Introduction
Methods
The Body Image Scale
Literature search strategy
Inclusion and exclusion criteria
Data extraction
Data analyses
Results
Search results
Study characteristics
Reference | Main aim of study | Population | Sample size |
---|---|---|---|
Anagnostopoulos et al. [16] | Examining reliability and validity of Body Image Scale in Greek | Breast cancer patients treated with mastectomy or breast-conserving surgery; Greece | 70 |
Gómez-Campelo et al. [31] | Validation of Body Image Scale in Spanish | Breast and gynecological cancer patients; Spain | 100 |
Hopwood et al. [14] | Development and validation of Body Image Scale in English | Breast cancer patients; UK | 682 |
Karayurt et al. [32] | Validation of Body Image Scale in Turkish | Ostomy patients; Turkey | 100 |
Khang et al. [33] | Validation of Body Image Scale in Korean | Breast cancer patients treated with mastectomy, breast-conserving surgery or oncoplastic surgery; South Korea | 155 |
Moreira et al. [17] | Validation of Body Image Scale in Portuguese | Postoperative breast cancer patients; Portugal | 173 |
Rhondali et al. [18] | To examine the construct of body image dissatisfaction and its measurement using a single question in patients with advanced cancer | Advanced cancer; USA | 81 |
Van Verschuer et al. [15] | Validation of Body Image Scale in Dutch | Breast cancer patients who have received breast conserving treatment or mastectomy; The Netherlands | 209 |
Whistance et al. [19] | Validation of Body Image Scale for colorectal patients undergoing surgery | Colorectal cancer patients undergoing surgery; UK | 82 |
Measurement properties
Structural validity
Reference | Methodology | Results | Methodological quality | Rating |
---|---|---|---|---|
Anagnostopoulos et al. [16] | EFAa, CFAb | Two factor solution: perceived attractiveness accounting for 52.7% of the variance, and body appearance satisfaction accounting for 8.4% of the variance. The two factors were positively intercorrelated (r = 0.81). Fit statistics were adequate. RMSEA: 0.058; SRMR: 0.069; CFI: 0.95. | Fair | – |
Gómez-Campelo et al. [31] | EFA, CFA | One factor solution accounting for 81.03% of the variance with acceptable fit statistics. SRMR: 0.059. | Fair | + |
Hopwood et al. [14] | EFA | One factor solution in three analyses accounting for 50.1–57.6% of variance. Two-factor solution for mastectomy subgroup: appearance/attractiveness (26.9% of variance) and body satisfaction (18.8% of variance) but results were not reproducible. | Excellent | + |
Karayurt et al. [32] | EFA, CFA | One-factor solution, fit statistics were acceptable. SRMR: 0.05; CFI: 0.96. | Fair | + |
Khang et al. [33] | EFA | One-factor solution for global (66.6% of variance), BCS (59.9% of variance), and mastectomy (74.4% of variance) subgroups. Two-factor solution for oncoplastic subgroup (40.2 and 28.6% of variance). | Good | + |
Moreira et al. [17] | PCAc | One-factor solution with eigenvalue of 6.12, explaining 61.2% of variance. | Fair | + |
Whistance et al. [19] | Multi-trait item scaling | One-factor solution single items each correlated well with the overall ten-item BIS scale with the exception of item 10 (r = 0.39). Removal of this item improved the scaling. Factor analysis suggested a one-factor solution, but item 10 had the lowest factor loading (0.41). This analysis was also repeated with item 10 excluded, and the factor loadings of the remaining nine items improved. | Poor | ? |
Internal consistency
Reference | (Sub)groups | Value (α) | Methodological quality | Rating |
---|---|---|---|---|
Anagnostopoulos et al. [16] | Satisfaction subscale (7 items) | 0.87 | Fair | + |
Attractiveness subscale (3 items) | 0.92 | |||
General body image concerns (5 items) | 0.81 | |||
Gómez-Campelo et al. [31] | Total sample | 0.97 | Fair | – |
Breast cancer subgroup | 0.97 | |||
Gynecological cancer subgroup | 0.97 | |||
Hopwood et al. [14] | Total sample | 0.93 | Excellent | + |
BCS subgroup | 0.91 | |||
Mastectomy subgroup | 0.91 | |||
Remaining subgroupsa | 0.86 | |||
Karayurt et al. [32] | Total sample | 0.94 | Fair | + |
Khang et al. [33] | Total sample | 0.94 | Good | + |
BCS subgroup | 0.92 | |||
Mastectomy subgroup | 0.96 | |||
Oncoplastic surgery subgroup | 0.92 | |||
Moreira et al. [17] | Total sample | 0.93 | Fair | + |
BCS subgroup | 0.93 | |||
Mastectomy subgroup | 0.92 | |||
Rhondali et al. [18] | Total sample | 0.88 | Fair | + |
Van Verschuer et al. [15] | Total sample (time 1) | 0.91 | Good | + |
Total sample (time 2) | 0.92 | |||
Whistance et al. [19] | Total sample (9-item scale) | 0.90 | Good | + |
Reliability
Measurement error
Hypothesis testing for construct validity
Known-group comparison | Convergent validity | |||||||
---|---|---|---|---|---|---|---|---|
Reference | Comparison groups | Results | Methodological quality | Rating | Comparison instrument | Correlations | Methodological quality | Rating |
Anagnostopoulos et al. [16] | Patients who underwent mastectomy vs. BCS vs. cancer-free women | Compared to women receiving breast-conserving surgery, women receiving mastectomy reported significantly more reduced perceived attractiveness, and greater dissatisfaction with body and appearance. | Fair | + | GHQ-28 | BIS appearance and attractiveness scale | Fair | – |
- Social dysfunction | 0.60; 0.38 | |||||||
- Anxiety/insomnia | 0.40; 0.26 | |||||||
High- vs. low-social dysfunction scores | For low-social dysfunction scores, there were no significant differences in general body image concerns among the three groups of women. However, for the high-social dysfunction scores, women who had undergone mastectomy exhibited significantly higher scores on general body image concerns, compared to cancer-free and BCS women’s scores. | - Somatic complaints | 0.54; 0.41 | |||||
Gómez-Campelo et al. [31] | Age and time since diagnosis | Significantly higher BIS scores in younger patients. No significant relation between BIS and time since diagnosis. | Fair | – | RSES | − 0.73 | Fair | + |
BDI | 0.83 | |||||||
BAI | 0.56 | |||||||
EORTC QLQ-C30 | − 0.63 | |||||||
Hopwood et al. [14] | Patients who underwent mastectomy vs. BCS | BIS scores were significantly higher in patients who were treated with mastectomy than those treated with BCS. | Good | + | ||||
Age | Significantly higher BIS scores in younger patients | |||||||
Khang et al. [33] | Patients who underwent mastectomy vs. BCS vs. oncoplastic surgery | BIS scores were significantly higher in patients who were treated with mastectomy than those treated by BCS or oncoplastic surgery. However, the statistical significance was found only between the mastectomy and oncoplastic surgery subgroups. | Fair | – | BESAA | − 0.30 | Fair | – |
RSES | − 0.12 | |||||||
HADS total | 0.52 | |||||||
HADS-A | 0.50 | |||||||
HADS-D | 0.46 | |||||||
WHOQOL-BREF | ||||||||
- Overall QOL | − 0.22 | |||||||
- General health | − 0.38 | |||||||
- Physical health domain | − 0.36 | |||||||
- Psychological domain | − 0.32 | |||||||
- Bodily image and appearance facet | − 0.31 | |||||||
- Social relationships domain | − 0.25 | |||||||
- Environmental domain | − 0.30 | |||||||
Moreira et al. [17] | Patients who underwent mastectomy vs. BCS; age and time since diagnosis | BIS scores were significantly higher in patients who were treated with mastectomy than those treated with BCS. The effect size (η2 = .13) was considered medium. No association with age and time since diagnosis. | Fair | – | ESS | 0.68 | Fair | – |
DAS24 | 0.75 | |||||||
ASI-R self-evaluative salience | 0.40 | |||||||
ASI-R motivational salience | − 0.12 | |||||||
WHOQOL-BREF | ||||||||
- General health | − 0.52 | |||||||
- Physical health domain | − 0.42 | |||||||
- Psychological domain | − 0.49 | |||||||
- Body image and appearance | − 0.66 | |||||||
Rhondali et al. [18] | Age | Significantly higher BIS scores in younger patients. | Poor | + | ASI-R | 0.24 | Poor | ? |
HADS-A | 0.52 | |||||||
HADS-D | 0.42 | |||||||
ESAS total symptom distress score | 0.41 | |||||||
ESAS physical distress subscore | 0.35 | |||||||
ESAS psychological distress subscore | 0.37 | |||||||
MBSRQ Overall appearance satisfaction item | − 0.44 | |||||||
Van Verschuer et al. [15] | Patients who underwent mastectomy vs. BCS | BIS scores were significantly higher in patients treated with mastectomy than those treated with BCS at both assessment times. The effect size (d = .47) was considered moderate. | Fair | + | ||||
Whistance et al. [19] | Patients with a stoma vs. patients without a stoma | BIS scores were significantly higher in patients with a stoma than patients without a stoma. | Good | + | EORTC QLQ-C30 emotion function | 0.45 | Good | – |
EORTC QLQ-C30 role function | < 0.40 (exact data not shown) | |||||||
EORTC QLQ-C30 social function | < 0.40 (exact data not shown) | |||||||
EORTC QLQ-C30 global quality of life | < 0.40 (exact data not shown) |
Responsiveness
Measurement property | Rating of measurement property | Quality of evidence |
---|---|---|
Structural validity | + | Moderate |
Internal consistency | + | Moderate |
Reliability | + | Moderate |
Measurement error | ? | |
Hypothesis testing | ± | Low |
Cross-cultural validity | NA | NA |
Criterion validity | NA | NA |
Responsiveness | ? |