Objective To adapt a scale to measure perceptions on food insecurity and hunger among households in urban and rural communities in Peru.Design Qualitative and quantitative methodology including consultation with regional experts, key informant interviews and focus groups. A field survey trial was conducted in urban and rural communities using an adapted version of the US Department of Agriculture (USDA) Food Insecurity and Hunger Module (FIHM).Setting Five communities in three regions in Peru - Lima (coast), Ayacucho (Andean highlands) and San Martn (Amazon basin).Subjects The qualitative component included forty intentionally selected people (fourteen key informants and twenty-six focus group participants). For the quantitative component 300 households that complied with selection criteria (poor or non-poor with at least one child below 12 years of age) were surveyed.Results Qualitative research showed that concern about food availability and access was common among the three regions but its main cause varied across them. Participation in food aid programmes was a strategy to face constraints in food access. Mothers perceptions on the importance of balanced meals varied across households from different regions. Quantitative results showed robust findings for the reliability of the adapted FIHMs fifteen-item scale (r > 0863). In addition, descriptive results confirmed parallelism of item responses in the scale for variables such as farm ownership, family size and use of Communal Kitchens.Conclusions This mixed-method study allowed us to adapt the USDA module to assess food insecurity in Peru. © 2009 The Authors.