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.标题：乳腺癌幸存者癌症躯体意象量表效度验证：基于认知访谈法 研究目的：本研究旨在采用认知访谈法，探究癌症躯体意象量表（Body Image Scale for Cancer Questionnaire, BIS）的结构效度。 研究方法：12名乳腺癌幸存者在完成BIS量表作答的同时参与认知访谈。要求每名参与者在答题过程中采用出声思考法，访谈者则依据图兰戈（Tourangeau）的问答模型（包含理解、提取、判断、作答四个环节）提出探查性问题。访谈内容均进行录音、转写，并采用演绎与归纳相结合的分析法开展数据处理。 研究结果：参与者对量表题项的解读存在显著差异，此类差异主要集中于理解维度。部分参与者认为部分题项的表述存在诱导性。在提取维度中，参与者能够举例说明自身躯体、生理状态与身体功能对其躯体意象的影响。参与者表达了对自身躯体的积极态度与感恩之情，但这一内容未被该量表所覆盖。判断维度反映出参与者在如何恰当地作答特定题项上存在不确定性。从作答维度来看，部分参与者认为部分题项作答难度较高。此外，BIS量表包含部分敏感题项，引发了部分参与者的情绪反应与不适感。 研究结论：本研究结果为量表的潜在修订提供了思路与建议，有望提升BIS量表应用于乳腺癌幸存者群体时的效度与适配性。 试验注册号：NCT04088877，注册日期：2019年9月13日。