Plain English Summary
Background and study aims
An estimated 32-64% of adolescent girls 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 behaviors, depression, smoking, low self-esteem and misuse of drugs and alcohol. Research suggests that parents can influence their children's body image. As a result, this study is evaluating a website that aims to improve body image and well-being among mothers and their adolescent daughters. Specifically, the Dove Self-Esteem Project Website for Parents (selfesteem.dove.com) is an online information hub designed to provide mothers with information and tools to help them build body confidence among their daughters and themselves. The website displays brief articles outlining expert advice, interactive activities (e.g., videos, games), and behavioural action tips.
Who can participate?
Mothers and their adolescent daughters (aged 11-14) from nine towns across the South, Mid and North of England
What does the study involve?
Mother-daughter pairs are randomly assigned to one of three groups. In the first group, mothers and daughters complete a series of questionnaires. In the second group, mothers and daughters complete the same questionnaires and mothers view the website for 30 minutes. In the third group, mothers and daughters complete the questionnaires and mothers view the website for 30 minutes using a tailored pathway through the website based on their preferences for particular website topic areas. Mothers and daughters complete questionnaires immediately before mothers are exposed to the website, then again 2 weeks, 6 weeks, and 12 months after viewing the website. Feedback is obtained from mothers on their reactions to the website, in order to inform future revisions and improvements to the website.
What are the possible benefits and risks of participating?
Taking part in this study gives mothers and daughters the chance to learn about some very important issues that can affect health and well-being, particularly in young adolescents. The website has already undergone online pilot testing, with the responses from parents being overwhelmingly positive. The website is expected to have a positive impact on mothers' and daughters' body image and well-being. In addition, both mothers and daughters are provided with a financial incentive for taking part in this study. Body image can be a sensitive and personal topic for some, particularly adolescent girls and women. Therefore, there is a risk that viewing the website and completing body image questionnaires may cause some distress. This risk is minimised in the current study as previous pilot research has shown that the website has received positive feedback from mothers. Furthermore, previous research has shown that these types of questionnaires and interventions are unlikely to result in any distress. Any participant showing signs of distress is provided with referrals to external sources of support.
Where is the study run from?
Centre for Appearance Research at the University of the West of England, Bristol, UK
When is the study starting and how long is it expected to run for?
January 2014 to August 2016
Who is funding the study?
This study is being funded by a research grant from the Dove Self-Esteem Project. The Dove Self-Esteem Project is the social mission for the multinational personal care brand Dove, which is owned by Unilever.
Who is the main contact?
Dr Phillippa Diedrichs
Dr Phillippa Diedrichs
Centre for Appearance Research
University of the West of England
Evaluating an internet-based intervention designed to improve body image and psychosocial well-being in adolescent girls and their mothers: a cluster randomised controlled trial with mother-daughter dyads
Study Hypothesis 1: relative to the assessment only control group, mothers who are exposed to the Dove Self-Esteem Project Website for Parents will report significantly improved body image, reduced severity of risk factors associated with poor body image, and improvements on related psychosocial outcomes, as will their daughters.
Study Hypothesis 2: intervention effects will be stronger when mothers received a tailored pathway through the website based on their preferences for content, as opposed to browsing the website without structured guidance.
Faculty of Health and Applied Sciences Research Ethics Committee at the University of the West of England, 14/11/2014, ref: HAS/14/03/60
Parallel three-arm cluster randomized controlled trial
Primary study design
Secondary study design
Cluster randomised trial
Quality of life
Patient information sheet
Not available in web format, please use the contact details to request a patient information sheet
Body image dissatisfaction, self-esteem, psychosocial well-being, help-seeking behaviors
A parallel three-arm cluster randomized controlled trial in nine towns across the UK with three towns in each condition (assessment only control; website unstructured; tailored pathway through website).
Assessment-only control: Mothers and daughters will not view the Dove Self-Esteem Website For Parents and will complete self-report questionnaires only.
Website-as usual: Mothers will be exposed to the Dove Self-Esteem Project Website for Parents under controlled conditions for 30 minutes. Mothers will view the website unstructured with no guidance. Mothers will then be encouraged to continue to use the website at home, although home viewing of the website is voluntary and not a requirement of the study.
Website-tailored: Mothers will be exposed to the Dove Self-Esteem Project Website for Parents under controlled conditions for 30 minutes. Mothers in this condition will be provided with an individualised, tailored pathway to follow while they browse the website. This pathway will be based upon their preferences website content topic areas and will guide them to view specific articles and content on the website. Mothers will then be encouraged to continue to use the website at home, although home viewing of the website is voluntary and not a requirement of the study.
Primary outcome measures
Body image assessed via self-report questionnaires pre-exposure to the website, 2 weeks post-exposure, 6 weeks post-exposure and 12-months post-exposure. Body Esteem Scale for Adolescents & Adults (Mendelson, Mendelson, & White, 2001)
Secondary outcome measures
Secondary outcomes include risk factors for body image, mother-daughter relationship measures, related psychosocial outcomes, help-seeking behaviours and process outcomes measured at the same time-points as the primary outcome measures (unless otherwise stated – see last paragraph).
Risk factor outcome measures:
1. Internalisation of appearance ideals; Sociocultural Attitudes Towards Appearance Questionnaire-3 (Thompson, van den Berg, Roehrig, Guarda, & Heinberg, 2004)
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)
3. Appearance-related social comparisons; Social Comparison to Models and Peers Scale (Jones, 2001)-Adapted.
4. Appearance-related teasing; Project EAT-III Teasing Scale (Neumark-Sztainer et al., 2007) - Adapted. Daughter-only measure.
5. Appearance-related conversations with friends; Appearance Conversations with Friends subscale of the Culture Among Friends (Jones, Vigfusdottir, & Lee, 2004)
6. Negative Body Talk Scale (Engeln-Maddox et al., 2012)
Dyadic outcome measures:
1. Maternal pressures towards appearance; Maternal Pressures Scale (Corning et al., 2010) – Adapted.
2. Frequency of conversations about body image between mothers and daughters; Purpose-built measure
Psychosocial and disordered eating-related outcome measures:
1. Positive and Negative Affect Schedule for Children (Ebesutani et al., 2012)
2. Self-esteem; Rosenberg Self-Esteem Scale Shortened (Neumark-Sztainer et al., 2007; Rosenberg, 1965)
3. Dietary restraint; Dutch Eating Behaviour Questionnaire, (van Strien, Frijters, Bergers, & Defares, 1986)
4. Eating disorder symptoms; SCOFF (Morgan, Reid, & Lacey, 1999)
5. Life engagement; Purpose-built measure
6. Help-seeking behaviours in relation to body image; Purpose-built measure
Mother and daughter process evaluation outcomes will be assessed post-intervention only via purpose-built self-report measures:
1. Ratings of interest, engagement and usefulness of the website
2. The extent mothers spoke or shared information on the website with their daughter
3. Daughters will be asked what, if anything, they have learned from the website
Interim check-in assessments:
Purpose-built check-in assessments of state body image and instances of body image conversations between mothers and daughters will be administered via mobile sms text messages four times between baseline and 2-week post-intervention data collection.
The following measures will be administered for a separate program of research investigating psychometric scale development and risk factors for body image:
1. Mother-daughter relationship quality; Purpose-built measure
2. Daughters perceived care from mother; Care subscale of the Parental Bonding Instrument (Parker et al., 1979). Daughter-only measure
3. Daughter's trust in mother; Trust subscale of the Inventory of Parent and Peer Attachment (Armsden et al., 1987) – Adapted. Daughter-only measure
4. Daughter's perception of communication between mother and daughter; Communication subscale of the Inventory of Parent and Peer Attachment (Armsden et al., 1987) – Adapted. Daughter-only measure.
5. Project-EAT III Body Areas Satisfaction Scale (Neumark-Sztainer, 2004)
6. Body Appreciation Scale (Tylka, 2011)
Overall trial start date
Overall trial end date
Participant inclusion criteria
Mother-daughter dyads meeting the following criteria:
1. Daughter aged 11-14 years old
2. Mother and daughter speak English and have lived in the UK for at least 10 years
3. Mothers identify at least one of eight key body image related issues as being relevant to their daughter
4. Mothers and daughters use the internet at least every 4-5 days
5. Mothers have not taken part in three or more market research studies in their lifetime, and none in the previous 6 months
Target number of participants
240 mother-daughter dyads: 80 in each condition of the trial, split evenly over 9 testing locations (clusters)
Participant exclusion criteria
1. Daughter not aged 11-14 years old
2. Mother and daughter do not speak English or have not lived in the UK for at least 10 years
3. Mothers do not identify body image as being relevant to their daughter.
4. Mothers and daughters do not use the internet at least once every 4-5 days.
5. Mothers have taken part in three or more market research studies in their lifetime, and/or have taken part in studies in the previous 6 months
Recruitment start date
Recruitment end date
Countries of recruitment
Trial participating centre
Centre for Appearance Research, University of the West of England
Centre for Appearance Research, University of the West of England
Funding Body Type
private sector organisation
Funding Body Subtype
Results and Publications
Publication and dissemination plan
The plan is 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
2016 results in: https://www.ncbi.nlm.nih.gov/pubmed/27175574