Exploring the Validity of the Body Image Scale with Survivors of Breast Cancer: A Cognitive Interview Approach

Title: Exploring the Validity of the Body Image Scale with Survivors of Breast Cancer: A Cognitive Interview Approach PURPOSE: The purpose of this study was to explore the construct validity of the Body Image Scale for Cancer Questionnaire (BIS) using cognitive interviews. METHODS: Twelve breast cancer survivors participated in a cognitive interview while completing the BIS. Each participant was asked to think-out-loud while answering items and an interviewer asked probing questions corresponding to Tourangeau’s question and answer model (comprehension, retrieval, judgement, response). Interviews were audio recorded, transcribed, and data were analyzed deductively and inductively. RESULTS: Participants’ interpretations of the questions varied significantly (comprehension category). Several participants perceived the phrasing of some questions to be leading. Within the retrieval category, participants were able to provide examples of how their physical, physiological, and body function affected their body image. Participants expressed positive attitudes towards, and gratitude for their body, which was not captured by the questionnaire. The judgement theme reflected participant uncertainty in how to respond appropriately to specific items. From a response perspective, participants found some items challenging to answer. Finally, the BIS included sensitive questions that elicited emotional reactions and discomfort for some participants. CONCLUSION: The findings of this study provide insight into, and suggestions for potential questionnaire revisions that may enhance the validity and relevance of the BIS for use with breast cancer survivors. Trial Registration Number: NCT04088877 registered September 13, 2019.