Dissertation

Body image in midlife: developing a psychosocial intervention for women who have received treatment for breast cancer

Lewis-Smith, Helena

2017

Overview

Survival rates for breast cancer have improved over the recent decades, and increasing numbers of women in midlife are coming to terms with the consequences of the disease and its treatment. Among the various side-effects associated with treatment are appearance and bodily alterations, which can elicit body image concerns and subsequently impose long-lasting adverse impacts upon psychological and physical health. Governments, health services, and support organisations have stressed the importance of the development, evaluation, and dissemination of psychosocial interventions that provide support for women adjusting to the residual consequences of the diagnosis and treatment of cancer, including body image distress. The overall aim of this thesis was to develop and assess the acceptability of an evidence-informed psychosocial intervention targeting body image among women in midlife who have undergone treatment for breast cancer. The thesis adopted a mixed-method pragmatic approach, and followed the Medical Research Council’s framework for the development and evaluation of complex interventions (Craig et al., 2008). First, a systematic review of existing body image interventions for women in midlife, including those treated for breast cancer, was conducted to assess the current status of the literature and identify existing effective interventions. Interventions targeting women in midlife (n=11) were found to have longer-lasting and larger effects on body image at post-test and were evaluated in studies of greater methodological rigour, compared with interventions targeting women who had undergone treatment for breast cancer (n=22). Second, an online survey tested and compared an established sociocultural model of body image (Tripartite Influence Model; Thompson, Heinberg, Altabe, & Tantleff-Dunn, 1999) between women in midlife who were treated (n=169), and not treated (n=323), for breast cancer, in order to assess potential targets for body image interventions and the applicability of research and interventions among women in midlife for use with women treated for breast cancer. This study revealed a similar pattern of risk factors among both groups, whereby sociocultural and psychological factors proposed within the model influenced body image. Next, an integration of findings from the systematic review and online survey informed the adaptation of an existing evidence-based and rigorously evaluated body image intervention for women in midlife (McLean, Paxton, & Wertheim, 2011) for use among women treated for breast cancer. Finally, the adapted intervention was evaluated for its acceptability through focus groups and interviews with women who had undergone treatment for breast cancer (n=22) and health professionals involved in their psychosocial care (n=5). The adapted intervention was found to be acceptable to both participant groups, pending some further amendments. In addition to informing the adaptation of an existing body image intervention for use with women who have undergone treatment for breast cancer, the findings also provide important implications for practice, theory, and research. The present research has identified previously unexplored sociocultural and psychological influences on the body image of women who have undergone treatment for breast cancer and reveals the value of a theoretical model developed within the wider body image field for a group with an altered appearance.

• Publisher: ProQuest Dissertations & Theses