Evidências de validade dos instrumentos comumente usados para avaliação dos transtornos alimentares em países de baixa e média renda

Abstract

Eating Disorders (EDs) are characterized by disturbances in eating behavior that can cause complications in physical and emotional health, quality of life and economic disadvantage for both the individual and society. In recent years, EDs have become a major public health problem due to the increase in prevalence. In low- and middle-income countries, data on the prevalence of EDs are scarce. A possible justification for this may be the lower availability of validated tools for the assessment of EDs.The Eating Attitudes Test (EAT), Eating Disorder Inventory (EDI), Eating Disorder Examination (EDE) and Eating Disorder Examination Questionnaire (EDE-Q), and for children the Children’s Eating Attitudes Test (ChEAT), Children’s Eating Disorder Examination (ChEDE), Children’s Eating Disorder Examination Questionnaire (ChEDE-Q), are the most recommended tools in the assessment of eating disorders. The objective of this study was to systematically review the validity evidence of the instruments commonly used to assess EDs in low- and middle-income countries. Methods: MEDLINE (VIA PUBMED), EMBASE, LILACS, SCOPUS, WEB OF SCIENCE, PSYCOINFO, and CABI databases, in addition to the gray literature, were searched. The search was first carried out on MEDLINE, and was adapted to the other databases, without any date or language restriction. Articles that describe the process of validating the questionnaires frequently used for tracking EDs were selected. Quality criteria were assessed using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN). Two researchers independently reviewed the studies and assessed the quality of the included studies. Results: A total of 28 studies were identified. The identified studies were carried out in 13 countries (10 middle-income and 3 low-income). Only 5 instruments (EDE, EDE-Q, EDI, EAT and ChEAT) were evaluated out of the 7 that were eligible for this review. According to the COSMIN quality rating, 17 studies performed the translation process (41% was adequate); 2 studies assessed content validity (100% was very good); 15 studies evaluated hypothesis testing (53% was adequate); 20 studies assessed structural validity (60% was adequate); 8 studies assessed criterion validity (87% was very good); 27 studies evaluated internal consistency (100% was very good), 12 studies evaluated test-retest (50% was very good), 3 studies evaluated measurement invariance (66% was very good). Twelve studies assessed minimal psychometric assessment. Conclusion: This review evaluated the psychometric properties of instruments commonly used to assess symptoms of eating disorders and recommended by the main guidelines. Although these instruments are being validated in different countries, with the results found we could see that there is still a lack of evidence from psychometric studies in low- and middle-income countries. Of the 135 countries in this income bracket, only 13 performed some type of validation on the included instruments. According to the COSMIN quality tool, most of the psychometric properties evaluated were very good.