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A comic-based body image intervention for adolescents in semi-rural Indian schools: A randomised controlled trial

Lewis-Smith, Helena; Ahuja, Latika; Hasan, Farheen; Gentili, Caterina; White, Paul; Diedrichs, Phillippa C.

A comic-based body image intervention for adolescents in semi-rural Indian schools: A randomised controlled trial Thumbnail


Authors

Latika Ahuja

Farheen Hasan

Paul White Paul.White@uwe.ac.uk
Professor in Applied Statistics



Abstract

Adolescents in India experience body dissatisfaction and its associated adverse impacts on physical and mental health and gender equality. However, evidence-based interventions are scarce. Mental health interventions worldwide have traditionally relied upon delivery by expert providers. However, this prevents scalability, particularly in rural settings, where resources are often lacking. Therefore, this study evaluated the efficacy of a low-resource teacher-delivered mixed-gender comic-based body image intervention among adolescents in semi-rural Indian schools. A randomised controlled trial was conducted among 2631 students (50 % girls; classes 6 to 8; Mage = 12.03 years, SD = 1.22) across 41 schools around the Jaipur district in Rajasthan. Each school was randomly allocated to receive six comic-based intervention sessions (n = 1347) or lessons-as-usual (n = 1284; control). The primary outcome of body esteem and related secondary and exploratory outcomes assessing mental health and gender stereotyping were assessed at baseline, 1 week-post-intervention, and 3-months follow-up (ClinicalTrials.gov, NCT04317755). Linear Mixed Model analyses revealed that compared to the control group, intervention students reported significantly higher body esteem and skin shade satisfaction, and significantly lower eating pathology, internalisation of appearance ideals, and gender stereotyping, with all effects maintained at follow-up. Compared to control group, boys in the intervention group also demonstrated significantly higher body image-related life engagement and body hair satisfaction at follow-up. Both students and teachers indicated high intervention acceptability via quantitative and qualitative findings. These findings present the first effective teacher-delivered school-based body image intervention in India, which can be implemented at scale using minimal resources, and thus indicates promise regarding broader dissemination across urban and rural settings.

Journal Article Type Article
Acceptance Date Jan 16, 2025
Online Publication Date Jan 26, 2025
Publication Date Mar 31, 2025
Deposit Date Jan 16, 2025
Publicly Available Date Feb 7, 2025
Electronic ISSN 2174-0852
Publisher Asociación Española de Psicología Conductual
Peer Reviewed Peer Reviewed
Volume 25
Issue 1
Article Number 100546
DOI https://doi.org/10.1016/j.ijchp.2025.100546
Public URL https://uwe-repository.worktribe.com/output/13620573

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