The Healthy Body Image (HBI) Program: A Program to Promote a Positive Body Image

Study Overview
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Brief Summary
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Too many Norwegian adolescents experience severe body dissatisfaction (40-70 %), and strive to accomplish the perfect body. At the same time, only 50 % meet the government's recommendations on physical activity and intake of fruits and vegetables. Also, 14-24 % has unhealthy sleeping habits. Optimizing these lifestyle factors is associated with physical and psychological health. These factors, along with the pressure to obtain the perfect body, are threatening the adolescent's physical and psychological health, jfr. Meld St nr 19. It is now a need for knowledge on how the investigators can contribute to promote positive body experience among the adolescents. It has recently, through a controlled study on elite youth athletes at Norwegian sports high schools, been shown that it is possible to change eating habits, improve body image and reduce new cases of eating disorder. It is now desirable to test an adapted program through a school-based program at regular Norwegian high school students (12th grade). Today, no controlled, school-based intervention studies with long-term follow-up have been conducted. The main aim of this project is to investigate if it is possible, through a school-based intervention program (Healthy Body Intervention), to promote positive body image, increase physical activity level, and healthy eating and sleeping habits in both boys and girls at Norwegian high schools. The intervention program will contribute with new evidence-based knowledge on the effect of an adapted health-promoting program.

Detailed Description
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The design is a school-based randomized controlled trial (RCT) intervention, using the methods questionnaire and interview to obtain data. Based on statistical power analyses, all high schools in Oslo and Akershus County will be asked to participate in the study. After the schools have responded, consenting schools will be stratified (by size and geographical affiliation) and randomized to the intervention or the control condition. To minimize contamination biases within schools, the investigators prepare a cluster-randomized design.The population should contain 17-20 schools (1400 students at 2nd year). Data collection is conducted through pre-test and post-test 1, 2, and 3 (acute, 3, and 12 month post-intervention). At post-test 1, a selection is invited to participate in an interview about feasibility in addition to the questionnaire. It is an intervention for students containing interactive lecturers with discussion, team work, discussions and home assignments.

Official Title
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The Healthy Body Image (HBI) Program: A Program to Promote a Positive Body Image. A School-based Randomized Controlled Trial

Conditions
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Quality of Life, Eating Behaviors, Physical Activity

Intervention / Treatment
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* Other: The Healthy Body Image intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Norwegian high schools High schools located in either Oslo or Akershus County Students in the 2nd grade fall 2016 Students within academic specialization education programs Teachers teaching included students in Norwegian, Social studies, Physical education, and contact teachers School nurses working at the randomly selected schools School administrators at randomly selected schools Exclusion Criteria: Schools that follow foreign school systems Students within vocational education programs School departments connected to prison

Ages Eligible for Study
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Minimum Age: 16 Years
Maximum Age: 19 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Healthy Body Image<br>Students receive the Healthy Body Image intervention containing 3x90 minutes of interactive workshops with the addition of related homework after each workshop. | Other: The Healthy Body Image intervention<br>* Interactive workshops (3 x 90 minutes) include training techniques to increase media literacy, enhance self-esteem, positive body image, awareness of perfectionism, and include discussions related to truths and myths related to life style factors. Homework is an extension of each workshop that is simple and not time-consuming tasks to increase reflection and awareness of how all the mentioned factors are a part of their lives.<br>* Other names: Healthy Body Image;|
| No Intervention: Control group<br>Students do not receive the intervention program. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Proximal and distal effect of the Healthy Body Intervention (HBI) program on change in positive body image | Participants are asked to respond to questions by choosing from different responses presented on a likert scale. Positive body image is assessed by the Experience of Embodiment Scale. | Participants are asked to complete the questionnaire at post-tests planned at week 1, 3 months and 12 months after intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Proximal and distal effect of the HBI program on change in self-esteem | Participants are asked to respond to questions by choosing from different responses presented on a likert scale. The scale used is the Rosenberg Self-esteem scale. | Participants are asked to complete the questionnaire at post-tests planned at week 1, 3 months and 12 months after intervention | 
| Proximal and distal effect of the Healthy Body Intervention (HBI) program on change in the prevalence of students meeting the recommendations for health promoting physical activity. | The outcome will be measured through a self-developed Physical Activity level/habit questionnaire, including choosing a specific response on a likert scale and response through open ended questions. | Participants are asked to complete the questionnaire at post-tests planned at week 1, 3 months and 12 months after intervention | 
| Experience of the intervention program and the feasibility of running the HBI program in schools. | To measure the outcome, a self-developed interview guide in addition to a self-developed questionnaire asking students and school staff about the experience of the intervention program and the feasibility of the intervention. When answering the questionnaire, participants are asked to respond by choosing a response on a likert scale. | Post-test is planned within first week after intervention | 
| Proximal and distal effect of the HBI program on change in eating behavior (nutrition intake | The outcome will be measured through a self-developed Food frequency questionnaire where responses are chosen from a likert scale. | Participants are asked to complete the questionnaire at post-tests planned at week 1, 3 months and 12 months after intervention | 
| Proximal and distal effect of the HBI program on change in sleeping quality and sleep patterns | The outcome is measured through The Bergen Insomnia Scale, 6 items and 3 items assessing delayed sleep phase and by asking the participants (using a likert scale) how many hours of sleep they usually get per night during a normal weekday and a weekend day. | Participants are asked to complete the questionnaire at post-tests planned at week 1, 3 months and 12 months after intervention | 
| Proximal and distal effect of the HBI program on change in academic achievements | Participants are asked to choose the correct grade they received on their last report card, from a scale presenting the possible grades. | Participants are asked to complete the questions included in the questionnaire package at post-tests planned at week 1, 3 months and 12 months after intervention | 
| Proximal and distal effect of the Healthy Body Intervention (HBI) program on change in health related quality of life | Participants are asked to respond to questions by choosing from different responses presented on a likert scale. Health related quality of life will be assessed through the Screening for and Promotion of Health Related Quality of Life in Children an Adolescents - a European Public Health Perspective - 10 (KIDSKREEN-10). | Participants are asked to complete the questionnaire containing all the below presented measures at post-tests planned at week 1, 3 months and 12 months after intervention | 
| Proximal and distal effect of the HBI program on change in symptoms of eating disorders | Symptoms of eating disorders is assessed by the Eating Disorder Examination Questionnaire - 11 (EDE-Q 11) | Participants are asked to complete the questionnaire at post-tests planned at week 1, 3 months and 12 months after intervention | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Body Image