Cross-cultural adaptation of body image assessment instruments for university students: a systematic review

Silva, Ravine Carvalho Pessanha Coelho da; Amaral, Ana Carolina Soares; Quintanilha, Augusta Karla Silva; Almeida, Vitor Alexandre Rabelo de; Rodrigues, Marcus Vinicius Freitas; Oliveira, Aldair J; Morgado, Fabiane Frota da Rocha

doi:10.1186/s41155-021-00177-w

Ravine Carvalho Pessanha Coelho da Silva ^** Correspondence: ravinecarvalho@hotmail.com

Federal Rural University of Rio de Janeiro, Rio de Janeiro, Brazil.

Rio de Janeiro, Brazil.

http://orcid.org/0000-0002-1537-8941

Ana Carolina Soares Amaral

Federal Institute of Education, Science and Technology of Southeast of Minas Gerais, Campus Barbacena, Barbacena, Brazil.

Augusta Karla Silva Quintanilha

Federal Rural University of Rio de Janeiro, Rio de Janeiro, Brazil.

Vitor Alexandre Rabelo de Almeida

Federal Rural University of Rio de Janeiro, Rio de Janeiro, Brazil.

Marcus Vinicius Freitas Rodrigues

Federal Rural University of Rio de Janeiro, Rio de Janeiro, Brazil.

Aldair J Oliveira

Federal Rural University of Rio de Janeiro, Rio de Janeiro, Brazil.

Fabiane Frota da Rocha Morgado

Federal Rural University of Rio de Janeiro, Rio de Janeiro, Brazil.

* Correspondence: ravinecarvalho@hotmail.com

Authors’ contributions

Ravine Carvalho Pessanha Coelho da Silva and Fabiane Frota da Rocha Morgado: General conception of the project; writing of the article; data analysis; and discussion of the article. Ana Carolina Soares Amaral and Vitor Alexandre Rabelo de Almeida: Data analysis. Marcus Vinicius Freitas Rodrigues: English translation and proofreading. All authors contributed to the critical review of the article. The author(s) read and approved the final manuscript.

Competing interests

The authors declare that they have no competing interests.

	Author Year Location	Objective (To assess the cross-cultural adaptation of the…)	Methodological guide	Population	Type of validity	Type of reliability	Reported limitations	Reported strengths	Main results	Quality (Value / °/o)
01	Barra et al. (2019)Barra, J. V., Silva, W. R., Maroco, J., & Campos, J. A. D. B. (2019). Adaptação transcultural e validação do Questionário de Atitudes Socioculturais em Relação à Aparência-4 (SATAQ-4) aplicado a estudantes universitários.[Cross-cultural adaptation of the Sociocultural Attitudes Towards Appearance Scale- 4 (SATAQ-4) applied to university students]. Cadernos de Saúde Pública , 35 (5), 00170218. https://doi.org/10.1590/0102-311X00170218. https://doi.org/10.1590/0102-311X0017021... Brazil	SATAQ-4 to the Portuguese Language and Brazilian students	Beaton, Bombardier, Guillemin, and Ferraz (2007)Beaton, D., Bombardier, C., Guillemin, F., & Ferraz, M. B. (2007). Recommendations for the cross-cultural adaptation of the DASH & Quick DASH outcome measures. Institute for Work & Health, 1 (1), 1–45.	1051 YUS—BS 18-30 years old	CFA FV/CV CTW/ DV / CW	IC	Dificulty in the generalization of results.	V and R of the SATAQ-4	λ = 0.729-0.976; X ²/gl = 8.39; CFI = 0.98; TLI = 0.98; RMSEA = 0.08; r = 0.063-0.590; a = 0.84-0.95.	40 / 95.2
02	Shoji, Meh ling, Hautzinger, and Herbert (2018)Shoji, M., Mehling, W. E., Hautzinger, M., & Herbert, B. M. (2018). Investigating Multidimensional Interoceptive Awareness in a Japanese Population: Validation of the Japanese MAIA-J. Frontiers in psychology, 9 , 1855. https://doi.org/10.3389/fpsyg.2018.01855. https://doi.org/10.3389/fpsyg.2018.01855... Japan	MAIA to the Japanese population	Beaton et al. (2000)Beaton, D. E., Bombardier, C., Guillemin, F., & Ferraz, M. B. (2000). Guidelines for the process of cross-cultural adaptation of self-report measures. Spine, 25 (24), 3186–3191. https://doi.org/10.1097/00007632-200012150-00014. https://doi.org/10.1097/00007632-2000121...	390 YUS—BS mean age of 20.3 years old	EFA CV/ CTW/ DV/ DW / CW	IC	Cultural differences affected Differences in the sample Reduction of 7 items in the scale	Difference in the factorial structure	λ > 0.40; a = 0.67-0.87	33/78.5
03	Chakroun-Baggioni, Corman, Spada, Caselli, and Gierski (2017)Chakroun-Baggioni, N., Corman, M., Spada, M. M., Caselli, G., & Gierski, F. (2017). Desire thinking as a confounder in the relationship between mindfulness and craving: Evidence from a cross-cultural validation of the Desire Thinking Questionnaire. Psychiatry research, 256 , 188–193. https://doi.org/10.1016/j.psychres.2017.06.051. https://doi.org/10.1016/j.psychres.2017.... France	DTQ to a sample of university students	Brislin, 1986Brislin, R. W. (1986). The wording and translation of research instruments. In W. J. Lonner, & J. W. Berry (Eds.), Cross-cultural research and methodology series, Vol. 8. Field methods in cross-cultural research , (pp. 137–164). Sage Publications, Inc..	436 YUS—BS mean age of 19.1 years old	CFA PV	IC / TRT	Measures SR Cross-sectional model (makes it difficult to draw conclusion of causality)	Study related with different measures	λ > 0.50; SB scaled X ² (34)= 150.60, p <0.001, SB scaled X ² /df=4.43; RMSEA =0.09 (90% IC: 0.07-0.10); CFI=0.94. ICC= 0.71; 95% Cl = 0.50-0.83 Omega coefficients= 0.84-0.90	37/ 88.0
04	Bas et al. (2017)Bas, M., Karaca, K. E., Saglam, D., Arıtıcı, G., Cengiz, E., Köksal, S., & Buyukkaragoz, A. H. (2017). Turkish version of the Intuitive Eating Scale-2: Validity and reliability among university students. Appetite, 114 , 391–397. https://doi.org/10.1016/j.appet.2017.04.017. https://doi.org/10.1016/j.appet.2017.04.... Turkey	IES-2 to the Turkish language	Brislin (1986)Brislin, R. W. (1986). The wording and translation of research instruments. In W. J. Lonner, & J. W. Berry (Eds.), Cross-cultural research and methodology series, Vol. 8. Field methods in cross-cultural research , (pp. 137–164). Sage Publications, Inc.. Bracken and Barona (1991)Bracken, B. A., & Barona, A. (1991). State of the art procedures for translating, validating and using psychoeducational tests in cross-cultural assessment. School Psychology International, 12 (1-2), 119–132. https://doi.org/10.1177/0143034391121010. https://doi.org/10.1177/0143034391121010...	377 YUS—BS 19-31 years old	EFA CW/ DV/ CTW	IC/ TRT	SH CS Results cannot be compared to other groups	Good V and R R same as the original study EQ between scales	λ =0.69-0.96, KMO =0.87, X ² = 9043.49 (p < 0.001), a = 0.82.	37/ 88.0
05	Ulian et al. (2017)Ulian, M. D., Sato, P. d. M., Benatti, F. B., Campos-Ferraz, P. L. d., Roble, O. J., Unsain, R. F., … Scagliusi, F. B. (2017). Adaptação transcultural para o português dos Questionários de Desejos Intensos por Comida – Estado ou Traço (QDIC-E e QDIC-T) dos State and Trait Food-Cravings Questionnaires (FCQ-S and FCQ-T). [Cross-cultural adaptation into Portuguese of the State and Trait Food-Cravings Questionnaires (FCD-S and FCQ-T) Intense Food Wishes Questionnaires (QDIC-E and QDIC-T)]. Ciência & Saúde Coletiva, 22 (2), 403–416. https://doi.org/10.1590/1413-81232017222.18272015. https://doi.org/10.1590/1413-81232017222... Brazi	FCQ-S and FCQ-T to the Portuguese language.	Reichenheim and Moraes (2007)Reichenheim, M. E., & Moraes, C. L. (2007). Operacionalização de adaptação transcultural de instrumentos de aferição usados em epidemiologia. [Operationalization of cross-cultural adaptation of measurement instruments used in epidemiology]. Revista de SaúdePublica, 41 (1), 665–673.	22 YUS—W 20-24 years	CV	IC	SH Inaccuracy of the original translation	Excellent verbal comprehension Advances in research	a = 05-0.8	32/ 76.1
06	Carbonneau et al. (2016)Carbonneau, E., Carbonneau, N., Lamarche, B., Provencher, V., Bégin, C., Bradette-Laplante, M., … Lemieux, S. (2016). Validation of a French-Canadian adaptation of the Intuitive Eating Scale-2 for the adult population. Appetite, 105 , 37–45. https://doi.org/10.1016/j.appet.2016.05.001. https://doi.org/10.1016/j.appet.2016.05.... Canada	IES-2 to Canada	Beaton et al. (2000)Beaton, D. E., Bombardier, C., Guillemin, F., & Ferraz, M. B. (2000). Guidelines for the process of cross-cultural adaptation of self-report measures. Spine, 25 (24), 3186–3191. https://doi.org/10.1097/00007632-200012150-00014. https://doi.org/10.1097/00007632-2000121...	334 W and 75 M 18-65 years old	CFA CTW/ DV	IC / TRT	Sample specificity SH	SH Wide age range	λ =0.51 - 0.93, X ² (df = 222, n = 239) = 479.97, p < 0.001; NNFI = 0.911; CFI = 0.922; RMSEA = 0.070; 90% Cl of the RMSEA = 0.061-0.078. r = 0.64 to 0.90, a >0.70.	38/90.4
07	Silva, Costa, Pimenta, Maroco, and Campos (2016)Silva, W. R., Costa, D., Pimenta, F., Maroco, J., & Campos, J. A. D. B. (2016). Psychometric evaluation of a unified Portuguese-language version of the Body Shape Questionnaire in female university students. Cadernos de Saúde Pública, 32 (7). https://doi.org/10.1590/0102-311X00133715. https://doi.org/10.1590/0102-311X0013371... Brazil	BSQ to use in Brazil and Portugal in female university students	It is unclear	278—Portugal 248—Brazi YUS averagely 18 years old	CFA CW/ CCV	IC	It is unclear	It is unclear	λ =0.34-0.87, X ² /df 2.65-5.63, CFA and CFI = 0.81-0.95, NFI=0.78-0.93, RMSEA=0.07 -0.09, a =0.88-0.97.	32/ 76.1
08	Rousseau, Denieul, Lentilion, and Vails (2014)Rousseau, A., Denieul, M., Lentillon, V., & Valls, M. (2014). French validation of the Male Body Dissatisfaction Scale in a sample of young men. Journal de Thérapie Comportementale et Cognitive, 24 (3), 122–129. https://doi.org/10.1016/j.jtcc.2014.07.001. https://doi.org/10.1016/j.jtcc.2014.07.0... France	MBDS to France	Guillemin, Bombardier, and Beaton (1993)Guillemin, F., Bombardier, C., & Beaton, D. (1993). Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines. Journal of clinical epidemiology, 46 (12), 1417–1432. https://doi.org/10.1016/0895-4356(93)90142-n. https://doi.org/10.1016/0895-4356(93)901...	319 M YUS 15-23 years old	EFA and CFA CCV	IC / TRT	It is unclear	MBDS could be a useful instrument in identifying and detecting problems linked to body image in men	λ >0.40, X ² [300] = 3381.13, p < 0.001, KMO = 0.90, Chi2/df = 3.20; AGFI = 0.82; GFI = 0.86; RMSEA = 0.08, a =0.82-0.88.	33 / 78.5
09	Pakpour, Zeidi, Ziaeiha, and Burri (2014)Pakpour, A. H., Zeidi, I. M., Ziaeiha, M., & Burri, A. (2014). Cross-cultural adaptation of the Female Genital Self-Image Scale (FGSIS) in Iranian female college students. Journal of sex research, 51 (6), 646–653. https://doi.org/10.1080/00224499.2013.821441. https://doi.org/10.1080/00224499.2013.82... Switzerland	FGSIS-I - Iran Version - in a sample of college women	Guillemin, Bombardier, and Beaton (1993)Guillemin, F., Bombardier, C., & Beaton, D. (1993). Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines. Journal of clinical epidemiology, 46 (12), 1417–1432. https://doi.org/10.1016/0895-4356(93)90142-n. https://doi.org/10.1016/0895-4356(93)901... ; Beaton et al (2000)Beaton, D. E., Bombardier, C., Guillemin, F., & Ferraz, M. B. (2000). Guidelines for the process of cross-cultural adaptation of self-report measures. Spine, 25 (24), 3186–3191. https://doi.org/10.1097/00007632-200012150-00014. https://doi.org/10.1097/00007632-2000121...	1877 W YUS 19-29 years old	EFA and CFA CW/ CTW/ FV/CV / DV	IC/ TRT	Cross-sectional project SR Non-confidential data CS/SH	Instrument highly Ve R	λ = 0.45-0.83 KMO =0.78 and a X ² = 3649.05, df= 21, p < 0.001. X ²= 153.93, df= 14, p = 0.00004, GFI=0.86, NFI = 0.84, CFI = 0.85, and RMSEA = 0.191; a =0.79-0.86.	30/ 71.4
10	Campana, Tavares, Swami, and da Silva (2013)Campana, A. N. N. B., Tavares, M. d. C. G. C. F., Swami, V., & da Silva, D. (2013). An examination of the psychometric properties of Brazilian Portuguese translations of the Drive for Muscularity Scale, the Swansea Muscularity Attitudes Questionnaire, and the Masculine Body Ideal Distress Scale. Psychology of Men & Masculinity, 14 (4), 376–388. https://doi.org/10.1037/a0030087. https://doi.org/10.1037/a0030087... Brazil	DMS, SMAQ and MBIDS to Brazilian Portuguese	Beaton, Bombardier, Guillemin, and Ferraz (2002)Beaton, D., Bombardier, C., Guillemin, F., & Ferraz, M. B. (2002). Recommendations for the cross-cultural adaptation of health status measures , (vol. 12, pp. 1–9). American Academy of Orthopaedic Surgeons.	878 YUS—M 18-39 years old	CFA CTW/ DV / CV	IC	The scales were validated for a specific group of Brazilian men, instead of a larger and more heterogeneous group (e.g., adolescents and older adults)	Useful tools for investigations in body image Decrease of cultural barriers	λ >0.30, DMS Factor Structure = X ² = 239.28, p < .001; RMSEA = .067, GFI = .992, AGFI = .986, NFI = .987, CFI = .992, NNFI = .989, X²/gl = 4.98), a =0.86-0.87. SMAQ Factor Structure = X ² = 266.62, p < .001; RMSEA = .050, GFI = .993, AGFI = .990, NFI = .990, CH = .996, NNFI = .995, X ²/df = 3.17, a =0.64-0.90. MBIDS Factor Structure = X ² = 27.51, p < .001; RMSEA = .053, GFI = .998, AGFI = .995, NH = .996, CFI = .999, NNFI = .999, X ²/df = 3.43, a =0.84.	38/90.4
11	de Caivalho et al. (2013)de Carvalho, P. H. B., Ferreira, M. E. C., Kotait, M., Teixeira, P. C., Hearst, N., Cordás, T. A., & Conti, M. A. (2013). Equivalências conceitual, semântica e instrumental: análises preliminares da versão em português (Brasil) da Male Body Dissatisfaction Scale (MBDS). [Conceptual, semantic and instrumental equivalences: preliminary analyzes of the Portuguese (Brazil) version of the Male Body Dissatisfaction Scale (MBDS)]. Cadernos de Saúde Pública, 29 (2), 403–409. https://doi.org/10.1590/S0102-311X2013000200027. https://doi.org/10.1590/S0102-311X201300... Brazi	MBDS to male students in Brazil	Herdman, Fox-Rushby, and Badia (1998)Herdman, M., Fox-Rushby, J., & Badia, X. (1998). A model of equivalence in the cultural adaptation of HRQoL instruments: the universalist approach. Quality of life research: an international journal of quality of life aspects of treatment, care and rehabilitation, 7 (4), 323–335. https://doi.org/10.1023/a:1024985930536. https://doi.org/10.1023/a:1024985930536...	59 YUS—BS mean age of 23.5 years old	CV	IC	Needs psychometric analysis of validity and reliability	Advances in research	a = 0.92	21 / 50.0
12	Conti et al. (2012)Conti, M. A., Ferreira, M. E. C., Amaral, A. C. S., Hearst, N., Cordás, T. A., & Scagliusi, F. B. (2012). Equivalência Semântica da versão em português do “ Body Change Inventory”. [Semantic equivalence of the Portuguese version of the “Body Change Inventory”]. Ciência & Saúde Coletiva, 17 (9), 2457–2469. https://doi.org/10.1590/S1413-81232012000900026. https://doi.org/10.1590/S1413-8123201200... Brazil	BCI to the Portuguese language	Reichenheim and Moraes (2007)Reichenheim, M. E., & Moraes, C. L. (2007). Operacionalização de adaptação transcultural de instrumentos de aferição usados em epidemiologia. [Operationalization of cross-cultural adaptation of measurement instruments used in epidemiology]. Revista de SaúdePublica, 41 (1), 665–673.	47 YUS—BS mean age of: 22.7 years old	CV	It is unclear	Absence of V and R	Easy verbal comprehension	It is unclear	28/ 66.6
13	Amaral, Cordas, Conti, and Ferreira (2011)Amaral, A. C. S., Cordás, T. A., Conti, M. A., & Ferreira, M. E. C. (2011). Equivalência semântica e avaliação da consistência interna da versão em português do Sociocultural Attitudes Towards Appearance Questionnaire-3 (SATAQ-3). [Semantic equivalence and internal consistency of the Brazilian Portuguese version of the Sociocultural Attitudes Towards Appearance Questionnaire-3 (SATAQ-3)]. Cadernos de SaúdePública, 27 (8), 1487–1497. https://doi.org/10.1590/S0102-311X2011000800004. https://doi.org/10.1590/S0102-311X201100... Brazil	SATAQ-3 to the Brazilian Portuguese language.	Guillemin, Bombardier, Beaton (1993)Guillemin, F., Bombardier, C., & Beaton, D. (1993). Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines. Journal of clinical epidemiology, 46 (12), 1417–1432. https://doi.org/10.1016/0895-4356(93)90142-n. https://doi.org/10.1016/0895-4356(93)901...	146 YUS—70 M (mean age of 20.7) and 76 W (mean age of 20.3).	CV	IC	The article described only the initial cross- cultural adaptation process of the SATAQ-3. Absence of the V and R.	Items with easy comprehension. Items were not excluded IC similar to the original study	a = 0.74-0.92	34/80.9
14	Conti, Scagliusi, Queiroz, Hearst, and Cordas (2010)Conti, M. A., Scagliusi, F., Queiroz, G. K. d. O., Hearst, N., & Cordás, T. A. (2010). Adaptação transcultural: tradução e validação de conteúdo para o idioma português do modelo da Tripartite Influence Scale de insatisfação corporal. [Cross-cultural adaptation: translation and content validation into Portuguese of the Tripartite Influence Scale model of body dissatisfaction]. Cadernos de Saúde Pública, 26 (3), 503–513. https://doi.org/10.1590/S0102-311X2010000300008. https://doi.org/10.1590/S0102-311X201000... Brazil	TIS to the Portuguese language	Pasquali (2000)Pasquali, L. (2000). Princípios de elaboração de escalas psicológicas. In: Gorenstein, C., Andrade, L. H. S. G., Zuardi, A. W. Escalas de avaliação clínica em psiquiatria e psicofarmacologia. São Paulo: Lemos Editorial. p. 15–21. Herdman et al. (1998)Herdman, M., Fox-Rushby, J., & Badia, X. (1998). A model of equivalence in the cultural adaptation of HRQoL instruments: the universalist approach. Quality of life research: an international journal of quality of life aspects of treatment, care and rehabilitation, 7 (4), 323–335. https://doi.org/10.1023/a:1024985930536. https://doi.org/10.1023/a:1024985930536...	108 YUS—51 M (mean age of 18) 57 W (mean age of 19)	CV	IC	It is unclear	Items with easy comprehension. Satisfactoiy scores in the V	a > 0.80	21 /50.0

Methodological guide	N	%
Beaton et al. (2000Beaton, D. E., Bombardier, C., Guillemin, F., & Ferraz, M. B. (2000). Guidelines for the process of cross-cultural adaptation of self-report measures. Spine, 25 (24), 3186–3191. https://doi.org/10.1097/00007632-200012150-00014. https://doi.org/10.1097/00007632-2000121... , 2002Beaton, D., Bombardier, C., Guillemin, F., & Ferraz, M. B. (2002). Recommendations for the cross-cultural adaptation of health status measures , (vol. 12, pp. 1–9). American Academy of Orthopaedic Surgeons. , 2007Beaton, D., Bombardier, C., Guillemin, F., & Ferraz, M. B. (2007). Recommendations for the cross-cultural adaptation of the DASH & Quick DASH outcome measures. Institute for Work & Health, 1 (1), 1–45. )	5	35.7
Guillemin, Bombardier, Beaton (1993)Guillemin, F., Bombardier, C., & Beaton, D. (1993). Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines. Journal of clinical epidemiology, 46 (12), 1417–1432. https://doi.org/10.1016/0895-4356(93)90142-n. https://doi.org/10.1016/0895-4356(93)901...	2	14.2
Brislin (1970Brislin, R. W. (1970). Back-Translation for Cross-Cultural Research. Journal of Cross-Cultural Psychology, 1 (3), 185–216. https://doi.org/10.1177/135910457000100301. https://doi.org/10.1177/1359104570001003... , 1986Brislin, R. W. (1986). The wording and translation of research instruments. In W. J. Lonner, & J. W. Berry (Eds.), Cross-cultural research and methodology series, Vol. 8. Field methods in cross-cultural research , (pp. 137–164). Sage Publications, Inc.. )	2	14.2
Reichenheim and Moraes (2007)Reichenheim, M. E., & Moraes, C. L. (2007). Operacionalização de adaptação transcultural de instrumentos de aferição usados em epidemiologia. [Operationalization of cross-cultural adaptation of measurement instruments used in epidemiology]. Revista de SaúdePublica, 41 (1), 665–673.	2	14.2
Herdman et al. (1998)Herdman, M., Fox-Rushby, J., & Badia, X. (1998). A model of equivalence in the cultural adaptation of HRQoL instruments: the universalist approach. Quality of life research: an international journal of quality of life aspects of treatment, care and rehabilitation, 7 (4), 323–335. https://doi.org/10.1023/a:1024985930536. https://doi.org/10.1023/a:1024985930536...	2	14.2
Pasquali (1999)Pasquali, L. (1999). Instrumentos psicológicos: Manual prático de elaboração. [Psychological tools: Practical elaboration manual] LabPAM/IBAP, Brasília .	1	7.1
Bracken and Barona (1991)Bracken, B. A., & Barona, A. (1991). State of the art procedures for translating, validating and using psychoeducational tests in cross-cultural assessment. School Psychology International, 12 (1-2), 119–132. https://doi.org/10.1177/0143034391121010. https://doi.org/10.1177/0143034391121010...	1	7.1
It is unclear	1	7.1

Type of validity	N	%	Type of reliability	N	%
Content	9	64.2	Internal consistency	13	92.8
Confirmatory factor analysis	7	50	Test-retest	5	35.7
Construct	6	42.8	Intraclass correlation	1	5.5
Discriminant	6	42.8	Reproducibility	1	5.5
Convergent	5	35.7	Stability	1	5.5
Exploratory factor analysis	4	28.5	It is unclear	3	16.6
Face	2	14.2
Concurrent	2	14.2
Divergent	1	7.1
Predictive validity	1	7.2
Unclear	1	7.2

Limitations	N	%	Strengths	N	%
Sample homogeneity	4	28.7	Valid and reliable instrument	4	28.7
Absence of psychometric analysis	1	7.1	Excellent verbal comprehension of items	4	28.7
Absence of validity and reliability	1	7.1	Advances in research	2	14.2
Cross-sectional data collection	1	7.1	Same reliability as the original study	2	14.2
The initial process of cross-cultural adaptation	1	7.1	Decrease of cultural barriers	1	7.1
Testing in other populations	1	7.1	Utile and potent tool which allows rapid triage	1	7.1
Cultural differences	1	7.1	Difference of factorial stability	1	7.1
Loss or addition of items	1	7.1	Utilization of different measures	1	7.1
Non-confidential data	1	7.1	Equivalent scales	1	7.1
Translation inaccuracies	1	7.1	Wide age range	1	7.1
Absence of comparison between groups	1	7.1	Items were not lost	1	7.1
Difficulty in the generalization of results	1	7.1	Identify and detected body Image problems	1	7.1
Not informed (it is unclear)	3	21.4	Sample heterogeneity	1	7.1
			Not informed (it is unclear)	1	7.1

[1] * Correspondence: ravinecarvalho@hotmail.com

Brasil

Brasil

Cross-cultural adaptation of body image assessment instruments for university students: a systematic review

Abstract