Condition category
Mental and Behavioural Disorders
Date applied
17/12/2014
Date assigned
15/01/2015
Last edited
16/10/2015
Prospective/Retrospective
Retrospectively registered
Overall trial status
Completed
Recruitment status
No longer recruiting

Plain English Summary

Background and study aims:
An estimated 25-60% of adolescents in Western countries feel unhappy with the way they look. These body image concerns can have serious health consequences, including unhealthy weight control and exercise behaviours, depression, smoking, low self-esteem and misusing drugs and alcohol. This research will test a series of classroom-based workshops that aim to improve young people's body image. The workshops have been developed by the Dove Self-Esteem Project in collaboration with researchers, psychologists, teachers and students. They will be delivered to girls and boys aged 11-13 years in secondary schools in the South of England. To understand the impact of the workshops, our study will compare the body image and well-being of students who take part in the workshops to students who do not take part in the workshops over one year. We will also compare the impact of the workshops when they are delivered by researchers with expertise in body image and secondary school teachers who will receive brief training in how to deliver body image workshops. We will also get feedback from students and teachers to inform future revisions and improvement of the workshops.

Who can participate?
Year 7 and Year 8 classes from co-educational secondary schools in the South of England. The girls and boys in these classes will be approximately 11-13 years. The schools should have average or below average proportions of students with special educational needs and be medium-large in size (i.e., they will have 5 or more classes per year level).

What does the study involve?
Schools are randomly allocated into one of two groups. Students attending schools in group 1 are given body image workshop sessions. Students in group 2 have their usual timetabled class lessons.
The students who take part in the workshops receive either one 90-minute interactive body image lesson (i.e., the single session version of the body image intervention we are testing), or, five 45-minute interactive body image lessons over 5 weeks (i.e., the multi-session version of the intervention we are testing). The workshops are delivered in the classroom with one leader for approximately 25-30 students. The workshops target some of the key influences on young people's body image. This includes the nature and source of society's ideas of beauty and 'looking good'; skills for young people to think critically about the media and advertising; understanding and reducing how often we compete and compare our looks to other people; talking about appearance; and steps that young people can take in their everyday lives to challenge unrealistic beauty ideals. The materials have been developed to suit classes of boys and girls, and to cover both traditional and social media. Student learning is facilitated through class discussion, small group activities, and video clips. The workshops are run either by a university researcher who has experience in body image or by the school class teachers. Teachers receive 2-hours of group training, which covers body image, the lesson’s key concepts, and tips for addressing body image in the classroom.

What are the possible benefits and risks of participating?
The benefits for schools and students taking part in the research include staff development and training in relation to body image, students taking part in a program that is likely to benefit their health and well-being, ongoing access to free body image resources, and a donation to school equipment. Many schools and students report that they find taking part in research like this to be a rewarding experience, as they learn about new topics and feel a sense of reward for contributing to research that will benefit broader society. Body image can be a sensitive and personal topic for some young people. Therefore, there is a risk that taking part in body image lessons and completing body image questionnaires at school may cause some distress for children. This risk is minimised in the current study as prior research has shown that the workshop materials are likely to improve young people's body image and well-being. Furthermore, prior research has shown that using these types of questionnaires to ask children about body image is unlikely to result in any distress. Schools and students are also provided with referrals to external sources of support, and all data collection and workshops will be supervised by classroom teachers and a trained researchers.

Where is the study run from?
Centre for Appearance Research at the University of the West of England, Bristol (UK)

When is study starting and how long is it expected to run for?
January 2014 to January 2016.

Who is funding the study?
Dove Self-Esteem Project, Unilever (UK)

Who is the main contact?
Dr Phillippa Diedrichs

Trial website

Contact information

Type

Public

Primary contact

Dr Phillippa Diedrichs

ORCID ID

Contact details

Centre for Appearance Research
University of the West of England
Coldharbour Lane
Bristol
BS16 1QY
United Kingdom

Additional identifiers

EudraCT number

ClinicalTrials.gov number

Protocol/serial number

N/A

Study information

Scientific title

Cluster randomized controlled trial evaluating the effectiveness of classroom-based body image interventions when delivered to secondary school students by teachers and researchers

Acronym

Study hypothesis

1. We hypothesize that relative to the control group who will receive their usual class lessons, secondary school students receiving the body image interventions will report significantly improved body image, reduced severity of risk factors associated with poor body image, and improvements on related psychosocial and disordered eating outcomes.
2. We also hypothesize that intervention effects will be larger when delivered by external expert providers compared to teachers with limited experience delivering body image interventions.

Ethics approval

Faculty of Health and Applied Sciences Research Ethics Committee at the University of the West of England, 08/04/2014, ref: HAS/14/03/5)1

Study design

Phase 1: A parallel 3-arm cluster randomised controlled trial at six school sites with two schools in each condition (lessons as usual control; single session intervention researcher-led; single session intervention teacher-led).
Phase 2: A parallel 2-arm cluster randomised controlled trial at six school sites with two schools in each condition (lessons as usual control; 5-session intervention teacher-led)

Primary study design

Interventional

Secondary study design

Randomised controlled trial

Trial setting

Schools

Trial type

Quality of life

Patient information sheet

Not available in web format, please use the contact details below to request a participant information sheet.

Condition

Body image dissatisfaction, disordered eating, psychosocial well-being.

Intervention

1. Lessons As Usual Control:
Students will receive their usual timetabled schools lessons covering their usual subject areas.
2. Single Session Body Confidence Workshop:
Students will receive a 90-minute interactive classroom-based body image lesson with one provider for approximately 25-30 students ('The Dove Self Esteem Project Body Confidence Workshop for Schools: Single Session'). The lesson takes an etiological approach targeting risk factors for poor body image. It addresses the nature and source of societal appearance ideals, media literacy, appearance-related social comparisons, and body activism. The intervention materials are derived from an evidence-based body image intervention 'Happy Being Me' developed by Richardson & Paxton (2010). In this study, the 'Happy Being Me' materials have been abbreviated, adapted for a co-educational audience, and updated to cover both traditional and social media. Skills-based learning is facilitated through class discussion, small group activities, and video stimuli. Materials include a detailed lesson plan for the interventionist, PowerPoint slides and student activity sheets.
3. 5-Session Body Confidence Workshop Series:
Students will receive five 45-minute interactive classroom-based body image lessons with one provider for approximately 25-30 students ('The Dove Self Esteem Project School Workshops for Body Confidence: 5-session Series'). The lessons also take an etiological approach targeting risk factors for poor body image. They addresses the nature and source of societal appearance ideals, media literacy, appearance-related social comparisons, appearance-related conversations, and body activism. The intervention materials are derived from an evidence-based body image intervention 'Happy Being Me' developed by Richardson & Paxton (2010). In this study the 'Happy Being Me' materials were adapted for a co-educational audience, and updated to cover both traditional and social media and to include more interactive content. Skills-based learning is facilitated through class discussion, small group activities, and video stimuli. Materials include detailed lesson plans for the interventionist, PowerPoint slides and student activity sheets.

In the Researcher-Led trial arm, the intervention will be delivered by researchers with Masters or PhD-level qualifications in psychology and expertise in body image research. In the Teacher-Led trial arms, the intervention will be delivered by usual class teachers who receive 2-hours group training, covering body image, the lesson’s key concepts, and tips for addressing body image in the classroom.

Intervention type

Behavioural

Phase

Drug names

Primary outcome measures

Body image is the primary outcome assessed via self-report questionnaires at 1-week pre-intervention, immediate post-intervention (same day or week as final lesson delivered), 8-9 weeks follow-up, and 6- and 12-month follow-up (12 month will be assessed in the Phase 2 trial only).

1. Body Esteem Scale for Adolescents & Adults (Mendelson, Mendelson, & White, 2001)
2. Project-EAT III Body Areas Satisfaction Scale (Neumark-Sztainer, 2004)
3. Body dissatisfaction subscale of EDI-3 (Garner, 2004)
4. Weight and shape concern subscales of the EDE-Q (Fairburn & Beglin, 1994)

Secondary outcome measures

Secondary outcomes include risk factors for body image, related psychosocial and disordered eating outcomes, and process outcomes measured at the same timepoints as the primary outcome measures.

1. Risk Factor Outcome Measures:
1.1 Internalisation of appearance ideals; Sociocultural Attitudes Towards Appearance Questionnaire-3 (Thompson, van den Berg, Roehrig, Guarda, & Heinberg, 2004)
1.2. Perceived appearance-related sociocultural pressures; Purpose-built measure derived from existing scales of sociocultural pressures (e.g., Stice & Bearman, 2001; Thompson et al., 2004)
1.3. Appearance-related social comparisons; Social Comparison to Models and Peers Scale (Jones, 2001)-Adapted.
1.4. Appearance-related teasing; Project EAT-III Teasing Scale (Neumark-Sztainer et al., 2007) - Adapted.
1.5. Appearance-related conversations with friends; Appearance Conversations with Friends subscale of the Culture Among Friends (Jones, Vigfusdottir, & Lee, 2004)
2. Psychosocial and Disordered Eating-related Outcome Measures:
2.1. Negative affect; Positive and Negative Affect Schedule for Children (Ebesutani et al., 2012)
2.2 Self-esteem; Rosenberg Self-Esteem Scale Shortened (Neumark-Sztainer et al., 2007; Rosenberg, 1965)
2.3 Dietary restraint; Dutch Eating Behaviour Questionnaire, (van Strien, Frijters, Bergers, & Defares, 1986)
2.4 Eating disorder symptoms; SCOFF (Morgan, Reid, & Lacey, 1999)
2.5 Life engagement; Purpose-built measure.
3. Teacher and Student Process Evaluation Outcomes assessed post-intervention via lesson observations, self-report questionnaires and semi-structured focus groups:
3.1 Fidelity and competence of interventionists
3.2 Ratings of interest, comfort and engagement with the Workshops
3.3 Feedback on the workshop materials, key concepts and structure.
4. Media Exposure Outcome Measures (Phase 1 only measured 7-10 months post-intervention):
4.1 Purpose built visual analogue scales assessing body dissatisfaction and mood after exposure to media images.
5. Additional Measures: The following measures for a separate program of research investigating psychometric scale development and risk factors for body image.
5.1 Body Appreciation Scale (Tylka, 2011)
5.2 Negative Body Talk Scale (Engeln-Maddox et al., 2012)
5.3 Sociocultural Attitudes Towards Appearance Scale – 4 (Schaeffer et al., 2014)
5.4 School satisfaction, future asipirations (purpose built)
5.5 Importance of appearance to self-concept (purpose built)
5.6 Appearance-related worry (purpose built)

Overall trial start date

05/01/2014

Overall trial end date

30/01/2016

Reason abandoned

Eligibility

Participant inclusion criteria

School Inclusion Criteria:
1. Co-educational
2. ≥ 5 classes per year
3. Available to include all Year 7 and/or 8 classes in the study
4. Average or below national average proportion of students with special educational needs

Student Inclusion Criteria:
1. Young person enrolled in Year 7 or 8 at eligible British Secondary School.

Participant type

Healthy volunteer

Age group

Child

Gender

Both

Target number of participants

Phase 1: Target total N= 1700 participants; Control Arm = 590 students across 2 schools, Researcher-Led Arm = 590 students across 2 schools, Teacher-Led Arm = 590 students across 2 schools; Phase 2: Target total N=1180, Control Arm = 590 students across 2 schools, Teacher-Led Arm = 590 students across 4 schools..

Participant exclusion criteria

School Exclusion Criteria:
1. All girls or all boys school
2. < 5 classes per year
3. Not available to include all Year 7 and/or 8 classes in the study
4. Above national average proportion of students with special educational needs

Student Inclusion Criteria:
1. Young person not enrolled in Year 7 or 8 at an eligible British Secondary School.

Recruitment start date

01/02/2014

Recruitment end date

01/04/2015

Locations

Countries of recruitment

United Kingdom

Trial participating centre

Centre for Appearance Research
University of the West of England Coldharbour Lane
Bristol
BS16 1QY
United Kingdom

Sponsor information

Organisation

Centre for Appearance Research

Sponsor details

University of the West of England
Coldharbour Lane
Bristol
BS16 1QY
United Kingdom

Sponsor type

University/education

Website

http://www1.uwe.ac.uk/hls/research/appearanceresearch

Funders

Funder type

Industry

Funder name

Dove Self Esteem Project, Unilever

Alternative name(s)

Funding Body Type

Funding Body Subtype

Location

Results and Publications

Publication and dissemination plan

We plan to publish and present the results of this study in academic peer-reviewed journals, at conferences and public engagement events, and in Dove Self Esteem Project publications and promotional materials.

Intention to publish date

Participant level data

Not expected to be available

Results - basic reporting

Publication summary

2015 results in http://www.ncbi.nlm.nih.gov/pubmed/26469131

Publication citations

Additional files

Editorial Notes

16/10/2015: Publication reference added.