Evaluating the ‘Dove Confident Me’ 5-session body image intervention delivered by teachers in schools: A cluster randomised controlled effectiveness trial

Diedrichs, Phillippa C.; Atkinson, Melissa J.; Garbett, Kirsty M.; Leckie, George

Abstract

© 2020 Society for Adolescent Health and Medicine Purpose: Body dissatisfaction is common during adolescence and predicts poor psychological and physical health. Interventions have traditionally overrelied on delivery by external providers (e.g., researchers and psychologists), preventing scalability. This study evaluated the acceptability and effectiveness of a school-based body image intervention delivered by schoolteachers. Methods: Six British schools participated in a pragmatic cluster randomized controlled trial. Girls and boys aged 11–13 years received the five-session intervention delivered by their teachers (n = 848) or lessons-as-usual control (n = 647) and were assessed at baseline, postintervention, and 2-, 6-, 12-, 24- and 36-month follow-up. The primary outcome was body image (body esteem), secondary outcomes included risk factors for body image (internalization of appearance ideals, sociocultural pressures, social comparisons, appearance-related teasing, and conversations), and tertiary outcomes included psychosocial well-being (negative affect, self-esteem, dietary restraint, and life engagement). Results: Compared with the control group, intervention students demonstrated improvements in the primary outcome of body esteem at postintervention (Cohen's d =.15), 2-month (d =.26), and 6-month follow-up (d =.15). For girls, there was also a significant reduction in experienced appearance-related teasing at 6-month (d =.24) and 12-month (d =.30) follow-up. No other significant intervention effects were observed. The intervention was acceptable to students. Conclusions: These findings present the longest sustained improvements in a cognitive-affective body image outcome observed among girls and boys during a teacher-led universal body image program to date. Intervention refinement and improved teacher training may further improve outcomes. Task-shifting intervention delivery to community providers to scale up interventions is a promising strategy.

• Journal Article Type: Article
• Acceptance Date: Oct 5, 2020
• Online Publication Date: Nov 24, 2020
• Publication Date: Feb 1, 2021
• Deposit Date: Oct 15, 2020
• Publicly Available Date: Dec 10, 2020
• Journal: Journal of Adolescent Health
• Print ISSN: 1054-139X
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 68
• Issue: 2
• Pages: 331-341
• DOI: https://doi.org/10.1016/j.jadohealth.2020.10.001
• Keywords: Body image; Body dissatisfaction; Schools; Intervention; Adolescence; Task-shifting; Teachers
• Public URL: https://uwe-repository.worktribe.com/output/6778887
• Additional Information: This study was funded by a research grant from the Dove Self-Esteem Project, Unilever. The funders had no role in the study design, data collection and analysis, decision to publish, or manuscript preparation. They were permitted to review the manuscript and suggest changes, but the authors exclusively retained the final decision on content. Disclosure Statement: PD is an independent research consultant to the Dove Self-Esteem Project global education initiative and was on their Global Advisory Board from 2013-2016. The authors declare no other potential conflicts of interest in relation to this work. Clinical Trials Registration: ISRCTN16782819