Psychometric properties of the ORTO-R in a community-based sample of women and men from Poland

Study 1Items from ORTO-15 retained in ORTO-R

We used the full ORTO-15 measure [1], however only six items which were identified as the best markers of ON were considered in the current study [4]. Each item is answered on a four-point Likert scale (1 = ‘‘always’’, 2 = “often”, 3 = “sometimes”, 4 = ‘‘never’’). Items receiving a score of 1 reflect an ON tendency, while those with a score of 4 points indicate normal eating habits. As ORTO-15 is a reverse-scoring test, therefore, lower scores indicates a more pathological behavior. In present study, we used the original Polish [7] version of the ORTO-15.

The Eating Attitudes Test (EAT-26)

The EAT-26 [14] is a widely used standardized self-report measure of symptoms and concerns characteristic of eating disorders (EDs). The EAT-26 test consists of 26 items to be scored on a 6-point scale (1 = “always”, 2 = “usually”, 3 = “often”, 4 = “sometimes”, 5 = rarely”, 6 = “never”). In the present research, we used a total score as an indicator of the eating disorder pathology. We used the original Polish version of the EAT-26 [15]. In the current sample, Cronbach’s α coefficients of the EAT-26 was 0.907.

Study 2Items from ORTO-15 retained in ORTO-RORTO-R

The ORTO-R [12] comprise same six items, the content of which was however revised (for a full English version of ORTO-R see: https://osf.io/8zv7q/). In addition to that, several amendments were included as compared to ORTO-15. First, the response scale has been changed to a five-point Likert-type scale (1 = “never”, 2 = “rarely”, 3 = “sometimes”, 4 = “often”, 5 = “always"). Second, the counter intuitive reverse-scoring has been changed so the higher the test score, the higher are the ON thoughts and behaviors. Third, the order of items has been randomly mixed so the items with the same beginning appeared in random order to reduce the method bias. In the current study, we used the Polish translation provided by the author of the scale, which, however, has been never subjected to any formal analysis. In Study 2, the order of the revised items was presented as they originally appeared in the ORTO-15, while in Study 3, the order of items was mixed as suggested by the authors [12].

Three-Factor Eating Questionnaire (TFEQ-13)

The TFEQ-13 is a self-assessment Polish version of a 13-items questionnaire used to measure eating behaviors [16, 17]. The TFEQ-13 includes three subscales: cognitive restraint (CR, 5 questions), uncontrolled eating (UE, 5 questions), and emotional eating (EE, 3 questions). Twelve questions were scored on a four-point Likert scale: 0 = “definitely not”, 1 = “rather not”, 2 = “rather yes”, and 3 = “definitely yes”. The question thirteen was scored on an eight-point Likert scale ranging from 1 = “I never restrain from eating” to 8 = “I always restrain from eating”, and was recoded as follows: 1 or 2 (into 0), 3 or 4 (1), 5 or 6 (2), and 7 or 8 (3). In the present study, in the internal consistency estimates were: α = 0.77 for cognitive restraint, α = 0.76 for uncontrolled eating, and α = 0.86 for emotional eating.

The Düsseldorf Orthorexia Scale (PL-DOS)

The PL-DOS is a self-report Polish version of a questionnaire for assessing and screening ON [18]. The scale consists of 10 items with the following answer options: 1 = “this does not apply to me”, 2 = “this does rather not apply to me”, 3 = “this does somewhat apply to me”, and 4 = “this applies to me”. In this study, the DOS-PL has shown high internal consistency (α = 0.80).

Study 3ORTO-RHealth perception

Health perception was measured by using two questions: (1) “To what degree are you worried about your health?” where answers were scored on a five-point Likert scale: 1 = “not at all”, 2 = ”a little”, 3 = “a moderate amount”, 4 = “a lot”, 5 = “a great deal”, (2) “How is your health in general?” where answers were also scored on a five-point Likert scale: 1 = “poor”, 2 = “fair”, 3 = “good”, 4 = “very good”, 5 = “excellent”.

Conscious Food Choices

The Conscious Food Choices Scale is a self-report Polish version of a three-items questionnaire used to measure conscious consumption [19], i.e. “Before buying a food product, I will read the nutrition information displayed on the label”, “Before buying a food product, I will pay attention to the country of origin of the groceries that I will be buying”, “Before buying a food product, I will pay attention to how much the food products are processed”. Participants were asked to determine their willingness to do these things on a scale from 1 = “I definitely will not do this” to 5 = “I will definitely do this”.

Statistical analyses

To test the internal structure of the ORTO questionnaires, a confirmatory factor analysis (CFA) was carried out in Mplus v. 7.2. [20], using robust maximum likelihood estimation to account with the lack of multivariate normality. Missing observations were handled using the full information maximum likelihood estimation. We assessed a model in which a single latent variable was loaded by six indicators. To evaluate the goodness-of-fit of a model, multiple indices were calculated; the root mean square error of approximation (RMSEA) (values ≤ 0.06 indicate a good-fitting model and values > 0.10 indicate poor model), the comparative fit index (CFI) and Tucker-Lewis Index (TLI) (values ≥ 0.90 indicate good model fit), and standardized root mean square residual (SRMR) (values < 0.05 show good fitting models) [21, 22]. Internal consistency of the ORTO-R was calculated using Cronbach’s α values. To assess validity, we used the Pearson’s correlation test. To compare whether the correlations between items from ORTO-15 and ORTO-R are different (Study 2), Z-test was applied.

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