Cross-cultural adaptation, validation and reliability of the Body Area Scale for Brazilian adolescents Adaptação transcultural, validação e confi abilidade da Body Area Scale para adolescentes brasileiros


The aim of this study was to translate, validate and verify the reliability of the Body Area Scale (BAS). Participants were 386 teenagers, enrolled in a private school. Translation into Portuguese was conducted. The instrument was evaluated for internal consistency and construct validation analysis. Reproducibility was evaluated using the Wilcoxon test and the coefficient of interclass correlation. The BAS demonstrated good values for internal consistency (0.90 and 0.88) and was able to discriminate boys and girls according to nutritional state (p = 0.020 and p = 0.026, respectively). BAS scores correlated with adolescents’ BMI (r = 0.14, p = 0.055; r = 0.23, p = 0.001) and WC (r =0.13, p = 0.083; r = 0.22, 0.002). Reliability was confirmed by the coefficient of inter-class correlation (0.35, p < 0.001; 0.60, p < 0.001) for boys and girls, respectively. The instrument performed well in terms of understanding and time of completion. BAS was successfully translated into Portuguese and presented good validity when applied to adolescents. Validation Studies; Body Image; Adolescent Introduction The body image is a multifaceted construct, defined as perceptions and attitudes regarding one’s own body appearance, involving thoughts, beliefs, feelings, and behaviors 1. Its assessment is based on verifying the degree of dissatisfaction and satisfaction a subject reports in regard to his or her body, which includes the evaluation of beliefs 2,3. Adolescence is a critical period in the development of one’s body image, when several intertwining factors, including pubertal development, awakening for sexual activity and enhancement of one’s societal role, may in conjunction exert influence over this process 4. So far, few epidemiological studies from developed countries have investigated the multidimensional aspects of body image among adolescents. Among US girls for instance, 40 to 70% reported dissatisfaction with at least two of their body parts. Evidence from other surveys show that 50 to 80% of girls wish they were slimmer, while 20 to 60% report being on diets 5. In contrast, boys would rather be taller and stronger, and express dissatisfaction with their weights and shapes of their entire bodies, as well as of body parts 5. Among the scarce Brazilian data on this subject, studies by Conti et al. 6,7 and Pinheiro & Giugliani 8 apparently confirm those findings. In the former two surveys, girls and boys reported ARTIGO ARTICLE Conti MA et al. 2180 Cad. Saúde Pública, Rio de Janeiro, 25(10):2179-2186, out, 2009 being unhappy with several of their body parts, whereas in the latter, 82% of interviewees reported dissatisfaction with their body image – namely, 55% of girls wished they were slimmer and 28% of boys would like to be bigger. Dissatisfaction with their bodies among youth, and the particular wish that boys express to grow stronger have been shown to have an association with the development of eating disorders and depression 9. Therefore, early detection of such dissatisfaction may be useful for the establishment of prevention measures, as well as for the management of eating disorders and depression among adolescents. A critical issue for body image research concerns the selection of accurate and trustworthy instruments 10. According to Thompson 10, there are at least 50 measurement tools available. However, few have been properly evaluated. Investigators must first clarify which specific dimension of body image is of their particular interest so as to opt for a tool that, given its psychometric properties, will enable proper evaluation. Among available instruments, questionnaires and scales have been the most widely used, due to their practical applicability and readiness for correction, and also because they allow for epidemiological surveys with large population samples 11. When targeting adolescents, commonly used tools include the silhouette and the body parts scales, as well as questionnaires 12 that address multiple aspects of body image, including affective, behavioral and cognitive components. One of these instruments is the Body Area Scale (BAS) 13, defined as an assessment technique of attitudinal accuracy, capable of evaluating satisfaction with one’s weight and with different body parts, therefore capturing comprehensive information on one’s body image. In addition, it has been shown to be easily understandable and feasible for application in clinical practice and research. Though originally used to survey young women, this instrument has also been applied to adolescents 6,7,14,15. Validation of the scale by Richards et al. 16 revealed satisfactory scores for both US adolescent girls and boys. Given that there are no validated scales for the assessment of body image among Brazilian adolescents, as well as the lack of validity and reliability studies, in the present survey we have aimed at translating the BAS into Portuguese, and at validating and verifying its reliability when applied to Brazilian adolescents. Methods This is a methodological study 17, carried out in 2006, at a private educational institution located in São Bernardo do Campo, São Paulo State, Brazil, as part of a broader project of validation of epidemiological methods to assess body image among adolescents 15,18. The sample comprised all students who attended Junior and Senior High School at that institution, with ages ranging from 10 to 17 years old. The BAS document underwent cross-cultural adaptation 19,20,21, as follows: (1) translation – at first the original English document was independently translated into Portuguese by two experienced researchers, who were fluent in English; (2) synthesis – based on the two translated documents, both researchers agreed upon a consensus Portuguese version; (3) back-translation – the consensus version was then back-translated into English by a scholar, who is an English native speaker; (4) discussion with experts was then carried out for analysis of semantic, idiomatic, experiential and conceptual equivalences; (5) the final version of the document was completed (Figure 1). The BAS comprises 24 items and the satisfaction degree for each is assessed using a Likert scale: 1 – very satisfied; 2 – fairly satisfied; 3 – neutral; 4 – fairly dissatisfied; and 5 – very dissatisfied. The final score equals the total number of body areas the subject is dissatisfied with (rated 4 and 5). Scores range thus from zero (none) to 24 (all areas), and the higher the score, the more dissatisfied the adolescent. The questionnaire was applied collectively in the classroom, followed by anthropometric assessment, according to the methods proposed by Gordon et al. 22. Soon after completing assessment, a second interview was scheduled for three weeks thereafter 11. The first author (M.A.C.) conducted these procedures. Two measurements of weight, height, waist circumference (WC) and waist-hip ratio (WHR) were carried out, and the mean values used for analysis. Classification of nutritional status was accomplished, according to World Health Organization (WHO) recommendations 23 for this particular age group: (1) underweight < 5th percentile; (2) eutrophic between 5th percentile and 85th percentiles; (3) at risk of overweight ≥ 85th percentile and < 90th percentile; and (4) obese ≥ 90th percentile. In order to verify their degree of understanding, adolescents were asked to answer the following question after filling out the questionnaire: “Did you understand what has been asked for CROSS-CULTURAL ADAPTATION, VALIDATION AND RELIABILITY OF THE BODY AREA SCALE 2181 Cad. Saúde Pública, Rio de Janeiro, 25(10):2179-2186, out, 2009 Figura 1 Model of the Body Area Scale. Body characteristics 1 Very satisfi ed 2 Moderately satisfi ed 3 Neutral 4 Moderately dissatisfi ed 5 Very dissatisfi ed

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@inproceedings{Conti2009CrossculturalAV, title={Cross-cultural adaptation, validation and reliability of the Body Area Scale for Brazilian adolescents Adaptação transcultural, validação e confi abilidade da Body Area Scale para adolescentes brasileiros}, author={Maria aPareCida Conti and Norman Hearst and Alu{\'i}sio Augusto Cotrim Segurado}, year={2009} }