Body Image, Identity Development, and Social Media Use Among Youth With Visual Impairment: A Single Case Intervention Study

2. Background and Rationale VI is a term used to describe a partial or complete loss of vision that cannot be corrected with glasses or contact lenses. It can range from mild visual difficulty to complete blindness. It can be caused by either congenital or acquired eye maldevelopments (PVI: peripheral VI) or disruptions in central visual pathways (CVI: cerebral VI). A recent meta-analysis highlights a striking global prevalence of VI in those under 20. Most PVIs stem from genetic issues, like hereditary retinal dystrophies. In contrast, CVI involves damage to post-geniculate visual pathways due to factors like birth hypoxic-ischemic damage, and, as such, is very frequent in children with cerebral palsy. Up to 70% of individuals with genetic syndromes (such as Down Syndrome and other neurodevelopmental disorders) have VI. For this study in particular, children and adolescents with a moderate CVI and children and adolescents with a moderate visual impairment according to the definitions of the World Health Organizations Report on Vision, who have functional impairments that require adjustments, tools and/or support at school will be included. Children and adolescents whose vision can be corrected with glasses and/or contact lenses do not fit the requirement of this study. VI significantly impacts psychological, educational, and social performance, adding mental burden and affecting individuals' quality of life (QoL). In this regard, children with VI experience worse QoL than population-based samples, body image development and mental and social well-being.

Regarding body image development, children and adolescents with VI face unique challenges in developing their body image compared to their unaffected peers. Body image development is a crucial developmental task during childhood, marked by significant biological (e.g., development of secondary sex characteristics), cognitive (e.g., increased self-reflection skills), and psychosocial changes (e.g., heightened importance of peer relationships), directing children's focus toward their evolving physical bodies. Children and adolescents with VI are at a heightened risk of developing negative body image, influenced by various challenges across different contexts (i.e., personal, interpersonal including peer and parental relationships, and societal including media portrayal of appearance), contributing to feelings of differentiation from their unaffected peers. Scholars have advocated to more systematically explore and identify experiences of youth with VI that can nourish and/or harm their healthy body image development. Building on the identification of these experiences, amongst others, the VIPPSTAR project aims to offer the first holistic framework for a life-long enhancement of health, well-being, and autonomy of children and adolescents with VI of different degrees of severity. The VIPPSTAR project will do this through building an online platform, which will contain an avatar that will assist adolescents with VI in several elements of their life; nutrition, physical activity and body image. The current study will solely use the body image module of the platform.

While different factors contribute to body image development, one potentially profound socialization factor is social media. Social media play a dominant role in the lives of children and adolescents, especially visual platforms like Instagram, TikTok, Snapchat and YouTube. For people of all ages and with different types of VI, social media are known to play a big role in their lives. However, since the visual nature of these platforms, users are encouraged to present themselves in a physically attractive way. The idealized appearance images on these platforms typically reflect narrow beauty standards. Exposure to such idealized bodies on social media can lead to internalization of these ideals and adopting them as personal beliefs.

As adolescence marks period with a high risk for the development body image concerns, scholars have noted this developmental period as a key time for intervention. Furthermore, digital and/or mobile interventions have high potential for success for adolescents. Previous research additionally showed that having social media literacy can be a protective factor for body image. Consequently, the present intervention study will examine the effectiveness of doing weekly exercises on body image states in VI children and adolescents. This study specifically focuses on children and adolescents (10-18 years old old) since they are avid social media users. Furthermore, the development of body-related beliefs and behaviors are especially salient during this developmental stage. Additionally, interventions targeting body image and social media literacy have previously been shown to have a small effect in adolescents without a visual impairment. The primary study objective is therefore to explore if doing exercises about body image and social media literacy related to body image can improve the body image of children and adolescents with VI. Conducting this intervention study might lead to a more comprehensive approach of the development of these children and adolescents.

3. Study Design and Objective 3.1 Study objective