Scaling up evidence-based body-image interventions for adolescents: Studies from the UK, India, and Indonesia

Garbett, Kirsty M.

Abstract

The field of adolescent body image research is well established and has been burgeoning since the mid-1990s. Body image concerns are prevalent among adolescents globally, and the extensive psychological and physical health consequences are widely recognised, particularly in high-income, English-speaking contexts (Cash, 2017). Encouragingly, a number of modifiable risk and protective factors have been identified and targeted interventions have shown effectiveness. The majority of these interventions are delivered by health professionals or researchers and target high-risk individuals, typically young women (Becker, Perez, et al., 2017), across Europe, Australia, and the United States (Chua et al., 2020). Reliance on expert provision, usually through face-to-face contact, makes many interventions costly, unsustainable, and inaccessible for most. As demonstrated by Kazdin and Blaze (2011), even doubling professionally delivered evidence-based interventions would still only reach a small proportion of those in need. In low- and middle-income countries, these statistics are even more concerning with even fewer health professionals available (Patel et al., 2016). As such, there is an urgent need to develop interventions that move away from the traditional health professional led model, to ensure interventions are scalable, cost-effective, and most importantly, accessible to reach those in need.

The eight publications presented in this thesis seek to improve the real-world impact of evidence-based body image interventions by evaluating the impact of low-cost, scalable body image interventions. Moreover, this thesis expands the regions where body image interventions are typically developed and evaluated (namely, in Europe, Australia, and the United States) to consider the efficacy of interventions in India and Indonesia. Lastly, this thesis explores the issue of measurement when working in new cultural contexts, specifically in the development and validation of a culturally adapted body image measure for use among Indian adolescents. Together, the findings of these publications advance the field of body image scholarship in relation to task-shifting intervention delivery, adaptation and development of cultural relevant evidence-based programmes, and validation of measures in new cultural contexts.

To circumvent the barrier of health professional led provision in the dissemination of body image interventions for adolescents, Publication 1 and 2 report on the evaluation of an online intervention for mothers of UK adolescent girls. The randomised controlled trial reported in Publication 1 provided support that mothers can be effective facilitators in the delivery of body image interventions for their daughters. That said, it is widely recognised that mothers’ engagement in interventions to improve the body image of their daughters is often low (Hart et al., 2015), limiting dissemination potential. Publication 2 explores mother and daughter preferences for intervention content with the view to improve uptake, engagement with, and ultimately the dissemination of, these types of interventions.

Publication 3 and 4 evaluate teacher-led interventions in UK schools. Prior to these studies, school-based body image programmes had almost exclusively been evaluated when delivered by external providers. Few teacher-led interventions had been evaluated, and none reported sustained improvements in adolescent body image (Yager et al., 2013). Publication 4 is the first study to show improvements in body image among adolescents following the delivery of a teacher-led classroom-based intervention up to six-months later. As well ensuring the accessibility and scalability through task-shifting intervention delivery to teachers, these studies provide useful insights to inform task-shifting of school-based interventions across the mental health field. These insights are presented in Publication 5, which reports on the extensive acceptability data collected during Publication 3 and 4.

Building upon the above studies, Publication 7 examined the acceptability and preliminary efficacy of a school-based intervention once adapted for use in a new cultural context; namely, in urban India. This publication is an important and novel development in the field. There is high demand for school-based mental health interventions in countries such as India (Ministry of Health and Family Welfare, 2014; Parikh et al., 2019), yet research efforts remain sparse. To robustly measure intervention impact in India, this project was underpinned by the adaptation and validation of the Body Esteem Scale for Adults and Adolescents among Indian adolescents (Publication 6).

The final publication presented combines my learnings from the previous publications to report on the development and evaluation of a novel, social-media based intervention for Indonesian adolescent girls (Publication 8). This publication presents the protocol for a randomised controlled trial currently underway in Indonesia to evaluate a six-part series, developed in collaboration with an Indonesian creative agency, a non-profit technology focused organisation, a local research agency, and industry. This publication demonstrates my leadership skills within academia, and ability to work across multiple, multicultural stakeholders to achieve scalable evidence-based interventions for adolescents.

In conclusion, this thesis brings together a body of work that explores methods for scaling up and improving the reach of body image interventions for young people. The findings suggest task-shifting intervention delivery to community members, such as schoolteachers and parents, and employing online strategies, are scalable and sustainable options to disseminate evidence-based body image interventions to adolescents. Collectively, they demonstrate the need for a multi-level approach to tackling body image concerns, in that no one intervention will suit all those in need. Further, this thesis provides evidence that culturally adapted, evidence-based interventions can be efficacious in new cultural contexts. Issues regarding the validity of body image measures when working internationally are also considered.

Citation

Garbett, K. M. Scaling up evidence-based body-image interventions for adolescents: Studies from the UK, India, and Indonesia. (Thesis). University of the West of England. Retrieved from https://uwe-repository.worktribe.com/output/8267413

• Thesis Type: Thesis
• Deposit Date: Dec 18, 2021
• Publicly Available Date: Aug 30, 2022
• Public URL: https://uwe-repository.worktribe.com/output/8267413
• Award Date: Aug 30, 2022