Evaluating the Impact of Body Image Edutainment on Adolescent Girls' Body Image
Condition: Body Image; Eating Disorder Symptom
MeSH terms: Feeding and Eating Disorders
Study type: Interventional

Summary: 
      Body image is one of the leading concerns for young people. These concerns may can have
      serious consequences, including anxiety, depression, risk taking behaviours, eating disorders
      and suicidal ideation.

      An extensive body of research highlights the negative effects associated with viewing
      idealistic media among adolescents. More recently, research has looked at harnessing media
      and technology to develop and disseminate material that counteracts these harmful effects.
      Using 'edutainment' (entertainment with educational content) to develop and disseminate
      interventions is a novel avenue of research. 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. To
      date, body image micro-interventions have been focused on adult samples, with little research
      exploring how this intervention model may cater to adolescents.

      The aim of the present study is to conduct a randomised controlled trial to evaluate the
      efficacy of a brief body image video micro-intervention to improve body image and acceptance
      of appearance diversity among girls, in addition to appearance-related internalised racism
      among the Black subgroup of girls.

      The body image video micro-intervention is a 3-minute episode from Girls Room; a mini-series
      developed to address risk factors for body image. The series was developed through a
      collaboration between Lena Waithe, Dove (Unilever) and the Centre for Appearance.

      The comparison control group will watch a 3-minute episode from an equivalent popular series
      which does not contain any appearance-related content.

      In addition to the outcomes of interest, post-video acceptability checks will also be
      assessed to determine viewers' enjoyment, engagement, and identification with the video, as
      well as their intent to re-engage and share.

      To undertake this project, 1848 adolescent girls will be recruited via an external research
      agency. Female-identifying North American citizens, aged 12-18 years old will be recruited,
      stratified to include 50% Black and 50% non-Black adolescents. The participants will be
      randomised to watch either the Girls Room episode, or control episode, at either 25%, 50% or
      100% length of exposure. Before watching the video, they will complete baseline measures of
      demographics, state body satisfaction, acceptance of diversity of appearance, and
      appearance-related internalised racism (Black girls only). They will then be exposed to the
      video, before completing the measures again (post-exposure), along with acceptability checks.
      Participants will then be provided with a debrief of study aims and a list of support
      sources.
    

Detailed description: 
      Background

      Body image is one of the leading concerns for young people. This is particularly concerning,
      given that body dissatisfaction is a key risk factor for serious mental and physical health
      issues, including anxiety, depression, risk taking behaviours, eating disorders and suicidal
      ideation.

      An extensive body of research highlights the negative effects associated with viewing
      idealistic media among adolescents. More recently, research has looked at harnessing media
      and technology to develop and disseminate material that disrupts and counteracts these
      harmful effects. 'Edutainment', entertainment with educational content, is an effective
      method for delivering and modelling health promotion material in mainstream media. Further,
      it offers an alternative to traditional, intense interventions that are, at times,
      unnecessary or unsuitable for milder concerns.

      Body image micro-interventions have proven effective at providing immediate and short-term
      improvements in body image among adult women, and research is beginning to explore their
      impact among young people. A recent study found that evidence-informed body image animations
      produced immediate and short-term improvements in children's body satisfaction, media
      literacy, and self-efficacy in addressing appearance teasing. However, these effects were
      less potent for older children (i.e., adolescents); which may be attributable to the use of
      cartoons, as opposed to real-life characters. The effects of viewing real-world depictions of
      positive body image attitudes and behaviours has yet to be evaluated.

      In collaboration with Dove (Unilever) and Lena Waithe (an Emmy-Award winning American
      screenwriter, producer and actress), body image experts from the Centre for Appearance
      Research (CAR) developed a series of brief videos that depict real-life characters addressing
      key risk factors for body image concerns.

      This study aims to evaluate the acceptability and impact of viewing one 5-minute episode of
      Girls Room (Episode 1: One of One') on the body image of 13-18-year-old girls from the US.
      The research questions are as follows:

      1. Does watching Girls Room result in improved body image and acceptance of diversity of
      appearance among adolescent girls compared with watching an equivalent series that is popular
      among adolescent girls and typical of content on Instagram?

      a. Are these effects moderated by the ethnicity of the viewer (Black versus all other
      ethnicities)?

      3. Does watching Girls Room result in reduced appearance-related internalized racism among
      Black adolescent girls compared with watching an equivalent series that is popular and
      typical of content on Instagram?

      Design

      This study adopts an experimental pre-post 2 x 2 design, which includes following two
      independent variables:

        1. Ethnicity of viewer (2 Levels) i. Black ii. Non-Black (this will include all other
           ethnicities expect Black)

        2. Video condition (2 levels) i. Body image video (Girls Room) ii. Equivalent series that
           is popular among adolescent girls and typical of content on Instagram (Chicken Girls)

      There are three outcome measures (dependent variables) of interest:

        1. State Body Image (primary outcome)

        2. State Acceptance of Diversity of Appearance (secondary outcome)

        3. State Appearance-related Internalized Racism- to be measured among Black girls only
           (secondary outcome)

      There is also one moderator:

      1. Ethnicity of the viewer (Black vs. Non-Black)

      Participants & Recruitment

      The current content is aimed at improving body image risk factors and increasing knowledge
      and protective factors prevalent amongst adolescent girls. Therefore, the research will
      utilise a representative sample of North American girls aged 12-18 years old. They will be
      stratified to be 50% Black and 50% other ethnicities, who are current users of Instagram or
      YouTube.

      To achieve the agreed upon research objectives and in alignment with project timelines, the
      recruitment process will be out-sourced to an external professional recruitment agency. The
      agency's brief will outline the following inclusion criteria; female North American citizens,
      aged 12-18 years old; English speaking, not participated in academic or market research
      elated to mental health or social media in the preceding 6 months. Participants will be
      offered agency credit for their participation.

      A sample size of 640 (160 girls per cell) is necessary for 80% power to detect a partial eta
      squared as low as 0.012, and based on the assumption that there will be a correlation between
      Time 1 (pre) and Time 2 (post) measures of 0.5.

      Intervention

      Girls Room, a body image mini-series, was developed in collaboration with Lena Waithe, Dove
      and CAR. Video content was informed by empirical evidence related to body image prevention
      and intervention. The series consists of five, 3-minute videos, with each video targeting a
      key risk factor for body image (see below). The five videos aired on Instagram TV (IGTV) in
      March 2020.

      Procedure

      Girls will not be briefed on the purpose of the study, the research questions, or their
      condition prior to or during study participation. However, they will be given sufficient
      information to provide informed consent. They will also be advised that they may be asked the
      same questions twice throughout the study. After completing the study, participants should be
      fully debriefed and provided with sources of support.

      The online study will include validated, age-appropriate, self-report measures that assess
      demographics and the immediate impact of video exposure on adolescents' body image and
      associated risk and protective factors. Outcome assessments will be conducted at two time
      points, including immediately before (time one) and after video exposure (time two).
      Assessments and video exposure will occur within one session. The survey will be conducted
      online, at home, and should take no longer than 25 minutes for participants to complete.

      Recruitment and survey dissemination will be conducted by a third-party research agency. The
      agency will contact eligible participants via their parents, with consent required by both
      parent and child. Following consent, the child will participate in a once-off survey that
      consists of four phases:

        1. Baseline assessments of demographics, body image, acceptance of appearance diversity,
           internalised racism (Black participants only)

        2. Randomisation into exposure condition

        3. Video exposure

        4. Post-exposure assessments of body image, acceptance of appearance diversity,
           internalised racism (Black participants only), acceptability checks (Enjoyment,
           Engagement, and Identification, Re-engagement, and Sharing)

      Participants will then be provided with a debrief of study aims and a list of support
      sources.
    

Intervention name(s): Girl's room video; Control video - Chicken Girls
Intervention type(s): Behavioral; Other
Intervention description(s): Girls Room, a body image mini-series, developed in collaboration with Lena Waithe, Dove and CAR.
Video content was informed by empirical evidence related to body image prevention and intervention. The series consists of five, 3-minute videos.
The videos follow the lives of a 5 best friends, and each video targets a key risk factor for body image:
Appearance comparison
Body appreciation
Body talk
Body functionality
Appearance teasing & bullying
Appearance focus
The five videos aired on Instagram TV (IGTV) in March 2020.; Chicken Girl's Episode - appearance neutral episode matched for target audience and video length
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Prevention