A Cluster Randomised Controlled Trial of Three School-based Body Image Interventions Delivered by Teachers

Background:

Body image is recognised as an important public health issue by governments, policy-makers, and health professionals. Poor body image is associated with engagement in unhealthy weight loss behaviours, depression, reduced academic performance, and has been established as an important risk factor in the development eating disorders. Within Western societies, poor body image is also common, with an estimated 25-61% of adolescent girls and boys being dissatisfied with their appearance. This underlines the importance of prevention and early intervention. As such, researchers, governments and health professionals are increasingly seeking effective evidence-based body image interventions that can be disseminated to the public, in a bid to reduce body image concerns and other adverse negative health related effects such as eating disorders. However, widespread dissemination of these programmes remains a challenge due to the difficulty of reaching individuals at risk, the traditional focus on females only, and the reliance on expert intervention facilitators.

Although it can be difficult reaching those at risk with individual targeted prevention programs, school-based interventions provide a useful opportunity to reach large and diverse groups of children and young people, crossing all levels of risk and gaining access to those who may otherwise not receive necessary intervention. Effective school-based interventions are designed to reduce the presence or influence of risk factors for body image concerns (e.g., internalisation of appearance ideals, appearance pressures from friends, family and the media, appearance-related teasing and bullying, and negative emotions such as depression and anxiety) in an effort to promote healthy body image. Previous school-based work has demonstrated some success in reducing body concerns at the conclusion of program implementation and over meaningful follow-up periods, with evidence showing media literacy and cognitive dissonance approaches to be useful in this context. However, there is still room for improvement in the magnitude of effects for universal programmes, and the majority are still targeted at girls and led by expert facilitators. Consequently, further evaluation of different approaches in this setting is required.

In addition, another factor which is still rather mixed within the literature, and has an impact on how universal programmes are delivered, is regarding the use of expert-led versus teacher-led interventions. Previous reviews have shown that programs are more effective when facilitated by dedicated expert interventionists. However, evidence from previous studies conducted by the investigators supports the notion that teachers can deliver a body image intervention effectively with minimal training. Hence, more research is needed to understand the effectiveness of teacher led interventions further, as successful task-shifting to non-expert providers has been identified as an important goal for disseminating mental health interventions at scale.

Therefore, the aim of this research is to evaluate the efficacy and acceptability of adapted interventions based on mindfulness and cognitive dissonance, respectively, for delivery to adolescent girls and boys (aged 13-14 years) by trained teachers. They will be compared against an existing universal intervention with support for teacher-led delivery and a class-as-usual control group.