Translation and validation of the Chinese version of the orthorexia nervosa assessment questionnaires among college students

Psychometric properties of the ORTO-R in an adult population: the Turkish version, reliability, and validity study

PURPOSE

This study aimed to examine the psychometric properties of a Turkish version of the ORTO-R scale by testing its factorial structure, reliability, and validity in a large adult population.

METHODS

This cross-sectional study was conducted between November 2022 and February 2023. Through an online questionnaire, 1077 participants were recruited. Confirmatory factor analysis (CFA) was used to examine the construct validity of the questionnaires. The internal consistency of the ORTO-R scale was evaluated with Cronbach's alpha, Omega and test-retest coefficients. For the convergent and divergent validity of the scale, Pearson correlation analysis was performed on the scores of the Eating Attitude Test-26, the Generalized Anxiety Disorder-7 and the Life Satisfaction Scale.

RESULTS

The two-factor model fit the data well. Analyses confirmed that the two-factor model of the ORTO-R had acceptable or good fit indices (χ 2/df = 2.126; GFI = 0.997; CFI = 0.992; AGFI = 0.992; TLI = 0.985; RMSEA = 0.032; SRMR = 0.029). According to the reliability coefficients, the orthorexia nervosa and method subscales were found to be reliable. The correlations supported the convergent and divergent validity of the scale.

CONCLUSIONS

The results demonstrate that the Turkish version of the ORTO-R is a valid and reliable instrument for assessing orthorexic behaviors in a theoretically meaningful way.

LEVEL OF EVIDENCE

Level V, descriptive study.

Reliability generalization meta-analysis of orthorexia nervosa using the ORTO-11/12/15/R scale in all populations and language versions

BACKGROUND

The ORTO scale was developed in 2004 as a self-report questionnaire to assess symptoms of orthorexia nervosa (ON). ON is an unhealthy preoccupation with eating healthy food. The scale aims to measure obsessive attitudes and behaviors related to the selection, purchase, preparation, and consumption of pure, healthy food. Since its development, the ORTO-15 has been adapted into several shorter versions. The objective was to conduct a reliability generalization meta-analysis of the ORTO scale and its variant versions in all populations and languages.

METHODS

A systematic literature search was conducted to identify studies reporting the internal consistency of ORTO. Random-effect models were used to evaluate summary statistics of reliability coefficients, weighting the coefficients by the inverse variance using the restricted maximum likelihood method. The heterogeneity among the reliability coefficients was evaluated and assessed using numerous statistical metrics. The tau (τ), tau2 (τ2), I2, H2, R2, df, and the Q-statistic are among those obtained. Meta-regression analyses were used to examine moderators such as age and sex.

RESULTS

Twenty-one studies (k = 21) involving 11,167 participants (n = 11,167) were analyzed. The overall effect estimate on internal consistency was 0.59 (95% CI 0.49-0.68), with a minimum reliability coefficient of 0.23 and a maximum reliability coefficient of 0.83. The heterogeneity statistics were found to have an I2 of 99.31%, which suggested high heterogeneity owing to a decrease in the confidence interval (95% CI) and an increase in variability. Sensitivity analysis revealed that a few studies strongly influenced the overall estimate. Egger's test suggested possible publication bias. Neither age nor sex significantly moderated reliability via meta-regression.

CONCLUSIONS

The ORTO scale has a relatively low pooled reliability coefficient. Alternative ON assessment tools with enhanced psychometric properties are needed. Clinicians should not base diagnoses or treatment decisions on ORTO alone. Comprehensive psychiatric assessment is essential for accurate ON evaluation.