Hypothesis / aims of study
This is the first study to validate a scale for assessing body image (BI) among middle-aged women with urinary incontinence (UI) in Brazil. Body image is defined as the internal and subjective representation of physical appearance and bodily experience, a multifaceted phenomenon that aggregates the perception of the appearance and functioning of the body considering the behavioral, attitudinal and perceptive dimensions of the individual. Urologic diseases such as UI can generate dissatisfaction with the body since they are associated with depression, anxiety, negative perception about the quality of life, impact on social, personal realignments and loss of femininity. Therefore, the objective of this study was to validate a scale of assessment of body satisfaction among incontinent Brazilian women in middle age as well as to evaluate the body satisfaction of this population studied.
Study design, materials and methods
This was an observational and transversal study, with subjects between 40 and 60 years of age from a convenience and non-probabilistic sample. The questionnaire underwent a cross-cultural translation process for the Portuguese language using the Recommendations for the Cross-Cultural adaptation of Healthy Status Measure. The severity of incontinence and the impact on quality of life were evaluated using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). The sample size was estimated based on between 5 and 10 respondents per item of the instrument, which has been considered necessary for a scale validation study. This is the Body Appreciation Scale (BAS), which consists of 13 items, is one-dimensional and self-manageable and its items are answered from a Likert scale with scores ranging from 1 to 5 points. It is based on four aspects considering the positive body image: respect for the body being attentive to its needs and engaging in healthy behaviors; body protection through rejection of unrealistic body image images shown in the media; favorable opinions of one's own body and acceptance of one's own body despite its weight and body shape. High scores mean appreciation with the body. The ethical requirements for research were followed prior to the start of collection. Participants answered a questionnaire characterizing the sample and ICIQ-SF. The analysis was done using the statistical program LISREL 8.54 from the Unweighted Least Squares method. For all measures used in this method, only values equal to or greater than 0.9 will be accepted. Five models were tested: A (1 factor with all variables), B (1 factor without variables 9 and 12), C (1 factor without variables 8, 9 and 12), D (2 factors without variables 7 and 11) and E (2 factors without variables 8, 7 and 11). The analyzes for identification of the corporal appreciation were processed in SPSS 17.0.
A total of 126 women with a mean age of 49.95 years (SD = 6.41) participated in this study. Using the ICIQ-SF, it was suggested that the highest prevalence of UI was of stress urinary incontinence. The mean ICIQ-SF score was 5.50 ± 2.1 with a median of 4, a minimum value of 2 and a maximum of 10, indicating a slight impact on women's quality of life. Regarding the validity of the scale, among the five models studied, Table 1 shows that the model B (1 factor without variables 9 and 12) has the best fit. The internal reliability of the scale (Cronbach's alpha) was 0.74 for this model. Figure 1 shows the Scale Measurement Model.
Considering model B as the best fit, we used the factorial loads to develop a body image score. In this sense, the evaluation of this construct resulted in an average of 3.83 (SD = 0.81) for the studied population (1 no appreciation and 5 maximum body appreciation). The score found indicates that the women participating in this research do not present problems with respect to their own body.
Interpretation of results
The data provided in Table 1 and Figure 1 show that the parameters found in the BAS study represented by the B model presented acceptable and more adjustable values regarding a more adequate scale and with validated parameters for the evaluation of the body image among Brazilian women incontinent in middle age. The fact of assertions (9- “I spend time worrying about the shape or weight of my body”) and (12- “I allow idealized images of lean women in the media to affect my attitudes toward my body”) have been excluded from the model, to the finding of the data found in the literature. Older women, when compared to younger ones, present a smaller concern with their body, and receive smaller influences of the media with respect to the negative evaluation regarding their own. Therefore, this issue generates a lower index of corporal dissatisfaction with the passing of the age. The mean score of 3.83 identified in the assessment of body image perception among the women in this study reveals that their perception of body image is positive, indicating an appreciation with their own body according to the scale. However, the negative perception of body image among women with UI is directly related to the severity of symptoms and perception of quality of life. Our sample did not show the severity of UI symptoms and its impact on women's quality of life was mild, which may justify a positive body image in the sample studied.