Body dysmorphic disorder (BDD): Translation, cross-cultural adaptation and validation of the Body Image Disturbance Questionnaire (BIDQ) / Ruzanna Hussain

Ruzanna , Hussain (2024) Body dysmorphic disorder (BDD): Translation, cross-cultural adaptation and validation of the Body Image Disturbance Questionnaire (BIDQ) / Ruzanna Hussain. Masters thesis, Universiti Malaya.

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Abstract

Body Dysmorphic Disorder (BDD) is a relatively common but often underdiagnosed disorder. BDD can be challenging for orthodontists to diagnose due to the lack of a universally accepted diagnostic tool to aid in diagnosis or prediction of BDD among orthodontic patients. The Body Image Disturbance Questionnaire (BIDQ) is a tool that can be utilized to evaluate the perception of negative body image in patients. Aims: The aim of this study is to translate and validate the Body Image Disturbance Questionnaire (BIDQ) into a culturally adapted version for assessing perception of negative body image in Malaysian orthodontic patients. Methods: A quantitative study was carried out involving 30 orthodontic patients at the Postgraduate Orthodontic clinic, Universiti Malaya. Individuals aged 18 to 40 years old who were able to speak in Malay and/or English language were recruited. The first step of the research involved forward-synthesis-backward translation. The translation process followed a methodological guideline with bilingual translators and expert input from medical officers, English lecturers and certified translator. Eight content validity experts—an orthodontist, psychiatrist, methodologist, a language expert and all forward and backward translators—reviewed the translated questionnaires for relevance and comprehension in the next phase. Iterative revisions resolved discrepancies and created culturally appropriate and context-sensitive Malay and English BIDQs. The process of continuous revisions fixed inconsistencies and produced a culturally and contextually sensitive Malay BIDQ draft. Testing translated questionnaires on adult orthodontic patients validated them. Probe interviews were used to reevaluate questionnaire clarity and comprehensiveness, identify ambiguities, and assess response options. Both were scored for I-CVI and I-FVI, including inter-rater reliability. The expert committee used all findings to finalize the questionnaires. Results: The BIDQ was successfully translated and culturally adapted for the Malaysian population using the forward-backward translation method, resulting in a Malay Body Image Disturbance Questionnaire (M-BIDQ). Content validation was conducted by a team of eight experts. It obtained a perfect CVI score of 1.00 for relevance and representativeness, along with a Kappa score of 0.78. A total of 30 adult orthodontic patients, were interviewed to assess the clarity and comprehensiveness by face validity and the resulting high FVI score of 0.89. Conclusion: The original BIDQ has been translated into Malay and culturally adapted for Malaysian use. The FVI and CVI scored highest, demonstrating their relevance and understanding in assessing negative body image perceptions. Clinicians and researchers can use this translated version for Malaysian orthodontic patients to pre-diagnose BDD in patients. To improve research reliability and confidence, construct and criterion validation should be done in the future.

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