Evaluating Dove Confident Me Single Session in Indonesia
Study Details
Study Description
Brief Summary
Negative body image is an important public health concern for young people due to its prevalence and detrimental impact on young people's health, education, and social life. Encouragingly, a number of interventions have been designed to improve adolescent body image in school settings, with promising results. However, the vast majority of studies testing these interventions are conducted in high-income, English speaking countries, despite increasingly recognition that negative body image is a global concern. As such, it is important to develop and disseminate interventions to foster positive body image among adolescents in low-to-middle income countries, too.
Research indicates high prevalence rates of negative body image among adolescents in many Asian countries. Indonesia - the focus of the present research - is an emerging middle-income country in South East Asia. A recent U-Report Poll (UNICEF, 2020) found almost 80% of the young people surveyed wanted to change something about their appearance, suggesting a degree of body dissatisfaction and approximately 50% stopped themselves from doing something that was important to them because of appearance concerns. Moreover, according to the same poll, over 90% of Indonesian adolescents surveyed reported to wanting to learn ways to improve their body image in school or online.
To date, no body image interventions have been adapted and trialled in Indonesia. Therefore, this project aims to evaluate the effectiveness as well as the acceptability and feasibility of a specially adapted version of Dove Confident Me Single Session among Indonesian adolescents that will be integrated into UNICEF's Life Skills Education curriculum. Notably, the session has been designed to be feasible to deliver in low-resource schools (e.g., that do not access to the internet or facilities to show videos or PowerPoint slides).
To assess the acceptability, feasibility, and effectiveness of the intervention, the study will compare the body image and well-being of students who take part in the programme to students who do not take part in any programme (classes as usual). Investigators will also gather in-depth feedback from students, and teachers via focus groups and surveys, in order to inform future improvement of the programme for wider implementation.
To undertake this project, the investigators will recruit students and teachers from approximately 10-15 state junior secondary schools in Indonesia via a local research agency. Students will complete questionnaire assessments of body image and well-being before and after programme period, and again 8 weeks later to assess longer-term benefits.
COVID response: In light of the pandemic and schools predominantly providing online instruction rather than face-to-face learning, the study will take place online.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
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N/A |
Detailed Description
Detailed COVID Response Description.
Though the intervention was specifically designed to be delivered in person and avoided the use of technology to make it accessible to as many Indonesian adolescents as possible, circumstances with COVID-19 have meant that the trial will need to conducted online to minimise undue harm and the spread of infection. From March-present (February) 2021, the vast majority of schools have stopped in person teaching and are providing education to young people remotely. The Indonesian Ministry of Education and Culture has provided schools and students with data packages to facilitate online learning.
To avoid delays with the commencement of this trial, we will be executing this trial online.
Teacher training will include self-directed learning via UNICEF's teacher training e-module for Life Skills Curriculum which includes the intervention of focus on body image. Teachers will then attend two training sessions with a member of the research team who is trained in delivering the intervention. These sessions will run through background knowledge about body image, propose how we expect the lesson to look, give the opportunity for teachers to ask questions, and explore common questions/statements from students.
Schools will be recruited for the study via email correspondence from the research agency in Indonesia and information sheets will be sent out to parents/guardians. Parents/guardians will provide informed consent to the school. Students will provide informed consent during the baseline assessment, they will complete the surveys across three time points via Qualtrics on personal devices at home. The acceptability focus groups with teachers and students from the intervention condition will take place via a video conferencing platform such as Zoom. The intervention will be delivered online via video conferencing platform.
To ensure this method of the trial is feasible, we need to ensure students have access to a device (laptop or iPad), have a stable internet connection and are familiar with video conferencing platforms for learning. To meet these demands, we will recruit in higher SES areas.
Further, given that this method is different from the original plan for this trial (i.e., for every aspect to be conducted in person), we will be running an internal acceptability pilot. That is, we will test the feasibility and acceptability of key study elements - i.e., delivering the pre and post surveys and the intervention online with two classes prior to deciding to go ahead with the full trial online. The pilot trial will recruit an intervention class and a control class and data collection will match the three time points of the main trial. Additionally, we will be conducting small focus groups with students to access their feedback on the intervention. If the data quality from the pilot is poor and the engagement in the lesson is low, we will suspend the trial until schools resume face to face learning and the COVID-19 risk is much lower (e.g., when there is widespread uptake of the vaccine).
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Dove Confident Me Indonesia - Single Session Dove Confident Me Indonesia Single Session is school-based, body image curriculum. |
Behavioral: Dove Confident Me Indonesia Single Session
Dove Confident Me Indonesia Single Session is an adaptation of Dove Confident Me Global Single Session, designed to be facilitated by schoolteachers or school counsellors. Dove Confident Me Indonesia includes four interactive activities (to be delivered in a single 90-minute session) as well as a homework challenge and commitment pledge. The programme incorporates three primary techniques to improve Indonesian adolescents' body confidence and self-esteem: (1) psychoeducation, (2) media literacy, and (3) cognitive dissonance as well as two secondary techniques: (4) self-affirmation and (5) cognitive reframing. As the curriculum was adapted to be delivered in Indonesian schools with limited resources, videos or PowerPoint presentations are not included. Instead, a detailed teacher guide and student worksheets are provided.
Due to COVID-19, the intervention will be delivered online via video conferencing platform.
|
| No Intervention: Lessons As Usual Control School lessons as usual. |
Outcome Measures
Primary Outcome Measures
- Change in body esteem [Baseline; post intervention (1 week after the intervention) and follow-up (8 weeks after the intervention).]
Body esteem will be assessed using the weight and appearance evaluation subscales of the Body Esteem Scale for Adolescents & Adults (BESAA, Mendelson, Mendelson & White, 2001). Responses to the 18 items are on a 5-point Likert-type scale. Once the appropriate items are reverse coded, scores will be averaged with higher scores indicating higher body esteem.
Secondary Outcome Measures
- Change in internalisation of societal appearance ideals [Baseline; post intervention (1 week after the intervention) and follow-up (8 weeks after the intervention).]
Internalisation of societal appearance ideals will be assessed using the general subscale of the Sociocultural Attitudes Towards Appearance Questionnaire-3 (SATAQ-3; Thompson, Van Den Berg, Roehrig, Guarda, & Heinberg, 2004). Scores will be averaged with higher scores indicating higher internalisation. Mean score range = 1-5.
- Change in mood [Baseline; post intervention (1 week after the intervention) and follow-up (8 weeks after the intervention).]
Positive and negative affect will be measured using the Positive and Negative Affect Schedule (Crawford & Henry, 2004). Scores on each subscale will be averaged; with higher scores indicating greater negative affect and positive affect respectively. Mean score range for each subscale = 1-5.
- Change in life engagement [Baseline; post intervention (1 week after the intervention) and follow-up (8 weeks after the intervention).]
Life engagement will be assessed using the Body Image Life Disengagement Questionnaire (BILD-Q; Atkinson & Diedrichs, Manuscript in Preparation). This measure assesses the extent that worries or feeling bad about the way you look has stopped you, or are likely to stop you, from engaging in life activities (e.g., going to a social event, doing physical activity, giving an opinion, going to school). Scores are averaged; with higher scores indicating greater avoidance of activities due to appearance concerns. Mean score range = 1-4.
- Change in tendency to engage in appearance comparisons [Baseline; post intervention (1 week after the intervention) and follow-up (8 weeks after the intervention).]
Two purpose-built items will assess participants' tendency to engage in appearance comparisons. Responses to both items will be on a 5-point Likert-type scale (1=Never to 5=Often). Scores will be averaged with higher scores indicating a greater tendency to engage in appearance comparisons.
- Skin shade satisfaction. [Baseline; post intervention (1 week after the intervention) and follow-up (8 weeks after the intervention)]
Three purpose-built items will assess participants' satisfaction with their skin shade (i.e., the precise colour of their skin). Responses to the initial two items will be on a 5-point Likert-type scale. 'How dissatisfied or satisfied you are with the colour of your skin?' is rated from 1=very dissatisfied to 5 = very satisfied. 'Which of the following statements do you agree with the most' - 1 = I would like my skin colour to be lighter, 2 = I would like my skin colour to stay the same and 3 = I would like my skin colour to be darker. The final skin shade satisfaction item will use a visual representation of skin colours (1=darkest skin shade to 9=lightest skin shade). Participants will be asked which skin shade is most alike to their current skin colour, and then which skin shade is closest to their 'ideal' skin colour.
Eligibility Criteria
Criteria
Inclusion Criteria:
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All participating schools must be state junior secondary schools.
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Students in grade 7 through 9 are eligible.
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Students must speak Bahasa Indonesia and must have moderate-high literacy. levels in Bahasa Indonesia - i.e., need to be able to read on their own.
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Students must have access to a device with online access (e.g., laptop or iPad).
Exclusion Criteria:
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Non-Bahasa Indonesia speaking students.
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Religious or private schools.
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Centre for Appearance Research, UWE | Bristol | United Kingdom | BS16 1QY |
Sponsors and Collaborators
- University of the West of England
- Indonesia University
- University of Hawaii
- UNICEF
- Unilever R&D
Investigators
- Principal Investigator: Nadia Craddock, EdM, Centre for Appearance Research, UWE
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- DSEP_UNICEF_INDO
- HAS-HSS-18-098