Evaluating Dove Confident Me Single Session in Indonesia
Condition: Body Image
Study type: Interventional

Summary: 
      Negative body image is an important public health concern for young people due to its
      prevalence and detrimental impact on young people's health, education, and social life.
      Encouragingly, a number of interventions have been designed to improve adolescent body image
      in school settings, with promising results. However, the vast majority of studies testing
      these interventions are conducted in high-income, English speaking countries, despite
      increasingly recognition that negative body image is a global concern. As such, it is
      important to develop and disseminate interventions to foster positive body image among
      adolescents in low-to-middle income countries, too.

      Research indicates high prevalence rates of negative body image among adolescents in many
      Asian countries. Indonesia - the focus of the present research - is an emerging middle-income
      country in South East Asia. A recent U-Report Poll (UNICEF, 2020) found almost 80% of the
      young people surveyed wanted to change something about their appearance, suggesting a degree
      of body dissatisfaction and approximately 50% stopped themselves from doing something that
      was important to them because of appearance concerns. Moreover, according to the same poll,
      over 90% of Indonesian adolescents surveyed reported to wanting to learn ways to improve
      their body image in school or online.

      To date, no body image interventions have been adapted and trialled in Indonesia. Therefore,
      this project aims to evaluate the effectiveness as well as the acceptability and feasibility
      of a specially adapted version of Dove Confident Me Single Session among Indonesian
      adolescents that will be integrated into UNICEF's Life Skills Education curriculum. Notably,
      the session has been designed to be feasible to deliver in low-resource schools (e.g., that
      do not access to the internet or facilities to show videos or PowerPoint slides).

      To assess the acceptability, feasibility, and effectiveness of the intervention, the study
      will compare the body image and well-being of students who take part in the programme to
      students who do not take part in any programme (classes as usual). Investigators will also
      gather in-depth feedback from students, and teachers via focus groups and surveys, in order
      to inform future improvement of the programme for wider implementation.

      To undertake this project, the investigators will recruit students and teachers from
      approximately 10 state junior secondary schools in Indonesia via a local research agency.
      Students will complete questionnaire assessments of body image and well-being before and
      after programme period, and again 8 weeks later to assess longer-term benefits.

      COVID response: In light of the ongoing pandemic, some research activities will take place
      online. Decisions on delivery format (online / in-person / hybrid) were made on the basis of
      continued risk assessments and considerations of local government guidelines.
    

Detailed description: 
      Detailed COVID Response Description. Though the intervention was specifically designed to be
      delivered in person and avoided the use of technology to make it accessible to as many
      Indonesian adolescents as possible, circumstances with COVID-19 have meant that aspects of
      trial need to be conducted online to minimise undue harm and the spread of infection.
      Decisions on delivery format were based on regular risk assessments and considerations of
      local government guidelines. Accordingly, the internal pilot was conducted entirely online as
      most schools were exclusively offering remote learning and the risk in the area was high. In
      contrast, shortly following the commencement of the main trial, schools in Surabaya returned
      to 100% in person teaching (January 2022). Consequently, some research activities, including
      the lesson, took place in school while sticking to health and safety measures (e.g., social
      distancing, wearing masks, etc.).

      Teacher training will include self-directed learning via UNICEF's teacher training e-module
      for Life Skills Curriculum which includes the intervention of focus on body image. Teachers
      will then attend two online training sessions with a member of the research team who is
      trained in delivering the intervention. These sessions will run through background knowledge
      about body image, propose how we expect the lesson to look, give the opportunity for teachers
      to ask questions, and explore common questions/statements from students.

      Schools will be recruited for the study via email correspondence from the research agency in
      Indonesia and information sheets will be sent out to parents/guardians. Parents/guardians
      will provide informed consent to the school. Students will provide informed consent to the
      school and during the baseline assessment. Students will complete the surveys across three
      time points via Qualtrics on personal devices at home or at school. The acceptability focus
      groups with teachers and students from the intervention condition will take place via a video
      conferencing platform such as Zoom. The intervention will be delivered online via video
      conferencing platform.

      To ensure this method of the trial is feasible, we need to ensure students have access to a
      device (laptop or iPad), have a stable internet connection and are familiar with video
      conferencing platforms for learning. To meet these demands, we will recruit in higher SES
      areas.

      Further, given that we did not initially plan to conduct any aspects of the trial online, we
      ran an internal acceptability pilot. That is, we tested the feasibility and acceptability of
      key study elements - i.e., administering the surveys online across three timepoints and
      delivering the intervention online with two classes. Additionally, we conducted small focus
      groups with students to access their feedback on the intervention. If the data quality from
      the pilot is poor and the engagement in the lesson is low, we will suspend the trial until
      schools resume face to face learning and the COVID-19 risk is much lower (e.g., when there is
      widespread uptake of the vaccine).
    

Intervention name(s): Dove Confident Me Indonesia Single Session
Intervention type(s): Behavioral
Intervention description(s): Dove Confident Me Indonesia Single Session is an adaptation of Dove Confident Me Global Single Session, designed to be facilitated by schoolteachers or school counsellors. Dove Confident Me Indonesia includes four interactive activities (to be delivered in a single 90-minute session) as well as a homework challenge and commitment pledge. The programme incorporates three primary techniques to improve Indonesian adolescents' body confidence and self-esteem: (1) psychoeducation, (2) media literacy, and (3) cognitive dissonance as well as two secondary techniques: (4) self-affirmation and (5) cognitive reframing. As the curriculum was adapted to be delivered in Indonesian schools with limited resources, videos or PowerPoint presentations are not included. Instead, a detailed teacher guide and student worksheets are provided.
Due to COVID-19, the intervention will be delivered online via video conferencing platform.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Two-arm parallel clustered randomised controlled trial
Masking: Single (Outcomes Assessor)
Primary purpose: Prevention