At EDAC we are committed to making research accessible. Our Plain Speaking Summaries include plain language text on published papers and an interview with the authors. In this Plain Speaking Summary, Phaedra Longhurst introduced her paper that was published in 2024 and is interviewed by an Ellen Maloney, EDAC peer researcher.
Paper Synopsis
The full paper can be found here.
AIMS:
A growing body of research focuses on body appreciation, known as acceptance or favourable opinions towards the body, while participating in rejection of media-promoted ideas of appearance. Originally, body appreciation was measured using the Body Appreciation Scale (BAS). A revised version of the BAS consists of the BAS-2, in which poor-performing/gender-specific items were replaced with more items covering a more contemporary understanding of body appreciation. However, the BAS-2 is not validated to assess body appreciation or positive body image in Autistic populations, who present with sensory differences and suggest a difference in the experience surrounding body appreciation. As there is increased co-occurrence surrounding body and eating-related concerns and autism, this study aims to better understand the construct of body appreciation in Autistic individuals, and establish an autism-appropriate measure of positive body image.
KEY FINDINGS:
Exploratory factor analysis led to the extraction of a 12-item, unidimensional model of BAS-2A scores in a split-subsample of n=273. A confirmatory factor analysis supported the unidimensional BAS-2A scores within a second split-subsample of n=277. BAS-2A scores demonstrated adequate composite reliability, lack of variance in measures across gender identity, and patterns of construct validity. In both women and men, BAS-2A scores were positively associated with self-esteem, well-being, quality of life and adaptive coping. BAS-2A scores were negatively correlates with dietary restraint, weight/shape overevaluation, body dissatisfaction and depression. The BAS-2A scores were able to demonstrate incremental validity, and were also able to predict self-esteem over-and-above body dissatisfaction. Temporal stability of the BAS-2A scores over 3 weeks was unsupported, and scores are time-dependent.
METHOD:
This was a mixed method study meaning part qualitative and part quantitative. The first part involved revising the pre-existing BAS-2 (BAS-2A) by asking the Autistic community to rate the current measures based on understanding, how meaning could be interpreted, and whether ableist or offensive language / constructs were embedded. This revised scale was further clarified ‘iteratively and inductively’ to include autism-specific experiences such as sensory experiences, following a routine to care for one’s own body, etc. Exploratory and confirmatory factor analyses were used to assess the reliability and validity of the BAS-2A using test and retest subsamples, with data factorability assessed using the Keiser Meyer-Olkin (KMO) measure of sampling adequacy and Bartlett’s test of sphericity. Outside of measurements of body appreciation, self esteem was measured using the Rosenberg Self-Esteem Scale, well-being was measured using the PERMA Profiler, quality of life was assessed using the World Health Organisation Quality of Life Questionnaire, adaptive coping was assessed via “Emotional Support” items in the Brief COPE, dietary restraint was measured using the Eating Disorder Examination Questionnaire, and levels of depression were assessed using the Depression, Anxiety and Stress Scale.
RESULTS:
The total sample size for this study consisted of 269 men and 281 women (N=550), with an age range of 18 to 72 years. 71.8% of participants identified as having received a formal autism diagnosis, with 28.2% in the process of receiving an autism diagnosis. Exploratory factor analysis in both women and men samples identified the BAS-2A items contained adequate common variance for factor analysis, but fit indices were less than ideal. To rectify, the BAS-2A factors underwent scale purification, in which 12 out of the original 16 items were retained. Under the retained factors, loadings suggest similarity in structure across both men and women, with adequate composite reliability. Confirmatory factor analysis reported fit indices suggesting an acceptable fit of BAS-2A factors to data, with acceptable convergent validity. Assessment of temporal stability found that while scores correlated across time, that there were significant increases in BAS-2A scores in 3-week vs. baseline measures. Assessment of measurement invariance identified that there were no significant differences in BAS-2A scores across men and women, as well as across autism status. Hierarchical linear models for both women and men were established, with findings supporting the incremental validity of the BAS-2A.
Construct validity identified both positive and negative correlations associated with BAS-2A scores. For both men and women, scores positively correlated with self-esteem, well-being, psychological/social/environmental quality of life, and adaptive coping. BAS-2A scores negatively correlated with weight/shape overvaluation and body dissatisfaction, but differed across gender. In women, BAS-2A scores negatively correlated with depression and moderately associated with dietary restraint, however the later inverse correlation was not reported in men. No significant correlations between age and gender were found.
IMPACT:
Impact from this work covers the generation of the 12-item BAS-2A, which has been validated as a tool to assess the construct of body appreciation in autistic adults from the United Kingdom. However, researchers and clinicians should highlight the lack of temporal stability be aware that the instrument may not be temporally stable. The authors suggest that there may be value in using the BAS-2A to further theory and practice aimed at promoting positive body image in the autistic population, but to consider the spatial stability associated with the BAS-2A. Overall, the BAS-2A is able to provide researchers and clinicians the opportunity to conduct accurate correlational and prospective research on body appreciation in Autistic people, and may utilise this instrument for investigating existing and/or developing new intervention programs for eating disorders. It is therefore hoped that the BAS-2A serves as an essential component for an area of research that is both novel and greatly in need of attention.
DISSEMINATION:
This study was published in the Body Image journal and can be read here. The study is open access so is available for anyone to read!
SUMMARY:
The aim of this study was to provide the first psychometric measure of positive body image for use in autistic populations. Existing BAS-2 items were modified, based on an analysis of face validity in a sample of autistic adults and, with the assistance of expert review and community involvement, a novel pool of additional items to better reflect body appreciation in autistic adults was developed. The BAS-2 was also revised to be measured on a new 5-point response scale, ranging from none of the time (1) to all of the time (5), with the inclusion of a visual aid. Overall, evidence from this study supports the resultant 12-item scale – the BAS-2A (see Appendix 1) – as a psychometrically robust measure of body appreciation for use in autistic adults. Specifically, the BAS-2A was found to have a unidimensional factor structure using exploratory factor analysis, which was then cross-validated by our confirmatory factor analysis-based findings in a second split-half subsample. This research found evidence of adequate composite reliability, convergent, concurrent, and incremental validity, and strict invariance across gender identities and autism status.
