Development and validation of the brief-satisfaction with appearance scale for systemic sclerosis

Body image concerns are understudied in systemic sclerosis (SSc; scleroderma). The objective was to develop and cross-validate a brief version of the Satisfaction with Appearance Scale (SWAP) in order to reduce item redundancy, increase SSc relevancy, and improve the feasibility of body image assessment in SSc.

Female patients with SSc in a development sample (Johns Hopkins Scleroderma Center) and a validation sample (Canadian Scleroderma Research Group Registry) completed the 14-item SWAP. Items for the 6-item Brief-SWAP were selected based on theoretical considerations and psychometric data from the development sample. In both samples, internal consistency reliability, convergent validity, and the hypothesized 2-factor structure (perceived social impact and subjective dissatisfaction) were compared between the Brief-SWAP and SWAP.

Two hundred seventeen women from the development sample and 654 women from the validation sample completed the SWAP. Cronbach's alpha for the Brief-SWAP was 0.82 in both samples, compared with 0.90 and 0.91 for the full SWAP. Correlations between the Brief-SWAP and SWAP were 0.94 and 0.95 in the development and validation samples, respectively. All correlations of the Brief-SWAP and SWAP with measures of convergent validity were substantively equal with no statistically significant differences in either sample. Based on confirmatory factor analysis, model fit for the Brief-SWAP was good in the development (χ2 [4]=9.0, comparative fit index [CFI]=0.99, Tucker-Lewis Index [TLI]=0.99, root mean square error of approximation [RMSEA]=0.07) and validation samples (χ2 [4]=19.5, CFI=0.99, TLI=0.99, RMSEA=0.08) and better than for the SWAP.

The Brief-SWAP is a reliable and valid measure of body image dissatisfaction and social discomfort in SSc that is shorter and more feasibly implemented than the SWAP.