Evaluating a Social Media-Based Intervention to Reduce Body Dissatisfaction Among Young Indonesian Women
Condition: Body Image
Study type: Interventional

Summary: 
      The researchers conduct a randomised controlled trial to evaluate a social media-based
      intervention aimed at reducing body dissatisfaction among young Indonesian women between 15
      and 19 years old.The intervention (titled Warna-Warni Waktu) consists of six sequential
      videos that tell a fictional story of a typical Indonesian young woman. The videos address
      known risk factors for body dissatisfaction and include evidence-based techniques to mitigate
      body dissatisfaction. In addition, the intervention encompasses 18 short online activities
      intended to encourage participants to think critically about the messages learnt in the
      videos and practice applying the lessons in real life.

      The primary aim is to evaluate the short-term (immediate and four-week post) impact of the
      intervention on young Indonesian women. The primary outcome is trait body dissatisfaction.
      Secondary outcomes include internalisation of societal appearance ideals, mood, and skin
      shade satisfaction.

      The second aim is to evaluate the effectiveness of the videos individually on eliciting
      state-based improvements (i.e., improvements in the moment) in body dissatisfaction and mood.
      This will be a within-group design, whereby only participants in the intervention condition
      complete single-item measures of body dissatisfaction and mood immediately before and after
      watching each episode. Further exploratory analyses are also planned.

      Approximately 2000 young Indonesian women are recruited for this research project.

      The study's hypotheses are as follows:

        1. Participants randomised to the intervention condition experience improved body
           satisfaction, mood, and skin shade satisfaction, and reduced internalisation of
           appearance ideals at post-intervention (1 day following the intervention), and 1 month
           follow-up, relative to the waitlist control condition.

        2. Each video in the Warna-Warni Waktu series elicits immediate state-based improvements in
           body satisfaction and mood.

        3. Greater engagement and adherence in the Warna-Warni Waktu intervention results in
           greater body satisfaction, mood, skin shade satisfaction, and reduced internalisation of
           appearance ideals. This analysis is exploratory in nature, depending on participants'
           engagement and adherence in the intervention during the trial.
    

Detailed description: 
      Background

      There is a need for culturally-relevant, accessible, and scalable prevention efforts to
      reduce body dissatisfaction and improve positive body image among Indonesian girls.
      Currently, no body image interventions for this population exist.

      Recruitment

      Participants are recruited using a local research agency's database of previous research
      participants.

      Previous participants over the age of 40 are contacted via telephone and screened regarding
      having a daughter within the eligible age range. If the respondent has more than one daughter
      in the age range, only one is eligible. If the respondent does not have a daughter between 15
      and 19 years of age, the recruiter enquires if the respondent knows another family with a
      daughter of this age. If so, the recruiter requests the telephone number of that family in
      order to make contact. Only one phone number is requested per call.

      Should an eligible daughter be 15-17 years old, the recruiter reads the parental information
      sheet to the parent. Parents are then requested to provide verbal consent for the daughter's
      participation, as well as verification of the parents' identity and daughter's age. Parents
      then answer questions relating to the family's socio-economic status before the recruiter
      requests to speak to the daughter. If the daughter is not present, the recruiter requests a
      call back. The daughter is then screened for eligibility and informed verbal assent obtained.
      Following a successful call, the parental information sheet is sent to the parent via
      WhatsApp, and written informed parental consent obtained.

      Should an eligible daughter be aged 18 or 19 years old, a similar pattern of communication
      occurs. Parents verify the age of the parents and the daughter, and respond to questions
      regarding the family's socio-economic status. Rather than parents providing informed verbal
      and written consent, this is completed by the daughters, in the same manner with which it is
      completed by parents of those aged 15-17 years. Verification of identities and ages is
      achieved through video calls via the presentation of a National ID card and family
      registration card.

      Intervention

      The intervention, Warna-Warni Waktu (translation to English: Colourful Time Travel), was
      developed over a 20-month period, from October 2019 to May 2021. In addition to the close
      collaboration amongst body image academics, creative agencies, social media specialists,
      not-for-profit organisations, as well as industry funders, development involved three rounds
      of feedback from the intervention's target audience.

      The narrative story told in the six-video series is based on the concept of time travel so as
      to convey the additive impact of body image concerns to young people. A combination of both
      animated characters and real people are used.

      Four risk factors for the development of body image concerns are relevant, as identified by
      the researchers: 1) social media and influencers 2) appearance-based comparisons 3)
      appearance-based teasing, and 4) body talk. Each of these risk factors are targeted in videos
      two through five, with videos one and six being the introductory and concluding videos. Each
      video is four to five minutes in length. A number of change techniques (including those based
      upon psychoeducation and media literacy) are embedded within the videos.

      Each video is accompanied by one to five short interactive activities, designed to elicit
      cognitive dissonance. Research consistently shows body image interventions that are
      interactive generate the most positive outcomes.

      Procedure

      All participants enter the study (i.e., complete the baseline assessment questionnaire) on
      the same day (Day 1). Participants receive a data package a day prior to this from the
      research agency to ensure participants have ample mobile phone data to allow participation in
      the study. A link to the baseline assessment, hosted on Qualtrics (Qualtrics, Provo, UT), is
      sent to participants via WhatsApp, along with a unique participant identification number
      (PIN). Participants are requested to enter the PIN on the first page of the baseline survey,
      in order to match participant responses over time. Participants have 24 hours to complete the
      baseline assessment; participants that have not completed the baseline assessment within the
      first 8 hours are sent a reminder message. Following the 24-hour window, participants who
      have completed the baseline assessment are randomised into one of the two conditions.
      Participants are alerted on Day 2 to what happens next, depending on which condition each has
      been randomised. Participants randomised to the intervention condition are informed to expect
      a series of links to be sent over the following six days. Participants in the control
      condition are informed that contact will be made again in one weeks' time to complete a
      second assessment.

      On the third day (Day 3), participants in the intervention condition are sent the unique PIN
      and a link to the first video in the intervention. Again, participants are requested to enter
      the unique PIN on the first page of the link. Before watching video one in the Warna-Warni
      Waktu series, participants complete state measures of body satisfaction and affect. State
      measures of body satisfaction and affect are asked again, immediately after the video. Next,
      participants are presented with the reinforcer activities for video one to complete. This
      process is repeated on Days 4-8, for videos two-six.

      On Day 9 of the study, participants in both conditions are sent a link to complete the second
      assessment. As with the baseline assessment, participants are given 24 hours to complete this
      assessment, with reminder messages sent to non-completers after the first eight hours. The
      same process is executed for the third and final assessment, one month later on Day 37.

      Following the third assessment, all participants are debriefed on the study aims and provided
      with additional sources of mental health support, as well as a certificate of participation.
      Those in the waitlist control condition are provided with a link to the Warna-Warni Waktu
      video series to watch, if desired.
    

Intervention name(s): Warna-Warni Waktu
Intervention type(s): Behavioral
Intervention description(s): Six videos and eighteen reinforcer activities
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Prevention
Keywords: body dissatisfaction; body satisfaction; positive body image