A B S T R A C T
Household water insecurity is a complex socio-ecological phenomenon with wide-ranging health, economic, social, and psychological impacts. Given the vital role of water in human life and sustainable development, adopt proper management and household consumption patterns play a pivotal role in mitigating wastage and conserving water resources. This study aims to identify the determinants and consequences of rural household water insecurity, utilizing a qualitative approach and a meta-synthesis methodology. The research dataset comprised 230 scientific documents published between 2010 and 2025, retrieved from four international databases - Wiley, Scopus, Google Scholar, and ScienceDirect - and three domestic databases - Magiran, SID and Noormags - using keywords relevant to water insecurity, water consumption management, and rural households. The main stages of the meta-synthesis were conducted in accordance with the seven-step approach proposed by Sandelowski and Barroso. A total of 5 dimensions, 11 components, and 74 concepts were identified based on the document analysis. The primary dimensions encompassed human, social, economic, climatic, and political factors. The extracted components included individual, professional, justice, health, cultural, psychological, financial, welfare, physical, environmental, and governmental aspects. Furthermore, the consequences of water insecurity on rural communities can be categorized into three social, economic, and climatic dimensions. Within the dimension of social consequences, two main themes of health and psychology identified; similarly, regarding economic and climatic consequences, the main themes were identified as financial and environmental, respectively. These results underscore the multifaceted nature of household water insecurity and the necessity of designing integrated policies and interventions to manage this crisis in rural communities.
Extended Abstract
Introduction
Water, as one of the most vital resources for life and human development, plays a fundamental role in meeting people's basic needs and safeguarding public health. However, access to safe and sufficient water faces serious challenges in many low- and middle-income countries. Water insecurity has given rise to numerous issues, including social migration, threats to health and livelihoods, shortages of safe and sanitary water, social conflicts, increased poverty, threats to food security, constraints on economic development, and more. Limited water resources coupled with their inefficient and uneconomical use are among the main factors restricting development, especially agricultural development and increased food production. The ever-growing demand for water under particular climatic conditions, especially in the agricultural sector, has pushed the country's villages to the brink of a severe water crisis and, consequently, political, economic, social, and environmental tensions. Over time, these tensions are likely to lead environmental degradation and the underdevelopment of villages.
Water insecurity is defined as a condition where the affordability, reliability, adequacy, and safety of water are significantly diminished or unattainable, thereby threatening or jeopardizing well-being. In other words, water insecurity refers to a situation where access to sufficient and clean water for family members is not consistently available, which hinders a healthy and active life. Water serves as the most critical axis of environmental development, capable of influencing the structural-spatial distribution of development and posing fundamental challenges to long-term planning processes. The study of water security issues has emerged as a political, social, and economic necessity, as the scope of interactions and relationships extends beyond local and regional levels, becoming a matter of national and international concern. Water insecurity is a multidimensional phenomenon influenced by various social, economic, and environmental factors.
Therefore, for a better understanding of this phenomenon, it is essential to comprehensively and systematically examine its different dimensions, including the severity of insecurity, adaptability, and resilience. Among the social consequences of water insecurity are social migration, conflicts and social tensions, increased poverty, reduced well-being and prosperity, diminished living standards, and heightened hunger. Economic consequences encompass the limitation of economic development, threats to livelihoods, rising unemployment rates and decreased agricultural and crop production. Environmental repercussions involve threats to health, food security, reduced access to clean and safe water, the spread of diseases, increased natural events such as floods, land subsidence, droughts, and damage to infrastructure and facilities, as well as environmental pollution, threats to groundwater resources and loss of biodiversity.
Today, water insecurity is considered one of the greatest threats to human life, to the extent that researchers at the World Economic Forum in 2009 argued that, given the close relationship between water security and the production of food, energy, climate, economic growth, and human security, the greatest threat challenging today's world is water insecurity. Water security and management in the agricultural sector are the most critical strategy for the country's sustainable development, and given the country's development process and the transformation of the national economy, the agricultural sector has become an important pillar of the country's security and economic vitality. More precisely, according to conducted studies, factors such as water scarcity and the water crisis, climatic variables, population growth, fragmented water resource management, as well as economic development and changes in consumption patterns, influence the emergence of water insecurity in human settlements. Water insecurity is a multidimensional phenomenon that is influenced by various social, economic, and environmental factors. Therefore, to better understand this phenomenon, it is necessary to comprehensively and systematically examine its various dimensions, including the severity of insecurity, adaptation, and resilience. Studying the phenomenon of water insecurity in rural areas is of great importance and justifies the need for research in this field. Examining the level of household water insecurity helps policymakers and planners gain an accurate understanding of the current situation and the existing challenges in providing household water.

Methodology
This study aimed to identify the influencing factors and consequences of rural household water insecurity, employing a qualitative approach and the meta-synthesis method. The main stages of the meta-synthesis were carried out in accordance with the seven-stage method of Sandelowski and Barroso (2007) as outlined below.
Step One - Formulating the Research Question: The main research question is “What are the factors affecting and the consequences of rural household water insecurity?”
Step Two - Systematic Literature Review: In order to achieve theoretical saturation in identifying the factors affecting and the consequences of rural household water insecurity, all studies published between 2010 to 2025 were reviewed from four international databases (Wiley, Scopus, Google Scholar, and ScienceDirect) and three domestic databases (Magiran, SID, and Noormags) using the keywords ‘water insecurity’, ‘water consumption management’, and ‘rural household’.
Step Three - Article Search and Selection: After rereading the full text of the articles, some studies were excluded based on the title (5), abstract (14), and unrelated content (29), and ultimately 42 studies remained for extracting the influencing factors and consequences of rural household water insecurity.
Step Four - Extracting Article Information: The content of the 42 selected articles was examined, and the concepts identified as influencing factors and consequences of rural household water insecurity were reviewed.
Step Five - Analysis and Synthesis of Qualitative Findings: Based on the analysis conducted, themes were derived from the categorization of concepts, and categories were derived from the categorization of themes. From the 42 selected studies, 2 categories, 6 themes, and 56 concepts were identified as the factors influencing and the consequences of rural household water insecurity.
Step Six - Quality Control: In order to provide a descriptive narrative, scientific documents related to the research title were comprehensively identified and collected, and by examining the title, abstract, and content, documents related to the topic were identified and coded with high accuracy. To ensure interpretive validity, the opinions and suggestions of experts were consulted throughout the research stages. To assess the quality of the meta-synthesis section, the “Critical Appraisal Skills Programme (CASP)” tool was used, and the score obtained was above 40, indicating very good and acceptable quality. This tool enables the researcher assign scores to each article by considering ten criteria - including objective, rationale, design, sampling, data collection, reflexivity, ethical considerations, rigor in analysis, clarity of findings, and research value - thereby facilitating the selection valid and valuable articles. To assess the reliability of the extracted codes, three of the meta-synthesized sources were randomly provided to a Ph.D. graduate in the field of Agricultural Extension and Education who had work experience in this area for coding.
Step Seven - Presenting the Findings: In this stage of the meta-synthesis method, the findings obtained from the previous stages are presented, and the content of the research is described systematically and quantitatively.

Results and Discussion
Household water insecurity is considered one of the most fundamental challenges in many parts of the world, especially in developing countries. Exacerbated by climate change and seasonal fluctuations, this problem is intensifying and has serious negative effects on household health and well-being. Water is central to human well-being and has wide-ranging consequences for physical health, interpersonal relationships, social cohesion, and food security. Climate change, increased water consumption, and the deterioration of infrastructure exacerbate water-related problems and consequently affect the reliable and equitable distribution of water globally. Water security has become an urgent development priority. Therefore, identifying and simultaneously addressing all components of the phenomenon of water insecurity, including its influencing factors and consequences in rural communities, can provide a critical foundation for formulating effective strategies to enhance water security in rural areas. By identifying the factors influencing water insecurity and the consequences of this phenomenon for rural communities, policymakers can design programs that address these problems and make more informed decisions regarding resource allocation and long-term planning for sustainable development. Improving the state of water security requires a comprehensive and integrated approach that takes into account all social, economic, and environmental dimensions. Adopting preventive rather than reactive measures, investing in sustainable infrastructure, and strengthening local and inter-organizational cooperation are among the measures that can help improve water conditions and livelihoods in rural areas.
Based on the research conducted in this study, it was observed that limited domestic studies, limited studies have addressed household water insecurity. In general, the studies conducted domestically and internationally regarding the factors affecting household water insecurity in rural areas classify these factors into three categories: individual and demographic factors, geography and climate, and socioeconomic factors. However, employing a meta-synthesis approach in accordance with Sandelowski and Barroso's seven-stage method, the present study adopted a more comprehensive and inclusive framework, identifying a broader set of factors affecting water security and household water insecurity. These factors were categorized into five dimensions: human, social, economic, climatic, and political. In the human dimension, there were two main themes: individual and professional; in the social dimension, three main themes: justice, health, and cultural; in the economic dimension, three main themes: financial, welfare, and physical; in the climatic dimension, one main theme: environment; and in the political dimension, one main theme: governmental, which encompassed the subthemes—that is, the codes extracted from the research sources.
Extensive studies on the consequences of water insecurity for rural communities were also identified in this research, the most significant of which can be categorized into three dimensions: social, economic, and climatic consequences. In the social dimension, the most important consequences were grouped under two main thematic categories: health (including illness, hygiene, and impacts on children) and psychological (comprising vulnerability, psychological distress, conflicts, school dropout, and migration). Regarding economic consequences, the most important outcomes included reduced income, food insecurity, diminished welfare, poverty, livelihood disruption, reduced productivity, decreased agricultural production, and unemployment. In the climatic dimension, the key consequences identified were threats to sustainability, sustainable development, pollution, and biodiversity loss.

Conclusion
This study was conducted with the overall aim of identifying the factors affecting and the consequences of household water insecurity in rural areas, in accordance with Sandelowski and Barroso's seven-stage method. Based on document analysis, a total of 5 dimensions, 11 components, and 74 concepts were identified. The main dimensions included human, social, economic, climatic, and political factors. The extracted components were: individual, professional, justice, health, cultural, psychological, financial, welfare, physical, environmental, and governmental. The consequences of water insecurity for rural communities were also categorized into three dimensions: social, economic, and climatic consequences. Within the social dimension, two main themes - health and psychological - were identified. In the economic and climatic dimensions, two main themes - financial and environmental - were identified, respectively. These results indicate the multidimensional nature of household water insecurity in rural communities.
The research findings indicated that household water insecurity in rural areas is a multidimensional phenomenon rooted in human, social, economic, climatic, and political factors; consequently, response interventions should also have an integrated and cross-sectoral nature. At the policy-making level, the development of a national program for rural household water security - led by the Ministry of Energy and implemented in collaboration with the Ministry of Health and Medical Education and the Ministry of Agriculture Jihad - can provide a framework for identifying vulnerable households and enabling the targeted allocation of support resources. At the implementation level, reducing the distance to water sources, improving drinking water quality, expanding storage systems, and providing education on water consumption management and water hygiene are among the measures that can reduce the health and psychological consequences of water insecurity. Furthermore, designing financial support mechanisms for low-income households and paying attention to equity in the distribution and implementation of water supply projects play an important role in strengthening economic resilience. Finally, improving water literacy and strengthening social participation, especially the role of women in water resource management, can lead to the institutionalization of sustainable consumption patterns.

Funding
There is no funding support.

Authors’ Contribution
Leila Baniameryan: gathering data, reviewing previous studies, data analysis.
Amirhossein Alibaygi: Guide to the work, editing the text of the article.

Conflict of Interest
Authors declared no conflict of interest.

Acknowledgments
We are grateful to all the scientific consultants of this paper.