Abstract

This study aimed to present the cross-cultural adaptation of the State and Trait Food Cravings Questionnaires (FCQ-S and FCQ-T) into Portuguese. Tools were translated and back-translated, field experts evaluated the conceptual, operational and item-based equivalence and a sample of students assessed tools, evaluating the level of understanding and analyzing internal consistency through Cronbach’s coefficient. In addition, the semantic equivalence was assessed though the intraclass correlation coefficient between the bilingual scores in each question of both versions (English and Portuguese). Tools were considered easy to understand (experts scored 95.4% and 97% for the FCQ-T and FCQ-S, respectively, and 81.8% of students considered them easy to understand), and showed satisfactory internal consistency values (FCQ-T ranged from 0.6 to 0.8 and FCQ-S ranged from 0.5 to 0.8). From the cross-cultural adaptation process, the satisfactory results enable the recommendation of the Brazilian version of FCQs.

Cross-cultural adaptation; Food craving; Translation; Questionnaires

Introduction

In English, the term “food craving” refers to an intense desire or an urgency to eat certain food¹1. Tiffany ST, Wray JM. The clinical significance of drug craving. Ann N Y Acad Sci 2012; 1248:1-17.. What differentiates such desire from hunger is the intensity and specificity of the former. While food craving may be due to a biological stimulus, pleasurable sensations accompanying eating – such as relief from guilt and stress – can also trigger it²2. Meule A, Hermann T, Kübler A. A short version of the Food Cravings Questionnaire – Trait: The FCQ-T-reduced. Front Psychol 2014; 5:190.. Although food cravings are often associated with overeating, they do not necessarily reflect a disturbed eating, nor are they synonymous of overeating²2. Meule A, Hermann T, Kübler A. A short version of the Food Cravings Questionnaire – Trait: The FCQ-T-reduced. Front Psychol 2014; 5:190.. However, such behavior, if not occasional, can contribute to health problems. For example, food cravings are a striking feature of bulimia nervosa³3. Lee S, Kim KR, Ku J, Lee J, Namkoong K, Jung Y. Resting-state synchrony between anterior cingulate cortex and precuneus relates to body shape concern in anorexia nervosa and bulimia nervosa. Psychiatry Res 2014; 221(1):43-48., but they are also prevalent in unspecified eating disorders and obesity. These also appear to be associated with bouts of binge-eating³3. Lee S, Kim KR, Ku J, Lee J, Namkoong K, Jung Y. Resting-state synchrony between anterior cingulate cortex and precuneus relates to body shape concern in anorexia nervosa and bulimia nervosa. Psychiatry Res 2014; 221(1):43-48..

This scenario has been driving investigations into aspects that influence food cravings. Kemps and Tiggemann⁴4. Kemps E, Tiggemann M. Approach bias for food cues in obese individuals. Psychology & Health 2015; 30(3):370-380. investigated whether stimulus or avoidance messages influenced women’s food intake. It was observed that obese women had a faster response than normal weight women to consume food when it was associated with the stimulus messages⁴4. Kemps E, Tiggemann M. Approach bias for food cues in obese individuals. Psychology & Health 2015; 30(3):370-380..

In addition, Klatzkin et al.⁵5. Klatzkin RR, Gaffney S, Cyrus K, Bigus E, Brownley KA. Binge eating disorder and obesity: Preliminary evidence for distinct cardiovascular and psychological phenotypes. Physiol Behav 2015; 142:20-27. observed that obese women with binge-eating, when compared to obese women and normal weight women without binge-eating, had higher blood pressure, greater depressive and stress-related symptoms and a more conflicting relationship with food. Immediate response to external stimuli, as noted in the study by Kemps and Tiggemann⁴4. Kemps E, Tiggemann M. Approach bias for food cues in obese individuals. Psychology & Health 2015; 30(3):370-380., can be particularly problematic in obesogenic environments found in most western countries, in which palatable foods are almost permanently accessible and available.

Food overexposure can lead to excessive consumption, and consequently lead to weight gain, especially among individuals who are more vulnerable to external stimuli. This scenario is especially alarming considering the current global attention on obesity and its consequences for health⁶6. World Health Organization (WHO). Obesity: preventing and managing the global epidemic: report of a WHO consultation. Geneva: WHO; 2000. WHO Technical Report Series 894.. On a global scale, in 2014, more than 1.4 billion adults were overweight and of these, almost 200 million men and 300 million women were obese⁶6. World Health Organization (WHO). Obesity: preventing and managing the global epidemic: report of a WHO consultation. Geneva: WHO; 2000. WHO Technical Report Series 894.. The current estimate is that 33% of the world population are obese⁶6. World Health Organization (WHO). Obesity: preventing and managing the global epidemic: report of a WHO consultation. Geneva: WHO; 2000. WHO Technical Report Series 894..

In Brazil, 12.4% of men and 16.9% of women are estimated to be obese⁷7. Instituto Brasileiro de Geografia e Estatística (IBGE). Antropometria e estado nutricional de crianças, adolescentes e adultos no Brasil: Pesquisa de Orçamentos Familiares 2008-2009. Rio de Janeiro: IBGE; 2010.. According to data from the Chronic Diseases Risk and Protection Factors Surveillance System by Telephone Inquiry (VIGITEL), in the period from 2006 to 2012, obesity prevalence in the adult population increased from 11.6% to 17.4%⁸8. Brasil. Ministério da Saúde (MS). Secretaria de Vigilância em Saúde. VIGITEL. Brasil 2012: Vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico. Brasília: MS; 2013.. Results of Klatzkin et al.⁵5. Klatzkin RR, Gaffney S, Cyrus K, Bigus E, Brownley KA. Binge eating disorder and obesity: Preliminary evidence for distinct cardiovascular and psychological phenotypes. Physiol Behav 2015; 142:20-27. are also relevant, since eating disorders also lead to significant physical, social, psychological and health diseases (e.g. coronary problems, growth problems, unregulated electrolyte balance) and can even lead to death⁹9. Bamford B, Barras C, Sly R, Stiles-Shields C, Touyz S, Le Grange D, Hay P, Crosby R, Lacey H. Eating disorder symptoms and quality of life: Where should clinicians place their focus in severe and enduring anorexia nervosa? Int J Eat Disord 2015; 48(1):133-138..

Binge-eating has been shown to be more prevalent in male adults, with worldwide estimates varying from 0.78% to 2.0% (values that are close to or equal for females)¹⁰10. Mitchison D, Mond J. Epidemiology of eating disorders, eating disordered behaviour, and body image disturbance in males: a narrative review. Int J Eat Disorder 2015; 3:20.. Regarding bulimia nervosa and anorexia nervosa, these estimates are more variable, ranging from 0.13% to 1.34% for the former and from 0.00% to 0.53% for the latter. On the other hand, unspecified eating disorders have global prevalence of 3.38%¹⁰10. Mitchison D, Mond J. Epidemiology of eating disorders, eating disordered behaviour, and body image disturbance in males: a narrative review. Int J Eat Disorder 2015; 3:20.. In Brazil, a study carried out with a population of adolescents with low socioeconomic level in Rio de Janeiro revealed that 37.3% had binge-eating symptoms¹¹11. Ferreira JES, Veiga GV. Eating disorder risk behavior in Brazilian adolescents from low socio-economic level. Appetite 2008; 51(2):249-255.. In a study conducted with female Porto Alegre dwellers, 16.5% evidenced eating disorders symptoms¹²12. Nunes MA, Barros FC, Olinto MTA, Camey S, Mari JDJ. Prevalence of abnormal eating behaviors and inappropriate methods for weight control in young women from Brazil: a population – based study. Eat Weight Disord 2003; 8(2):100-106.. Another study evaluated 1,807 children and adolescents living in Minas Gerais and found that 13.3% of the sample had eating disorders symptoms¹³13. Vilella JEM, Lamounier JA, Dellaretti Filho MA, Neto JRB, Horta GM. Transtornos alimentares em escolares. J Pediatr 2004; 80(1):49-54.. Studies conducted in the Brazilian Northeast also found data related to the prevalence of eating disorders. In a sample of 1,273 participants, it was found that the prevalence of periodic binge-eating disorder was 4.3% and the prevalence of bulimia nervosa was 1.0%¹⁴14. Prisco APK, Araújo TM, Almeida MMG, Santos KOB. Prevalência de transtornos alimentares em trabalhadores urbanos de município do Nordeste do Brasil. Cien Saude Colet 2013; 18(4):1109-1118.. A study conducted with schoolchildren identified that 23% of the participants had eating disorders symptoms¹⁵15. Alves TCHS, de Santana MLP, Silva RCR, Pinto EJ, Assis AMO. Fatores associados a sintomas de transtornos alimentares entre escolares da rede pública da cidade do Salvador, Bahia. J Bras Psiquiatr 2012; 61(2):55-63. Considering association between food cravings and obesity, eating disorders and health problems, detection and treatment of this behavior is fundamental.

Examples of tools developed to access food cravings-related aspects are the Attitudes to Chocolate Questionnaire (ACQ)¹⁶16. Benton D, Greenfield K, Morgan M. The development of the attitudes to chocolate questionnaire. Pers Indiv Differ 1998; 24(4):513-520., the Orientation Towards Chocolate Questionnaire (OCQ)¹⁷17. Cartwright F, Stritzke WG. A multidimensional ambivalence model of chocolate craving: construct validity and associations with chocolate consumption and disordered eating. Eat Behav 2008; 9(1):1-12. and The Food Craving Inventory (FCI)¹⁸18. White MA, Whisenhunt BL, Williamson DA, Greenway, FL, Netemeyer RG. Development and validation of the Food-Craving Inventory. Obes Res 2002; 10(2):107-114.. Each of these tools have a different approach to the construct in question and, while of great value and contribution, are limited to evaluating customary food-specific cravings (such as chocolate, for example) and associating more emphatically such cravings to feelings of guilt or ambivalent behavior. Such characteristics limit the range of tools to only a few food cravings dimensions.

In response to the dissatisfaction with the available tools related to this construct, Cepeda-Benito et al.¹⁹19. Cepeda-Benito A, Gleaves DH, Williams TL, Erath S A. The development and validation of the State and Trait Food-Craving Questionnaires. Behav Ther 2000; 31(1):151-173. developed and validated the Food Cravings Questionnaires (FCQs). Differently from tools highlighted above, FCQs were constructed to evaluate cravings for different foods, without restricting them to specific categories. In addition, the questionnaires encompass eating-related behavioral, cognitive and psychological aspects, which makes them multidimensional tools¹⁹19. Cepeda-Benito A, Gleaves DH, Williams TL, Erath S A. The development and validation of the State and Trait Food-Craving Questionnaires. Behav Ther 2000; 31(1):151-173.. FCQs combine two tools, which access different food craving aspects: Food Cravings Questionnaire-Trait (FCQ-T) and the Food Cravings Questionnaire-State (FCQ-S). In the FCQ-T, the respondent is asked to consider which foods he usually has cravings for; in FCQ-S, the respondent is asked to consider which specific foods he has cravings for at the time he/she answers the questionnaire.

The FCQ-T consists of 39 statements and was developed to access food cravings aspects over time and in various situations, considering them as a (usual) trait behavior of the respondent¹⁹19. Cepeda-Benito A, Gleaves DH, Williams TL, Erath S A. The development and validation of the State and Trait Food-Craving Questionnaires. Behav Ther 2000; 31(1):151-173.. Higher scores in this questionnaire are related to a more exaggerated eating¹⁹19. Cepeda-Benito A, Gleaves DH, Williams TL, Erath S A. The development and validation of the State and Trait Food-Craving Questionnaires. Behav Ther 2000; 31(1):151-173..

The FCQ-S is composed of 15 statements and is a tool sensitive to changes in contextual, psychological and physiological states in response to specific situations (such as stressful events or food deprivation), considering the food craving as a (sporadic) state behavior of the respondent¹⁹19. Cepeda-Benito A, Gleaves DH, Williams TL, Erath S A. The development and validation of the State and Trait Food-Craving Questionnaires. Behav Ther 2000; 31(1):151-173.. Higher scores in this questionnaire are associated with greater food deprivation, negative eating-related experiences and a greater susceptibility to triggers that lead to eating¹⁹19. Cepeda-Benito A, Gleaves DH, Williams TL, Erath S A. The development and validation of the State and Trait Food-Craving Questionnaires. Behav Ther 2000; 31(1):151-173.. Totals of both tools for the full subscales and their dimensions are calculated by adding the corresponding scores of each statement¹⁹19. Cepeda-Benito A, Gleaves DH, Williams TL, Erath S A. The development and validation of the State and Trait Food-Craving Questionnaires. Behav Ther 2000; 31(1):151-173..

To the best of our knowledge, FCQs are the only published food cravings evaluation tools that have been validated psychometrically. Available versions include the original version, in English¹⁹19. Cepeda-Benito A, Gleaves DH, Williams TL, Erath S A. The development and validation of the State and Trait Food-Craving Questionnaires. Behav Ther 2000; 31(1):151-173., as well as in Spanish²⁰20. Cepeda-Benito A, Gleaves DH, Fernandez MC, Vila J, Reynoso J. The development and validation of Spanish versions of the state and trait food cravings questionnaires. Behav Res Ther 2000; 38(11):1125-1138., Dutch²¹21. Franken IHA, Muris P. Individual differences in reward sensitivity are related to food craving and relative body weight in healthy women. Appetite 2005; 45(2):198-201., Korean²²22. Noh J, Kim JH, Nam H, Lim M, Lee D, Hong K. Validation of the Korean version of the General Food Cravings Questionnaire-Trait (G-FCQ-T). Korean Journal of Clinical Psychology 2008; 27:1039-1051. and German²³23. Meule A, Lutz A, Vögele C, Kübler A. Food cravings discriminate differentially between successful and unsuccessful dieters and non-dieters. Validation of the Food Craving Questionnaires in German. Appetite 2012; 58(1):88-97.. Since there are no validated national food cravings investigation tools, this paper aimed to present the cross-cultural adaptation of the State and Trait Food Cravings Questionnaires (FQC-S and FQC-T) for use in Brazilian studies.

Methodology

The cross-cultural adaptation operationalization process was based on the procedures suggested by Reichenheim and Moraes²⁴24. Reichenheim ME, Moraes CL. Operacionalização de adaptação transcultural de instrumentos de aferição usados em epidemiologia. Rev Saude Publica 2007; 41(1):665-673., which include some stages. FCQs authors authorized their use for this process.

We emphasize that each of the questionnaires has particularities. In the FCQ-T, respondents should indicate on a 6-point scale (which varies from never, rarely, sometimes, frequently, very frequently, always) how often each statement is true for them in each situation¹⁹19. Cepeda-Benito A, Gleaves DH, Williams TL, Erath S A. The development and validation of the State and Trait Food-Craving Questionnaires. Behav Ther 2000; 31(1):151-173.. This questionnaire is composed of nine dimensions or subscales that evaluate: 1) the intention and the plans to eat; 2) anticipation of the positive reinforcement that can result from eating; 3) anticipation of relieving negative states and feelings because of eating; 4) the possible lack of control over eating; 5) thoughts or concerns about food; 6) food cravings as a physiological state (such as hunger); 7) possible emotions before or during food cravings; 8) triggers that can give rise to food cravings and; 9) guilt because of food cravings or of giving in to them¹⁹19. Cepeda-Benito A, Gleaves DH, Williams TL, Erath S A. The development and validation of the State and Trait Food-Craving Questionnaires. Behav Ther 2000; 31(1):151-173..

In the FCQ-T, respondents should indicate on a 5-point scale how much they currently agree with each statement at this very moment, ranging from: strongly disagree, disagree, neither agree nor disagree, agree, strongly agree. The FCQ-T consists of five dimensions or subscales that assess at the time of the interview: 1) food cravings; 2) anticipation of the positive reinforcement that can result from eating; 3) anticipation of relieving negative states and feelings as a result of eating; 4) lack of control over food and; 5) food cravings as a physiological state (such as hunger)¹⁹19. Cepeda-Benito A, Gleaves DH, Williams TL, Erath S A. The development and validation of the State and Trait Food-Craving Questionnaires. Behav Ther 2000; 31(1):151-173..

In a first step, in order to obtain the semantic, conceptual and item equivalence, the 39 and 15 statements, as well as the underlying subscales of the respective tools of the FCQs were translated from English to Portuguese. This step was conducted separately by two experienced and fluent English researchers, resulting in versions 1 and 2 of the instrument. The next step analyzed and compared these versions, which was carried out by a researcher who works with food practices. Version 3 of the tool was established based on the considerations of this professional.

The third step sought to evaluate the tool content validity. Thus, version 3 was submitted to 12 experts in the field of Nutrition (n = 9), Philosophy (n = 1), Psychology (n = 1) and Anthropology (n = 1) in order to clarify language and translation. To this end, we selected some statements of tool version 3 that were not entirely clear in terms of language and translation, and we asked specific questions through an online questionnaire with multiple-choice options on the Surveymonkey secure site. A new version of the tool (version 4) was prepared from the feedback of these professionals.

Subsequently, we asked these professionals (9 respondents) to read the modified version of the tool in its entirety and to assess the clarity and comprehension of each statement, responding to a 6-point scale with the following alternatives: “I did not understand”, “I understood a little”, “I more or less understood”, “I understood almost everything, but I had some doubts”, “I understood almost everything” and “I understood perfectly and I had no doubts”. If they did not understand a question or had trouble with language, we asked them to suggest changes and justify them. Criterion of sufficient understanding used answers “I understood almost everything” and “I understood perfectly and I had no doubts”. From this process, we adjusted the tool, which resulted in the preparation of a new version (version 5).

The fourth stage involved tools pre-testing. To participate in the pre-test, we invited third-year Nutrition undergraduate students and asked them to respond to the tools and record suggestions if they faced difficulties in understanding them. All students during class period (n = 22) agreed to voluntarily participate in the pre-test. All were females, with a mean age of 21.6 years (SD = 1.7 years, range from 20 to 24 years) and average Body Mass Index of 21.1 kg/m² (SD = 2.2 kg/m² years, range from 17 kg/m² to 26 kg/m²). There was no refusal and/or abandonment. This activity aimed to have a critical view regarding the content and comprehension of the questionnaire. The next step aimed to evaluate the semantic equivalence between the translated and original versions. To that end, we invited seven bilinguals to respond to version 5 and the original version of the tool, again through an online questionnaire on the “Surveymonkey” secure survey site. They were randomly distributed in two groups: the former first answered the Portuguese language version and, after an interval of five days, answered the original English version. The converse was proposed for the second group. This version was later back-translated into English by a bilingual individual with fluency in Portuguese and English who had not participated in the earlier stages of cross-cultural adaptation.

Subsequently, we proceeded with the technical revision and the evaluation of the semantic equivalence between the original versions in English, Portuguese and the back-translation into English. This involved verifying the ability to transfer meanings from the concepts of the original instrument to the translated version. We sought to evaluate the impact that a specific term would have on the cultural context of the target population, as well as to evaluate the correspondence of perceptions and impacts of the tool in Portuguese on respondents, with a view to ensuring a similar effect in the respondents of the two cultural worldviews. The following linguistic aspects were evaluated: 1) the equivalence between the original in English and the Portuguese version, with care as to the referential meanings of terms and words of the translated version in relation to the original version (such as ideas or objects which words referred to); and 2) the general meaning of each item of the tool, also contrasting both the original and the translated versions into Portuguese. If necessary, the tool could have some terms replaced to allow full recovery of the desired equivalence, in which case a corrected version of the tool would be drawn up.

A statistical analysis using Statistical Package for Social Sciences (SPSS) version 21.0 was performed. Data descriptive (mean, standard deviations-SD, minimum and maximum values) and inferential analyzes were developed. The semantic equivalence was evaluated by the intraclass correlation coefficient (ICC) between scores obtained by the bilingual subjects in each question of the English and Portuguese versions. The internal consistency of the questions was evaluated through Cronbach’s Alpha coefficient analysis. The evaluation regarding content and comprehension of questionnaires was shown by means of percentages (%) and their respective SDs.

Tools pre-test participants completed the informed consent form. The study was approved by the Ethics Committee of the institution involved, under number 892.715.

Results

Translation and cross-cultural adaption

Regarding the evaluation of the semantic equivalence, after comparing tools initial translations, feedback from the consultation with experts and back-translation, suggestions for altering terms and expressions were considered, revised and discussed, resulting in tools adjustments. This new discussion and redefinition of terms occurred due to expressions not easily translated into Portuguese or that were not commonly used in Portuguese. Adaptations made to statements can be seen in Chart 1.

In the FCQ-T, the expression of statement 5, “food cravings” was back-translated to “a food craving”. Thus, we decided to change the translation of “a food craving” (in Portuguese, um desejo intenso) to “food cravings” (in Portuguese, desejos intensos). Statement 6, I feel like I have food on my mind all the time was back-translated to I notice that I think about food all the time. In this case, we decided to keep the first translation (in Portuguese, Eu sinto que estou o tempo todo pensando em comida), since if a literal translation of this statement were made, it would not make sense in the Brazilian cultural context. Thus, the change in relation to the original sentence was necessary, but its meaning was preserved. In statement 23, When I crave certain foods, I usually try to eat them as soon as I can, the word usually had been translated as generally. After consulting with experts, it was changed to normally. In this same item, the sentence as soon as I can was back-translated to as fast as I can. Thus, it was decided to change the translation from as fast as I can to as soon as possible. The expression of the statement to eat appetizing foods that are in my reach was back-translated into to eat appetizing foods when these are within reach. Thus, it was decided to change the translation of It is difficult to resist the temptation to eat appetizing foods when they are within my reach to It is difficult to resist the temptation to eat appetizing foods that are within my reach (In Portuguese, É difícil resistir à tentação de comer comidas apetitosas quando elas estão ao meu alcance para É difícil resistir à tentação de comer comidas apetitosas que estão ao meu alcance).

The FCQ-S tool has also undergone some modifications. The expression of statement 10 If I had was back-translated in the same way as proposed in the original tool. Thus, we chose to change the translation of If I had access to one or more specific foods, I could not stop eating them to If I had one or more specific foods, I could not stop eating them. Another example refers to statement 15, I feel weak because of not eating. The term weak has raised issues among specialists, and it may mean physical weakness (as in being without energy) or an emotional weakness (as in feeling morally unsuccessful). In order to make the meaning of the sentence clearer, we decided to include an observation in this item. These changes are common in the adaptation process and ensure both adequacy to the Brazilian culture and the original idea. The final Portuguese version of the tool appears in Chart 2 and 3.

Verbal comprehension

After evaluation of experts, the FCQ-T obtained a mean percentage of comprehension of 95.4% (SD = 7.5%) and the FCQ-S obtained a mean percentage of comprehension of 97% (SD = 6.6%). Of the 22 students who participated in the pre-test of the tool, 81.8% said tools were easy to understand; 9.1% said tools were repetitive and; 9.1% reported some difficulty in understanding used expressions (e.g. doubts regarding the meaning of term “comforted”).

Internal consistency

The tool showed satisfactory Cronbach’s alpha coefficient values (Table 1). Regarding FCQ-T, values ranged from 0.6 to 0.8. Subscales S8, S5 and S2 recorded a coefficient of 0.8; subscales S4, S6 and S7 scored a coefficient of 0.7 and subscales S1, S3 and S9 achieved a coefficient of 0.6. As for the FCQ-S, values ranged from 0.5 to 0.8. Subscales S3 and S4 recorded a coefficient of 0.5; subscales S2 and S5 scored a coefficient of 0.8 and subscale S1 achieved a coefficient of 0.7. Table 1 also shows the results of mean values, SD and minimum and maximum values obtained by university students for FCQ-T and FCQ-S subscales.

Intraclass Correlation Coefficient

Tables 2 and 3 show the results of the ICC used to verify the conceptual, semantic and item equivalence for the pairs of each question in Portuguese and English and for the FCQ-T and FCQ-S subscales, respectively. Regarding answers in Portuguese and English, in the FCQ-T, ICC ranged from 0.70 to 0.99; as for the FCQ-S, this coefficient ranged from 0.52 to 1.00. As regards subscales, in the FCQ-T, the ICCs were higher than 0.80, varying from 0.87 to 1.00; in the FCQ-S, this coefficient ranged from 0.77 to 0.96.

Discussion

This paper shows the initial stage of the cross-cultural adaptation process of the State and Trait Food Cravings Questionnaires (FCQ-S and FCQ-T). The questionnaires were translated and back-translated and were evaluated by experts from different areas and students. Five versions were developed before achieving the adapted final version.

In the translation and back-translation stage, in view of the concern to preserve contents of the original version within the Brazilian cultural context, some terms were not translated literally. In some cases, the literal correspondence of a term would have implied a different and decontextualized understanding of this culture. It is also important to be careful with the selection of easily understood and comprehensive expressions. One aspect that differs from the original version of the tools concerns their adaptation to the male population. The Portuguese gender identifier extension “(a)” was included in all questions to ensure understanding by both sexes. The assessment of verbal comprehension was excellent, considering that both the experts consulted and students reported almost no difficulty in understanding the tools. Regarding the evaluation of the conceptual, semantic and item equivalence performed by bilinguals, moderate intra-class correlation coefficients were noted in some questions (FCQ-T: statement 25; FCQ-S: statement 7). This was probably because translation had not been entirely clear in relation to the original English version. These statements were reviewed and adjusted. In the final version of the tool, the Likert point scale was used to facilitate participants’ understanding and data analysis, as well as the format and sequence of questions in the same way as in the original version. Among the limitations of this study is the fact that pre-test was limited to female participants of a small age group, of high schooling and in a single region of Brazil.

Regarding the internal consistency analysis, FCQ-T and FCQ-S showed total values equivalent to 0.93 and 0.86, respectively, similar to those found in the original version (0.97 and 0.94, respectively)¹⁶. Thus, we can affirm that the Portuguese version of the tool preserved the coherence and integration of their underlying items. While these tools seek to measure a phenomenon strongly influenced by cultural aspects, the statistical analyzes proved the clarity and comprehension of the statements and their good internal relationship.

We can conclude that the Brazilian version of tools can be recommended for future applications. These tools will be useful for future psychometric analyzes and the implementation and evaluation of food cravings in different population groups and covering different behavioral (cognitive and psychological) aspects. They can be implemented, for example, to study obesity and eating disorders and to evaluate the impact of nutritional interventions.

In the case of eating disorders, one could observe how individual weight gain would influence the response profile of questionnaires; in the case of obesity, one could observe how behavioral changes would influence the response profile of the questionnaires. Considering increased obesity and overweight in recent years and the prevalence of food cravings in obese people, this research – currently scarce in Brazil – is very relevant. We emphasize the need for construct and factorial validation analyzes, as well as evaluation of their reproducibility.

References

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