Supplementary file 1_Translation, adaptation, and validation of the body image scale among cancer patients in Malaysia.docx

BackgroundChanges in body image resulting from cancer and its treatment’s adverse effects negatively impact mental health and quality of life. However, no instrument to measure body image concerns has been translated, adapted, and validated for cancer patients in Malaysia. This study translated the Body Image Scale (BIS) into Malay and assessed its psychometric properties among patients with various types of cancer in Malaysia.
MethodsInitially, the translation of the original English version of the BIS was conducted by two native Malay-speaking translators and back translation by a native English-speaking translator. The Malay version of the Body Image Scale (BIS-M) was then evaluated by a panel of content experts to attain content validity and then tested in a pilot study with 30 native Malay-speaking cancer patients to attain face validity. Then, 200 cancer patients with various types of cancer were recruited, and they were administered the sociodemographic and clinical characteristics questionnaire, the BIS-M, and the Malay versions of the Body Self-Image Questionnaire-Short Form (BSIQ-SF) (as comparator to assess convergent validity) and Acceptance and Action Questionnaire version II (AAQ II-M) (as comparator to assess discriminant validity). The internal consistency, test–retest reliability, construct validity, and convergent and discriminant validity of the BIS-M were evaluated.
ResultsThe BIS-M exhibited good internal consistency with Cronbach’s α of 0.895 and good test–retest reliability with the intraclass correlation coefficient of its items, and the total score ranged from 0.605 to 0.885 (p < 0.001). The BIS-M demonstrated good face, content, convergent, and discriminant validity. Construct validity assessment with confirmatory factor analysis (CFA) revealed that BIS-M consisted of a single factor similar to the original English version [chi square to degree of freedom ratio (χ2/df) = 1.862, p = 0.004; comparative fit index (CFI) = 0.974, goodness of fit index (GFI) = 0.935, Tucker Lewis index (TLI) = 0.959, root mean square of error of approximation (RMSEA) = 0.056].
ConclusionThe BIS-M is ready for use to assess body image issues which affect cancer patients of both genders. This instrument is expected to evaluate the effectiveness of various psychosocial interventions on enhancing positively perceived body image among cancer patients in Malaysia.

背景 癌症及其治疗的不良反应所导致的体像变化，会对心理健康与生活质量产生负面影响。然而，目前尚无针对马来西亚癌症患者的体像担忧评估工具完成翻译、调适与效度验证。本研究将体像量表（Body Image Scale, BIS）译为马来语，并在马来西亚各类癌症患者中评估其心理测量学属性。

方法 首先，由两名母语为马来语的翻译人员完成BIS原版英文版本的翻译，再由一名母语为英语的翻译人员进行回译。随后，由内容专家小组对马来语版体像量表（Body Image Scale-Malay, BIS-M）进行评估以确立内容效度，并针对30名母语为马来语的癌症患者开展预试验以评估表面效度。之后，招募200名各类癌症患者，向其发放社会人口学与临床特征问卷、BIS-M，以及体像自评问卷简版（Body Self-Image Questionnaire-Short Form, BSIQ-SF）马来语版（作为评估会聚效度的对照工具）与接纳与行动问卷第二版（Acceptance and Action Questionnaire version II, AAQ II-M）（作为评估区分效度的对照工具）。随后对BIS-M的内部一致性、重测信度、结构效度以及会聚与区分效度进行评估。

结果 BIS-M表现出良好的内部一致性，克朗巴哈α（Cronbach’s α）系数为0.895；同时具备良好的重测信度，其条目组内相关系数范围为0.605至0.885（p < 0.001）。BIS-M展现出优异的表面效度、内容效度、会聚效度与区分效度。通过验证性因子分析（Confirmatory Factor Analysis, CFA）开展的结构效度评估显示，BIS-M与原版英文量表一致，均为单因子结构[卡方自由度比（χ²/df）=1.862，p=0.004；比较拟合指数（CFI）=0.974，拟合优度指数（GFI）=0.935，塔克-刘易斯指数（TLI）=0.959，近似误差均方根（RMSEA）=0.056]。

结论 BIS-M可用于评估影响两性癌症患者的体像问题。该工具有望用于评估各类社会心理干预措施对提升马来西亚癌症患者积极体像感知的效果。