Available online 22 January 2024, 151576

Author links open overlay panel, AbstractObjective

This study aimed to evaluate the psychometric properties and validity of the Korean version of the Body Image After Mastectomy Scale (K-BIMS).

Methods

This validation study was divided into two phases. Phase 1 included the translation of the K-BIMS according to the World Health Organization recommendations, investigation of content validity by five experts, and a pilot study involving 10 participants for the final list of K-BIMS items. The study participants included 156 women who met the inclusion and exclusion criteria to verify the validity–reliability of the K-BIMS. Phase 2 included a validity–reliability analysis of the K-BIMS. This included convergent validity, known-group validity, construct validity assessed by confirmatory factor analysis, and item-total score correlation. We assessed internal consistency using the Cronbach α.

Results

The K-BIMS confirmatory factor analysis demonstrated good fitness of indices and validity including content validity, convergent validity, and known-group validity was satisfactory. Internal consistency reliability was satisfying with a Cronbach α reliability of .89.

Conclusions

The results revealed that the K-BIMS is a valid and reliable instrument for assessing appearance-based behaviors and beliefs about body image distress among women who underwent reconstructive surgery after mastectomy.

Implications for Nursing Practice

To identify individuals who exhibit maladaptive symptoms and are at risk of developing long-term body image problems, the K-BIMS can be used as a point-of-care screening tool. Therefore, the K-BIMS can be used as an early screening tool to proactively offer accessible and affordable solutions.

Section snippetsBackground

Breast cancer is one of the most prevalent cancers among women worldwide, with an incidence of more than 2.1 million new cases reported annually.1 Mastectomy as the primary treatment for breast cancer is a preventive and therapeutic approach. However, it irreversibly and permanently changes the appearance of the body and induces adverse effects, including negative body image,1,2 which may be associated with a loss of female identity, a decline in fertility and sexual attraction, negative

Design

This methodologic study translated the BIMS into Korean and tested its validity and reliability.

Participants

The target participants of this study were Korean women with breast cancer. We recruited participants through an online platform. Data collection was performed through a web-based survey by posting a recruitment document in an online community. Before the survey, the participants were informed of the study's purpose, anonymity, confidentiality, and right to withdraw at any time. This study was

Content Validity

We evaluated the content validity of the K-BIMS using both the item-level content validity index (I-CVI) and the scale-level content validity index (S-CVI). This calculates the proportion of experts who responded to each question with 3 or 4 points.35 Content validity is categorized as relevant if the I-CVI value is at least 0.78 and the S-CVI is at least 0.90 for five or more experts.35

Construct Validity

We evaluated the factor structure of the K-BIMS using confirmatory factor analysis (CFA). According to Kang,36

Sample Characteristics

In this study, 156 participants were included (Table 2), ranging in age from 28 to 67 years, with a mean age of 42 ± 7.7 years. Most participants (99.6%) were heterosexual. Further, most participants (78.2%) were married; however, 30 (19.2%) were single/never married, and four (2.6%) were divorced or separated. Of all participants, 103 (66%) had a bachelor's degree, 18 (11.5%) had a master's degree or higher, 24 (15.4%) had an associate degree, and 11 (7.1%) had at least a high school

Discussion

This study examined the validity and reliability of the K-BIMS. To the best of our knowledge, this is the first instrument used in Korea to comprehensively assess adverse perceptions that contribute to the behaviors of patients who have undergone mastectomy and reconstructive surgery. The translation and validation process demonstrated that the K-BIMS met the required levels of content validity, construct validity, convergent validity, known-group validity, and reliability measures.

Conclusion

This study showed that the overall K-BIMS had high internal consistency, with a Cronbach α reliability of .89. This finding is consistent with the strong internal consistency of the original version of the BIMS1 (Cronbach α = .81). This suggests that all five symptom domains are critical to the K-BIMS scale. However, all symptom domains, except for the weight domain (0.59), exhibited good internal consistency. The small number of checklist items in the weight domain may have led to lower

Limitations

This study has some limitations. First, because the online recruitment techniques did not allow for verification of test–retest reliability within the same group during the study period, further studies are required to ensure instrument stability. Second, data collection was conducted through an online community where breast cancer survivors were more eager to search for information and were more interested in their physical recovery. This may have affected the results; therefore, research on

Implications for Nursing Practice

Body image disturbance requires consistent medical attention throughout the cancer continuum.54 The K-BIMS could support prescreening for the risk of body image disturbance in Korean women who have undergone reconstructive surgery after mastectomy. The K-BIMS can be used in future research and clinical settings. With a better understanding of body image after mastectomy, interventions can be developed and applied to combat body image problems. Nurses can incorporate the K-BIMS in clinical

Author Contributions

Sook Jung Kang was responsible for conceptualization and writing – review and editing. Goh Eun Choi was responsible for conceptualization, formal analysis, and writing the original draft.

CRediT authorship contribution statement

Sook Jung Kang: Conceptualization, Writing – review & editing. Goh Eun Choi: Conceptualization, Formal analysis, Writing – original draft.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Data Availability

Please contact the corresponding author for data availability.

Funding Source

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Ethical Approval

This study was approved by Ewha Womans University's Institutional Review Board.

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