A cross-cultural exploration of positive and negative body image and well-being among breast cancer survivors in Australia and China

Body image significantly impacts the psychological and physical well-being of breast cancer survivors, with cultural factors shaping its expression and effects. This study aimed to examine the cultural differences in positive and negative body image of female breast cancer survivors in Australia (N = 338) and China (N = 116) and their associations with well-being. We assessed a path model examining how self-objectification, mindful self-care, and body acceptance by others influences body appreciation, functionality appreciation, and body dissatisfaction-and, in turn, their impact on well-being outcomes (quality of life and psychological distress). No significant between-group differences in body image were observed after controlling for demographic and medical factors. Across both countries, mindful self-care and body acceptance by others were associated with higher positive body image. However, the role of body acceptance by others differed culturally: in the Chinese sample it was associated with both positive and negative body image pathways, whereas in the Australian sample it was more directly related to well-being outcomes. Body dissatisfaction consistently predicted poorer well-being across both groups. Positive body image showed a more differentiated pattern: functionality appreciation predicted quality of life in Australian but not in Chinese participants, while body appreciation was associated with lower psychological distress only in the Chinese sample. These findings suggest that positive and negative body image contribute differently to well-being across cultures and that the psychological mechanisms underlying positive body image may vary across cultural contexts. Understanding these culturally embedded pathways may inform more tailored psychosocial interventions for breast cancer survivors.