivers suggests that there may be social and economic factors associated with religious affiliation influencing food security. Possible considerations include charitable practices and church-related responsibilities within the Christian community, which could strain their resources and affect food insecurity. For instance, religious practices such as prioritising tithing or contributions to the church [59] may reduce the disposable income available for food-related expenses. Church-related responsibilities might involve time and financial commitments, which could divert resources away from personal and household needs. These religious practices could intersect with caregivers’ socio-economic status and exacerbate the risk of food insecurity. The finding may reflect variations in socioeconomic status, cultural practices, or geographical locations among Christians in slum communities [5, 22], contributing to differences in food security outcomes. These factors are likely to influence their support for the vulnerable and address their food security issues. These findings align with Mohiddin et al. [60] and Nartey et al. [32], who identified ethnicity and religion as key determinants associated with reduced food security among the urban poor.

Furthermore, the study showed that informal caregivers identified as married exhibited a decrease in food security status compared to single participants in slum communities. This finding may be influenced by the economic dynamics within marital relationships, including shared financial responsibilities, larger household needs, or potential variations in income sources [61]. The relationship between marital status and food security could be influenced by family size. Larger families may face challenges in resource allocation, potentially impacting the overall food security status of married caregivers [28, 48] in slum communities. Gender roles and contributions to household income may play a role. The finding might indicate disparities in economic contributions between married and single individuals, influencing their ability to secure sufficient food resources [62]. Another explanation is that participants who were married experienced food insecurity because they had more responsibilities or mouths to feed.

The general expectation was that informal caregivers with NCDs or frequently ill would often use their financial resources on medical care leaving them with limited income for purchasing food [5]. In this study, however, participants without NCD or never being ill are experiencing food insecurity. These findings are at variance with Kandt et al. [29] and Takala et al. [63] where they identified NCDs, and frequency of illness as some of the key determinants associated with reduced food security among the urban poor. The plausible explanation for the variance is that caregiving responsibilities in the Ghanaian culture are often shared among family members, and those perceived as vulnerable may receive additional financial and material support from wealthier siblings or extended family relations. Participants who reported never being ill or not suffering from NCDs might face hidden vulnerabilities such as unemployment, social isolation, or other economic challenges contributing to decreased food security [64, 65]. The finding may indicate those hidden vulnerabilities may face limitations which potentially affect their ability to secure adequate food resources. Informal caregivers without chronic diseases may face economic strain due to healthcare costs, for the individuals they care for. This financial burden could contribute to the observed decrease in food security. The finding underscores the complex interplay between the health and socioeconomic status of people. While chronic diseases are often associated with increased economic burdens, the findings of this study suggest that other factors, such as access to resources or support networks, also play a significant role in determining food security [66]. It is also important to highlight that food insecurity among caregivers is associated with adverse physical health outcomes [22, 23]. Addressing food insecurity among caregivers has positive implications for improving their well-being to perform their responsibilities to care recipients.

Again, in this study, informal caregivers who had not registered for the national health insurance scheme experienced food insecurity. The study’s findings are in tandem with Marlow et al. [34] study which found that individuals who had not registered in the national health insurance enrolment status were linked to reduced food security. In situations where caregivers lack health insurance coverage, the financial burden of medical expenses can further worsen food insecurity [31]. The enrolment status in national health insurance serves as a measure of access to healthcare services. This improved access could positively influence the economic well-being of caregivers, contributing to higher food security. Caregivers without health insurance may defer the pursuit of medical care owing to financial reasons [67]. The delay has the potential to exacerbate health conditions, thereby leading to increased healthcare expenditure and subsequently, reduced resources for food.

Policy and practice implications

In the realm of policy implications, the insights gathered from this study contributes to the realisation of goal 2 and 3 of the United Nations health-related Sustainable Development Goals (SDGs) by 2030. The study addresses factors influencing food security status, contributing to the understanding of food security issues among informal caregivers of older adults in slum communities, thus aligning with efforts to eliminate hunger by achieving SDG 2. The research sheds light on the correlation between caregiver health-related factors and food security status, providing insights relevant to health and well-being initiatives, especially for older adults in slums thereby achieving SDG 3. Additionally, the study findings may serve as valuable input for policy development aimed at improving food security status among informal caregivers of older adults, with a focus on informal caregivers residing in slums in Ghana. The study suggests that policymakers and healthcare providers can collaboratively work towards creating inclusive policies, improving healthcare access, and promoting economic opportunities to enhance food security for all informal caregivers. Policymakers can use this information to formulate policies aimed at improving food security among informal caregivers. For instance, recognising the vulnerability of certain age groups or educational backgrounds may lead to policies that provide additional support or resources to those groups.

Regarding practical implications, the study outcomes present opportunities for public health interventions focusing on improving the overall well-being of informal caregivers to address not only food security but also related health issues. Such insights are essential for improving food security status among informal caregivers of older adults in this specific demographic, socio-economic and health characteristics. The study advocates for understanding the relationship between socio-demographic factors such as age, level of education and food security to inform the development of targeted policies and interventions to address existing gaps in the limited information available for enhancing food security among informal caregivers of older adults. This achieves the aim of intensifying measures that can augment the caregivers’ ability to provide optimal care to their recipients. For instance, programs addressing these associations require a comprehensive approach that considers the intersectionality of socioeconomic, health, and cultural factors may be more effective.

Limitations of the study

The limitations of this study include the inability to establish causation due to the cross-sectional design, making it challenging to infer the direction of relationships between identified factors and food security status among informal caregivers of older adults in slum communities. Additionally, the reliance on self-reported data may introduce response bias, and the study’s contextual and geographical scopes may not encompass the full complexity of factors influencing food security. Furthermore, regional, and contextual variations could affect the generalizability of findings beyond the specific study area.

Given the study’s quantitative nature, it acknowledges limitations in accounting for qualitative factors influencing food security status among informal caregivers of older adults in the study region. Therefore, the study recommends that future research employs longitudinal designs, and a more extensive range of variables may provide a more comprehensive understanding of the dynamics involved in addressing food insecurity among informal caregivers of older adults. Understanding these factors can provide more targeted insights for policymakers and program implementers.

Conclusion

In conclusion, this study reveal key factors influencing food security status among informal caregivers of older adults in slum communities in Ghana. The findings underscore a positive association between the age and educational level of caregivers and an enhanced food security status. Conversely, caregiver factors such as ethnicity, religion, marital status, the presence of NCDs, frequency of illness, and enrolment status in the national health insurance scheme are linked to diminished food security status among informal caregivers of older adults in slum communities. These insights provide an understanding of the complex interplay of caregiver characteristics and their impact on food security, offering valuable considerations for targeted interventions and policy development aimed at improving the well-being of both caregivers and the older adults they support in slum areas. Furthermore, the study underscores the need for extensive research on improving food security among informal caregivers of older adults, not only in the Ashanti Region but also on a national, regional, and local scale within developing countries.

Data availability

The datasets utilized or analyzed in this present study can be obtained from the corresponding author upon reasonable request.

Abbreviations

NCDs:

Non–communicable diseases

NHIS:

National Health Insurance Scheme

SDG:

Sustainable Development Goal

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Acknowledgements

We extend our deepest gratitude to all those who contributed to the successful completion of this research work. We also extend our acknowledgement to the authors and publishers whose works informed our research. We would like to express our heartfelt thanks to the participants of this research, whose willingness to share their experiences and insights has been crucial to the depth and richness of the findings. Additionally, we express gratitude to Miss. Pamela Konadu, Mr. Obeng Diawuo Van-ess, Mr. Opoku Mensah, Miss. Abigail Obiri Yeboah and Mr. Anokye Pius Opoku for their valuable assistance in the data collection process. Your contributions have significantly enhanced the understanding of food security dynamics among informal caregivers in slum communities.

Funding

This research work was conducted without any external funding.

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Authors

Contributions

Conceptualization, DA and WA-D; methodology, DA, WA-D and BOB; software, WA-D and AAM; formal analysis, WA-D.; data curation, DA, AAM and BOB; writing—original draft preparation, DA; writing—review and editing, DA, WA-D, AAM WA-D. and BOB.; supervision, DA. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Dina Adei.

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This study strictly adhered to rigorous ethical standards, obtaining clearance from the Committee on Human Research, Publication, and Ethics at Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (Ref. CHRPE/AP/528/23). To uphold transparency and participant respect, we communicated the study’s objectives and secured both oral and written informed consent before initiating data collection. Participants were explicitly briefed on the voluntary nature of their involvement, assuring them the option to refrain from answering sensitive or personal questions and withdraw from the study at any point without facing penalties.

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Not applicable.

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Adei, D., Agyemang-Duah, W., Boateng, B.O. et al. Predictors of food security status among informal caregivers of older adults residing in slums in Ghana. Ó£»¨ÊÓƵ 25, 447 (2025). https://doi.org/10.1186/s12889-025-21666-y

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  • DOI: https://doi.org/10.1186/s12889-025-21666-y

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