Translation, adaptation, and validation of the body image scale among cancer patients in Malaysia

Changes 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.

Initially, 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.

The 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 (χ ²/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].

The 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.