Abstract
BackgroundDue to the prevalence and associated adverse health consequences of negative body image among adolescents globally, there is a need to develop acceptable, effective, and scalable interventions. School-based body image interventions delivered by trained teachers show promise in reducing negative body image in adolescents. However, there is currently a lack of evidenced-based body image interventions for use in low- and middle-income countries (LMICs). This paper outlines a protocol for the development and evaluation of Dove Confident Me Indonesia: Single Session, a single-session, teacher-led body image intervention for Indonesian adolescents.MethodThe effectiveness of the intervention will be evaluated using a cluster randomised controlled trial design. Due to the COVID-19 pandemic, the trial will be conducted online. Trained teachers or school guidance counsellors will deliver the intervention. Self-report questionnaires will be collected at three time points: baseline, post-intervention, and two-month follow-up. The primary outcome is body esteem. Secondary outcomes are internalisation of appearance ideals, mood, engagement in life activities, tendency to engage in appearance comparisons, and skin shade satisfaction. A minimum of 1000 participants will provide 95% power to detect small-to-medium intervention effects. To account for attrition and potential internet issues, the sample will comprise of 2000 Indonesian adolescents in grades 7–9, attending state junior high schools in Surabaya, East Java. Quantitative and qualitative data on acceptability of the intervention will also be collected from teachers and students. Additionally, fidelity of lesson implementation will be assessed. This project received ethical approval from the Universitas Indonesia and the University of the West of England. The intervention will be disseminated in junior high schools throughout Indonesia via UNICEF’s Life Skills Education (LSE) programme, which will be freely available for teachers to download.DiscussionThis paper presents Dove Confident Me Indonesia: Single Session, a culturally adapted school-based intervention designed to improve Indonesian adolescents’ body image. It details the plan for evaluation, highlighting the strengths and limitations of the proposed study design. It will be informative for others aiming to adapt evidence-based school curricula to promote well-being among adolescents in LMICs.Trial registrationNCT04665557. Registered 11th December 2020.
Highlights
Paper and study aims This paper aims to describe how Dove Confident Me Indonesia: Single Session was culturally adapted for use in Indonesian junior high state schools
The aim of the study outlined in this paper is to evaluate Dove Confident Me Indonesia: Single Session, as delivered online to students by schoolteachers or school guidance counsellors working in Indonesian state schools, in terms of intervention effectiveness and acceptability
The school allocated to the waitlist control will be provided with lesson materials following Time one (T3)
Summary
1) Define body confidence (high body esteem).Psychoeducation n/a2) Explain why body confidence is important.3) Share information on the current state of body confidence amongIndonesian boys and girls.Activity One: Appearance Ideals – the ‘Perfect-Looking” Girl/ Boy1) In small same-gender groups, students generate and record physical Psychoeducation attributes that comprise the 'ideal' appearance for girls or for boys in their student worksheets (see Fig. 3). 2) Guided class discussion critically exploring societal appearance ideals (i.e., changes over time, differences across cultures, relevant influences, are they realistic?).Internalisation of appearance idealsActivity Two: Is It Worth It?1) Guided class discussion examining the costs of pursuing societal appearance ideals related to time, money, emotions, health, and relationships. 2) In small groups, students record the costs using silhouettes provided in their student worksheets (i.e., individual costs are recorded inside the silhouette; community and societal costs are recorded outside the silhouette). 3) As a class and in pairs, students share why pursuing societal appearance ideals is a bad idea.Cognitive dissonance. Studies indicate that as many as two-thirds of early- to midadolescents in high-income countries report negative body image [6,7,8] This is concerning as longitudinal evidence indicates that negative body image during adolescence predicts poor outcomes including low self-esteem, depression, disordered eating, and the onset of risky health behaviours, such as smoking [7, 9, 10]. There is a current lack of adequately powered, theory-driven body image intervention research in low- and middle-income countries (LMICs) [16, 17] This underscores the need for transparent intervention development and evaluation research focused on alleviating negative body image among adolescents in these settings
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