Reflections on the conceptual framework

My research was guided by White’s (2000) model, which conceptualizes the multidimensionality of body image as it is applied to cancer patients and their affected body part(s). White’s model is based on a self-schema (i.e., one’s beliefs about the self) and a body image-schema (i.e., one’s belief about her appearance), which initiates and will influence how the appearance-based changes resulting from the cancer experience are processed. My study was the first that I am aware of to apply White’s (2000) model to breast cancer survivorship and physical activity. This was a limitation since White’s (2000) model did not specifically focus on breast cancer survivors’ and their participation in endurance sporting events such as the CIBC Run for the Cure 5k. Despite this

limitation, I decided to use White’s model, primarily because it conceptualized the multidimensionality of body image in cancer patients. Since White’s model focused on the multidimensionality of body image, I used it to assure the dimensions (e.g., self-schema, body image self-schema, investment in changed body image feature, appearance, emotions, etc.) were reflected in the women’s semi-structured interviews. Specifically, I employed White’s model to guide the interview questions related to thoughts, feelings, behaviours, and attitudes of the women’s body image. I used each dimension of White’s model to guide the interview questions to highlight the complexity of the women’s body image experiences. However, since White’s model was generally applied to cancer patients, it would have been beneficial for the model to focus on the dimensions as they apply to different types of cancer and affected body part(s). In my case, if White’s (2000) model focused specifically on breast cancer then it would have provided a clearer understanding of the dimensions as they applied to the women in my study. I addressed this limitation by creating the interview questions as they fit the purpose of my study and the women’s thoughts, feelings, behaviours, and attitudes of their body image

experiences. In addition, it would have been beneficial if White’s (2000) model had been used in different contexts including physical activity. Since research has shown that physical activity can alleviate psychological concerns such as body image from cancer (McDonough et al., 2008; Schmitz, 2011), further insight would have provided how physical activity can shape a cancer’s patient body image and the role that it plays in their affected body part(s). Perhaps White’s (2000) model could also include specific

dimensions, such as sport competences, physical strength, and physical conditioning, that play a role in the cancer patient’s thoughts, feeling, attitudes, and behaviours about their body image and participation in physical activity. More specifically, these types of added dimensions (e.g., sport competences, physical strength, and physical conditioning) would provide further insight into the multidimensionality of body image in cancer patients and how training and participating in physical activity shapes their body image experiences.

Based on my research, future research should continue consider using White’s model to explore the multidimensionality of body image to better understand breast cancer survivors’ body image experiences, as has previously been recommended (Brunet et al., 2013).

White’s (2000) model also emphasized the need for a social constructivist perspective when exploring cancer survivors’ experiences. This approach aligns with Blood’s (2005) recommendation to provide opportunities for women to voice their thoughts, feelings, attitudes, and behaviours related to their body image experiences.

According to Blood (2005), body image is not a “consistent and stable construct” (p.132), and because of this women can recognize the changes that occur over time and can better understand their body image experiences in a positive light. As the researcher, it was important for me to identity that body image experiences are complex and dynamic, to make sure that I was not directing the women to focus on one dimension of body image.

To address this concern, I concentrated on the broader dimensions of body image in the women’s stories, meaning that I framed the interview questions around the women’s thoughts, feelings, attitudes, and behaviours of their body image experiences.

Blood’s work also informed my research by emphasizing the importance of allowing women to voice their thoughts, feelings, attitudes, and behaviours about their body image experiences, a gap that previously been recognized (Brunet et al., 2013).

Given that Blood’s (2005) work focused on providing women opportunities to voice their thoughts, feelings, attitudes, and behaviours of their body image experiences, she has yet to address this concern of women’s body image experiences being heard as it applies to women involved in physical activity and specific populations such as breast cancer survivors. Perhaps physical activity and sporting contexts provide women with unique experiences that shape their thoughts, feelings, attitudes, and behaviours about

their body image. Since researchers have shown that sports participation to help women develop a positive body image (Frederickson & Roberts, 1997; Greenleaf, Boyer, &

Petrie, 2009; Petrie & Greenleaf, 2011), providing the women opportunities to express their voices in physical activity and sporting contexts may demonstrate body image to be experienced differently than in non sporting contexts. For example, women involved in physical activity and sports maybe more likely to voice positive thoughts, feelings, attitudes, and behaviours about their body image because of physical skills (e.g., strength, speed, and agility) versus only on appearance (Greenleaf, Boyer, & Petrie, 2009).

A second critique broadly looks at qualitative research and social constructivism.

Social constructivism has been critiqued on how reality can be understood and promotes knowledge since it lacks the objectivity and generalizability purported by positivism (Alexander, 2006; Lincoln & Guba, 2002). Positivists have argued that social

constructivism focuses on subjectivity and exploring human experience at the expense of objectivity and knowing “truth” (Alexander, 2006; Haverkamp & Young, 2007).

Alternatively, social constructivists argue that providing a deeper level of understanding individual’s experiences is a priority over generalizability (Lincoln & Guba, 2002).

Qualitative research has created resistance and confusion for positivists to understand how reality is socially constructed particularly using a social constructivism lens in health related research (Broom & Willis, 2007). Specifically, Broom and Willis (2007) stated that positivist health researchers have a hard time understanding how the experiences of individual’s with cancer are socially constructed. In regards to my work on breast cancer and body image, positivists might argue that body image is a fixed entity and that an individual’s thoughts, feelings, behaviours, and attitudes are measurable (Blood, 2005).

Furthermore, positivists would likely suggest that the knowledge of women’s body image and breast cancer experiences is not found nor constructed, but that knowledge is

objective and can be achieved from scientific method and quantification (Broom &

Willis, 2007; Schwandt, 2002).

To address this debate, Broom and Willis (2007) stated that there are both subjective and objective aspects to health related research such as cancer. Quantitative and qualitative research each serve their own purposes and generate knowledge based on the chosen methodologies (Broom & Willis, 2007). Although I chose a qualitative

methodology and was guided by a social constructivist worldview, I think that quantitative research remains important to research on breast cancer survivors, body image, and physical activity; most specifically, because it allows researchers to make generalizations about their research (Lincoln & Guba, 2002). In addition, quantitative approaches would allow for the testing of any potential essential structures underlying women’s body image experiences and their participation in physical activity. Essential structures is a term used in empirical phenomenology to describe the components that make up the essential structures of individual’s experiences (Berry, Kowalski, Ferguson,

& McHugh, 2010; Giorgi & Giorgi, 2003).

According to the literature (Mitchell et al., 2007; McDonough et al., 2008; Parry, 2007; Sabiston et al., 2007), social support is important to breast cancer survivors

because they receive informational support (e.g., cancer treatments and surgeries) and emotional support (e.g., empathy) from the other women participating in the physical activity. Some of the essential structures that are important to the women’s experiences and participation may include informational support, emotional support, and social integration (Holland & Holahan, 2003; McDonough et al., 2008; McDonough et al., 2011; Sabiston et al., 2007). This is consistent with Holland and Holahan’s (2003) study that found the social provisions of attachment, reassurance of worth, social integration, and guidance to be important to the social support of breast cancer survivors. The women in their study reported that attachment, reassurance of worth, social integration, and guidance resulted in greater perceived social support and psychological well-being.

Furthermore, testing some of these essential structures would help better understand the relationship between variables and the types of social support that the women experience from participating in physical activity.

An example of a potential direction that might be particularly well-suit to

quantitative research is the development of a body image and cancer questionnaire based on White’s (2000) heuristic body image model, specifically one assessing the

multidimensionality of body image among a cancer population. This type of instrument development might be useful in tracking of specific body-related changes resulting from cancer (White & Hood, 2011). I offer this recommendation with caution, however, because, Blood (2005) has critiqued quantitative research stating that it objectifies

women’s bodies at the expense of their lived experiences. Having said this, I would argue that quantitative research generates important knowledge on the relationships between variables, such as between women’s thoughts, feelings, attitudes, and behaviours about their body image and the changing physical body. Furthermore, creating a

multidimensional body image and cancer questionnaire, perhaps one similar to Cash and colleagues’ Multidimensional Body Self Relations Questionnaire (MBSRQ), based on White’s (2000) model would move the field forward by endorsing the

multidimensionality of cancer patient’s body image and comprehensively highlight the body image variables that are important to cancer patient’s body image experiences.

Additionally, it seems important to assess social support variables, since the women in my study frequently spoke about the social support they received from other women in both the CIBC Run for the Cure 5k and dragon boating. Researchers have shown social support to be an important determinant of women’s participation in physical activity (e.g., Penedo & Dahn, 2005). Furthermore, measuring social support would also derive results that may include how frequent the breast cancer survivors are receiving social support over a given period of time and provide insight into breast cancer

survivors’ motivation to participate and adherence to physical activity (Eyler, Brownson, Donatelle, King, Brown et al., 1999). This would also lead to further understanding of breast cancer survivors’ body image experiences, since the women have stated that informational and emotional support plays an important role in their participation, especially in helping them relate to one another in their body image and breast cancer experiences (McDonough et al., 2011; Parry, 2007; Sabiston et al., 2008). Overall, quantitative and qualitative research methods are important to the future development of body image and breast cancer research because they both generate knowledge that contribute to the understanding of body image and body-related changes from cancer and how they can impact breast cancer survivors’ quality of life.