Participants
The study included 924 adults between the ages of 18 and 64. Before the study, a power analysis was performed using the G*power software to determine the number of individuals to be included in the sample. Based on alpha (α) = 0.05, power (1-β) = 0.80, and the considered effect size, the minimum required sample size was calculated as 560 participants, and it was decided that at least 616 individuals should be recruited with the possibility of 10% data loss. Simple random sampling was used. A questionnaire was used as the data collection tool, which was disseminated via e-mail or WhatsApp to the individuals who agreed to participate in the study. The participants were able to fill out the online questionnaire after they agreed to participate in the study.
The demographic characteristics of the participants, their name, age, height, and body weight were recorded based on self-report. Several scales with established validity and reliability in Turkish were used to determine the criterion validity of the scale, namely, the Eating Attitudes Test - Short Form (EAT-26) [27, 28], Satisfaction with Life Scale (SWLS) [29, 30], and the Body Appreciation Scale (BAS) [31, 32]. All these scales include inquiries supporting the research hypothesis.
For the validity and reliability study of the Turkish EDE-Q-13, permission was obtained from Lev-Ari [25] via e-mail. The questionnaire was then translated according to the guidelines created by Beaton et al. [33]. The original English version of the questionnaire was translated into Turkish by two independent translators, who speak both Turkish and English. One of the translators has a medical/clinical background, and the other has no such background. A single Turkish questionnaire was created by evaluating the two translations. This Turkish version was translated back into English by two native English speakers with a good command of Turkish, and their back-translations were compared to the original translation version. The Turkish form of the scale was finalized by a team of translators and researchers. For the retest, thirty people were selected randomly, and they were asked to fill out the questionnaire again after 15 days.
Measurements
EDE-Q-13
EDE-Q was developed by Fairburn and Beglin [5] to evaluate eating disorders and consists of 28 items. It evaluates eating behaviors during 28 days in 4 subscales: Restraint, Shape Concern, Weight Concern, and Eating Concern. The validity and reliability study of the Turkish version of the scale in adolescents was performed by Yucel et al. [13]. Each item in EDE-Q is scored on a 7-point Likert-type scale (0 = never, 1 = 1–5 days, 2 = 6–12 days, 3 = 13–15 days, 4 = 16–22 days, 5 = 23–27 days, 6 = every day). The scores of the scale are evaluated based on the some of the scores of the items in the entire scale or each subscale of the scale, and higher scores indicate higher levels of eating disorder psychopathology [5].
EDE-Q-13 consists of 13 items and 5 subscales, namely Eating Restraint (ER), Shape and Weight Over-Evaluation (SWO), Body Dissatisfaction (BD), Bingeing, and Purging [25]. Its validity study was conducted by Lev-Ari et al. [25], and the scale showed a strong positive correlation with the original EDE-Q. The Cronbach's alpha values for the subscales of EDE-Q-13 were reported as 0.99 for SWO, 0.89 for BD, 0.92 for ER, 0.89 for Bingeing, and 0.63 for Purging.
EAT-26
The Eating Attitudes Test - Short Form (EAT-26) was developed by Garner et al. [27]. Ergüney-Okumuş et al. [28] conducted the validity and reliability study of the Turkish version of EAT-26 and reported a Cronbach's alpha value of 0.84. The evaluation of EAT-26 scores is made based on the total score according to a 6-point Likert-type scale, and item 26 is scored in reverse. A higher total EAT-26 score indicates a higher risk of eating disorders. In this study, the Cronbach's alpha coefficient of EAT-26 was measured as 0.91.
Body Appreciation Scale (Bas)
The Body Appreciation Scale (BAS) was developed by Avalos et al. [31] to measure the extent to which an individual is satisfied with their body, accepts their body as-is, and takes care of it. Scoring is done based on a 5-point Likert-type scale (1 = Never, 5 = Always). Higher total scores on this 13-item scale indicate greater body appreciation.
The validity and reliability study of the scale in Turkish was performed by Bakalım et al. [32] The Turkish version of the scale consists of 9 items and two subscales. The results of a competing model analysis showed that a two-factor model (Factor 1 = General Body Appreciation; Factor 2 = Body Image Investment) with four items deleted was the best of the proposed models. The Cronbach's alpha coefficient of the scale was reported as 0.94, and the test-retest reliability coefficient was 0.90 in the Turkish version. In this study, the Cronbach's alpha coefficient was found 0.94.
Satisfaction With Life Scale (Swls)
In 1985, Diener et al. [29] developed a valid and reliable measurement instrument to examine satisfaction with life. The Satisfaction with Life Scale is a one-dimensional and 5-item measurement instrument. Increasing scale scores indicate increasing satisfaction with life. Its validity and reliability study in Turkish was performed by Dağlı et al. [30]. Each item is scored with a 5-point Likert-type scale:1 = I strongly disagree, 2 = I slightly agree, 3 = I moderately agree, 4 = I mostly agree, and 5 = I completely agree. The Cronbach’s alpha internal consistency coefficient of the Turkish version was reported as 0.88, and the test-retest reliability coefficient was 0.97. In this study, the Cronbach's alpha coefficient of the scale was found 0.88.
Body Mass Index (Bmi)
The height and body weight values of the participants were recorded based on self-report. Body Mass Index (BMI) values were calculated with the following equation: 'BMI = Body weight (kg)/ (height (m))2. According to the World Health Organization (WHO) [34], BMI is classified as: <18.5 kg/m2 (underweight), 18.5–24.9 kg/m2 (normal weight), 25.0-29.9 kg/m2 (overweight), and ≥ 30 kg/m2 (obese).
Ethics declarations: Ethical approval was obtained from the Social and Human Sciences Ethics Committee of Tokat Gaziosmanpaşa University (Decision date: 07.06.2021/ Decision number: 15/ 01–2).
Construct Validity
Explanatory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were performed to assess the reliability and construct validity of the adapted scale. The CFA was performed using the AMOS-24 software. The following parameters were examined within the scope of CFA: The Kaiser–Meyer–Olkin (KMO) value and multiple fit indices including RMSEA (Root Mean Square Error of Approximation), GFI (Goodness-of-Fit Index), AGFI (Adjusted Goodness-of-Fit Index), CFI (Comparative Fit Index), NFI (Normed Fit Index), TLI (Tucker–Lewis Index). In CFA, χ2/df ≤ 3.0, RMSEA ≤ 0.05, 0.90 ≤ GFI, 0.95 ≤ AGFI, 0.95 ≤ CFI, 0.95 ≤ NFI and 0.95 ≤ TLI, indicate good fit, and 3 ≤ χ2/df ≤ 5, 0.05 ≤ RMSEA ≤ 0.08, 0.80 ≤ GFI ≤ 0.90, 0.85 ≤ AGFI ≤ 0.95, 0.85 ≤ CFI ≤ 0.95, 0.80 ≤ NFI ≤ 0.95, and 0.80 ≤ TLI ≤ 0.95 indicate acceptable fit for Model Confirmatory Factor Analysis Fit Indices [35].
Statistical Analysis
The data obtained in this study were analyzed using the SPSS (Statistical Package for the Social Sciences) for Windows 25.0 program. Descriptive statistical methods were used for data analysis. To determine the normality of the distribution of the data, Skewness and Kurtosis Tests and Z-values were used. The Cronbach’s alpha value was calculated using the SPSS program to determine internal consistency indicating reliability. A value of Cronbach's alpha should be at least 0.60 to be acceptable, and the good value is considered to be 0.70 or above [36]. Additionally, EFA and CFA were performed to assess the reliability and construct validity of the adapted scale. The CFA was performed using the AMOS program. A p-value smaller than 0.05 was considered statistically significant.