Abstract
The Body Image after Breast Cancer Questionnaire (BIBCQ) is a breast cancer specific tool for body image assessment which measures the long-term effects of breast cancer on different aspects of body image in breast cancer survivors. Culturally-appropriate instruments are needed for body image after breast cancer assessment. This study was conducted to assess the psychometric properties of the Persian version of BIBCQ. In this methodological study, BIBCQ was translated into Persian through forward-backward translation. In totally, 400 breast cancer survivors in north of Iran completed the BIBCQ. The content validity was assessed by twelve experts. The construct validity of the questionnaire was evaluated through exploratory and confirmatory factor analyses and its convergent and discriminant validity were evaluated using Fornell and Larcker’s approach. The reliability of the questionnaire was also evaluated through Cronbach’s alpha and McDonald’s omega. In exploratory factor analysis, five factors were identified. Second-order factor analysis showed an overarching concept that labeled “Body image stigma”. The questionnaire had acceptable content and convergent validity and composite reliability. This scale can be used in future studies to assess body image in Iranian breast cancer survivors. Healthcare policy makers can use the findings of the present study to develop care plans for improving body image and mental health among breast cancer survivors.
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Data Availability
The datasets analyzed during the current study are available from thecorresponding author on reasonable request.
References
Ahadzadeh, A. S., Sharif, S. P., Ong, F. S., & Khong, K. W. (2015). Integrating health belief model and technology acceptance model: An investigation of health-related internet use. Journal of Medical Internet Research, 17(2), e45. https://doi.org/10.2196/jmir.3564.
Altman, D. G., & Bland, J. M. (1991). Improving doctors' understanding of statistics. Journal of the Royal Statistical Society: Series A (Statistics in Society), 154(2), 223–248.
Anderson, J. C., & Gerbing, D. W. (1988). Structural equation modeling in practice: A review and recommended two-step approach. Psychological Bulletin, 103(3), 411–423.
Bab, S., Abdifard, E., Elyasianfar, S., Mohammadi, P., & Heidari, M. (2019). Time trend analysis of breast cancer in Iran and its six topographical regions: A population-based study. Journal of medicine and life, 12(2), 140–149. https://doi.org/10.25122/jml-2018-0087.
Bakewell, R. T., & Volker, D. L. (2005). Sexual dysfunction related to the treatment of young women with breast cancer. Clinical Journal of Oncology Nursing, 9(6), 697–702. https://doi.org/10.1188/05.CJON.697-702.
Baxter, N. N., Goodwin, P. J., Mcleod, R. S., Dion, R., Devins, G., & Bombardier, C. (2006). Reliability and validity of the body image after breast cancer questionnaire. The Breast Journal, 12(3), 221–232. https://doi.org/10.1111/j.1075-122X.2006.00246.x.
Begovic-Juhant, A., Chmielewski, A., Iwuagwu, S., & Chapman, L. A. (2012). Impact of body image on depression and quality of life among women with breast cancer. Journal of Psychosocial Oncology, 30(4), 446–460. https://doi.org/10.1080/07347332.2012.684856.
Brislin, R. W. (1970). Back-translation for cross-cultural research. Journal of Cross-Cultural Psychology, 1(3), 185–216. https://doi.org/10.1177/135910457000100301.
Brunet, J., Sabiston, C. M., & Burke, S. (2013). Surviving breast cancer: Women's experiences with their changed bodies. Body Image, 10(3), 344–351. https://doi.org/10.1016/j.bodyim.2013.02.002.
Caqueo-Urízar, A., Ferrer-García, M., Toro, J., Gutiérrez-Maldonado, J., Peñaloza, C., Cuadros-Sosa, Y., & Gálvez-Madrid, M. J. (2011). Associations between sociocultural pressures to be thin, body distress, and eating disorder symptomatology among Chilean adolescent girls. Body Image, 8(1), 78–81. https://doi.org/10.1016/j.bodyim.2010.11.004.
Castonguay, A. L., Pila, E., Wrosch, C., & Sabiston, C. M. (2015). Body-related self-conscious emotions relate to physical activity motivation and behavior in men. American Journal of Men's Health, 9(3), 209–221. https://doi.org/10.1177/1557988314537517.
Castonguay, A. L., Sabiston, C. M., Kowalski, K. C., & Wilson, P. M. (2016). Introducing an instrument to measure body and fitness-related self-conscious emotions: The BSE-FIT. Psychology of Sport and Exercise, 23, 1–12. https://doi.org/10.1016/j.psychsport.2015.10.003.
Castonguay, A. L., Wrosch, C., Pila, E., & Sabiston, C. M. (2017). Body-related shame and guilt predict physical activity in breast cancer survivors over time. Paper presented at the Oncology Nursing Forum, 44(4), 465–475. https://doi.org/10.1188/17.ONF.465-475.
Cohen, J. (1988). Statistical power analysis for the behavioral sciences. Hillsdale: Lawrence Erlbaum Associates, Publishers.
Colton, D., & Covert, R. W. (2007). Designing and constructing instruments for social research and evaluation: John Wiley & Sons.
Cox, T., & Ferguson, E. (1994). Measurement of the subjective work environment. Work & Stress, 8(2), 98–109. https://doi.org/10.1080/02678379408259983.
Derbis, R., & Machnik-Czerwik, A. (2016). Adaptation of the body image after breast Cancer questionnaire in the polish context: Factorial structure and validity of the scale. Health Psychology Report, 4(2), 170–187. https://doi.org/10.5114/hpr.2016.56837.
Ebadi, A., Zarshenas, L., Rakhshan, M., Zareiyan, A., Sharifnia, S., & Mojahedi, M. (2017). Principles of scale development in health science. Tehran: jamee negar.
Esposito Vinzi, V., Chin, W. W., Henseler, J., & Wang, H. (2010). Handbook of partial least squares: Concepts, methods and applications: Heidelberg. Dordrecht, London, New York: Springer.
Falk Dahl, C. A., Reinertsen, K. V., Nesvold, I. L., Fosså, S. D., & Dahl, A. A. (2010). A study of body image in long-term breast cancer survivors. Cancer, 116(15), 3549–3557. https://doi.org/10.1002/cncr.25251.
Fingeret, M. C., Teo, I., & Epner, D. E. (2014). Managing body image difficulties of adult cancer patients: Lessons from available research. Cancer, 120(5), 633–641. https://doi.org/10.1002/cncr.28469.
Fok, D. (2011). Development and testing of a low vision product selection instrument (LV-PSI): A mixed-methods approach.
Fornell, C., & Larcker, D. F. (1981). Evaluating structural equation models with unobservable variables and measurement error. Journal of Marketing Research, 18(1), 39–50. https://doi.org/10.2307/3151312.
Ganz, P. A., Schagi, C. A. C., & Cheng, H.-L. (1990). Assessing the quality of life—A study in newly-diagnosed breast cancer patients. Journal of Clinical Epidemiology, 43(1), 75–86. https://doi.org/10.1016/0895-4356(90)90059-X.
Gatignon, H. (2003). Statistical analysis of management data: Springer.
Gonçalves, C. D. O., Tavares, M. D. C. G. C. F., Campana, A. N. N. B., & Cabello, C. (2014). Validation of the instrument "body image after breast cancer" in Brazil. Motriz: Revista de Educação Física, 20, 8–15. https://doi.org/10.1590/S1980-65742014000100002.
Goyal, N. G., Ip, E. H., Salsman, J. M., & Avis, N. E. (2019). Spirituality and physical health status: A longitudinal examination of reciprocal effects in breast cancer survivors. Supportive Care in Cancer, 27(6), 2229–2235. https://doi.org/10.1007/s00520-018-4494-5.
Gupta, A., Dhillon, P. K., Govil, J., Bumb, D., Dey, S., & Krishnan, S. (2015). Multiple stakeholder perspectives on cancer stigma in North India. Asian Pacific Journal of Cancer Prevention: APJCP, 16(14), 6141–6147. https://doi.org/10.7314/apjcp.2015.16.14.6141.
Hair, J. F., Black, W., Babin, B., & Anderson, R. (2013). Multivariate data analysis. Always learning: Pearson Education Limited.
Hayes, S. C., Johansson, K., Stout, N. L., Prosnitz, R., Armer, J. M., Gabram, S., & Schmitz, K. H. (2012). Upper-body morbidity after breast cancer: Incidence and evidence for evaluation, prevention, and management within a prospective surveillance model of care. Cancer, 118(S8), 2237–2249. https://doi.org/10.1002/cncr.27467.
Hofmeier, S. M., Runfola, C. D., Sala, M., Gagne, D. A., Brownley, K. A., & Bulik, C. M. (2017). Body image, aging, and identity in women over 50: The gender and body image (GABI) study. Journal of Women & Aging, 29(1), 3–14. https://doi.org/10.1080/08952841.2015.1065140.
Høy, B., Lillestø, B., Slettebø, Å., Sæteren, B., Heggestad, A. K. T., Caspari, S., et al. (2016). Maintaining dignity in vulnerability: A qualitative study of the residents’ perspective on dignity in nursing homes. International Journal of Nursing Studies, 60, 91–98.
Hungr, C., Sanchez-Varela, V., & Bober, S. L. (2017). Self-image and sexuality issues among young women with breast Cancer: Practical recommendations. Revista de Investigación Clínica, 69(2), 114-122. https://doi.org/10.24875/ric.17002200.
Javali, S. B., Gudaganavar, N. V., & Raj, S. M. (2011). Effect of varying sample size in estimation of coefficients of internal consistency. https://doi.org/10.9754/journal.wmc.2011.001649.
Jim, H. S. L., Pustejovsky, J. E., Park, C. L., Danhauer, S. C., Sherman, A. C., Fitchett, G., Merluzzi, T. V., Munoz, A. R., George, L., Snyder, M. A., & Salsman, J. M. (2015). Religion, spirituality, and physical health in cancer patients: A meta-analysis. Cancer, 121(21), 3760–3768. https://doi.org/10.1002/cncr.29353.
Keery, H., van den Berg, P., & Thompson, J. K. (2004). An evaluation of the tripartite influence model of body dissatisfaction and eating disturbance with adolescent girls. Body Image, 1(3), 237–251. https://doi.org/10.1016/j.bodyim.2004.03.001.
Koçan, S., & Gürsoy, A. (2016). Body image of women with breast Cancer after mastectomy: A qualitative research. The Journal of Breast Health, 12(4), 145–150. https://doi.org/10.5152/tjbh.2016.2913.
Lam, W. W., Li, W. W., Bonanno, G. A., Mancini, A. D., Chan, M., Or, A., & Fielding, R. (2012). Trajectories of body image and sexuality during the first year following diagnosis of breast cancer and their relationship to 6 years psychosocial outcomes. Breast Cancer Research and Treatment, 131(3), 957–967. https://doi.org/10.1007/s10549-011-1798-2.
Lasry, J.-C. M., Margolese, R. G., Poisson, R., Shibata, H., Fleischer, D., Lafleur, D., Legault, S., & Taillefer, S. (1987). Depression and body image following mastectomy and lumpectomy. Journal of Chronic Diseases, 40(6), 529–534. https://doi.org/10.1016/0021-9681(87)90010-5.
Lawshe, C. H. (1975). A quantitative approach to content validity. Personnel Psychology, 28(4), 563–575.
Lewis-Smith, H., Diedrichs, P. C., Bond, R., & Harcourt, D. (2020). Psychological and sociocultural influences on body image among midlife women with and without a history of breast cancer: Testing the tripartite influence model of body image. Body Image, 35, 114–125. https://doi.org/10.1016/j.bodyim.2020.08.011.
Lewis-Smith, H., Diedrichs, P. C., & Harcourt, D. (2018). A pilot study of a body image intervention for breast cancer survivors. Body Image, 27, 21–31. https://doi.org/10.1016/j.bodyim.2018.08.006.
Link, B. G., & Phelan, J. C. (2006). Stigma and its public health implications. The Lancet, 367(9509), 528–529. https://doi.org/10.1016/S0140-6736(06)68184-1.
Mammadzada, G., & Munir, K. (2018). Disclosure and insight of breast cancer diagnosis and mental well-being: A pilot study among Azerbaijani women. Psycho-oncology, 27(2), 700–702. https://doi.org/10.1002/pon.4436.
Momenimovahed, Z., & Salehiniya, H. (2019). Epidemiological characteristics of and risk factors for breast cancer in the world. Breast cancer (Dove Medical Press), 11, 151–164. https://doi.org/10.2147/BCTT.S176070.
Moreira, H., & Canavarro, M. C. (2010). A longitudinal study about the body image and psychosocial adjustment of breast cancer patients during the course of the disease. European Journal of Oncology Nursing, 14(4), 263–270. https://doi.org/10.1016/j.ejon.2010.04.001.
Munro, B. H. (2005). Statistical methods for health care research (Vol. 1): Lippincott Williams & wilkins.
Nafissi, N., Khayamzadeh, M., Zeinali, Z., Pazooki, D., Hosseini, M., & Akbari, M. E. (2018). Epidemiology and histopathology of breast cancer in Iran versus other middle eastern countries. Middle East Journal of Cancer, 9(3), 243–251. https://doi.org/10.30476/MEJC.2018.42130.
Sharif Nia, H., Ebadi, A., Lehto, R. H., Mousavi, B., Peyrovi, H., & Chan, Y. H. (2014). Reliability and validity of the persian version of templer death anxiety scale-extended in veterans of Iran–Iraq warfare. Iranian Journal of Psychiatry and Behavioral Sciences, 8(4), 29–37.
Nyblade, L., Stockton, M., Travasso, S., & Krishnan, S. (2017). A qualitative exploration of cervical and breast cancer stigma in Karnataka, India. BMC Women's Health, 17(1), 58. https://doi.org/10.1186/s12905-017-0407-x.
Pahlevan Sharif, S., & Sharif Nia, H. (2018). Structural equation modeling with AMOS. Tehran: Artin Teb.
Radoš, S. N., Vraneš, H. S., & Šunjić, M. (2014). Limited role of body satisfaction and body image self-consciousness in sexual frequency and satisfaction in pregnant women. The Journal of Sex Research, 51(5), 532–541. https://doi.org/10.1080/00224499.2012.744954.
Rodgers, R., Chabrol, H., & Paxton, S. J. (2011). An exploration of the tripartite influence model of body dissatisfaction and disordered eating among Australian and French college women. Body Image, 8(3), 208–215. https://doi.org/10.1016/j.bodyim.2011.04.009.
Rodriguez, A. M., Frenkiel, S., Desroches, J., De Simone, A., Chiocchio, F., MacDonald, C., et al. (2019). Development and validation of the McGill body image concerns scale for use in head and neck oncology (MBIS-HNC): A mixed-methods approach. Psychooncology, 28(1), 116–121. https://doi.org/10.1002/pon.4918.
Rohani, C., Abedi, H.-A., Omranipour, R., & Langius-Eklöf, A. (2015). Health-related quality of life and the predictive role of sense of coherence, spirituality and religious coping in a sample of Iranian women with breast cancer: A prospective study with comparative design. Health and Quality of Life Outcomes, 13, 40–40. https://doi.org/10.1186/s12955-015-0229-1.
Salmani, K., Nematollahzadeh Mahani, S. S., Shahbazi, S., Ostovar, Z., & Ganji, L. (2017). Compare the attribution styles, spiritual experiences, and resilience of women with breast cancer and healthy women. Quarterly Journal of Health Psychology, 5(20), 5–20.
Sarvimäki, A., & Stenbock-Hult, B. (2016). The meaning of vulnerability to older persons. Nursing Ethics, 23(4), 372–383. https://doi.org/10.1177/0969733014564908.
Schreiber, J. B., Nora, A., Stage, F. K., Barlow, E. A., & King, J. (2006). Reporting structural equation modeling and confirmatory factor analysis results: A review. The Journal of Educational Research, 99(6), 323–338. https://doi.org/10.3200/JOER.99.6.323-338.
Søndergaard, M., & Hofstede, G. (2001). Culture's consequences: Comparing values, behaviours, institutions, and organizations across nations. International Journal of Cross Cultural Management, 243–246. https://doi.org/10.9707/2307-0919.1014.
Sprangers, M. A., Groenvold, M., Arraras, J. I., Franklin, J., te Velde, A., Muller, M., & Aaronson, N. K. (1996). The European Organization for Research and Treatment of Cancer breast cancer-specific quality-of-life questionnaire module: first results from a three-country field study. Journal of Clinical Oncology, 14(10), 2756–2768.
Teo, I., Novy, D. M., Chang, D. W., Cox, M. G., & Fingeret, M. C. (2015). Examining pain, body image, and depressive symptoms in patients with lymphedema secondary to breast cancer. Psycho‐Oncology, 24(11), 1377–1383. https://doi.org/10.1002/pon.3745.
Tiggemann, M., & Hage, K. (2019). Religion and spirituality: Pathways to positive body image. Body Image, 28, 135–141. https://doi.org/10.1016/j.bodyim.2019.01.004.
Tripathi, L., Datta, S. S., Agrawal, S. K., Chatterjee, S., & Ahmed, R. (2017). Stigma perceived by women following surgery for breast cancer. Indian journal of medical and paediatric oncology: official journal of Indian Society of Medical & Paediatric Oncology, 38(2), 146–152. https://doi.org/10.4103/ijmpo.ijmpo_74_16.
Türk, K. E., & Yılmaz, M. (2018). The effect on quality of life and body image of mastectomy among breast cancer survivors. European journal of breast health, 14(4), 205–210. https://doi.org/10.5152/ejbh.2018.3875.
Waskul, D. D., & Van der Riet, P. (2002). The abject embodiment of cancer patients: Dignity, selfhood, and the grotesque body. Symbolic Interaction, 25(4), 487–513. https://doi.org/10.1525/si.2002.25.4.487.
Yeung, N. C., Lu, Q., & Mak, W. W. (2019). Self-perceived burden mediates the relationship between self-stigma and quality of life among Chinese American breast cancer survivors. Supportive Care in Cancer, 27(9), 3337–3345. https://doi.org/10.1007/s00520-018-4630-2.
You, S., & Shin, K. (2020). Sociocultural influences, drive for thinness, drive for muscularity, and body dissatisfaction among Korean undergraduates. International Journal of Environmental Research and Public Health, 17(14), 5260. https://doi.org/10.3390/ijerph17145260.
Zhang, J., Zhu, X., Tang, L., Chen, G., Wang, Y., Yang, Y., & Li, L. (2014). [Psychometric features of the body image after breast cancer questionnaire-Chinese version in women with breast cancer]. Zhong Nan Da Xue Xue Bao Yi Xue Ban, 39(1), 73–77. https://doi.org/10.11817/j.issn.1672-7347.2014.01.013.
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Hereby, we would like to thank the Research Administration of Islamic Azad University, Babol Branch, Babol, Iran, and all women who participated in this study.
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This study funded by vice chancellor of research and technology, Islamic Azad University, Babol Branch, Babol, Iran. The funder had role in data collection, but had no role in decision to publish, analysis or preparation of themanuscript.
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H SH N and MF: concept and purpose of the study. H SH N, MF, SJ R, MN and MN: Design of the study. SJ R, MN and MN: Acquisition of data. H SH N and MF: Analysis and interpretation of data. H SH N, MF, SJ R: Drafting of manuscript. H SH N, MF, SJ R, MN, and MN: Critical revision. All authors read and approved the final manuscript.
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Sharif Nia, H., Firouzbakht, M., Rekabpour, SJ. et al. The psychometric properties of the Persian version of the body image after breast Cancer questionnaire: A second- order confirmatory factor analysis. Curr Psychol 42, 3924–3934 (2023). https://doi.org/10.1007/s12144-021-01741-4
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DOI: https://doi.org/10.1007/s12144-021-01741-4