Evidence based assessment/Instruments/Eating Attitudes Test

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Lead section[edit]

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The lead section gives a quick summary of what the assessment is. Here are some pointers (please do not use bullet points when writing article):

  1. Make sure to include a link to the "anchor citation"
  2. What are its acronyms?
  3. What is its purpose?
  4. What population is it intended for? What do the items measure?
  5. How long does it take to administer?
  6. How many questions are inside? Is it multiple choice?
  7. What has been its impact on the clinical world in general?
  8. Who uses it? Clinicians? Researchers? What settings?
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The Eating Attitudes Test (EAT, EAT-26), created by David Garner, is a widely used self-report questionnaire 26-item standardized self-report measure of symptoms and concerns characteristic of eating disorders. The EAT has been a particularly useful screening tool to assess "eating disorder risk" in high school, college and other special risk samples such as athletes. Screening for eating disorders is based on the assumption that early identification can lead to earlier treatment, thereby reducing serious physical and psychological complications or even death. Furthermore, EAT has been extremely effective in screening for anorexia nervosa in many populations.

The EAT-26 can be used in a non-clinical as well as a clinical setting not specifically focused on eating disorders. It can be administered in group or individual settings and is designed to be administered by mental health professionals, school counselors, coaches, camp counselors, and others with interest in gathering information to determine if an individual should be referred to a specialist for evaluation for an eating disorder. It is ideally suited for school settings, athletic programs, fitness centers, infertility clinics, pediatric practices, general practice settings, and outpatient psychiatric departments. It is designed for adolescents and adults.

The EAT-26 is rated on a six-point scale based on how often the individual engages in specific behaviors. The questions may be answered: Always, Usually, Often, Sometimes, Rarely, and Never. Completing the EAT-26 yields a "referral index" based on three criteria: 1) the total score based on the answers to the EAT-26 questions; 2) answers to the behavioral questions related to eating symptoms and weight loss, and 3) the individual’s body mass index (BMI) calculated from their height and weight. Generally a referral is recommended if a respondent scores "positively" or meets the "cut off" scores or threshold on one or more criteria.

The Eating Attitudes Test (EAT, EAT-26), created by David Garner, is a widely used self-report questionnaire 26-item standardized self-report measure of symptoms and concerns characteristic of eating disorders. The EAT has been a particularly useful screening tool to assess "eating disorder risk" in high school, college and other special risk samples such as athletes. Screening for eating disorders is based on the assumption that early identification can lead to earlier treatment, thereby reducing serious physical and psychological complications or even death. Furthermore, EAT has been extremely effective in screening for anorexia nervosa in many populations.

The EAT-26 can be used in a non-clinical as well as a clinical setting not specifically focused on eating disorders. It can be administered in group or individual settings and is designed to be administered by mental health professionals, school counselors, coaches, camp counselors, and others with interest in gathering information to determine if an individual should be referred to a specialist for evaluation for an eating disorder. It is ideally suited for school settings, athletic programs, fitness centers, infertility clinics, pediatric practices, general practice settings, and outpatient psychiatric departments. It is designed for adolescents and adults.

The EAT-26 is rated on a six-point scale based on how often the individual engages in specific behaviors. The questions may be answered: Always, Usually, Often, Sometimes, Rarely, and Never. Completing the EAT-26 yields a "referral index" based on three criteria: 1) the total score based on the answers to the EAT-26 questions; 2) answers to the behavioral questions related to eating symptoms and weight loss, and 3) the individual’s body mass index (BMI) calculated from their height and weight. Generally a referral is recommended if a respondent scores "positively" or meets the "cut off" scores or threshold on one or more criteria.

Psychometrics[edit]

Steps for evaluating reliability and validity[edit]

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  1. Evaluate the instrument by referring to the rubrics for evaluating reliability and validity (both external Wikiversity pages). For easy reference, open these pages in separate tabs.
    1. Reliability rubric
    2. Validity rubric
  2. Refer to the relevant instrument rubric table. This is the table that you will be editing. Do not confuse this with the external pages on reliability and validity.
    1. Instrument rubric table: Reliability
    2. Instrument rubric table: Validity
  3. Depending on whether instrument was adequate, good, excellent, or too good:
    1. Insert your rating.
    2. Add the evidence from journal articles that support your evaluation.
    3. Provide citations.
  4. Refer to the heading for the instrument rubric table ("Rubric for evaluating norms and reliability for the XXX ... indicates new construct or category")
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Instrument rubric table: Reliability[edit]

The internal consistency reliability of the Eating Attitudes Test is good. Data from David Garner and Paul Garfinkel produced alpha coefficients of 0.79 for the anorexia nervosa subjects and 0.94 for the pooled sample.[1]

Click here for instrument reliability table

Reliability[edit]

Not all of the different types of reliability apply to the way that questionnaires are typically used. Internal consistency (whether all of the items measure the same construct) is not usually reported in studies of questionnaires; nor is inter-rater reliability (which would measure how similar peoples' responses were if the interviews were repeated again, or different raters listened to the same interview). Therefore, make adjustments as needed.

Reliability refers to whether the scores are reproducible. Unless otherwise specified, the reliability scores and values come from studies done with a United States population sample. Here is the rubric for evaluating the reliability of scores on a measure for the purpose of evidence based assessment.

Evaluation for norms and reliability for the XXX (table from Youngstrom et al., extending Hunsley & Mash, 2008; *indicates new construct or category)
Criterion Rating (adequate, good, excellent, too good*) Explanation with references
Norms Adequate Multiple convenience samples and research studies, including both clinical and nonclinical samples[citation needed]
Internal consistency (Cronbach’s alpha, split half, etc.) Excellent; too good for some contexts Alphas routinely over .94 for both scales, suggesting that scales could be shortened for many uses[citation needed]
Interrater reliability Not applicable Designed originally as a self-report scale; parent and youth report correlate about the same as cross-informant scores correlate in general
Test-retest reliability (stability Good r = .73 over 15 weeks. Evaluated in initial studies, with data also show high stability in clinical trials[citation needed]
Repeatability Not published No published studies formally checking repeatability

Instrument rubric table: Validity[edit]

According to a research study on the instrument by David Garner and Paul Garfinkel, the total EAT score significantly correlated with criterion group membership (r = 0.87, p < 0.001), suggesting a high level of concurrent validity. [1]

Click here for instrument validity table

Validity[edit]

Validity describes the evidence that an assessment tool measures what it was supposed to measure. There are many different ways of checking validity. For screening measures, diagnostic accuracy and w:discriminative validity are probably the most useful ways of looking at validity. Unless otherwise specified, the validity scores and values come from studies done with a United States population sample. Here is a rubric for describing validity of test scores in the context of evidence-based assessment.

Evaluation of validity and utility for the XXX (table from Youngstrom et al., unpublished, extended from Hunsley & Mash, 2008; *indicates new construct or category)
Criterion Rating (adequate, good, excellent, too good*) Explanation with references
Content validity Excellent Covers both DSM diagnostic symptoms and a range of associated features
Contruct validity (e.g., predictive, concurrent, convergent, and discriminant validity) Excellent Shows Convergent validity with other symptom scales, longitudinal prediction of development of mood disorders, and associations with family history of mood disorder. Factor structure complicated; the inclusion of “biphasic” or “mixed” mood items creates a lot of cross-loading
Discriminative validity Excellent Multiple studies show that GBI scores discriminate cases with unipolar and bipolar mood disorders from other clinical disorders
Validity generalization Good Used both as self-report and caregiver report; used in college student as well as outpatient and inpatient clinical samples; translated into multiple languages with good reliability
Treatment sensitivity Good Multiple studies show sensitivity to treatment effects comparable to using interviews by trained raters, including placebo-controlled, masked assignment trials. Short forms appear to retain sensitivity to treatment effects while substantially reducing burden.
Clinical utility Good Free (public domain), strong psychometrics, extensive research base. Biggest concerns are length and reading level. Short forms have less research, but are appealing based on reduced burden and promising data

Development and history[edit]

Click here for instructions for development and history
  • Why was this instrument developed? Why was there a need to do so? What need did it meet?
  • What was the theoretical background behind this assessment? (e.g. addresses importance of 'negative cognitions', such as intrusions, inaccurate, sustained thoughts)
  • How was the scale developed? What was the theoretical background behind it?
  • If there were previous versions, when were they published?
  • Discuss the theoretical ideas behind the changes.

The EAT was developed in response to a National Institute of Mental Health consensus panel that recognized a need for screening large populations to increase early identification of anorexia related symptoms. Additionally, the NIMH wanted a measure that could be used to examine the social and cultural factors involved in the development and maintenance of eating disorders [2]. The original version of the EAT was published in 1979, with 40 items each rated on a 6-point likert scale [3]. In 1982, Garner and colleagues modified the original version to create an abbreviated 26-item test [4]. The items were reduced after a factor analysis on the original 40-item data set revealed there to be only 26 independent items [5]. Since that time, the EAT has been translated into many different languages and has gained widespread international as a tool to screen for eating disorders [6]. Both the original paper and the subsequent 1982 publication are 3rd and 4th on the list of the 10 most cited articles in the history of the journal Psychological Medicine a prominent peer-reviewed journal in the fields of psychology and psychiatry.

The EAT-26 should be used as the first step in a two-stage screening process. Accordingly, individuals who score higher than a 20 should be referred to a qualified professional to determine if they meet the diagnostic criteria for an eating disorder. The EAT-26 is not designed to make a diagnosis of an eating disorder and should not be used in place of a professional diagnosis or consultation. The EAT should only be used as a screener for general eating disorders, as research has not shown it to be a valid instrument in making specific diagnoses [7].

Permission to use the EAT-40 or EAT-26 can be obtained from David Garner through the EAT-26 website [2] or the River Centre Clinic [3]. Instructions and scoring information can be obtained from the EAT-26 website for no charge.

Impact[edit]

  • This assessment is useful in evaluating a range of target behaviors found in Anorexia Nervosa. Clinicians are able to use this assessment and get results in a timely manner. What was the impact of this assessment? How did it affect assessment in psychiatry, psychology and health care professionals?
  • What can the assessment be used for in clinical settings? Can it be used to measure symptoms longitudinally? Developmentally?

Use in other populations[edit]

  • It has been used in various parts in China (ex: Shenzen, Hong Kong, and Hunan) and in Mexico. [8] [9]
  • There is a translation of the EAT-40 in Spanish. [10]
  • There is also a translation of the EAT in Zulu. [11]
  • There was also a study done for children. [12]

Scoring instructions and syntax[edit]

We have syntax in three major languages: R, SPSS, and SAS. All variable names are the same across all three, and all match the CSV shell that we provide as well as the Qualtrics export.

Hand scoring and general instructions[edit]

Click here for hand scoring and general administration instructions

There are three parts to this 26 question test, each part assessing a different dimension of the respondent's attitude towards eating. Part A deals with age, weight, and other physical attributes of the respondent. Part B screens for the respondent's attitude towards their height, weight, and shape. Part C asks about behavioral tendencies of the respondent over the past six months. It is important to note that results from EAT-26 should not take the place of an expert medical opinion.


Scoring

A respondent's score is often used in addition to the BMI norms for their age. The responses for Part A are also taken into consideration.

Dieting scale items: 1, 6, 7, 10, 11, 12, 14, 16, 17, 22, 23, 24, and 26

Bulimia and food preoccupation scale: 3, 4, 9, 18, 21, and 25

Oral Control Scale: 2, 5, 8, 13, 15, 19, and 20


The sum of questions 1-26 yield the total score.

Always: 3 points

Usually: 2 points

Often: 1 point

Sometimes, Rarely, Never: 0 points


Question 26 scored as

Always, usually, often: 0points

Sometimes: 1 point

Rarely: 2 points

Never: 3 points


The behavioral questions are scored as follows:

2-3 times a month for question A: positive screen

Once a month or less for question B and C: positive screen

Once a day or more for question D: positive screen

Yes for question E: positive screen


Interpretation

A score of 20 or more on questions 1-26 suggests a high risk for an eating disorder. It is recommended that the respondent be referred to a professional for further diagnosis. Any behavioral question that yields a "positive screen" indicates that the respondent should seek evaluation from a professional.

If there are any hand scoring and general administration instructions, it should go here.

CSV shell for sharing[edit]

Click here for CSV shell
  • <Paste link to CSV shell here>

Here is a shell data file that you could use in your own research. The variable names in the shell corresponds with the scoring code in the code for all three statistical programs.

Note that our CSV includes several demographic variables, which follow current conventions in most developmental and clinical psychology journals. You may want to modify them, depending on where you are working. Also pay attention to the possibility of "deductive identification" -- if we ask personal information in enough detail, then it may be possible to figure out the identity of a participant based on a combination of variables.

When different research projects and groups use the same variable names and syntax, it makes it easier to share the data and work together on integrative data analyses or "mega" analyses (which are different and better than meta-analysis in that they are combining the raw data, versus working with summary descriptive statistics).

R/SPSS/SAS syntax[edit]

Click here for R code

R code goes here

Click here for SPSS code

SPSS code goes here

Click here for SAS code

SAS code goes here

See also[edit]

Here, it would be good to link to any related articles on Wikipedia. For instance:

External links[edit]

Example page[edit]


References[edit]

  1. 1.0 1.1 Garner & Garfinkel, (1979) http://eat-26.com/Docs/Garner-EAT-40%201979.pdf
  2. Garner, D.M., & Garfinkel, P.E. (1980). Socio-cultural factors in the development of anorexia nervosa. Psychological Medicine, 10, 273-279.
  3. Garner, D.M., & Garfinkel, P.E. (1979).Psychological Medicine, 9, 273-279.
  4. Garner et al. (1982). The eating attitudes test: Psychometric features and clinical correlates. Psychological Medicine, 12, 871-878.
  5. Garner, David M.; Olmsted, Marion P.; Bohr, Yvonne; Garfinkel, Paul E. (1982-11-01). "The Eating Attitudes Test: psychometric features and clinical correlates". Psychological Medicine. 12 (04): 871–878. doi:10.1017/S0033291700049163. ISSN 1469-8978.
  6. Alvarez-Rayón, G.; Mancilla-Díaz, J. M.; Vázquez-Arévalo, R.; Unikel-Santoncini, C.; Caballero-Romo, A.; Mercado-Corona, D. (2013-07-26). "Validity of the Eating Attitudes Test: A study of Mexican eating disorders patients". Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity. 9 (4): 243–248. doi:10.1007/BF03325077. ISSN 1124-4909.
  7. Garner et al. (1982). The eating attitudes test: Psychometric features and clinical correlates. Psychological Medicine, 12, 871-878.
  8. Lee, Sing; Lee, Antoinette M. (2000-04-01). "Disordered eating in three communities of China: A comparative study of female high school students in Hong Kong, Shenzhen, and rural Hunan" (in en). International Journal of Eating Disorders 27 (3). doi:10.1002/(sici)1098-108x(200004)27:3%3C317::aid-eat9%3E3.0.co;2-2. ISSN 1098-108X. http://doi.wiley.com/10.1002/%28SICI%291098-108X%28200004%2927%3A3%3C317%3A%3AAID-EAT9%3E3.0.CO%3B2-2. 
  9. https://www.researchgate.net/profile/Claudia_Unikel/publication/7893989_Validity_of_the_Eating_Attitudes_Test_A_study_of_Mexican_eating_disorders_patients/links/00b7d537e26df6527a000000.pdf
  10. Castro, J., Toro, J., Salamero, M., & Guimerá, E. (1991). The Eating Attitudes Test: Validation of the Spanish version. Evaluación Psicológica, 7(2), 175-189.
  11. Szabo, Christopher P; Allwood, Clifford W (2004-10). [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1414705/ "Application of the Eating Attitudes Test (EAT-26) in a rural, Zulu speaking, adolescent population in South Africa"]. World Psychiatry 3 (3): 169–171. ISSN 1723-8617. PMID 16633489. PMC PMC1414705. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1414705/. 
  12. Michael J. Maloney, Julie McGuire, Stephen R. Daniels, Bonny Specker Pediatrics Sep 1989, 84 (3) 482-489;

Warning: Default sort key "Eating Attitudes Test" overrides earlier default sort key "7 Up 7 Down Inventory".