Tools

Semi-structured Interview
            A protocol was prepared to conduct a semi-structured interview. A set of pertinent questions for conducting the interview was developed by the researcher following the criteria of relevance and significance of the items to the field of positive body image. They were based on existing theories and the conclusions of the important selected studies of the field. The interview protocol prepared in the pilot study was used in this phase for collecting data. The following items were included in the interview protocol of semi-structured interview of the qualitative study:
1.      Please describe in detail the way you think and feel about your body?
2.      Describe in detail about the importance of positive body image.
3.      What significant information you have received from your close relatives (Family, Spouse, Boyfriend/Girlfriend etc.) about your body?
4.      In what manner you can achieve a positive image of your body?
5.      How does your positive body image influence your social relationships?
6.      In your opinion, what type of messages about positive body image should be encouraged by society (TV, Cinema, Magazines, News Papers etc.)?
Body Appreciation Scale
            To assess the degree to which participants had positive attitudes towards their bodies, the Body Appreciation Scale (Avalos et al., 2005) was used. The scale was originally in English which was translated first in Hindi followed by retranslation in English by three researchers. The scale consists of 13 items tapping participants’ feeling about their body image (e.g., “I respect my body”). Items were rated on a 5-point scale (1 = Never, 5= Always), and were averaged to arrive at a total score (higher scores reflected greater body appreciation). This scale has been widely used by the researchers around the globe for the study of positive body image. The Cronbach’s alpha coefficients of the scale have been reported .92 and .94 for male and female, respectively (Tylka, 2013).
Audio Tape Recorder
            The verbatim contents of the interviews of the participants were audio recorded with the help of recording device available in the mobile phone version Moto G3. The verbatim inscriptions of the recorded interviews were prepared with comments, if any, to smooth the process of carrying out analysis of the collected data by the judges/experts using the thematic analysis. The data of all the participants were organized according to the order of the items of the interview followed by the analysis employing the thematic analysis method (Braun & Clarke, 2006).
Body Mass Index (BMI)
            The body mass index (BMI) or Quetelet index is a value derived from the mass (weight) and height of an individual. The BMI is defined as the body mass divided by the square of the body height and is universally expressed in units of kg/m2, resulting from mass in kilograms and height in meters. According to the World Health Organization (2016), the normal range of BMI extends from 18.50 to 25.00. 

Procedure

            The first phase of the study employed semi-structured interview according to pre-developed protocol. After the insights developed from conducting the pilot study, some minor modifications were done in the procedure. Following the inclusion of suggestions of three experts, the number of items of the pilot study was reduced from nine to six. All the six items were translated from Hindi to English following translation and retranslation method. The other details of the procedure are the same as were observed in the pilot study.
            After having finalized the interview protocol, the participants were recruited. To choose the genuine participants, the inclusion and inclusion criteria were strictly followed. Normal BMI (18.50-25.00), high scores on Body Appreciation Scale (above fifty); apparent physical and mental health and age range from 20 to 35 were the criteria of recruiting the participants in the study. Those participants were allowed to take part in the pilot study who strictly satisfied these criteria. With these preparations, the proposal of the pilot study was put before the Ethical Committee of the Department of Psychology, School of Humanities & Social Sciences, [BLINDED FOR REVIW] for its approval to conduct the study.
After its approval, the actual data collection was started. Twelve participants were recruited for the study. Before the start of data collection, a rapport was established and the participants were debriefed about the basic objectives of the study. These questions were asked in the style of normal conversation. In addition to these questions, the researchers asked some probe questions in an attempt to clarify the queries arose out of the interview. According to the protocol, the interviews of the participants were conducted and the same was also audio-taped with the help of recording device available in the mobile phone version Moto G3. The verbatim inscriptions of the recorded interviews were prepared with comments, if any, to smooth the process of carrying out the thematic analysis of the collected data by the judges/experts using the thematic analysis. The data of all the participants were organized according to the order of the items of the interview followed by the analysis employing thematic analysis method as per the guidelines of Braun and Clarke (2006) which involves familiarizing with data, generating initial codes, searching for themes, reviewing themes, defining and naming themes and producing the report.
To enhance the reliability and validity of the analysis of qualitative data, to ascertain the procedural details, the efficacy of the items of the interview protocol and to finalize the actual process of data analysis, researchers involved his research supervisor and one more faculty member of the department in the process of data analysis. These three members read and re-read the data and came up with their independent findings regarding the major theme and sub-themes of positive body image. After they had completed data analysis and reached to their themes and sub-themes, a conference of the three was held to check and establish consistency of the descriptions, themes and sub-themes inherent in the data. It followed a thorough discussion to reach a consensus about the procedural details and ascertain the efficacy of the procedure and items as well. After the discussion, the researchers agreed on minor modifications in the items of the protocol of the semi-structured interview.
The outcomes of the pilot study proved very important and useful for conducting the actual study. Important modifications, guidelines to be observed in the process of interview, the role of the interviewer, the place and style of interview and many other procedural details were clarified which certainly had positive impacts on the quality of the data that were collected in the actual qualitative study. The number of questions to be queried was reduced from nine to six for the actual study. The method of analysis also got improved especially in the conference. The method of allotting codes was ascertained. The pilot study helped a lot in developing a uniform method of data analysis, allotting codes and coming up with themes and sub-themes as well as the method of conducting interviews.

Results

            Many important attributes of positive body image were generated out after the analysis of the qualitative data. Theme 1 denoted that positive body image is a complex phenomenon which comprises of cognitive, emotional and behavioural components. The scrutiny of the data showed that positive body image has many facets. For example, the participants showed positive thoughts, memory, and decision making regarding their body attributes. Positive body image facilitates people in their satisfaction with life, respecting others and himself/herself helps build confidence and feel inner comfort. Positive body image comes from spirituality; it is not a matter of social comparison. People with joyous nature have a positive outlook towards their body attributes. Positive body image helps shape the mental and physical health. Positive Body image is not only limited to physical fitness but also to the concerns of demeanour.
            Theme 2 showed that positive body image is important for self-confidence, success in life and social status. Positive body image of the participants has been found to contribute to enhancing their self-confidence, success and social status. These contributions of positive body image were expressed in many ways. For instance, thinking positively about the body increases self-confidence. The individuals with positive body image do not care much about what others think. Positive body image helps to achieve social status. The positive body image is a source of happiness. Positive comments from close relatives help enhance positive body image. Self-respect towards one’s body helps maintain positive body image. Family support enhances the positive experience of the body. Regular health care positively affects body image.
            Theme 3 demonstrated that yogic practices, meditation, media and literature help attain positive body image. Positive body image can be cultivated by practising yoga and meditation regularly. Motivational stories, videos etc. help enhance and maintain a positive body image. Positive health practices facilitate achieve a positive body image. Positive media and literature are important for the development of positive body image. Facing negative messages about body image is important for achieving positive body image.
            Theme 4 showed that positive body image helps in enhancing and maintaining a relationship.  Social relationship plays an important role in maintaining the positive body image. Positive body image helps to get prestige in society. Positive body image helps enhance and maintain relationships in society. Feedback of other person related to the body can affect your relationship. Positive body image helps to attract the opposite gender.

Discussion

            The results of the qualitative study have evinced that positive body image is a complex phenomenon which is shaped and regulated by an intricate interplay of personality attributes, interactions, emotions, cognitions, multiple outcomes and social influences. The findings of the study demonstrated that there were four major themes with many sub-themes which emerged out the thematic analysis of the qualitative data. The theme 1 signifies that positive body image led to positive thoughts, memory and decision making of the participants of both the gender. Theme 2 denoted that the participants with perceptions of positive body image reported self-confidence, success in life and social status. Theme 3 indicated that positive health practices such as yogic practices and meditation had important contributions in managing their positive body image. Theme 4 denoted that positive body image helped the participants of both the sex to develop, maintain and enhance interpersonal and social relationships.
            The results obtained in the present study find sufficient support from previous studies conducted on positive body image. Previous studies have reported that body image is an inseparable constituent of self-concept affecting human functioning, performance and quality of life (Cash & Smolak, 2011). Positive body image has also been reported to regulate and impact interpersonal relationships, self-esteem, eating behaviours, well-being and other dimensions of human behaviours irrespective of age, gender, cultural background and personality attributes of the individuals in previous studies (Cash & Smolak, 2011). Like previous findings, the present study reported that positive body image signified perceptual, affective, cognitive and behavioural body images constituting four major dimensions of positive body image (National Eating Disorder Association, 2018). The results of the present also exhibited that individuals possessing positive body image exhibit a clear, true perception of body shape, appreciate their natural body shape, feel proud and accept the uniqueness of their body (National Eating Disorder Association, 2018).
Many positive attributes and outcomes have been reported by the previous researchers carrying positive body image. Similar to the previous findings, the present study had shown that positive body image entailed optimism, self-esteem, social support, adaptive coping and weight stability. The major themes and sub-themes of the present study have many similarities with the themes reported by previous researchers. A close examination of the qualitative data of the present study has evinced that many positive outcomes were reported to be carried with having a positive body image which gets supported from previous studies (Lyubomirsky & Lepper, 1999; Swami et al., 2008, 2013). Similar to the previous findings, the present study also corroborated that the desire to lose weight, look beautiful, healthy and energetic with productive and good performance was closely associated with the positive body image which, in turn, shape functioning and performance of the individuals (Chaiton et al., 2009). Previous studies have also reported a variety of components of positive body image which included body appreciation, body acceptance, inner positivity influencing outer demeanour, a broad conceptualization of beauty, media literate, unconditional acceptance from others, spirituality/religion and listening to and taking care of the body (Wood-Barcalow et al., 2010b). Thus, four themes along with many sub-themes emerged from the analysis of the qualitative data fulfilled the first and big goal of the present study.

Study 2: Quantitative Phase

            The results of the qualitative phase of the study indicated that the construct of positive body image is multi-faceted and multi-dimensional in nature, different from the negative body image, characterized by different attributes and regulatory mechanisms, closely associated with a host of measures namely body appreciation, positive rational acceptance coping, body image flexibility, body functionality, attunement, body pride, positive and self-accepting body talk, body sanctification, a broad conceptualization of beauty and body acceptance by others (Webb et al., 2015). The positive body image has been reported to play a significant role in positive human functioning and productivity proliferating across age, gender and cultures (Webb et al., 2015). In this backdrop, the quantitative phase of the study was planned in consonance with the insights emerged from the qualitative study. This phase of study attempted to prepare a list of relevant items for further establishment of a scale of positive body image for adults of the Indian population.

Objectives

1.      To prepare items for positive body image scale from the descriptions of the qualitative data, and
2.      To standardize a comprehensive tool to measure positive body image based on the themes and descriptions of the qualitative data,

Methods and Procedure

The major goal of the quantitative phase of the study was to prepare items for positive body image scale and establish empirically its reliability and validity. Initially, a list of 110 items was prepared followed by face validation of the items by three experts who have sufficient background in psychological theorizing, measurement and research. After face validation, only 45 items were retained for empirical validation on an adult sample.

Sample

            In the quantitative phase of the study, 507 participants comprising 268 males (M = 26.29, SD = 2.75) and 239 females (M = 24.83, SD = 2.43) age ranging from 20-35 years pursuing their undergraduate and postgraduate studies from different educational institutions of Sagar, Madhya Pradesh, India were recruited. The convenient sampling procedure was used to select the participants for the study.

Tools

General Health Questionnaire
            To measure the general health of the participant, General Health Questionnaire (Goldberg & Hillier, 1979) was used. The participants were asked to compare their recent psychological state with their usual state. For each item, four answer possibilities are available. The higher the score the poorer was the psychological well-being.
Quality of Life
            Quality of life of the participants was assessed through the WHO Quality of Life inventory (World Health Organization, 1996). This questionnaire comprises 26 items. It entails four domains: physical quality of life, psychological quality of life, social quality of life and the environmental quality of life. The scoring pattern was based on a five-point scale.

Procedure

            After the procurement of the psychometric tools, the participants were approached individually and debriefed about the basic goals of the study. Then the participants were supplied with a set of the scales. Participants were instructed to read the instructions carefully before giving the responses of any questionnaire. The mean, standard deviation (SD), t-test, Pearson Product Moment Method of Correlation and factor analysis were carried out on the data.

Results

            The central aims of the second phase of the study were to estimate the reliability and validity of the positive body image scale by assessing its association with the scores of general health and quality of life. Results have presented in three sections.     As per the method discussed above, the descriptions of the contents of the inscriptions were prepared. On the basis of these descriptions, a list of 50 items was prepared initially. Three experts were engaged to ascertain the face validity of the items. A pool of items was generated on the basis of emerged themes and attributes of positive body image. Initially, 50 items were written in Hindi language and to assess the face validity of the scale again three experts have critically scrutinized all the 50 items and finally, 30 items were found suitable to go for empirical validation. All the items were rated on a seven-point scale (1-Very Strongly Disagree, 2-Strongly Disagree, 3-Somewhat Disagree, 4-Neutral, 5-Somewhat Agree, 6-Strongly Agree, 7-Very Strongly Agree).
            To ascertain dimensional attributes of the positive body image scale, the scale was administered on five hundred seven adults. The factor structure was computed by the principal component analysis with Varimax Rotation Method was computed. Six items were excluded from the scale due to their poor loadings. The details of the values of factor loadings of the 30 items have been presented in Table 2.
Table 2
Factor loadings of the items of the Positive Body Image Scale
S. No. Items Factor Loadings
I II
1. I respect my body and its parts. .769 .063
2. I feel good about my body. .763 .136
3. I do not compare my body and its parts to anyone else. .557 .142
4. My body is attractive. .547 .259
5. I am satisfied with my body. .691 .136
6. I think exercise is essential to keep the body healthy. .757 .081
7. I want people to accept my body as it is. .754 .161
8. My body makes me self-confident. .609 .329
9. My body makes me happy. .633 .323
10. I have so many good qualities in my body. .499 .378
11. My body has an important contribution to become successful in my life. .355 .441
12. I think physical beauty has great importance in life. -.006 .474
13. Positive body image is helpful in the adjustment. .347 .446
14. My body is a gift given by God. .401 .369
15. The image of my body is helpful in making social relations. .157 .663
16. My body image enhances my personality. .162 .617
17. My body attracts people. .194 .574
18. The image of my body is helping me in attaining my social status. .068 .671
19. My body image helps me to take advantage of opportunities in different areas. .112 .678
20. People respond positively to my body. .131 .574
21. I am conscious and aware of my body. .225 .494
22. I follow the systematic routine to maintain my body image. .278 .564
23. I think Sport/Gaming is important to maintain the body image. .364 .467
24. I enjoyed being part of social gatherings. .240 .501
             After the factor analysis of the items of the scale, two major factors of positive body image emerged. After close consideration of the contents of items of each factor, they were labelled as body appreciation and body effectiveness. The details of the two components are as under:

Body Appreciation

            The items of Factor 1 were labelled as body appreciation. The body appreciation referred to the respect, satisfaction, acceptance, positive feelings, attractiveness, self-enhancing effects and God-giftedness of body and its attributes. This name was appropriate as it involved respect for the body, good feeling, non-comparison, attractiveness, high satisfaction with the body and its attributes, promotive aspects (exercise), desire for acceptance of real body and its attributes by others, enhancing (self-confidence, happiness), positive perception (many good qualities) and a gift of God. These attributes of positive body image were also evident in the verbalizations of the participants of the qualitative study. It consisted of 11 items.

Body Effectiveness

            This body effectiveness dimension consists of the items that consisted of the effectiveness of body in achieving various life success and outcomes and helpful in achieving social praise, opportunities, positive feedback, identity as well as positive efforts. This label was appropriate as body effectiveness was reported to be helpful in life success, adjustment, beauty, effective social relationships, effective personality, attractive capacity, social praise and status, life opportunities, positive responses of others, familiarity, positive efforts (systematic routine, Sport/Gaming) and positive social and interpersonal outcomes of the participants. 

Psychometric Properties

            The reliability and validity of the components and overall scale were estimated. The details are as under:
Reliability
            The scale comprises of two dimensions of positive body image: body appreciation and body effectiveness comprising 11 items and 13 items, respectively. The reliability was estimated by computing Cronbach’s Alpha which was .878, .844 and .903 body appreciation, body effectiveness and overall positive body image scale, respectively
Validity
            Its validity was estimated by computing correlations among the scores of the body appreciation, body effectiveness and overall positive body image, and the scores of physical quality of life, psychological quality of life, social relation quality of life, environmental quality of life and overall quality of life. In addition, the scores of body appreciation body effectiveness and overall positive body scale were correlated with the scores of and somatic, depression and overall general health.
The scores of body appreciation exhibited significant positive correlations with the scores of physical (r = .231, p = .000), psychological (r = .299, p = .000), social relation (r = .157, p = .010) and environmental (r = .226, p = .000) dimensions of quality of life of the male participants. Likewise, the scores of the female participants on body appreciation and the scores of physical (r = .290, p = .000), psychological (r = .411, p = .000), social relation (r = .175, p = .007) and environmental (r = .308, p = .000) aspects of quality of life also exhibited significant positive correlations. Similarly, the overall scores on this measure demonstrated significant positive correlations with the scores of physical (r = .235, p = .000), psychological (r = .336, p = .000), social relation (r = .174, p = .000) and environmental (r = .240, p = .000) aspects of quality of life.
The results showed that there were significant positive correlations among the scores of body effectiveness and the scores physical (r = .298, p = .000), psychological (r = .291, p = .000), social relation (r = .218, p = .000) and environmental (r = .196, p =.001) aspects of quality of life of the males. The same trend also got repeated in the case of females again where this dimension of positive body image showed significant positive correlations with scores of the physical (r = .374, p = .000), psychological (r = .303, p = .000), social relation (r = .188, p = .004) and environmental (r = .226, p =.000) aspects of quality of life. Similarly, significant positive correlations were also observed among the scores of body effectiveness and the scores of physical (r = .329, p = .000), psychological (r = .316, p = .000), social relation (r = .212, p =.000) and environmental (r = .218, p = .000) aspects of quality of life.
            The results showed that there were significant positive correlations among the scores of overall positive body image and the scores of physical (r = .300, p = .000), psychological (r = .329, p = .000), social relation (r = .213, p = .000) and environmental (r = .234, p = .000) aspects of quality of life of the males. The significant positive correlations among the scores of overall positive body image were also observed with the scores of physical (r = .374, p = .000), psychological (r = .303, p = .000), social relation (r = .188, p = .004) and environmental (r = .226, p = .000) aspects of quality of life of the females. Lastly, significant positive correlations among the scores of overall positive body image and the scores of physical (r = .329, p = .000), psychological (r = .316, p = .000), social relation (r = .212, p = .000) and environmental (r = .218, p = .000) dimensions of quality of life were observed for all the participants.
Contrarily, significant negative correlations were found among the scores of body appreciation and the scores of somatic (r = -.138, p = .024), depression (r = -.121, p = .048), general health (r = -.167, p = .006) of the male participants. For the females, the results showed similar trend as there were also significant negative correlations among the scores of body appreciation and the scores of depression (r = -.127, p = .05) and general health (r = -.191, p = .003) except somatic (r = -.119, p = .066). These values have been presented in Table 3.
Table 3
Coefficients of correlation among the scores of various components of positive body image, quality of life and general health of the male and female participants
S. No. Measures Gender
Male Female Overall
r p r p R p
1. Body Appreciation and Physical Quality of Life .231** .000 .290** .000 .235** .000
Body Appreciation and Psychological Quality of Life .299** .000 .411** .000 .336** .000
Body Appreciation and Social Relation Quality of Life .157** .010 .175** .007 .174** .000
Body Appreciation and Environmental Quality of Life .226** .000 .308** .000 .240** .000
Body Appreciation and Somatic Symptoms -.138* .024 -.119 .066 -.140** .002
Body Appreciation and Depression -.121* .048 -.127* .050 -.134** .004
Body Appreciation and Overall General Health -.167** .006 -.191** .003 -.178** .000
2. Body Effectiveness and Physical Quality of Life .298** .000 .374** .000 .329** .000
Body Effectiveness and Psychological Quality of Life .291** .000 .303** .000 .316** .000
Body Effectiveness and Social Relation Quality of Life .218** .000 .188** .004 .212** .000
Body Effectiveness and Environmental Quality of Life .196** .001 .226** .000 .218** .000
Body Effectiveness and Somatic Symptoms -.018 .772 -.036 .580 -.045 .325
Body Effectiveness and Depression -.028 .643 -.043 .504 .003 .947
Body Effectiveness and Overall General Health -.055 .369 -.096 .138 -.031 .508
3. Overall Positive Body Image and Physical Quality of Life .300** .000 .377** .000 .321** .000
Overall Positive Body Image and Psychological Quality of Life .329** .000 .394** .000 .363** .000
Overall Positive Body Image and Social Relation Quality of Life .213** .000 .204** .001 .218** .000
Overall Positive Body Image and Environmental Quality of Life .234** .000 .295** .000 .255** .000
Overall Positive Body Image and Somatic Symptoms -.081 .189 -.082 .205 -.098* .033
Overall Positive Body Image and Depression -.079 .200 -.091 .161 -.065 .158
Overall Positive Body Image and Overall General Health -.118 .054 -.156* .016 -.108* .019
(*p< .05, ** p< .01)