📄 medicine

Psychometric properties of the Body Shape Questionnaire in postpartum women from Northeast Brazil

This study validates the Brazilian version of the Body Shape Questionnaire as a psychometrically sound, unidimensional instrument with high internal consistency for assessing body image dissatisfaction in postpartum women from Northeast Brazil.

Original authors: Mariza Reis do Amaral, Bruna Silva Souto, Luana Ravany Café da Silva, Paula Eloise de Sousa Campos, Camila Almeida Neves de Oliveira, Victor Daniel Santos Silva, Andreza Gysllaynny Delmondes Saraiva

Published 2026-07-08

📖 5 min read🧠 Deep dive

CC BY 4.0

Original authors: Mariza Reis do Amaral, Bruna Silva Souto, Luana Ravany Café da Silva, Paula Eloise de Sousa Campos, Camila Almeida Neves de Oliveira, Victor Daniel Santos Silva, Andreza Gysllaynny Delmondes Saraiva, Luis Fernando Reis Macedo, Camila Takáo Lopes, Gyllyandeson de Araújo Delmondes

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

Imagine your body after having a baby as a house that has just undergone a massive renovation. The walls have shifted, the furniture has been rearranged, and the layout is completely different from what it was before. For many women, looking at this "renovated house" can feel confusing or even upsetting. They might feel like the house doesn't match the blueprint they had in their heads.

This research paper is like a team of architects and inspectors trying to test a specific tool (a questionnaire called the Body Shape Questionnaire, or BSQ) designed to measure how much a woman is worried about her "renovated house."

Here is the breakdown of what the researchers did and found, using simple analogies:

The Goal: Testing the Ruler

The researchers wanted to know: Is this specific ruler accurate for measuring the "body worries" of new moms in Northeast Brazil?

Even though this ruler has been used for years in other places, the researchers knew that a new mom's experience is unique. It's like trying to use a ruler designed for measuring a skyscraper to measure a garden shed; you need to make sure the tool actually fits the job.

The Process: Gathering the Data

The Participants: They asked 268 new mothers (mostly between 20 and 29 years old) to fill out a survey.
The Survey: The survey had 34 questions. Think of these questions as 34 different "sensors" placed around the house to detect feelings of dissatisfaction. The women answered on a scale from "Never" to "Always" regarding how they felt about their bodies over the last four weeks.
The Location: The study took place in hospitals and clinics in the São Francisco Valley region of Brazil.

The Investigation: Finding the "Heartbeat" of the Survey

The researchers used two main methods to see how the survey worked, similar to how you might test a new engine:

Exploratory Analysis (The "Listening" Phase):
They first listened to the data to see if the 34 questions naturally grouped together into different categories (like "worry about weight," "worry about clothes," etc.).
- The Surprise: The computer suggested there might be six different groups of questions.
- The Reality Check: However, when they looked closer, they saw that the first group was so much louder and stronger than the other five that it was drowning them out. It was like having a choir where one singer is so loud that the other five are just whispering in the background. This suggested that all the questions were actually measuring one main thing: a general feeling of body dissatisfaction.
Confirmatory Analysis (The "Proof" Phase):
They then tested this "one big thing" theory against theories that said there were two or three separate things.
- The Result: The "one big thing" model fit the data perfectly. The other models (two or three parts) looked okay on paper, but the parts were so tangled up with each other that they couldn't really be told apart. It was like trying to separate two colors of paint that had been mixed so thoroughly they were just one shade of purple.

The Cleanup: Removing the Broken Sensors

During the testing, the researchers noticed that three specific questions (sensors) weren't working well. They were "staticky" and didn't connect to the main signal.

These questions were about extreme behaviors like forcing yourself to vomit, using laxatives, or wanting to change your body surgically.
Because these behaviors are very rare among the women in this study, these questions didn't help measure the general feeling of body worry.
The Fix: The researchers removed these three questions. The remaining 31 questions formed a very clean, strong, and accurate tool.

The Verdict: A Reliable Tool

The study concluded that the Brazilian version of this questionnaire is excellent for measuring body image worries in new mothers.

It is Unidimensional: It measures one clear, strong feeling (dissatisfaction with body shape) rather than a jumble of different feelings.
It is Reliable: The results are consistent. If you ask the same woman the same questions, she will likely give a similar answer.
The Score: The tool scored very high on reliability (0.97 out of 1.00), which is like a thermometer that gives you the exact same temperature reading every time you check it.

Why This Matters (According to the Paper)

The paper states that having a tool that works well is crucial. Just as a doctor needs a reliable thermometer to check for a fever, nurses and doctors need a reliable "body worry thermometer" to understand how new mothers are feeling emotionally.

The study confirms that this specific tool can be used to screen (check for) body dissatisfaction in new moms in this region. It helps identify women who are struggling with how they see their "renovated house," which is a key step in understanding their mental health during this special time.

In short: The researchers took a 34-question survey, tested it on 268 new moms, found that it mostly measures one big feeling, removed three broken questions, and confirmed that the remaining 31 questions make a very accurate and reliable tool for understanding how new mothers feel about their bodies.

Technical Summary: Psychometric Properties of the Body Shape Questionnaire in Postpartum Women from Northeast Brazil

Problem Statement
Body image dissatisfaction in the postpartum period is a clinically significant phenomenon linked to psychological distress and adverse maternal mental health outcomes. While the Body Shape Questionnaire (BSQ) is a widely used instrument for assessing body shape concerns, its psychometric validity specifically within the postpartum population remains unestablished. Existing evidence suggests that postpartum body image is distinct from general body image due to specific morphological, functional, and symbolic changes. Furthermore, previous adaptations of the BSQ in Brazil were validated on medical students, yielding a four-factor structure that may not generalize to postpartum women. There is a critical need for validated, context-specific measurement tools to support evidence-based nursing care and maternal mental health assessment.

Methodology
This psychometric study evaluated the internal structure validity and reliability of the Brazilian version of the BSQ (Di Pietro & Silveira, 2009) in a sample of 268 postpartum women recruited from hospital and primary healthcare services in the Sub-middle São Francisco Valley region (Petrolina, PE, and Juazeiro, BA), Brazil.

Participants: Women aged 16 or older in the immediate (0–10 days) or late (>10 days) postpartum period. The sample had a mean age of 24.85 years, with a mean postpartum duration of 11.29 days.
Instrument: The 34-item BSQ, rated on a 6-point Likert scale (1 = never to 6 = always), assessing concerns over the past four weeks. Items were linguistically adapted to the female gender.
Statistical Analysis:
- Exploratory Factor Analysis (EFA): Conducted using Principal Axis Factoring (PAF) with Oblimin rotation. Factorability was assessed via the Kaiser–Meyer–Olkin (KMO) index and Bartlett's test of sphericity. Factor retention was determined via parallel analysis.
- Confirmatory Factor Analysis (CFA): Three competing models (one-, two-, and three-factor) were tested using the Diagonally Weighted Least Squares (DWLS) method with robust correction, suitable for ordinal data. Model fit was evaluated using CFI, TLI, RMSEA, and SRMR.
- Reliability: Internal consistency was assessed using McDonald's omega ( $\omega$ ).
- Software: Analyses were performed using JASP (version 0.95.2.0).

Key Results

Factorability: The correlation matrix was adequate for factor analysis (KMO = 0.94; Bartlett's test $\chi^2$ = 7,606.97, $p < 0.001$ ).
Dimensionality:
- Parallel analysis initially suggested a six-factor solution. However, a significant discrepancy between the first eigenvalue ( $\lambda_1$ = 15.82) and subsequent eigenvalues ( $\lambda_2$ = 1.93; $\lambda_3$ = 1.33) indicated that the majority of common variance was concentrated in a single general dimension.
- CFA Models: The one-factor model demonstrated adequate fit (CFI = 0.99; TLI = 0.99; RMSEA = 0.03). While two- and three-factor models showed excellent fit indices, they exhibited high inter-factor correlations (0.76–0.85), suggesting poor discriminant validity and supporting a unidimensional interpretation.
Item Performance: In the initial one-factor model, items Q16, Q26, and Q32 (assessing compensatory behaviors like body modification ideation, vomiting, and laxative use) showed factor loadings below the 0.30 threshold.
Re-specified Model: Upon removing these three low-loading items, a 31-item unidimensional model was re-estimated. This model maintained excellent fit (CFI = 0.99; TLI = 0.99; RMSEA = 0.03) with all remaining items showing significant loadings (0.44 to 0.86).
Reliability: The instrument demonstrated high internal consistency ( $\omega$ = 0.97).

Key Contributions

Context-Specific Validation: The study provides the first empirical evidence regarding the psychometric properties of the Brazilian BSQ specifically for postpartum women, a population where the instrument's adequacy was previously unknown.
Structural Clarification: Contrary to the four-factor structure found in the original Brazilian adaptation (medical students), this study supports an essentially unidimensional structure for postpartum women. This suggests that in this specific context, body shape concerns are best understood as a single latent trait rather than distinct sub-dimensions.
Item Refinement: The identification of items related to severe compensatory behaviors (Q16, Q26, Q32) as having low discriminative utility in this non-clinical postpartum sample offers insight into the specific expression of body dissatisfaction during the puerperium, which appears more cognitive-affective than behavioral.
Clinical Utility: The findings validate the use of the BSQ (potentially in a 31-item format) as a screening tool for body image dissatisfaction in maternal health settings.

Significance and Claims
The authors claim that the Brazilian version of the BSQ possesses adequate psychometric properties for screening body shape dissatisfaction in postpartum women. The study asserts that the instrument captures the "experiential core" of body dissatisfaction in this period, characterized primarily by subjective discomfort, self-criticism, and appearance monitoring rather than extreme compensatory behaviors.

The significance of these findings lies in their potential to enhance evidence-based nursing practice. By providing a validated measurement tool, the study supports the early identification of body dissatisfaction, which is associated with emotional distress and adverse maternal outcomes. The authors posit that incorporating such standardized measures into postpartum care can facilitate more comprehensive assessments and interventions tailored to the psychosocial needs of new mothers.

The paper maintains a modest stance, acknowledging limitations such as the cross-sectional design (precluding temporal stability assessment), the lack of stratification by postpartum phase, and the reliance on Classical Test Theory. The authors conclude that while the BSQ is appropriate for screening in this context, further research is needed to establish measurement invariance across different perinatal stages and to explore associations with clinical outcomes.