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Evaluation of the Satisfaction with Appearance Scale and Its Short Form in Systemic Sclerosis: Analysis from the UCLA
Sarah D Mills1, Rina S Fox1, Erin L Merz1
1From the San Diego State University (SDSU)/University of California, San Diego (UC San Diego) Joint Doctoral Program in Clinical Psychology, and Department of Psychology, SDSU, San Diego; Department of Psychology, California State University, Dominguez Hills, Carson; Department of Medicine, University of California, Los Angeles, Los Angeles, California; Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA.S.D. Mills, MS, MPH, Doctoral Student; R.S. Fox, MS, MPH, Doctoral Student, SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology; E.L. Merz, PhD, MPH, Assistant Professor, Department of Psychology, California State University, Dominguez Hills; P.J. Clements, MD, MPH, Professor Emeritus; S. Kafaja, MD, Clinical Instructor, Department of Medicine, University of California, Los Angeles; V.L. Malcarne, PhD, Professor, Department of Psychology, SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, and Department of Psychology, SDSU; D.E. Furst, MD, Professor, Department of Medicine, University of California, Los Angeles; D. Khanna, MD, MSc, Associate Professor, Department of Medicine, University of Michigan.
Objective:
Changes in appearance are common in patients with systemic sclerosis (SSc) and can significantly affect well-being. The Satisfaction with Appearance Scale (SWAP) measures body image dissatisfaction in persons with visible disfigurement; the Brief-Satisfaction with Appearance Scale (Brief-SWAP) is its short form. The present study evaluated the reliability and validity of SWAP and Brief-SWAP scores in SSc.
Methods:
A sample of 207 patients with SSc participating in the University of California, Los Angeles Scleroderma Quality of Life Study completed the SWAP. Brief-SWAP scores were derived from the SWAP. The structural validity of both measures was investigated using confirmatory factor analysis. Internal consistency reliability of total and subscale scores was assessed with Cronbach's alpha coefficients. Convergent and divergent validity was evaluated using the Center for Epidemiological Studies Depression Scale, the Health Assessment Questionnaire-Disability Index, and the Medical Outcomes Study Short Form-36 questionnaire.
Results:
SWAP and Brief-SWAP total scores were highly correlated (r = 0.97). The 4-factor structure of the SWAP fit well descriptively; the 2-factor structure of the Brief-SWAP fit well descriptively and statistically. Internal consistencies for total and subscale scores were good, and results supported convergent and divergent validity.
Conclusion:
Both versions are suitable for use in patients with SSc. The Brief-SWAP is most efficient; the full SWAP yields additional subscales that may be informative in understanding body image issues in patients with SSc.
