Title: A feasibility study to inform an RCT to evaluate an online psychosocial intervention for young people with appearance-altering conditions (YP Face It).
Funder: Department of Health (England)

Abstract: Background One in 44 young people (aged 12-17) have a condition, disease, or injury causing a ‘visible difference’ (‘disfigurement’)(1,2). Irrespective of cause, location or severity, disfigurement can impact on normal social development and health-related quality of life, especially during adolescence(5-9). Surgical and medical advances are not a panacea for the distress many suffer daily - 1/3 report negative body image, low self-esteem, social anxiety, and poor academic performance(14-20). Negative body image is a key component and predictor of disordered-eating, depression, smoking, steroid and diet-pill use, unhealthy tanning behaviour, exercise and social avoidance(24). If not addressed, social anxiety can lead to anxiety disorders in adulthood: an economic burden from both social and health perspectives(21-26). People with a visible difference benefit from psychosocial support to develop self-management skills rather than relying exclusively on medical and surgical solutions(3), but provision of evidence-based psychosocial interventions for young people (YP) is inadequate(4). However, interventions based on cognitive behavioural therapy (CBT) and social interaction skills training (SIST) show promise(4). An RCT of a CBT and SIST-based online intervention for adults with a visible difference (FaceIT) demonstrated reduced depression, anxiety and appearance concerns(38).In collaboration with YP and clinical experts, we evaluated the suitability of FaceIT for YP . Extensive changes to its content and delivery were recommended, so we collaborated with YP, parents, experts, and a web-design company to design YP Face It for 12-17 year olds. This programme proved acceptable to 28 health professionals and 30 YP with a wide-range of appearance-altering conditions(12). Aims: To establish the feasibility of an RCT of YP Face It, delivered through primary care, for YP distressed by a condition/injury/treatment affecting their appearance. Specifically: acceptability and feasibility of an RCT comparing YP Face It and usual care, with usual care only feasibility of recruitment procedures, outcome measures and the choice of/ability to collect data for a health economic evaluation in an RCT. Plan of investigation: YP (12–17 years) with appearance-related distress and a condition known to affect appearance, and a parent/carer will be recruited via GP practices. Sixty YP will be randomised to usual care (control) or usual care plus YP Face It (intervention). Those in the intervention group will access YP Face It at home. The intervention takes 13 weeks to complete. It has 7 weekly sessions (each takes 30-40 minutes to work through), followed by a booster session 6 weeks later. To assess feasibility of data collection in an RCT, all participants will be asked to complete outcome measures at baseline, 13, 26 and 52 weeks. Data for economic analysis and parental questionnaires about their child’s well-being and behaviour will be collected at the same time points. After 14 and 52 weeks, semi-structured interviews with 12-15 purposively sampled YP and parents from each group will explore the acceptability and feasibility of the recruitment process, randomisation, retention and outcome measures, and experiences of completing YP Face It (intervention group). Following this study and a successful RCT we anticipate the following patient, parent and NHS benefits: Patients: reduced appearance-related distress and social anxiety, improved psychological well-being. Parents: reduced worry about child’s distress, knowledge that child is being supported without the need to miss school/college and without them having to take time off work to attend therapy in secondary care. NHS: these centre on the benefits to YP. Reduced use of NHS resources (GP visits, inpatient and outpatient admissions, input from other health professionals). GPs will have a resource to offer immediate support, rather than waiting for specialist face-to-face interventions (e.g. clinical psychology).


Research activity codes: 7.1 INDIVIDUAL CARE NEEDS
Health categories: MENTAL HEALTH;GENERIC HEALTH RELEVANCE