Expert Peer Facilitation of the EVERYbody Project

Study Overview
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Brief Summary
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The third trial of the EVERYbody Project explored the efficacy of using expert peer leaders to deliver the two-session, inclusive, group body image intervention compared to a time-matched video and expressive writing group through three-month follow-up. Expert peer leaders were college students with lived and/or academic expertise who were screened for facilitation readiness through a two-day training.

Detailed Description
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The first two trials of the EVERYbody Project demonstrated that a gender-inclusive, diversity-focused, dissonance-based group body image intervention could improve eating disorder risk factors among college students, particularly when the two session program was delivered by individuals with expertise (faculty or staff with body image expertise). When peer interventionists were used (college students with body image interest who completed a two-day training before facilitating groups), the effects of the EVERYbody Project were diminished. Although peer facilitation is commonly used for delivering dissonance-based body image interventions, an open training peer facilitation model (where all students who are trained are eligible to deliver the intervention) may not be the most beneficial for leading inclusivity-focused body image groups. The current trial of the EVERYbody Project (Trial 3) explores a novel strategy to implement this program using expert peer facilitators. College students with lived or academic expertise in both body image and diversity topics were recruited to complete a two-day training. The training included practice and feedback on the two session intervention content as well as training on inclusive facilitation. Following the training, peer leaders completed a facilitation readiness self-evaluation and were evaluated by trainers for facilitation expertise. Only students who passed the expertise threshold were invited to facilitate EVERYbody Project groups. The expert peer facilitation of the EVERYbody Project was compared to a time-matched two session passive video and expressive writing intervention. College students within a university in the Pacific Northwest United States were invited to participate in the group intervention (universal intervention target, gender inclusive). Outcome assessment included a comparison of changes in eating disorder risk factors and symptoms across randomization conditions from pre-post intervention through three-month follow-up. Program satisfaction was assessed at post-intervention and program application was assessed post-intervention and at three-month follow-up.

Official Title
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Expert Peer Facilitation of the EVERYbody Project: A Randomized-controlled Evaluation of a Diversity-focused, Dissonance-based, Universal Body Image Program for College Students

Conditions
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Body Image, Eating Disorder Symptom

Intervention / Treatment
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* Behavioral: EVERYbody Project
* Other: Video + Expressive Writing


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Current college student enrolled at institution where research was taking place Exclusion Criteria: None

Ages Eligible for Study
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Minimum Age: 18 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: Prevention
Allocation: Randomized
Intervention Model: Factorial Assignment
Interventional Model Description: After signing up for a specific time slot, participants were randomized in blocks of 20 to the EVERYbody Project or video comparison condition (two blocks of 10 participant slots were available in each time slot)
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: EVERYbody Project: Expert facilitator version<br>This gender inclusive, dissonance-based body image program was created from focus group feedback. Based on the Body Project, the program retains key dissonance activities while expanding the inclusivity focus (e.g., expanding the gender focus, exploring diversity within appearance ideals, critically discussing the impact of limited diversity representation in cultural appearance norms). Around 10% of content from the previous trial was modified to form the current intervention. Changes focused on enhancing diversity-focused content. College students with body image content interest completed two days (16 hours) of training on the program manual, group management, and conducting inclusive conversations. Post training, students self-assessed their facilitation readiness and were evaluated by two trainers on facilitation expertise. Peer leaders with sufficient expertise were invited to facilitate EVERYbody Project groups. | Behavioral: EVERYbody Project<br>* Brief behavioral group intervention (4 hours across two meetings)<br>|
| Active Comparator: Video + Expressive Writing group<br>Video + expressive writing groups were facilitated by a peer leader following a detailed script. This intervention was designed as an active but low-dissonance comparison condition. Participants viewed two separate documentary movies related to gender and/or appearance-related pressures (one during each session): (1) The Illusionists, and (2) The Mask You Live In. Participants engaged in a brief (10 minute) reflective writing exercise after each film. In order to keep dissonance low, participants were told that their reflections would not be shared with anyone and they were not turned in. Peer facilitators received brief (1 hour) training on the video group manual. | Other: Video + Expressive Writing<br>* Brief video-based group intervention (4 hours across two meetings)<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Eating disorder symptoms | Eating disorder symptoms were assessed with an 8-item version of the Eating Disorders Examination Questionnaire (EDEQ). The 8-item version of the EDEQ yields a Global score (average across all 8 items). | Change from baseline through post-intervention (1-2 weeks) and follow-up (3 months) | 
| Body Dissatisfaction | The Satisfaction and Dissatisfaction with Body Parts Scale (SDBPS) assessed satisfaction and dissatisfaction with nine parts of the body that are commonly endorsed as concerning (e.g., stomach, thighs, hips). The average score was used in this study (average across all 9 items). | Change from baseline through post-intervention (1-2 weeks) and follow-up (3 months) | 
| Internalized cultural appearance norms | The two Internalization subscales of the Sociocultural Attitudes Toward Appearance Questionnaire-4 (SATAQ-4) assess internalized cultural messages surrounding appearance and attractiveness. The two internalization subscales were combined for this study (average across all 10 items), following prior research. This survey was assessed at all outcome time points (Survey 1, 2, and 3), plus midway through the intervention (following Session 1 of the program). | Change from baseline through post-intervention (1-2 weeks) and follow-up (3 months) | 
| Negative affect | Negative affect was assessed with 20 items from the fear, guilt, and sadness subscales of the Positive and Negative Affect Schedule-Revised (PANAS-X). The average of all 20 items was used in this study. | Change from baseline through post-intervention (1-2 weeks) and follow-up (3 months) |