Cross-cultural adaptation of the Internet Gaming Disorder Scale – Short Form (IGDS9-SF) to the Brazilian context

Abstract Introduction The Internet Gaming Disorder Scale – Short Form (IGDS9-SF) assesses the severity, harmful effects and/or consequences of excessive online and offline gaming. Its conciseness and theoretical foundations on current diagnostic criteria of gaming disorders make it a useful resource for clinical and screening settings. Objective To describe the process of cross-cultural adaptation of the IGDS9-SF to the Brazilian context. Methods The cross-cultural adaptation involved the steps of independent translation of the instrument, synthesis version, back-translation, pre-test and elaboration of the final version. Content validity assessment was conducted by a multidisciplinary committee of experts and consisted of both a quantitative analysis (calculation of content validity coefficients – CVC) and a qualitative analysis (assessment of the experts’ comments and suggestions). The pre-test sample consisted of 30 gamers with variable sociodemographic characteristics. Results The cross-cultural adaptation of the scale followed the proposed protocol, and the CVC was satisfactory (≥ 0.83) for all the structures and equivalences assessed. Most of the suggestions made by the experts were accepted (mainly adjustments and language standardization). The gamers who participated in the pre-test judged the scale easy to understand and did not suggest changes. Discussion The Brazilian version of the IGDS9-SF showed adequate content validity and is available for researchers and clinicians, as well as for the investigation of additional psychometric characteristics.


Introduction
Internet gaming disorder (IGD) can be characterized as a dysfunctional, recurrent and/or problematic pattern of using both online and/or offline video games. 1 to escape or relieve negative states; and i) impairment/ loss of significant relationships, employment, study, or career opportunities due to gaming. 3 The impacts associated with IGD are many, with an emphasis on a) impairments in social, professional, academic, and family activities and relationships 3-5 ; b) use of gaming as a resource for coping with or procrastinating contact with life difficulties 2 ; c) stimulation of violent behaviors when games involve this theme 6 ; and d) increasingly hostile behaviors toward the surrounding environment. 7 IGD may affect individuals of all ages and its prevalence in adolescents and adults ranges between 10 and 37%, 8,9 being more predominant among male gamers. 10,11 The time spent in gaming activities also varies widely, with studies reporting continuous gaming for up to 72 hours a week in disordered gaming cases. 6 The comorbid conditions most commonly associated with IGD according to available evidence are major depressive disorder, social anxiety, and attention-deficit hyperactivity disorder. 12,13 Given the severity, recurrence, and significant impairments associated with IGD, it has become increasingly important to identify and treat affected It also presented a moderate reliability indicator (internal consistency, with alpha = 0.87). Furthermore, the IGDS9-SF has already been translated and validated in seven languages: Slovenian, 20 Portuguese from Portugal, 21 Italian, 22 Persian, 23 Polish, 24 Turkish, and Chinese. In those studies, the psychometric properties of the IGDS9-SF were also found to be adequate  The process of cross-cultural adaptation of the instrument is described in detail in Table S1, available as online-only supplementary material.

Results
The mean score obtained for each of the equivalences assessed and the CVC calculated for each of the instrument's structures are presented in Table 1.
As seen in Table 1, all components of the IGDS9-SF Changes were made in the instructions and on items 4 and 5 to improve the overall cultural equivalence of the instrument. Thus, the word "console" was replaced by "videogame," "sistematicamente" was replaced by "repetidamente", and "passatempo" was replaced by "hobbies." Minor adjustments were also made on items 1 and 6 in order to standardize language, adopting "atividade de jogo" rather than "experiência de jogo" or "hábito de jogar." Finally, a minor correction on item 9 of the Portuguese version was made because "importante" is a qualifier that applies only to the noun "relacionamento," and not to the remaining nouns in the sentence.
One final consideration refers to item 5, for which the lowest semantic equivalence CVC was found. When assessing this item, one of the judges rated equivalence as "somewhat equivalent," arguing that the translation of the word "previamente" to "antigo" altered the meaning of the sentence. Although the argument was valid, since the two words are not synonymous according to the Michaelis Portuguese dictionary, 28  Internet -Versão Reduzida" and can be found in Table   S2, available as online-only supplementary material.
In the pre-test stage, the items were easily understood by the sample, and there were no further suggestions of modification in any part of the instrument.

Discussion
The IGDS9-SF was created to assess symptoms of disordered gaming according to the DSM-5 and has been widely used internationally, with several psychometric validation and adaptation studies to many languages. Until now, the cross-cultural adaptation of the instrument had not been performed in Brazil, a gap that was fulfilled by the present study.
The cross-cultural adaptation of the scale followed all the steps of the method proposed by Beaton et al. 25 To accomplish the pre-established steps, a team of translators with different academic backgrounds was formed to increase the chances of finding terms that were most adequate to the wide Brazilian cultural context. The training background of professionals involved in the translation of scales in a process of cross-cultural adaptation is important to preserve the original characteristics of the instrument, making it appropriate for the population with which it is intended to be used. 28,29 The characteristics of the experts that formed the adaptation committee followed the recommendations made in the literature 29,30 : all members were bilingual and experts in the fields of psychology and psychiatry, with previous knowledge about the construct under assessment. The use of a quantitative methodology to assess content validity is another strength of this study, as it helps minimizing potential biases due to subjectivity inherent to this type of assessment. This approach helped increase the robustness of the analyses by providing reliable indicators. [31][32][33] In addition, the consideration and incorporation of the

Disclosure
No conflicts of interest declared concerning the publication of this article.