‘Dove Confident Me Indonesia: Single Session’: study protocol for a randomised controlled trial to evaluate a school-based body image intervention among Indonesian adolescents

Abstract

Background Due 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. Method The 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. Discussion This 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 registration NCT04665557. Registered 11th December 2020.

Cultural adaptation and validation of the Positive and Negative Affect Schedule for Children (PANAS-C) among Indonesian adolescents

“…It has been shown to be a valid and reliable measure of PA and NA among Indonesian adolescents that can be utilized to bolster present and future mental health research throughout Indonesia. Speci cally, the newly adapted PANAS-C addresses the lack of a single robust affect measure for Indonesian adolescents required to strengthen understanding of mental health issues impacting the nation's young people, such as self-harm [24], depression [30], and anxiety [35], and to inform prevention efforts, such as with the inclusion of this validated version of the Indonesian PANAS-C in effectiveness trials for body image interventions aimed at Indonesian adolescents [99,100]. Given that the rates of depression and anxiety among Indonesian young people are of growing concern [27,101], it would be useful to test the robustness of the Indonesian PANAS-C among a clinical sample.…”

Mitigating Harms of Social Media for Adolescent Body Image and Eating Disorders: A Review

“…A single-session version of the Dove Confident Me intervention was evaluated in a sample of Indonesian adolescent boys and girls (N=1926, M age =13.7 years; 59.4% girls). 45 The program was led by guidance counselors and delivered in five schools. Adaptations were made to the original Dove Confident Me intervention 39 to enhance its cultural relevance for Indonesian adolescents.…”

Body image as a global mental health concern

“…As documented in other cultural contexts, in Asian countries body image concerns have been associated with eating disorder symptoms (Yamamiya et al, 2008 ; Chisuwa and O’Dea, 2010 ; Kaewpradub et al, 2017 ), depression (Prusaczyk and Choma, 2018 ), and poorer quality of life (Santhira Shagar et al, 2021 ). In very recent years, prevention efforts have been extended to affluent and developing areas of Asia (Craddock et al, 2021 ; Danthinne et al, 2022 ; Garbett et al, 2022 ); however, more work is needed.…”

“…Finally, given the global rates and commonalities of body image concerns, greater efforts should be made to prevent and decrease these concerns. Although scalable interventions have started to emerge across the globe (Marchand et al, 2011 ; Craddock et al, 2021 ; Garbett et al, 2022 ), this work is still in its infancy. In addition to developing such programs, working with stakeholders and policymakers is crucial to decreasing universal risk for body image concerns effectively at a global level, with Western media emerging as a particularly important target (Bell et al, 2016 ).…”