Development and validation of the McGill body image concerns scale for use in head and neck oncology (MBIS‐HNC): A mixed‐methods approach

Abstract

Objective The aim of this study was to develop and validate a patient‐reported outcome measure to evaluate body image concerns in head and neck cancer (HNC) patients. Methods Items were created using a combination of deductive (eg, US Food and Drug Administration Qualification of Clinical Outcome Assessments, literature review) and inductive approaches (eg, subject matter experts, HNC patients). Items were translated for use in both Canadian English and Canadian French using back‐translation. A two‐step empirical validation process using the Classical Test Theory (CTT) and Rasch Measurement Theory (RMT) was conducted with 224 and 258 HNC patients, respectively, having undergone disfiguring surgery within the past 3 years. Results Analyses suggest two subscales for MBIS‐HNC: social discomfort (10 items) and negative self‐image (11 items). The McGill Body Image Concerns Scale–Head and Neck Cancer (MBIS‐HNC) is reliable with high internal consistency (0.98), high test‐retest reliability over a two‐week period (ICC = 0.88), moderate to high convergent validity (range r = 0.43‐0.81), and divergent validity (range r = 0.12‐0.15). RMT was used in addition to CTT. Disordered thresholds led to the modification of the number of response options, and items were deleted based on differential item functioning and high local dependency. Unidimensionality of both subscales and supporting a total score was confirmed. The measure was however characterized by the presence of an important floor effect, confirmed with poor targeting as demonstrated by the person‐item threshold distribution. Conclusion Evidence gathered from our theory‐driven validation study using CTT and RMT provides practitioners and researchers with a useful and easy to use self‐report measure.

Body Image Concerns in Patients With Head and Neck Cancer: A Longitudinal Study

“…Second, while the Body Image Scale was the best measure to use at the time of the study, it was initially developed for patients with breast cancer and includes items that may not be representative of the head and neck cancer experience. In future studies, one may want to use a body image concern measure more specific to HNC such as the recently developed and validated FACT/McGill Body Image Scale – Head & Neck (FACT-MBIS) ( Rodriguez et al, 2019a , b ). Finally, recruitment in large university settings may limit result generalizability to less resourced contexts.…”

Biopsychosocial Markers of Body Image Concerns in Patients with Head and Neck Cancer: A Prospective Longitudinal Study

“…The Body Image Scale used in the study may also be a limitation, as although it was the preferred measure at the time of the study, the measure was created for breast cancer patients and may be missing items specific to the experience of patients with HNC. Future studies may choose to use the recently created and validated body image concern measure specific to HNC known as the FACT/McGill Body Image Scale—Head and Neck (FACT-MBIS) [ 39 ]. Finally, patients who dropped out presented certain characteristics (lower functional status) that may limit the study’s generalizability.…”

Dealing with the Vicissitudes and Abject Consequences of Head and Neck Cancer: A Vital Role for Psycho-Oncology

“…If we are to advance the care of these patients with head and neck cancer, routine measurement of these aspects of their quality of life may prove helpful followed by prompt referrals to psycho-oncological supports. Fortunately, reliable and well-validated measures have been developed to assist in such measurement of their body image [ 34 ] and any sense of shame or stigma [ 35 ] resulting from their head and neck cancer or its treatment. Measures of body image, depression and anxiety can be included in distress screening, considered an essential component of patient-centered care, and endorsed as the sixth vital sign [ 36 , 37 ].…”