The Dove Self-Esteem Project: A Randomised Controlled Evaluation Assessing the Impact of a Body Image Chatbot on Brazilian Adolescents' Body Confidence
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 1,715
- 试验地点
- 1
- 主要终点
- Change in state body satisfaction
研究概览
简要总结
High prevalence of body and eating concerns in Brazilian populations is well-documented, with risk observed across the lifespan. Prevalence rates of body dissatisfaction range between 26.6 - 56% and 10.7- 36% for adolescent girls and boys, respectively (1, 2, 3). The prevalence of these disordered attitudes and behaviours are mirrored in older populations, and have shown to manifest within family units (6). Further, Brazilian consumer trends reflect these attitudes and behaviours, with it being the leading country in diet pill consumption and aesthetic surgeries, and second in the world for total aesthetic procedures (i.e., surgical and non-surgical), with 2.27 million procedures conducted annually (8).
Despite the scope of body and eating concerns, few evidence-based interventions have been developed and tested for Brazilian populations and even fewer are accessible, scalable or cost-effective. Harnessing technology to deliver evidence-based care is a key focus for researchers. Micro-interventions (brief, low intensity, self-administered interventions), offer an alternative to traditional, intense interventions that may be unsuitable for milder concerns. Body image micro-interventions have proven effective at providing immediate and short-term improvements in body image among women (9). To date, body image micro-interventions have been developed and evaluated among high-income, White, English-speaking samples, with little research exploring how this intervention model may cater to other cultures and countries.
The aim of the present study is to conduct a randomised controlled trial (RCT) to evaluate the immediate and short-term impact of a chatbot on Brazilian adolescents' body image, affect and body image self-efficacy. Primary outcomes include immediate and short-term changes in state- and trait-based body image, respectively. Secondary outcomes include immediate changes in state-based affect and short-term changes in trait affect and body image self-efficacy.
The chatbot intervention is designed to target sociocultural risk and protective factors for body image using eight, brief therapeutic techniques derived from several evidence-based theories, including media literacy, cognitive behaviour theory and positive body image. The chatbot was developed through a collaboration between Dove (Unilever), United Nations Children's Fund (UNICEF), The Centre for Appearance Research, and Talk 2 U.
The comparison control condition will be assessment only. This is informed by a care as usual framework; whereby, Brazilian adolescents are not currently offered body image prevention or intervention resources at school or within the community.
To undertake this project, 2800 adolescent girls and boys will be recruited through an external research agency. Participants will be randomised to either the chatbot or assessment only conditions. Those in the intervention condition, will be encouraged to engage with the chatbot over a 72-hour period, where they will be assessed on state-body satisfaction and affect immediately before and after completing an intervention technique. All participants will be assessed on trait body image, affect and body image self-efficacy at baseline, post-intervention (72-hours) and at one-week and one-month follow-ups. At completion of the one-month follow-up, all participants will receive a debrief form, outlining the study aims and objectives, and additional resources for body and eating concerns. Those in the assessment only condition will be invited to engage with the chatbot; however, their engagement will not be monitored or assessed. Lastly, to compensate participants for their time, they will receive an electronic voucher to the value of approx. US$25 and US$21, for the intervention and control condition, respectively.
详细描述
Background
High prevalence of body and eating concerns in Brazilian populations is well-documented, with risk observed across the lifespan. With a population of 211 million people, prevalence rates of body dissatisfaction range between 26.6 - 56% and 10.7- 36% for adolescent girls and boys, respectively (1, 2, 3). Equally, an emerging proportion of adolescents report engaging in disordered eating (i.e., binge eating [10.4%], dietary restriction [8.7%]) and weight control behaviours (i.e., vomit and laxative use [.3 - 7.4%]; 4,5). The prevalence of these disordered attitudes and behaviours are mirrored in older populations, and have shown to manifest within family units (6). A meta-analysis into eating disorder prevalence among Brazilian university students (Mage = 21.6 years) reported 14.9% of students met criteria for an eating disorder, with cases highest among nutrition students (7). Meanwhile, Brazilian parents' perceptions of their child's weight during early adolescence (i.e., 11 years), has shown to predict higher weight gain and engagement in weight control behaviours during late-adolescence (i.e., 18 years; 6). Brazilian consumer trends reflect these attitudes and behaviours, with it being the leading country in diet pill consumption and aesthetic surgeries, and second in the world for total aesthetic procedures (i.e., surgical and non-surgical), with 2.27 million procedures conducted annually (8). Despite the scope of body and eating concerns, few evidence-based interventions have been developed and tested for Brazilian populations and even fewer are accessible, scalable or cost-effective.
It is widely accepted among health professionals, policy makers and governments that the global burden of mental health will never be successfully met by extant health professionals and services alone. Further, current intervention modalities (e.g., face-to-face psychotherapy) may be unnecessary or unsuitable for milder concerns, which may be responsive to lower intensity interventions that demand fewer resources. Harnessing technology to deliver evidence-based care is a key focus for researchers. Micro-interventions (brief, low intensity, self-administered interventions), offer an alternative to traditional, intense interventions that may be unsuitable for milder concerns. Body image micro-interventions have proven effective at providing immediate and short-term improvements in body image among women (9). To date, body image micro-interventions have been developed and evaluated among high-income, White, English-speaking samples, with little research exploring how this intervention model may cater to other cultures and countries. Given the prevalence of body image concerns among Brazilian adolescents, coupled with health care disparities, developing evidence-based micro-interventions for scalability is an imperative step in mental health research for Brazil.
The aim of the present study is to evaluate a chatbot that targets risk and protective factors for body image among Brazilian adolescents. Using a two-armed randomised controlled trial design (i.e., intervention vs. assessment only), the study will assess the chatbot's efficacy at eliciting immediate and short-term improvements in adolescents' state- and trait-based body image, affect and body image self-efficacy. This is the first artificial intelligence chatbot to target body image among adolescents, particularly in Brazil; thus, a secondary aim is to assess user's intervention engagement and adherence.
A set of hypotheses were formulated for overall chatbot efficacy (H1-H2), moderation effects within sub-samples (H3) and intervention engagement and adherence (H4):
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Prevention
- 盲法
- Single (Outcomes Assessor)
盲法说明
Data analysts will be blinded to condition allocation (dummy coded) when conducting statistical analyses on primary and secondary trait outcomes; however, blind analyses cannot be conducted on primary and secondary state measures due to the within-group design. Two datasets will be created one for between group analyses with dummy coding, and a second dataset for within group analyses without dummy coding.
入排标准
- 年龄范围
- 13 Years 至 18 Years（Child, Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Those aged 13-18 years old; Portuguese speaking; Brazilian resident; and, have access to Facebook Messenger.
排除标准
- 未提供
研究组 & 干预措施
Body image chatbot
The artificial intelligence chatbot, Topity, is designed to target sociocultural risk and protective factors for body image using eight therapeutic techniques derived from several evidence-based theories, including media literacy, cognitive behaviour theory and positive body image. The intervention aims to engage users in techniques that teaches users how to 1) Critically analyse and evaluate media content to reduce vulnerability to negative media influences (i.e., media literacy theory; 10); 2) Identify and challenge unhelpful thinking styles and behaviours that perpetuate body image distress (i.e., cognitive behaviour theory; 11); and 3) Appreciating the features, functions and health of the body, beyond it's appearance (i.e., positive body image theory; 12). Users will be assessed on state body satisfaction and affect before and after engaging with a technique to assess the immediate impact of the micro-intervention.
干预措施: Body image chatbot (Behavioral)
Assessment only
The comparison control condition will be assessment only. This is informed by a care as usual framework; whereby, Brazilian adolescents are not currently offered online body image prevention or intervention resources at school or within the community.
结局指标
主要结局
Change in state body satisfaction
时间窗: Immediately pre-intervention and immediately post-intervention (change)
Measured via a 11-point Likert scale (0 = not at all satisfied; 10 = very satisfied).
Change in trait body image
时间窗: Baseline, post-intervention (72-hours following baseline assessment), one-week follow-up (7-days following post-intervention assessment) and one-month follow-up (28-days following post-intervention assessment).
Brazilian version of the Body Esteem Scale for Adolescents and Adults (BESAA; 13); a 23-item scale, comprising of three subscales: appearance esteem, weight esteem and attribution. Responses are scored on a 5-point Likert scale (1 = never to 5 = always).
次要结局
- Change in state affect(Immediately pre-intervention and immediately post-intervention (change))
- Change in trait affect(Baseline, post-intervention (72-hours following baseline assessment), one-week follow-up (7-days following post-intervention assessment) and one-month follow-up (28-days following post-intervention assessment).)
- Change in body image self-efficacy(Baseline, post-intervention (72-hours following baseline assessment), one-week follow-up (7-days following post-intervention assessment) and one-month follow-up (28-days following post-intervention assessment).)
- Total acceptability of the intervention(Through intervention completion, over the course of 72-hours.])
- Total intervention adherence(Through intervention completion, over the course of 72-hours.)